quote:

Originally posted by Gustofer:
He's an amateur politician playing politics with professionals.

He may be an amateur in their world, but they are also amateurs in his. And I would put my money on a successful someone from his world before someone from Ryan's world. His presidency is a hair over two months old. He is still feeling them out. I have no doubt he will be successful.

I've never really needed to use my employer provided health insurance, nor my VA benefits, but have paid plenty for both, in Different ways.

I can certainly empathize with those who have pre-existing conditions wanting to be covered, but then is "insurance" even the right word for it anymore?

If the government forced Geico to give you a policy, then forced them to pay for the wreck you had last year, they might have a right to be unhappy about it.

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President Trump campaigned on the promise that preexisting conditions must be covered. So, how are people with preexisting medical conditions to be protected in any "true" conservative replacement bill?

Rather than discussing all the inside-the-beltway palace intrigue, how or why would the free market cover people with preexisting conditions?

Isn't this a big issue in all of this? Yet, no one seems willing to discuss it.

It seems equally true that the proposed bill that only promised a 10% premium reduction was not something that produced affordability.

chellim1, is the "true" conservative health care approach to have it all free market without the government setting any threshold for minimum coverage?

Yes.
What would I buy, if I could? Catastrophic coverage only. If it didn't cover regular check ups and basic, predictable care... all of that would be much cheaper because there would be a competitive marketplace with prices listed ahead of time. I would bring my check book and pay my doctor at the time of service because there would be no third party payer involved.

What, then do I need insurance for? I only need insurance for a car accident, a heart attack, cancer... something where I need major treatment and don't have time or opportunity to shop around for my best option. I would be willing to have a 5,000 or even a 10,000 deductible, because that's an amount I could save and set aside (perhaps in a tax-free HSA) for this purpose.

How or why would the free market cover people with preexisting conditions?
The answer is that there has always been a policy available to cover people with almost any preexisting condition. Of course, it's more expensive, and not every insurance carrier will cover it, so you may have to work a little harder to find it... but that doesn't mean it should be mandated by government. That's just the wrong and most expensive approach. You could also shop for policies (just like life insurance) that couldn't be cancelled or terminated once you got sick as long as you continue to pay the premium.

But if there is no risk-based underwriting, it's not insurance.

quote:

Originally posted by chellim1:

quote:

President Trump campaigned on the promise that preexisting conditions must be covered. So, how are people with preexisting medical conditions to be protected in any "true" conservative replacement bill?

Rather than discussing all the inside-the-beltway palace intrigue, how or why would the free market cover people with preexisting conditions?

Isn't this a big issue in all of this? Yet, no one seems willing to discuss it.

It seems equally true that the proposed bill that only promised a 10% premium reduction was not something that produced affordability.

chellim1, is the "true" conservative health care approach to have it all free market without the government setting any threshold for minimum coverage?

Yes.
What would I buy, if I could? Catastrophic coverage only. If it didn't cover regular check ups and basic, predictable care... all of that would be much cheaper because there would be a competitive marketplace with prices listed ahead of time. I would bring my check book and pay my doctor at the time of service because there would be no third party payer involved.

What, then do I need insurance for? I only need insurance for a car accident, a heart attack, cancer... something where I need major treatment and don't have time or opportunity to shop around for my best option. I would be willing to have a 5,000 or even a 10,000 deductible, because that's an amount I could save and set aside (perhaps in a tax-free HSA) for this purpose.

How or why would the free market cover people with preexisting conditions?
The answer is that there has always been a policy available to cover people with almost any preexisting condition. Of course, it's more expensive, and not every insurance carrier will cover it, so you may have to work a little harder to find it... but that doesn't mean it should be mandated by government. That's just the wrong and most expensive approach. You could also shop for policies (just like life insurance) that couldn't be cancelled or terminated once you got sick as long as you continue to pay the premium.

But if there is no risk-based underwriting, it's not insurance.

Thanks for the response. For the most part,I have had that type of insurance for decades.

But, once I had my first heart attack, I have no real ability to change. We never switched to any kind of Obamacare. For someone who didn't have the ability to keep paying for private insurance, that person would be without coverage. Once it gets to $3,000.00 per month, average people are priced out.

For many years, the fact that we were priced into a group coverage kept the rates down. If I had to go to the market now, I'm sure it would be up around $4,000.00 per month for major medical. I have a friend that has a premium in that ball park.

