A Free Market(ish) Approach to fixing Healthcare
Instead of an individual mandate(which is unconstitutional) Congress may pass a tax exemption for every dollar spent on healthcare directly (unlimited, no minimum) or insurance(with a cap) by Citizens. Remove the 10% of income minimum per item on medical expenses etc..
HSA's should be exempt from capital gains and contributions should be tax exempt from income tax. Regular income schedule/capital gains should apply if taken out for other expenditures.
As we already have "Universal Healthcare" although haphazardly and terribly planned through a mandate to treat and a combination of medicaid/unpaid medical bills etc. I actually propose keeping the pre-existing condition clauses of the ACA. I realize this will increase premiums for those of us without pre-existing conditions but it should reduce the amount of money paid to the government to then pay for medicaid expenses and/or help drive down costs for unpaid bills. I also think the concept actually impedes a free market by locking individuals into their current healthcare provider thus not allowing for competition.
One size fits all policies would be eliminated. All young and healthy people should be able to purchase cheap high deductible catastrophic insurance if that's all they want to purchase. Overall, that would bring in more people into the "universal" net and reduce one of our major failures which is catastrophic bills having to be paid by the state or the hospital. This would reduce costs to the rest of us paying normal premiums.
Caps on donations to charities serving high risk pools should be reduced(think St Jude's Children's Hospital) and I actually view federal funding of research hospitals as a good thing as well as prize funds for cures/breakthroughs in research. Pure research(where you might not know what you will get) is a place where the market forces aren't necessarily great without patent or other government protection. We should also stop letting the rest of the world bully our pharma industries as we are essentially subsidizing all medical pharma research for all the "socialized" medical programs of the world. I'd probably also be fine with rolling high risk pools into medicaid but putting them on a voucher system so that they can purchase their own medical care in an open market with competition.
Open up competition across state borders for Health Insurance to help manage costs through competition. Create some standardized rules/best practices around administration etc. through use of the interstate commerce clause. We already do this in plenty of industries. Think DOT or clean air act, mandates are federal, rules are made and enforced at a state level within the guidelines of those federal mandates.
Is this ideal? Fuck no. Would it be an improvement over the current system? I think so. It's full of compromise, doesn't really touch medicaid or medicare, and is *maybe* politically feasible. Probably not in today's hyper-partisan atmosphere though.
Disagree with something? Great! That's what I've got so far. It's a working draft. I'm happy to take feedback and improve it with your help. Policy wonks welcome.
Comments
-
Some interesting ideas.UW_Doog_Bot said:As promised if a bit late. Blame Facebook's ultra shitty search function and my laziness & apathy for convincing people of politics online in general.
Instead of an individual mandate(which is unconstitutional) Congress may pass a tax exemption for every dollar spent on healthcare directly (unlimited, no minimum) or insurance(with a cap) by Citizens. Remove the 10% of income minimum per item on medical expenses etc..
HSA's should be exempt from capital gains and contributions should be tax exempt from income tax. Regular income schedule/capital gains should apply if taken out for other expenditures.
As we already have "Universal Healthcare" although haphazardly and terribly planned through a mandate to treat and a combination of medicaid/unpaid medical bills etc. I actually propose keeping the pre-existing condition clauses of the ACA. I realize this will increase premiums for those of us without pre-existing conditions but it should reduce the amount of money paid to the government to then pay for medicaid expenses and/or help drive down costs for unpaid bills. I also think the concept actually impedes a free market by locking individuals into their current healthcare provider thus not allowing for competition.
One size fits all policies would be eliminated. All young and healthy people should be able to purchase cheap high deductible catastrophic insurance if that's all they want to purchase. Overall, that would bring in more people into the "universal" net and reduce one of our major failures which is catastrophic bills having to be paid by the state or the hospital. This would reduce costs to the rest of us paying normal premiums.
