Impeding changes to our Health Care system

Originally Posted by classicman

Redux - just a thought here -
Why cannot we merge a system of regulation by the Feds with the state option. Won't the fed regulations on what they can charge... cover the insureds?
I'm really just sick of this at this point.

That is pretty much with the Senate did in its version

State-administered Exchanges with states having the option to opt out..and with federal statutory standards for coverage option with limits co-pays andout-of-pocket cost and required certification and approval of premium increases...the details of which would be in the regulations.

Subtitle D
PART I—Establishment of Qualified Health Plans

PART II—Consumer Choices and Insurance Competition....


But, by now, I'm tired or repeating myself.

[TheMercenary]

Subtitle D deals with drug plans.

Subtitle D – Medicare Part D Improvements for Prescription Drug Plans and MA–PD Plans

Originally Posted by TheMercenary

Subtitle D deals with drug plans.

Subtitle D – Medicare Part D Improvements for Prescription Drug Plans and MA–PD Plans

It would probably help if you looked at the Patient Protection and Affordable Care Act as passed by the Senate:

Title I - Subtitle D - Parts I (establisment of qualified plans) , Part II (consumer choice and insurance competition), Part III and IV (state flexibility)

[classicman]

The other thought was just a catastrophic plan. But that doesn't seem to really address the issues of preventative care and ER overcrowding, I don't think.

The Senate version, IIRC had the states doing the regulation not the Fed. If that is correct, then it seems to defeat the purpose of preventing the state jumping issue.

Originally Posted by classicman

The Senate version, IIRC had the states doing the regulation not the Fed. If that is correct, then it seems to defeat the purpose of preventing the state jumping issue.

Nope...the Senate version has federal regulations on minimum coverage options, maximum co-pays and out-of-pocket expenses and regualted premium adjustments ...with states doing the administration of the exchanges or opting out.

This is the only way to prevent the insurance companies from "shopping around " for the least regulated states and setting up shop there.

[classicman]

Hmm - I think I'll have to reread that again. I am admittedly confused about what was in which when.

[TheMercenary]

Originally Posted by Redux

It would probably help if you looked at the Patient Protection and Affordable Care Act as passed by the Senate:

Title I - Subtitle D - Parts I (establisment of qualified plans) , Part II (consumer choice and insurance competition), Part III and IV (state flexibility)

You are right. I have it open in front of me. I was in the wrong Title. It still does not regulate it the way you state it does.

[TheMercenary]

Originally Posted by Redux

Nope...the Senate version has federal regulations on minimum coverage options, maximum co-pays and out-of-pocket expenses and regualted premium adjustments ...with states doing the administration of the exchanges or opting out.

This is the only way to prevent the insurance companies from "shopping around " for the least regulated states and setting up shop there.

And when the states opt out then what?

Originally Posted by TheMercenary

And when the states opt out then what?

Then a federal non-profit would administer it in those states.....using a model similar to the House version where the entire Exchange would have been administered federally.

The Senate version gives the states more flexibility but still provides consumers in ALL states with certain minimum protections, re: coverage options, co-pays and out-of-pockets, and premium adjustments (in order for a company to be approved for the Exchange).

[TheMercenary]

But when they opt out the rules for those states that opt out are not the same. They are not regulated the same.

Originally Posted by TheMercenary

But when they opt out the rules for those states that opt out are not the same. They are not regulated the same.

The minimum regulations are the same for all states....the flexibility is in the administration, not the regulation.

It also gives flexibility to insurance companies that might not be large enough or have interest in being in a national exchange, but very interested in particular states..thus increasing competition in those states but under which those companies still have to meet minimum federal standards.

The key feature of the Republican plan was to allow insurance companies to sell across state lines, with virtually no federal regulations so that the companies would look for the state (or US terrirtory) with the least regulation and least consumer protections, establish a presence in that state, and then sell across state lines to consumers across the country.

[classicman]

Please note that I believe that the goal of many of those that support the current plans in Congress is to ultimately get to single payer universal coverage provided by the government – because I have read many comments from supporters stating that this is what they support. I am against that. I don’t believe that government run health insurance will help anyone in the long run. I do, however, believe that the health care status quo is unacceptable and unsustainable. I want major changes.