I hated Obamacare when it came in because it always seemed like a bait headed to the switch: single payer. That still seems true. Government programs are inefficient, wasteful and do not produce the quality of a competing marketplace.

If the "true" conservative approach is to let the market sell an impossibly-priced product to those with preexisting conditions, that seems at odds with President Trump's campaign promises and what will make health care available for everyone.

If that is the "true" conservative approach, it may be that the Freedom Caucus has some work to do to explain why their approach is best as it tries to gather support.

Premiums could be greatly reduced by eliminating sick or elderly people from coverage. That seems to be the true market approach, then. I wish the "true" conservatives would consider more what impact the pure market solution would produce.

I have wondered whether it would work better to set a minimum coverage like policies for automobiles to force the market to compete equally but with a shared threshold.

It's not completely laissez-faire but it would provide a level of minimum care for all our people - not as a right but as a level of societal compassion regarding the reality of life. We grow older and we get sick.

You seem to read a lot of the Libertarian and "true" conservative writers. Have you seen or know of any response to what I describe? Rather than having a government run system, isn't there room to set minimums and then let the market freely compete as a compromise?

Earlier in this thread I asked if the conservative thing to do is to seek an ice flow and a bear.

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For many years, the fact that we were priced into a group coverage kept the rates down.

Yes!... that's the purpose of group coverage.

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Premiums could be greatly reduced by eliminating sick or elderly people from coverage. That seems to be the true market approach, then. I wish the "true" conservatives would consider more what impact the pure market solution would produce.

This would be the exact opposite of Obamacare. The sick are the only people who want it.
If there's true competition, the price will come down gradually, not all at once. When it's super-expensive people eliminate themselves from coverage, making the pool older and sicker.

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I have wondered whether it would work better to set a minimum coverage like policies for automobiles to force the market to compete equally but with a shared threshold.

Theoretically, the market should determine coverage as well. If insuring children up to age 26 is popular, that's what they will offer.

quote:

Originally posted by chellim1:

quote:

For many years, the fact that we were priced into a group coverage kept the rates down.

Yes!... that's the purpose of group coverage.

Since Obamacare, many people have moved from their group coverage because it was initially the only way to reduce his/her premium to a workable level. Now what for them if Obamacare is just repealed? No insurance ever again? Group coverage is no longer available for me. And, the old group was for younger people at entry.

quote:

Premiums could be greatly reduced by eliminating sick or elderly people from coverage. That seems to be the true market approach, then. I wish the "true" conservatives would consider more what impact the pure market solution would produce.

This would be the exact opposite of Obamacare. The sick are the only people who want it.
If there's true competition, the price will come down gradually, not all at once. When it's super-expensive people eliminate themselves from coverage, making the pool older and sicker.

I literally know of no one who is suggesting Obamacare as the solution so this seems like a distraction from the tougher question I'm asking about what do we wish to happen to people with preexisting conditions in any replacement approach.

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I have wondered whether it would work better to set a minimum coverage like policies for automobiles to force the market to compete equally but with a shared threshold.

Theoretically, the market should determine coverage as well. If insuring children up to age 26 is popular, that's what they will offer.

I think I was typing while you were probably writing:

It's not completely laissez-faire but it would provide a level of minimum care for all our people - not as a right but as a level of societal compassion regarding the reality of life. We grow older and we get sick.

You seem to read a lot of the Libertarian and "true" conservative writers. Have you seen or know of any response to what I describe? Rather than having a government run system, isn't there room to set minimums and then let the market freely compete as a compromise?

I was hoping you had more because it seems the answer has essentially been, "Well, the market will provide something at some price whether people could afford it or not." Is that the answer that you know of from the "true" conservative approach?

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Rather than having a government run system, isn't there room to set minimums and then let the market freely compete as a compromise?

Yes, of course. Life is like that... sometimes we take a stand on principle and sometimes we must compromise. But the problem is that insurance commissioners in states around the country have been adding "benefits" for years to the "basic coverage" thinking there is no cost to mandate each and every little thing. And before you know it... it's not affordable.

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I was hoping you had more because it seems the answer has essentially been, "Well, the market will provide something at some price whether people could afford it or not." Is that the answer that you know of from the "true" conservative approach?

The price will come down to the point where the product is attractive or the provider won't stay in business.

