What Does a Bi-Partisan HC Reform Bill Look Like

[Hayabusa Rider]

I understand that - it's the rate at which they are going up right now. These chronic conditions did exist 5, 10, 15, 20 years ago.

What you need to understand is that these conditions aren't static. With sedentary, stressful lifestyles combined with an aging demographic, you'll think of this as the good old days.

We're going to need to reallocate resources and have to figure out how to do that soon.

So far no one has demonstrated that they have the vaguest idea of what's coming down the road. They're merely interested in winning the next election.

That is why politicians make bad medicine. Their eyes always towards the next election first and foremost. They need to seek some guidance before making changes which cannot be undone in practice, and honestly, have you seen that done?

 

[ElFenix]

I understand that - it's the rate at which they are going up right now. These chronic conditions did exist 5, 10, 15, 20 years ago.

but treatments didn't, or they weren't as widespread. people either lived with their chronic conditions or died of them.

and of course every time one chronic or acute condition is reined in, 2 more arise. it's a hydra.

not to mention we didn't have children with adult-onset diabetes 20 years ago.

 

[Carmen813]

From what I see, part of the problem is that private and public insurances are trying to save money by putting more rules and regulations on providers. Sounds good, but because everything is so complicated it takes quite a bit of time and effort to get what should be relatively straightforward claims processed.

I dealt with a woman who is on Medicaid last week. Medicaids computer said that she wasn't covered, but her caseworker said she was. Well that's great, but we need valid numbers to bill. An hour later (I had to make the calls myself) I still knew nothing.

Apparently Medicaid changed her numbers, but didn't send out new cards to a lot of people. With private insurance one could call and get that taken care of. Not so with them. They refuse to give information to providers. So after yet another half hour, I find that she needs to go to the county medicaid office and they will write the number down on a piece of paper so she can give it to me. Not even her case worker can know it.

Well she goes down and they tell her that they won't give HER that info either, and she has to wait for a new card.

She should have that in a couple weeks.


She's the worst case in a couple months, but when it goes south, it typically takes days or more to get a resolution. In the meantime we're out I don't know how many man hours, the patient doesn't get treatment because we won't get paid, and the state just plays dumb.


So how much does that cost? A hell of a lot. The answer? More regulations.

We can't fucking win.

Our of curiosity, which county are you in? When I was on Medicaid (now FHP) everything was done through a private company...i.e., you picked a provider to handle all the insurance "stuff." In my case all my insurance claims went through Excellus BCBS.

 

[mect]

Okay, I'll give it a go, although I probably shouldn't seeing as I'm not a health expert. Here are some ideas that I think would be pulled from both sides.

Tort reform
Pay in government health care policy not supported by tax dollars to compete with the private system
Subsidized government plans for those with preexisting conditions, the level of subsidy depending on income level. Have a list of conditions, if a person is diagnosed, they qualify. This should help lower costs for private insurance, making it more affordable.
Vouchers for low income people to be used on either public or private health care plans.
Encourage creation of standards for medical plans. This would make things easier from a consumer perspective because it would be easier to know what is on a plan and to compare between providers. It would also allow the standardization of billing and insurance claims, which should greatly reduce overhead. Essentially, encourage what has been done in the electronics industry where standards allow interoperability between products by different manufacturers.
Allow insurance to be purchased across state lines to increase competition.
Creation of health savings accounts that can be used in conjunction with catastrophic insurance.
Mandate transparent billing and pricing for medical services.
Mandate purchase of health care, either public or private policy. Because those who say they're willing to take the risk really aren't, they just know if something bad happens, others will foot the bill.
Remove group insurance plans. With preexisting conditions out of the mix, this should allow people to buy the policy they want and keep it even when they change jobs. Companies could provide money to be applied towards insurance, but not have policies tied to the position.

As I said, I'm no expert, but it seems like a fair mix of ideas from both sides hopefully targeting both issues of cost and affordability. Of course, the problem is that most on both the right and left would vehemently disagree with it, but oh well.