1) I want to encourage competition based on price and customer satisfaction. Customer satisfaction should be driven by overall treatment and outcome. Not all that different from any other service.

2) I would like to see all healthcare related tax payments and exemptions removed. Employers should not receive any special tax treatment for providing healthcare to employees, but at the same time I should not be penalized for buying my healthcare on my own. This would enable insurance portability because I would buy my policy. My employer would not buy that policy. It would also change the competitive nature of insurance because insurers today work to meet the needs of the human resources departments within businesses, not the needs of the individuals on their plans. Yes, there is a difference.

Income taxes on health care workers should be removed. From the doctor to the janitor, the entire industry should be exempt. WAIT: Before you scream at me, think about this statement. If we can achieve real competition in health care, then by removing taxes we create room for prices to go down. For example, if a doctor wishes to take home $200k per year, that doctor needs to bill far more – varying by tax situation – to actually take home that $200k. The doctor also needs to pay staff, rent, equipment, etc, all of which are laden with taxes from income taxes to sales taxes. Keep in mind that even if the drugs the doctor injects you with were purchased tax free, the costs of those drugs included all the income taxes and other taxes the drug company and the company employees had to pay.

That we tax a patient, directly or indirectly, for trying to regain their health should be disturbing to every decent person. I would like to see Congress dedicate a committee to the removal of all health care related taxes.

3) No, I am not totally anti-government. I believe that government has some very important roles in health care. The first of those roles is to act as judge in disputes over complaints that insurers or the insured are failing to live up to their contracts. The ability to act as unbiased judge is huge and it is a role that is vital to protecting patients. It is a role that the government can not effectively play if the government also controls the health care industry. There is simply too much opportunity for influence and pressure. Think of it this way; how fair is it that if your health insurer denies coverage your appeal starts and ends with that health insurer? Why would it be different if that insurer is government? There are still budgets and careers and egos at play. Profits are gone but expenses still will need to be met by the government. However, when the insurer is private and the judge is government you increase the chance of a fair judgment.

4) The federal government should establish itself as the head of the standards body for the development of a nationwide healthcare information technology infrastructure – the computer network that will manage health records and billing, etc.

Those of you that have been part of an IT standards body, for example a standards body responsible for insuring that your PC can get your WiFi signal, know that this is an extremely complex undertaking. Standards bodies are complex organizations. Government as a whole, and individuals in government careers, can be very qualified to lead these bodies. Leadership involves constant politicking, compromise, deliberation, and deal making – the art of a operating a Constitutionally based representative government.

And, I bet Constitutional lawyers would find government’s involvement here very acceptable because it would absolutely involve interstate commerce.

5) When I first started writing on health care I opposed forcing individuals to buy health insurance, though I strongly believe that the economics in this country involves increasing the number of people that are actually paying into the system. I still hate the idea of forcing people to buy insurance, but I am coming around to the belief that we either need to insist that everyone that can possibly afford catastrophic coverage get that coverage or we need place some sort of payment requirement on those that visit emergency rooms or use some other means to get health care without paying. Maybe to avoid paying you have to prove you don’t own any luxury items or purchase alcohol or cigarettes. This sounds heartless on the surface, and maybe it is. But I would like to know that the part of my insurance and tax payments that go to pay for the health care of the uninsured is going to the truly needy. I believe that a portion of what we spend is to help those truly in need, but I also believe a portion goes to people that work the system and people that make bad decisions that I have to pay for.

6) Health care reform must include tax reform. I do not understand how we can burden the producers in this nation with complex, high taxes when we so desperately need to pump more money into health care, infrastructure, job creation, and a long list of other activities. Nothing would help ease the burden of health care costs and all the other above mentioned needs like an economic boom that benefited all segments of our economy. Simple as that. Tax simplification and reduction helps everyone at ALL income levels. I believe it helps those with low incomes but big ambitions the most. Naive?

7) Along with tax reform, we need to focus on cultural reform. See my many posts including yesterday’s post on encouraging President and Mrs. Obama to focus their efforts, first and foremost, on encouraging educational excellence, accomplishment, and self-reliance on the many people that they can reach in our society that no one else seems to reach – at least no one else that can act as positive role models.