BUT, yes, there is something more... much more. It's called charity. It's a beautiful thing.
Charity is voluntary and noble. Most Catholic hospitals were founded as charities, because the rich all had a private physician to come to their homes but the poor had nothing. That's how hospitals came to be. They were run by nuns and many of the doctors were private physicians who volunteered part time at hospitals.
Government is force.

quote:

Originally posted by ChicagoSigMan:

quote:

Originally posted by chellim1:

Why not just repeal the disaster and start fresh with some market based, simple reforms like allowing health insurance to be sold across state lines?

Exactly. A clean repeal bill. One sentence: "ACA is hereby repealed."

Then debate alternatives and pass some reforms.

Instead we get the free shit crowd and there backers in the GOP saying "Well, we have to have subsidies so people can buy insurance. We also have to make sure that people with preexisting conditions can't be turned down. We also have to make sure people can stay on their parents' insurance until they are eligible for AARP membership" and so forth and so on.

The people who want all this crap didnt vote Republican before...and they aren't going to vote for Republicans after. So I don't know why the GOP is so damn hellbent on preserving a giant entitlement.

The Republicans put a straight up "repeal the ACA" bill on Obama's desk when they knew he'd veto it. You'll notice the chickenchidtt #$^&^s won't put one on Trump's desk.

I don't think you can just straight-up repeal the bill. I mean, how would that work? It took years to put all these mechanisms in place. Lawyers, accountants, corporations, state governments, regulators...the list goes on...what would they do when it was repealed? What would the insurance companies sell?

The turmoil would be epic.

If you want the president and the Congress to look completely incompetent, a straight up repeal would be an excellent way to do that.

Heard from a friend who just left Humana. They are leaving the Individual healthcare marketplace. They will not be offered on the Federal Healthcare Exchange effective January 2018. Others, already announced that , absent big changes to the ACA, they will exit. I believe United Healthcare is one such carrier.

Healthcare isn't an Insurance problem now that Pre-Ex provisions are banned and Medical Loss Ratios are controlled..How do we lower the cost of TREATMENT? How do we deal with the ADVERSE SELECTION causing huge premium increases? The cost of healthcare was 17.8% of the GDP in 2015. There aren't enough millionaires and billionaires to fund "free" care.

Lifestyle issues, such as obesity, lack of exercise, abuse of legal prescription drugs, illegal drug use, excessive litigation leading to defensive and wasteful practices, spreading the R&D cost of new drugs across the rest of the world, and managing end of life care. Simple, eh? We also need to graduate more doctors and nurses.

The fact that we are an aging population drives costs too. The percentage of Americans over 65 is climbing and the average age of Americans is too This will strain resources needed for Social Security and Medicare. For a program like SS to stay solvent, you need 7:1 ratio of Active workers to Beneficiaries. We are under 3:1

Those of you who think selling across State lines is some panacea are dead wrong.

Healthcare is delivered locally. MY local Wm. Beaumont Hospital in Troy , MI does NOT compete with any "nearby" hospital in Illinois, Ohio, Indiana and so on.

Prospective Pricing will always have a geographic component. Retrospective pricing reflects the costs at the hospitals actually used.

Administratively, a carrier needs more staff to deal with multiple States. Contract writing, legal defense, State filing, lobbying State Insurance Commissioners, training and a host of backroom things.

The notion that competition fosters lower pricing when ACA controls Medical Loss Ratios is off base. Profit or Underwriting margin is only 3%.

Its a Washington Myth. Don't perpetuate it.

chellim1,

Thanks again for your reply. It just seems to me that even before Obamacare, market forces were driving the costs up and up. I remember that hard working folks were not able to keep up.

The Republicans were flummoxed to put up some fix. The Democrats then offered some solution that was simply terrible, redistributing health care to many who didn't pay for it while placing more on the back of productive citizens.

Now, the Republicans are in the driver's seat but can't convince enough of themselves on how to solve the original rising premium problem - let alone the Obama-intervention complications.

I honestly don't think the market will meaningfully fix the premium and coverage problem without some discipline from government at this point. The market is so artificial that I think some force, as you describe it, will be necessary.

In an ideal world it would not have been so but we are far from that now.

quote:

Originally posted by showpro:
I don't think you can just straight-up repeal the bill. I mean, how would that work? It took years to put all these mechanisms in place. Lawyers, accountants, corporations, state governments, regulators...the list goes on...what would they do when it was repealed? What would the insurance companies sell?

The turmoil would be epic.

I do disagree with that.

In the end, either you believe that services rendered and prices for services should be set by doctors and patients, or you believe that services and prices should be determined by governments, and the bureaucratic army of lawyers, accountants and regulators they employ.

