Harry Boy

Jesus Christ, are there any Indians on the NYC Fire Dept?

Where Are The Politically Correct Do-Gooders When it Comes To The American Indians.

When will we have our First Red President........

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Harry Boy (Genius)

In The Absence Of Law And Order Society Will Surely Destroy Itself

Patsfanin Philly

PFnV,
Well thought out but let me give you the flip side. Not all states are as well served and some only have one or two large carriers that effectively have a monopoly ( think cable TV pre-Dish and DirecTV and how great service was then as compared to now). Increased competition should and hopefully will result in lower rates if experience is any guide.
The best analogy I can think of is auto insurance where I have my pick of GEICO, Progressive, Allstate,, Erie, State Farm and can pick choose the plan to fit my needs ( high tort,low tort i.e. right to sue or not), high deductible or low, collusion or not and competition has me paying effectively the same as I did 20 years ago, probably lower if you factor in inflation. Those carriers have to be well capitalized and they are regulated by the individual states and by and large they issue policies in most states. There is usually one or two out of 50 that are exceptions.
Obviously the difference is that they are experience-rated so that those with more at-fault accidents pay more than a safe driver which couldn't be transferred to health insurance, unless you wanted to charge someone more for smoking or other lifestyle choices. The problem with that is that it is th e slippery slope argument of charging people more for eating fast food or being heavy which no one wants to touch. My carrier currently offers a credit for healthy choices such as going to the gym 2 times per week for a year....

PatsFanInVa

PFIP, I'll accept that there are states and areas that operate as de facto monopolies for one insurer. I think then the value we're pointing to is the availability, for the individual, of interstate insurance availability... I think what I mentioned in the previous post is really my only caveat, to make sure we're getting the value we perceive in terms of competition between/among companies.

I want to get Icy's opinion of the protections I suggested... beyond that, I think it would be cool to open a "conference committee" thread. Obviously the grenade throwers would show up in droves, but it would be kind of cool to put our puny little football-fan brains together and come up with a compromise "bill," meaning set of provisions, that we think would work.

Anyway the remainder of your post is good stuff, the analogy of auto insurance. Something troubling happens, however, when an insurance company cannot effectively adjust premiums to mitigate risk: the model simply breaks.

So one important feature for us will be to cover the currently uninsured and uninsureable (at reasonable cost.)

Already, this model begins to take on forms different from the car insurance model. If I cannot get affordable insurance for my car, "I should have thought of that before the wreck[s]."

But the problem in risk-based premiums in health insurance is not the lard-ass smoking alcoholic, who might be faced with a 50% higher bill; it is more the individual of any lifestyle, who has already had a condition at one time or another. If that individual is employed, he must cling to his current insurance (and job, since the insurance is not portable,) like it's his last friend on earth. Otherwise, "preexistent condition" may as well be carved on his tombstone.

And why not? He is the equivalent of a rusted out car with no brakes or mirrors, in the risk analysis the insurance company performs. Worse, actually. And while we can tell someone driving with no brakes, lights, or mirrors is illegal, we can't very well outlaw disease and "take them off the road," the dire pronouncements of the "Logans Run" theorists notwithstanding.

Nobody has proposed doing so, and nobody wants to. The whole point is for those who are sick to get care.

So our model has to somehow get at the risks that are can be gotten at; or, our model has to recognize and absorb the higher costs of risks, even when controllable (your case in point on obesity is a good example.)

One way of approaching this, is to adjust the premium downward to reward good behavior. It worked for going to the gym, right?

People would hate it if you "charge them 50% more for being an obese two-pack-a-day sedentary alcoholic," because "...there's nothing I can do about it."

But, an incentive structure could be worked out where a BMI in the non-obese range results in a "rebate check", just for instance, off the top of my head. Just throwing it out there... you think it's doable?

In other words, could one go through the tables, identify lifestyle choices, identify verification measures (like weighing and measuring for BMI during a once yearly physical, and offering an optional voluntary nicotine test for smoking [maybe that's overboard,]) and do the math based on the reward, with the conclusion that we could actually save X dollars per year based on those voluntary rewards for living right?

These preventative measures could go a long ways to easing the costs of curative care (which it is the point to provide in the first place.)

Again, just throwing it out there. I'm steadily losing the extra weight of 40 odd years (yay,) but still smoke a pack a day, and hardly ever drink heavily anymore. But it's evident to me that if you take me and my one million belly brothers across the country and measure outcomes, we'll cost the system plenty.

Is it kosher to incentivize healthier behavior?

After all, I believe we're morally obligated to try to cover the sick, not just the well. In other words we cannot in good conscience mitigate risk based on preexistent conditions. But we can address risk through these sorts of voluntary incentives, to a point.

I suppose we needn't design these policies; that's for the companies to do. If you want to join the one that "rebates" healthier behavior, you do; if you want to join the one that doesn't, you don't. I am sure this will be contentious from the POV of those who claim genetic or glandular factors in their obesity, or those who declare their alcoholism is a disease.

