• An old idea that still won’t work

    In yesterday’s debate, some of the candidates addressed what they might do after repealing the ACA. The most often answer I heard was to make sure that people who had chronic conditions, but who had insurance, could not be denied insurance if they decided to switch jobs or lost theirs.

    I get why this sounds good. It avoids the free rider problem by making sure people don’t wait until they are sick to get insurance. It also solves the problem of penalizing people who have gotten ill by trapping them at dead end jobs, or denying them the chance for future care. But there are so many holes here:

    1) What about the guy who gets cancer while at his job and then loses it? The average employer plan is about $15,000 for a family. If he’s laid off, there’s no way he could afford that, let alone COBRA, which is usually more expensive. Now he’s unemployed, and he has to drop his health insurance. Under this legislation, he can’t get it back. Notice, you don’t need cancer for this to happen. Tons of people have been laid off, and many of them have chronic conditions.

    2) What about the kid who gets diabetes when he’s 15, before he ever gets a job? There’s no real way to get grandfathered into this plan until we mandate that his parents keep him on insurance until he’s old enough to get it for himself. Surely we can’t penalize children whose parents couldn’t afford that? Tons of kids have chronic conditions.

    3) What about the woman whose job doesn’t provide insurance, and who doesn’t make enough to buy it? This isn’t that uncommon. Those people do get sick. What is she to do?

    4) What about when any of these people go to get new insurance and are told it will be $50,000 a year? After all, the candidates seemed to support limited guaranteed issue, but I didn’t hear anyone support community ratings.

    The problem here is that they all recognize the need to make healthy people buy insurance to avoid free riders and adverse selection, but they want to avoid the use of the mandate. That’s incredibly hard. They also ignore the fact that individual ratings will still make the cost of policies unobtainable for people with chronic conditions. In fact, they also ignore the fact that insurance is just too expensive for a significant number of people, period.

    Fixing how insurance is provided will mean regulations. Fixing how insurance is paid for will require spending. Given the candidates’ aversion to these things, I’m curious to know how improvements will be made.

    • Great summary and you go to the heart of the issue. Politicians simply do not understand the concept of group vs individual underwriting and coverage. Until they do their solutions will be unworkable.

    • I’m sure politicians “understand” it just fine.

      It’s the electorate they pander to that chooses not to understand it.

    • “The average employer plan is about $15,000 for a family.”


      That’s about what I pay in income tax, in Canada, in a year!

      Yes, we pay other taxes (12% sales tax, for example), but really, how can anyone think $15K a year is a good deal, let alone $50K a year for an individual with chronic conditions.

      And lest anyone argue “wait times” I can make an appointment with whichever GP I choose, and get an appointment within days. For urgent concerns can see my regular GP with in a couple of hours (on weekdays) or go to a walk-in clinic and usually be seen within 1 hour.

      For non-emergency chronic conditions I might have to wait (days, weeks, or in some cases a few months) to see a specialist. The last time I was referred to an opthamologist I was seen the same day.

      But for emergencies (i.e. hospital emergency room “emergencies”) I’ll likely be seen in 1 or 2 minutes, if not seconds.

      It’s still beyond my comprehension how such a large population can’t see how bad a system is. I can only presume it’s a life long indoctrination that “we’re #1 in every regard” regardless of what the data show.

    • The Republican base is mainly composed of retired people on Medicare,
      successful business owners, and working people who dislike Democrats for moral issues.

      Almost no one in this base is getting beat up in the health insurance market.

      The uninsured in this country do not form a voting bloc at all. The uninsured do not elect anyone by themselves, and George Bush completely ignored them while winning two elections in Texas and two national elections.

      There is nonetheless a lot of discontent about rising and unaffordable insuinsurance premiums. But Obama did not attack insurance premiums, either the companies or the hospitals who make the largest claims,

      Instead his administration cobbled together a plan to help people pay the $15,000,

      However, if you read the fine print in the small business tax credits you fill find them full of gaps and restrictions,

      And if you read the fine print in the tax credits and health exchanges,
      you start to see the same thing,

      One expects the Republicans not to have the courage to just extend Medicare and raise taxes to pay for it, The sad thing currently is that the Democrats did not have the courage to do this either.

      There is no cure for the defects of private insurance, other than social insurance.

    • One solution is a P-HRA.
      (Portable-Healthcare Reimbursement Arrangement).

      Employers make defined contributions into employee-owned accounts, eliminates employer hassles
      Other family members or part-time employers may contribute into shared family account, more money to purchase healthcare policy
      Account (policy) belongs to employee, stays with them between jobs, no COBRA
      Employee selects coverage to meet their need, no one-size fits all
      Employees keep left over funds to pay other medical expenses with a VISA healthcare card

      visit Lyfebank.com to see how this works

    • In 2008 and 2009, many individuals came forward with practical solutions. Who among those who voted for the Patient Protection and Affordable Care Act of 2010 had ever designed health coverage before that date? For those of us who have had decades of experience in designing coverage, no one leading the debate in the Democratic party cared to listen. PPACA was clearly focused primarily on buying votes with other people’s money. How else can you suggest that they can eliminate pre-ex, guarantee issue, extend coverage to age 26, ensure minimum coverage standards, and, at the same time, “reduce the deficit” (which remains to be seen).

      However, fact is, if the 2012 election swings this to the Republican party, none of expect them to listen either.

      No one is interested in practical, bipartisan, intergenerationally-savvy solutions; and won’t be until their preferred method of buying votes is tried and is found wanting. That goes for the D’s and the R’s.