 

[Carmen813]

Okay, I'll give it a go, although I probably shouldn't seeing as I'm not a health expert. Here are some ideas that I think would be pulled from both sides.

Tort reform
Pay in government health care policy not supported by tax dollars to compete with the private system
Subsidized government plans for those with preexisting conditions, the level of subsidy depending on income level. Have a list of conditions, if a person is diagnosed, they qualify. This should help lower costs for private insurance, making it more affordable.
Vouchers for low income people to be used on either public or private health care plans.
Encourage creation of standards for medical plans. This would make things easier from a consumer perspective because it would be easier to know what is on a plan and to compare between providers. It would also allow the standardization of billing and insurance claims, which should greatly reduce overhead. Essentially, encourage what has been done in the electronics industry where standards allow interoperability between products by different manufacturers.
Allow insurance to be purchased across state lines to increase competition.
Creation of health savings accounts that can be used in conjunction with catastrophic insurance.
Mandate transparent billing and pricing for medical services.
Mandate purchase of health care, either public or private policy. Because those who say they're willing to take the risk really aren't, they just know if something bad happens, others will foot the bill.
Remove group insurance plans. With preexisting conditions out of the mix, this should allow people to buy the policy they want and keep it even when they change jobs. Companies could provide money to be applied towards insurance, but not have policies tied to the position.

As I said, I'm no expert, but it seems like a fair mix of ideas from both sides hopefully targeting both issues of cost and affordability. Of course, the problem is that most on both the right and left would vehemently disagree with it, but oh well.

How do we pay for it?

 

[mect]

How do we pay for it?

Pay for which parts? I would assume the primary parts that would be expensive would be the subsidies for low income and those with pre existing conditions. Those would have to be paid for by increased taxes, but these should be more than offset by savings of not having those without insurance constantly checking into the ER every time they have a sniffle. I just don't see a good way for the private sector to handle people with preexisting conditions. They are guaranteed to lose money on them. There may be a way, but I don't see it.

 

[Carmen813]

Pay for which parts? I would assume the primary parts that would be expensive would be the subsidies for low income and those with pre existing conditions. Those would have to be paid for by increased taxes, but these should be more than offset by savings of not having those without insurance constantly checking into the ER every time they have a sniffle. I just don't see a good way for the private sector to handle people with preexisting conditions. They are guaranteed to lose money on them. There may be a way, but I don't see it.

I think covering everyone with pre-existing conditions would run about $12 billion a year. Which isn't that bad...

 

[woolfe9999]

I appreciate the ideas for bipartisan reform. These kinds of discussions are constructive.

My take on covering sick people is that I prefer the idea of barring insurance companies from denying them coverage, and letting them charge something like 50% more for the premiums. If you subsidize coverage for sick people, you are sending the wrong message about health - get sick and you will get free coverage, stay healthy and you have to pay for it.

- wolf

 

[mect]

I appreciate the ideas for bipartisan reform. These kinds of discussions are constructive.

My take on covering sick people is that I prefer the idea of barring insurance companies from denying them coverage, and letting them charge something like 50% more for the premiums. If you subsidize coverage for sick people, you are sending the wrong message about health - get sick and you will get free coverage, stay healthy and you have to pay for it.

- wolf

I think you could avoid this as long as the subsidies were set such that a person with a pre-existing condition still payed more than they otherwise would. By limiting insurance companies to charge only 50% more, you are essentially having only the insurance companies subsidize them rather than the nation. But I agree with your basic premise that they should pay more for insurance than a healthy person in the same income bracket would for equivalent insurance.

 

[woolfe9999]

I think you could avoid this as long as the subsidies were set such that a person with a pre-existing condition still payed more than they otherwise would. By limiting insurance companies to charge only 50% more, you are essentially having only the insurance companies subsidize them rather than the nation. But I agree with your basic premise that they should pay more for insurance than a healthy person in the same income bracket would for equivalent insurance.