I'd propose if you rebate the healthier behaviors, you would be bound to offer programs for those paying the "full rate" (i.e., the fatties, the smokers, the drunks,) and cover interventions such as weight watchers, smoking cessation, and addiction cures (alcohol, other drug treatment, etc.) What the hell. They're the pool paying for it.

So there's a buried trade-off there - no whining that "I can't help it," but no saying "screw you, we're incentivizing good health...." ... without providing some option to get from point A to point B.

I dunno, just shooting from the hip. Whattaya think?

Fogbuster

..... which is PRECISELY the point. America is the land of equal opportunity, except now there are "affirmative action" programs in place to make it "more equal" for some, Native Americans being one "affirmed" group.



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"All that is required for evil to triumph is for good to do nothing."

Rossmci90

I wonder why they forget to list health care as one of the factors that go into determining life expectancy? Because it is undeniable that improved health care will lead to increased life expectancy. The same applies to infant mortality.

Got to love all these half truths.

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Harry Boy

__________________
Harry Boy (Genius)

In The Absence Of Law And Order Society Will Surely Destroy Itself

Patsfanin Philly

I like it and I believe that we, from both ends of the spectrum could come up with a plan that would be acceptable...Wouldn't the talking heads have a field day..and of course ESPN would pretend it didn't happen..

>>>Something troubling happens, however, when an insurance company cannot effectively adjust premiums to mitigate risk: the model simply breaks.<<<
Isn't that what happens now with health premiums, that the young and healthy pay higher rates to pool the risk from those with higher needs? I have two employees, one a health nut who is at the gym 6 days a week and eats very healthy. I pay the same premium as for the other employee who smokes, drinks and uses the treadmill as a clothes rack....I like your idea of rebates for healthy behavior.
I think there is a way to cover the 15% of the population who doesn't have coverage without bankrupting the nation or destroying what we have. Right now, there is no reason that any child under the age of 19 shouldn't have health care with the availability of the CHIP program here in Pennsylvania, it covers 200,000 uninsured and has built in protections to prevent companies from dropping their coverage to throw people on the public dole. It has a low cost and no cost part, depending on the family's income and employment status and for those who earn too much for medical assistance.
CHIP A Brief History of CHIP
It covers 200,000 in the Commonwealth and can easily be applied nationwide. There is some federal funding available, though I'm not sure of the exact amount. Suppose you increase the covered age by a year or 2 years every year, as in to age 21, then 23, then 25 and you give them the option to purchase coverage if it's not available at work. It could be gradually implemented and would protection people's existing plans and reevaluate it after a year or two to see the costs and any unintended consequences. If it's successful, it could be implemented faster but ultimately it could solve the problem of covering the uninsured without wrecking the existing system or incentivizing companies to ditch their current plan for a public option as stated, this has built in safeguards.

PatsFanInVa

Okay, I don't know details on CHIP but this is again promising. (At the conclusion of this post I'll make the "Conference Committee" thread and cut and paste what you, me, and Icy have come up with so far.)

The problems I see in nationwide CHIP as expanded (in PA,) then growing to cover young adults, etc., is similar to what you reference at the outset:

As you add young adults, you take them out of other risk pools. That is the "magic bullet" of health insurance, from what I understand: The young pay for care they are much less likely to use for some time.

So if you take people from 19-21 and throw them into CHIP, CHIP becomes a better bet to be self-sufficient. However, since as a piece of the system at large it continues to infringe on the healthiest population -- the prime of life, no more childhood diseases, no middle-age aches and pains -- it will draw away support from the solvency of those risk pools addressing adult health. CHIP premiums will be low or free, and people would enjoy those rates to a certain age, but adult-pool premiums would be more expensive.

Another problem with progressively raising the CHIP age is that those who live in greatest fear of single-payer can point to the "creeping socialism" of a state program that carves out more and more into the state sector, by increasing the maximum CHIP age; "existing companies couldn't compete," rinse, repeat.

Last but not least: I saw that CHIP was initially enacted, then made national policy under Clinton (to some extent, at least, according to the link,) then expanded in 07, in its Pennsylvania form.

Was the national form watered down? Would the national form of CHIP just have to be strengthened to the current Pennsylvania standard?

Good stuff. Off to make the "conference committee"

PFnV

[Aside: While we are on the age subject, we have a wonderful demographic political reality: at present, the young -- who do not personally benefit from the "fix" (because they are disproportionately healthy) -- are disproportionately in favor of fixing the system, for the benefit of others, for ideological reasons. That is, the young feel they can bounce back from minor snafus, whereas the older population is staring down the barrel of a fixed income. They cannot afford mistakes. They are also in a position of having gotten wherever they are under a given set of rules. They do not want the rules to change and lose whatever it is that they earned under previous rules. They are invested, whether well-off or poor. They are therefore easier to scare. Both points of view are valid and we need to keep both of them in mind as we create our "new reality."]

PatsFanInVa

The committee room is reserved -

Health Care "Conference Committee"

Harry Boy

Why don't we have "million man marches" on Washington for the American Indians..........

We want more Indians on TV Sit Coms and in Commercials.

__________________
Harry Boy (Genius)

In The Absence Of Law And Order Society Will Surely Destroy Itself