8 . Health insurance today acts very much like a health care savings account in that almost everything that is a part of health care is paid for by health insurance. I believe that we should break out the health care savings account from the catastrophic, true insurance piece. Let the patient be the consumer for non-catastrophic care, making the best deal by using their health care savings account. I believe that insurers should offer rewards and penalties tied to insurance pricing based on patients following a course of routine health maintenance.

9) There are more than 1,000 health insurance providers in the U.S. We need to encourage competition among them. If that means opening up sales across state lines, fine. If not, then is there a better option?

10) My big concession to those that support strong government involvement. I believe that we need to restructure the insurance market – yes, forcibly through government action, so that the outcome is competitive and thus meets consumer needs, and can generate profits and incentives. I think that the best way to get to this environment may be by requiring this outcome.

So that it is folks. Have at it. The President meets with Republicans on February 25. I know, based on the readership of this blog, that our debate can impact that meeting.

Oh….One final thought. Whatever the health care outcome All government employees including Congress take part. No special privileges for the political class.

From Here

The libertarian concept of the above is built on the premise that insurance is like any other product...and it is not.

And that there should not be a tax-funded health safety net (I assume he opposes Medicare/Medicaid, SCHIP, welfare, food stamps, social security, etc) along with tax simplification and that will make a more efficient and "fair" system.

And numbers 9 and 10 are contradictory....9) calls for dedregulated free market..and that it will increase competition..and it wont, it will allow insurance companies to shop around the least regulated state and operate out of that state, but sell nationally....but 10)state-focused while recognizing the need for centralized regulations, which is what the Senate bill does.

A collection of libertarian talking points and contradictory solutions. Not very well thought out, IMO.

added:
Oh..and, btw, it starts with a biased, non-objective opinion.

[Happy Monkey]

1 is nice. But as things stand, the only time "satisfaction" is a meaningful metric is when you file a large claim, at which point (assuming there is any competition at all) the companies will be competing to not cover you.

Item 2 is interesting. I'd like to decrease the ties between healthcare coverage and employment as much as possible. I'd also like as many healthcare providers as possible to get tax exempt status - under the normal non-profit rules. The arguments here for exempting the whole industry from taxes are pretty specious.

3 is insufficient. In an industry that is usually colluding when it isn't an outright monopoly, and where competition is almost irrelevant, as you don't know how bad your de facto coverage is until it's too late to change providers, the government needs to do far more than enforce contracts, which are written by and for the benefit of the insurers.

4 is good.

5 is irrelevant. You already are charged if you go to the emergency room, and if you can't pay, you don't. Unless he's proposing they hold off treatment until the person pays or proves they are poor and teetotal.

6 is a non-sequitur. Simplifying taxes might be nice, but it is completely orthogonal to healthcare, and only a half-hearted attempt to link them is made even in this article.

7 starts OK, many of the US's health problems are culture-related. And education, accomplishment, and self-reliance are good, but I expect plenty of educated, accomplished, and self-reliant people sit in front of a computer and drink soda all day; I was expecting more of a health-related cultural connection here.

8 seems fine. On the one hand, insurance isn't often the best model for normal recurring costs, like checkups, but on the other hand, it is better in the long run to encourage preventive care. Maybe rewards/penalties would work as well as justcovering the care in the first place.

With 9, just about anything is a better option than allowing insurers to scuttle off to the least common denominator in regulation. If sales are opened across state lines, the insurer should have to obey the regulations in the state they are selling to. With that restriction, we'll see whether the proposals advocates are more interested in customers being able to buy across state lines, or insurers being able to sell across state lines.

10 - good goal.

Final thought - agreed. An addition: Allow anyone to buy into the government's plan.

[TheMercenary]

Originally Posted by Redux

The minimum regulations are the same for all states....the flexibility is in the administration, not the regulation.

I don't give a shit about the Republickin plans, they are not the majority and they do not have the responsibility for making things happen in Congress, the Demoncrats do have this responsibility. I care about the responsibility of the Demoncrats and what they are going to do with the power they have. It is a straw man argument to blame anyone else. Your Party has failed again. The regulation is not defined in the Bills before each house. The Devil is in the details.