Comments on: Rational Risk Pools

By: Gwen

Gwen — Mon, 12 Jul 2010 03:54:59 +0000

If everyone in this country who doesn’t need to be sitting in a doctor’s office looking for cures for every little problem that besets them, would get out and reserve medical service for those who really need to be there, the prices would automatically go down due to less demand. Less demand and competition between medical providers is the way to control costs. I know hypochondriacs who run to the doctor two or three times a week every week. The doctors never cure them, they just keep ‘em comin’. When someone in my family gets a scrape or cold or earache, we treat with home remedies or over the counter remedies and wait a few days to see if it resolves itself. Then if the condition seems beyond the control of us or nature, we do relent and seek medical care. I think the barrage of pharmaceutical advertisements on TV may be one reason people think they have to have a doctor and a pill for everything.

By: Gwen

Gwen — Mon, 12 Jul 2010 03:43:20 +0000

I agree with Charles Johnson. Most people could afford regular doctor visits, mammograms, even a broken arm. If you rack up a $10,000 hospital bill even, you can set up a payment program with the hospital and pay it off the same as you would a car. Heck, most of us can get a credit card with a $10,000 credit line and pay it off that way. I am one of those people with a pre-existing condition who can’t afford $500.00 a month for insurance that I’ll probably never use because the deductible is too high to ever be of use to me. All I really want is catastrophic insurance for cancer, diabetes, stroke, major accidents, etc. The government has prohibited insurance companies from offering catastrophic. They have all these mandates for preventative care in the insurance, probably because various medical special interest groups have lobbied for them. Alternative medicine groups like acupuncture are even trying to get themselves mandated. Do you want to pay for someones male enhancement drugs, for someones sex change, to have someone’s tattoo removed? The government is getting involved in the biggest racket ever to hit American citizens.

By: Danielle

Danielle — Thu, 20 May 2010 17:36:34 +0000

To call people antisocial who cannot afford insurance is disgusting! To assume that anyone goes without insurance purposfully makes me want to scream! What about people who have lost their, jobs their Cobra has run out and they have no choice but to turn to these high risk pools? Only 3-5% of people who qualify to recieve this insurance have it because it is so expensive. I have an uninsurable condition and I am in my early 30′s. If I want this insurance I will have to decide between defaulting on loans, food, clothing for my kids, etc. This insurance costs more than rent! I am not a dead beat there simply aren’t “great” jobs out there for every person. So you can act high and mighty about your current luck but let’s remember this economy is in the toilet and so many of us are struggling. Let’s also not forget we are all mortals and eventually a pricey medical procedure is in all of our futures. I am not saying this reform is the right answer but it gives hope to people in my situation who are suffering with no help in sight. Instead of belittling your fellow man why don’t you state your solutions. When you act hateful no one cares what you have to say. We are all brothers and sisters and we can find a better way.

By: Madeleine

Madeleine — Wed, 05 May 2010 21:21:23 +0000

my husb and has union helath insurance,he had it for years and then he retired and his insurance only paid 20% instead of 80% because the Medicare automatically kicked in,m we didnt’ ask for it, we pay for that too, but since Ob ama is cutting off mos tpayments for medicare where does that leave us,? After 30 years of paying we will be with out health care, I have never , ever been sick, never took meds, but my husband needs care and no because he is over 60 he won’t get it and now he has a pre-existing condition we can’t get decent insurance, these companies won’t last taking all these people with pre-existing conditions. Our insurance company didnt’ give us the boot when my husbnd got sicj so why do we need his crappy insurance? He ruined lot of peoples lives and well being, if this was just to make sure that people were getting health care I would say OK, but its not, he is picking and choosing who is able to get it and when. That is called genocide. He is not taking cchildren with disabilities either, I ould guess because they might live oto long . Thsi is bad news for anyone who isn’t healthy and young , whcih is most people today.

By: Virginia

Virginia — Wed, 05 May 2010 21:16:17 +0000

It seems to me that the only incentives that make any sense are paying for most of your health care out of pocket. And I think it will come down to that.

I don’t think there’s any way to subsidize insurance, make it fair for healthy people, and avoid creating incentives for abuse. You’re going to have free loaders no matter what you do, and the freeloaders will create huge problems for the system’s solvency.

If I had to pull out my crystal ball, I would guess that we’ll end up with some sort of hybrid: a single payer for those who don’t have money/have major health issues, and a private market for the rest of us that don’t want to deal with the state and don’t need care for a chronic illness. We might have really really high deductible plans, but most of our stuff will be private pay. At least that’s my hope.

That’s a pessimistic assessment. Perhaps tomorrow I’ll feel more optimistic.