Ah, I see your point. The sick person might pay 150% of the normal premium, but the insurance company could charge more than that since it actually costs them more than that to insure it, and the subsidies will make up the difference. That way the insurance companies don't have to raise premiums for healthy people to make up for the loss. Good thought.

- wolf

 

[Hayabusa Rider]

Our of curiosity, which county are you in? When I was on Medicaid (now FHP) everything was done through a private company...i.e., you picked a provider to handle all the insurance "stuff." In my case all my insurance claims went through Excellus BCBS.

I'm in Monroe. FHP is really medicaid for medications. If you look at your card you'll most likely see the format of XX#####X, two letters, five (I think) numbers, and a letter. If it's 4 numbers, a letter, then four more numbers, then BCBS handles everything.

Your hospitalization/physician care is handled by BCBS.

 

[daishi5]

I appreciate the ideas for bipartisan reform. These kinds of discussions are constructive.

My take on covering sick people is that I prefer the idea of barring insurance companies from denying them coverage, and letting them charge something like 50% more for the premiums. If you subsidize coverage for sick people, you are sending the wrong message about health - get sick and you will get free coverage, stay healthy and you have to pay for it.

- wolf

I have not read most of this, but I will take a brief shot.

-Tort reform
-Allow insurance to be sold across state lines
-Allow states to regulate the benefits of insurance sold in their state, require that they allow for "lower benefit" plans, while creating a structure to allow them to "penalize" these "low benefit plans" preferably through taxes.
-Eliminate any tax benefits of employer provided insurance,
-provide tax subsidies for personal insurance purchases - with a schedule to end the subsidies slowly over time.
-Either
-- mandate insurance coverage and eliminate "pre-existing conditions"
or
-- require all insurance providers to accept all buyers, but allow insurance providers to penalize buyers who have had lapsed coverage and pay the penalty over time through higher fees (will require regulation obviously)
-standardize whatever the VA uses for health care codes

I would prefer to do this one step at a time, but if we had to throw it all in at a time, this is what I think should be there, most of it comes from my right leaning bias. The biggest and most necessary step is to stop having employers provide health insurance. This is a huge agent issue. The company who buys the health insurance is not receiving the care from that insurance. The insurance company is providing care for the patient, but the patient does not have a realistic ability to switch insurers if the insurance company fails to come through for him. The customer the insurer is serving is not who is paying the bills, so the insurance company has very low incentives to provide good service.

I think that if we get to the point where health insurance is advertised like state farm, and all state it will make a huge difference. Right now, people don't shop for health insurance, they are given it. IF they shopped for it, insurance companies would be bending over backwords to prove to their potential customers that when things go bad they will be "in good hands." When the reputation of the insurance company directly affects who will buy insurance from them, insurance companies will dread a news story about how they refused to pay for "little susie's" cancer treatment. Right now, none of that happens, because large companies that buy insurance plans for their employees are not moved by "little susie" stories.

 

[shira]

1) Deregulate insurance markets and allow for sale of policies across state lines (instant competition)
2) Require insurance carriers to offer products to those with pre-existing conditions (no price controls)
3) Set up national rules for health savings accounts. Allow health savings accounts to be folded into retirement plan.
4) Tort reform aimed at eliminating the cost of "defensive medicine"

None of these suggestions deals with the core problem of rising costs. Taking one at a time:

(1) Competition between carriers doesn't address the main drivers of increasing costs: An aging population and newer/more-effective/more expensive treatments. All competition does is ensure that at the current technology baseline the efficiency will be maximized; it doesn't reduce the demand for medicine and therefore doesn't change the rate of cost growth.
(2) Carriers will be happy to offer insurance to those with pre-existing conditions: But the products will either be extremely limited or extremely expensive or both. A very limited level of coverage defeats the whole purpose of coverage. And full coverage at a prohibitively-expensive price is useless. What is needed is guaranteed, QUALITY coverage at a REASONABLE price; but the ONLY way that can happen is if virtually everyone (including low-risk patients) is covered, which gets right back into the "mandated coverage" problem that righties hate. Your #2 is like saying "more jobs" - it's a useless suggestion unless you can explain how you'd actually make it work.
(3) Health savings accounts just encourage spending - again, this is exactly the OPPOSITE of what's needed to "bend the curve." If you make medical procedures less expensive, demand will increase and costs will continue to rise. What's needed is to provide a DIS-incentive for medical procedures. The only way that's possible is to shift MORE of the cost onto the consumers of medicine. For example, mandate that insurance policies all must have (say) a $5,000 deductible for individuals or a $10,000 deductible for families. And costs beyond that point would be 100% covered. That sort of plan would reduce demand and therefore lower costs. It would also significantly reduce the cost of insurance policies.
(4) There's nothing wrong with tort reform, but the CBO has already calculated that the TOTAL savings (litigation costs + defensive medicine) would amount to only about 0.5% of the total cost of medicine in the U.S. That tiny savings doesn't remotely solve the overall problem.

 

[Carmen813]

I appreciate the ideas for bipartisan reform. These kinds of discussions are constructive.

My take on covering sick people is that I prefer the idea of barring insurance companies from denying them coverage, and letting them charge something like 50% more for the premiums. If you subsidize coverage for sick people, you are sending the wrong message about health - get sick and you will get free coverage, stay healthy and you have to pay for it.

- wolf

It does incentivize the wrong things, but not everyone who gets sick does it because they were living an unhealthy lifestyle.

 

[charrison]

None of these suggestions deals with the core problem of rising costs. Taking one at a time:

(1) Competition between carriers doesn't address the main drivers of increasing costs: An aging population and newer/more-effective/more expensive treatments. All competition does is ensure that at the current technology baseline the efficiency will be maximized; it doesn't reduce the demand for medicine and therefore doesn't change the rate of cost growth.
(2) Carriers will be happy to offer insurance to those with pre-existing conditions: But the products will either be extremely limited or extremely expensive or both. A very limited level of coverage defeats the whole purpose of coverage. And full coverage at a prohibitively-expensive price is useless. What is needed is guaranteed, QUALITY coverage at a REASONABLE price; but the ONLY way that can happen is if virtually everyone (including low-risk patients) is covered, which gets right back into the "mandated coverage" problem that righties hate. Your #2 is like saying "more jobs" - it's a useless suggestion unless you can explain how you'd actually make it work.
(3) Health savings accounts just encourage spending - again, this is exactly the OPPOSITE of what's needed to "bend the curve." If you make medical procedures less expensive, demand will increase and costs will continue to rise. What's needed is to provide a DIS-incentive for medical procedures. The only way that's possible is to shift MORE of the cost onto the consumers of medicine. For example, mandate that insurance policies all must have (say) a $5,000 deductible for individuals or a $10,000 deductible for families. And costs beyond that point would be 100% covered. That sort of plan would reduce demand and therefore lower costs. It would also significantly reduce the cost of insurance policies.
(4) There's nothing wrong with tort reform, but the CBO has already calculated that the TOTAL savings (litigation costs + defensive medicine) would amount to only about 0.5% of the total cost of medicine in the U.S. That tiny savings doesn't remotely solve the overall problem.

Shira

1 and 3 could are going to a big impact on insurance prices. There are significant prices differences in insurance depending on what state you live in(mostly due state regulation of plans). HSAs have been holding health care costs flat since they were put into play. They force the consumer to make better decisions about where and how they spend their money.

 

[charrison]

Oh, and btw, doing things like killing funding for stem cell research obviously aren't going to help...

- wolf

Stem cell funding never got killed. And currently it appears adult stem cells are showing lots of promise, which is what the govt has been funding.

 

[glenn1]

Since losing health insurance seems to be the big concern of many, I'd create a tax-paid universal catastrophic medical insurance program. Would be structured similar to how we now run unemployment insurance/SS disabilty - all pay in via payroll taxes, and for most would only be needed temporarily (between jobs, etc). Once you've minimized the concern of being without healthcare and/or being wiped out by an acute medical event, the rest can be worked out.