If you believe in government control of prices and services, you have to accept declining quality and rationing. In a world of unlimited demand prices are either set by market forces or by rationing.

The turmoil created by Obamacare is becoming epic and leading us to the holy grail of socialism: government control of the personal, including life and death.

quote:

Originally posted by chellim1:
I do disagree with that.

In the end, either you believe that services rendered and prices for services should be set by doctors and patients, or you believe that services and prices should be determined by governments, and the bureaucratic army of lawyers, accountants and regulators they employ.
If you believe in government control of prices and services, you have to accept declining quality and rationing.

In a world of unlimited demand prices are either set by market forces or by rationing.

The turmoil created by Obamacare is becoming epic and leading us to the holy grail of socialism: government control of the personal, including life and death.

Well, that's all great in theory. But in reality, repealing the bill resets the laws to what they were the day before the ACA was put in place. And that was already a large regulatory framework, not a free market. And all the corps and state governments have scrapped the programs that were in place under that framework and changed all of their practices to adapt to the current law.

It's obvious that an instant repeal would create utter chaos. Nearly all of the current insurance plans would become void and there would be none in place to replace them. Even private insurance plans would probably run afoul of the prior regulatory frameworks and be illegal. A total mess.

Alternatively, all the plans would have to continue to run under state regulations, but without any federal support. So everything goes into chaos at the state level.

Either way, it would be a disaster. All of this stuff is very detailed, complicated, and intermingled. You can't just scrap it. I imagine that's why they didn't.

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You can't just scrap it.

What ever did people do before the government stepped in to save them from themselves?

I have a preexisting condition, and there have been several points in my life where I did not have insurance. I made due. So will others.

There are several areas for improvement, but as Chellim1 has stated, the government took it in the wrong direction.

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that was already a large regulatory framework, not a free market. And all the corps and state governments have scrapped the programs that were in place under that framework

If that "large regulatory framework" you speak of is truly gone, maybe we will be better off without it.

Seriously, we did need some reforms to limit regulation and encourage more competition before Obamacare. I'm not saying it was ideal before Obamacare but I am saying Obamacare took us in the wrong direction.

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Either way, it would be a disaster. All of this stuff is very detailed, complicated, and intermingled. You can't just scrap it. I imagine that's why they didn't.

Well, you come down on the Paul Ryan side and I come down on the Rand Paul side. We disagree on that. I think ordered liberty is a beautiful thing. By "ordered liberty" I mean minimal interference by government. The police power exists to protect private property, not to take it from one and give to another.

Maybe I'm not making my point clear. I'm not saying we wouldn't be better off without all this government regulation--we would. That's not the problem. The problem is a straight-up repeal of ACA puts the ORIGINAL regulations back in place. It rewinds the laws to 2008, not 1900 or something. And no one is prepared for that. Not to mention that it would repeal zero of the state laws.

That's why the mantra was "repeal and replace" not just "repeal".

Pre-Existing Conditions PRE ACA

If you bought INDIVIDUAL insurance and liked changing carriers periodically, you had a big problem.

If you were in a GROUP PLAN, you generally were in good shape, even if your Employer moved his coverage periodically. MOST group plans in my State did not have a Pre-Ex clause. Some of those who did still paid on Pre Ex Conditions but only up to $5000 in the first year, after being in a premium paying status for 12 months, there were no exclusions, 18 months for dependents.

As an aside, NONE of our HMO plans have had Pre Ex in decades, thanks to the marketplace (union demands).

Before ACA, 80% of insured Americans were in GROUP PLANS, the Rest in Individual plans. The group plans I am speaking of were at least 50 employees in size.

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Before ACA, 80% of insured Americans were in GROUP PLANS, the Rest in Individual plans. The group plans I am speaking of were at least 50 employees in size.

An employee group is sometimes as few as 3 employees, including the owner. I had an architectural firm that consisted of an owner (with diabetes and other pre-existing conditions) and two employees. We got him pretty good and reasonable coverage for his small group.
(I should mention that I'm life and health licensed in addition to the other hats I wear)

In all fairness, the question at this point is the best transition, not whether Obamacare is good.

What did people do before and would again? Bankruptcy - not exactly a market force idea.

Hereditary debts are far more market driven. To say that people and large corporations have the same bargaining power with standard agreements on a gurney or in mortal distress is just not accurate.

Certainly the entire regulatory framework is not something that will be eliminated. Isn't a health care regime without regulation a practical myth?