By: C. Lewis

C. Lewis — Wed, 05 May 2010 21:13:40 +0000

I agree with Charles. Imagine having insurance to pay for the Big Mac. Then the “prices” will vary from $2 to $14. However, since no one will ever see the price besides the insurer and the franchise, the individual will keep ordering the most expensive thing on the menu. Insurance for routine care is a terrible result of our antiquated job-based health system. For example: I’m probably in the minority of women on this one, but I don’t want insurance to cover a routine pregnancy. I want insurance to cover all the freakishly weird things that can go wrong in a pregnancy. Many of the women I talk to define good insurance by the existence of “great maternity benefits.” What I consider to be good health insurance–ie, real protection against low probability but high cost events–doesn’t exist. HSAs come close, but they still have many limitations, including the tie to HDHPs. Fortunately, dreaming about what might be is still legal.

By: kris

kris — Wed, 05 May 2010 21:11:13 +0000

Someone still has to pay for the very expensive treatments of certain pre-existing conditions! And that will be the policy holders. There is no other way, unless they use our taxes, all our money, to supplement these huge outlays. That has been the problem in the private sector, and will be the problem in the public sector. There is no getting away from it! And/or, there will be caps, as in Britain, where $47,000/year outlay is the value of a human life, their medical treatment.

By: Charles Johnsen

Charles Johnsen — Wed, 05 May 2010 19:32:26 +0000

Patricia–Equality has nothing to do with it. Larger pools have nothing to do with it. It is all and only about political power replacing Patient Power, to quote a book title by somebody or other. We are all victims of the hoax that insurance should pay for hangnail removal instead of the heart operation that will bankrupt me. I need no pools or risk spreading for a yearly exam or a flu shot or a broken arm or even diabetes. I can pay for that stuff and I shop pretty good if I have time or if I can shop providers before I need care in anticipation of requiring it. I only need to spread risk for stuff like cancer. The gov does not want to mess with the bad stuff because it is too open ended, what with experimental care and all. All the gov wants is the routine stuff that goes on every day so even healthy people get a “benefit” from their silly ideology. Keeps them voting the right way, don’t you know. The same thing goes for employer benefits and Medicare.
The other thing to remember is that the government does not like change, never mind the slogans. Stability is the first principle of socialism. Poor stay poor, rich stay…well, not poor…and innovation is risky. What if some doc invents a new, cheaper way to fix a skin rash? It throws their carefully balanced (political) prices up for grabs.
I sympathize with you for having to prepay foolish prices for health care services for your whole life. Me too. After all, we both know the gov and the employer do not pay, as you say, we pay in taxes, inflation, lower wages, and higher prices for goods and services. But the answer is not to continue the scam with different payment schemes but to reform our national mindset about what “insurance” is and what “health care” is. Third party payments are down right evil. This is all about character, not accounting. As you say.

By: patricia Smith

patricia Smith — Wed, 05 May 2010 18:25:08 +0000

The uninsured, whom you call “antisocial”, are NOT welfare recipients, or non-workers. They earn a living and have taxes taken from them to fund public purposes, including free health care for other people. If you have legitimate concern for an equitable solution to health care, it seems to me it would begin with formation of pools of those in need of coverage. The larger the pool, the more chance of lower premium/better care.
Your comments begin by ostracizing working people, then immediately isolating them for punishment by higher cost and longer waits. I’ve paid for insurance my whole life, while buying used furniture and driving old cars. I did suffer four years uninsured before I reached 65 and medicare.
The starting point should be: one identical price per any service. Imagine Big Macs ranging from free to $2 to $7 to $14. People would tear the place apart, and well they should. Yet we accept Blue Cross “negotiated” rates far below what one uninsured is charged. The corruption of the collective judgement and the absence of fundamental scruples is mindboggling. I am so disheartened as to shun the debate; who can bring back national character and pride?

By: Bart Ingles

Bart Ingles — Wed, 05 May 2010 18:11:00 +0000

I still say that the smallest, most effective single change in this area would be to offer a partial premium subsidy for risk pool coverage comparable to the employer tax break. Preferably the subsidy would be more rational than the employer tax exclusion, e.g. not tied to the insured’s tax bracket.

If risk pool premiums were 200% of the going market rate, then e.g. a fixed 25% tax credit for risk pool coverage would reduce the effective cost to 150% of market. This percentage is not so high as to encourage excessive consumption, but should be high enough to encourage many consumers to spend their own dollars for coverage.

On John’s second point about transferring payment from exited to entered plans, what might be the conditions where this could be omitted? Covered employees can already switch plans when changing jobs or during open enrollment periods without payments between insurers; I’d always assumed that cost discrepancies were expected to cancel each other out. But obviously this leads to a sort of conformity between plans in order to avoid being excessively attractive to high-cost enrollees. But is this conformity necessarily a bad thing?