Caps on donations to charities serving high risk pools should be reduced(think St Jude's Children's Hospital) and I actually view federal funding of research hospitals as a good thing as well as prize funds for cures/breakthroughs in research. Pure research(where you might not know what you will get) is a place where the market forces aren't necessarily great without patent or other government protection. We should also stop letting the rest of the world bully our pharma industries as we are essentially subsidizing all medical pharma research for all the "socialized" medical programs of the world. I'd probably also be fine with rolling high risk pools into medicaid but putting them on a voucher system so that they can purchase their own medical care in an open market with competition.
Open up competition across state borders for Health Insurance to help manage costs through competition. Create some standardized rules/best practices around administration etc. through use of the interstate commerce clause. We already do this in plenty of industries. Think DOT or clean air act, mandates are federal, rules are made and enforced at a state level within the guidelines of those federal mandates.
Is this ideal? Fuck no. Would it be an improvement over the current system? I think so. It's full of compromise, doesn't really touch medicaid or medicare, and is *maybe* politically feasible. Probably not in today's hyper-partisan atmosphere though.
Disagree with something? Great! That's what I've got so far. It's a working draft. I'm happy to take feedback and improve it with your help. Policy wonks welcome.
In before HFS. -
-
Good shit @UW_Doog_Bot. I don't know if this is your own personal proposal or something already put forward by someone else, but it's the first time I've seen it.
I dig the compromise. Keep the pre-existing condition protection and further incentivize smart health finances like HSAs (though inevitably a chunk of people will fail to utilize this, it'll still have a material impact on cutting costs). The state "competition" idea should be a political no-brainer, I honestly have no idea why that's not brought up more. The easiest way to slash costs quickly would be to implement a system where you don't need 50 different entities of the same insurance company. No shit you have admin bloat when you have different rules and pricing structures every time you cross state lines.
Anywise, I'd 100% get behind this kind of system. Obviously it's far from a cure-all, but it's the kind of incremental progress that good legislation needs to look like. -
This is good. I've been sparring with Sledog and my IQ is down a few points. I want to go rest for a few hours and re-read this and give it the response it deserves. Seriously. I already have a few questions.
-
You really want to put some sanity into providing affordable health coverage, you’d consider declining benefits towards end of life.
What is the stat? Something like 75% of medical cost incurred in the last three weeks of life....that’s just fucking stupid to pump that kind of jack into keeping granny around for another couple days. Actuarially, somebody is covering those costs and it sure as fuck isn’t the old dead people - it gets passed on to the rest of the insurable pool. -
My mom asked us to kill her if she ever had to go to the home
We didn't and she spent 6 years in memory care. She had that covered with her investments but I'm sure her medical insurance took plenty of hits.
We need better end of life management. I actually feel bad that we didn't do it
She may have lost her memory but she was pissed. Wouldn't talk to me
Something to look forward to for you kids -
I watched my mom take care of her mom .. a process that was virtually 24/7/365 for a little over 4 years. Siblings didn't bear their share of the burden - I think that happens a lot. It took its toll and embittered her for a period of time. Not easy. I can see it. Agree. We need better.RaceBannon said:My mom asked us to kill her if she ever had to go to the home
We didn't and she spent 6 years in memory care. She had that covered with her investments but I'm sure her medical insurance took plenty of hits.
We need better end of life management. I actually feel bad that we didn't do it
She may have lost her memory but she was pissed. Wouldn't talk to me
Something to look forward to for you kids -
My work. Ty. It's developed over several years of discussion.GreenRiverGatorz said:Good shit @UW_Doog_Bot. I don't know if this is your own personal proposal or something already put forward by someone else, but it's the first time I've seen it.
I dig the compromise. Keep the pre-existing condition protection and further incentivize smart health finances like HSAs (though inevitably a chunk of people will fail to utilize this, it'll still have a material impact on cutting costs). The state "competition" idea should be a political no-brainer, I honestly have no idea why that's not brought up more. The easiest way to slash costs quickly would be to implement a system where you don't need 50 different entities of the same insurance company. No shit you have admin bloat when you have different rules and pricing structures every time you cross state lines.
Anywise, I'd 100% get behind this kind of system. Obviously it's far from a cure-all, but it's the kind of incremental progress that good legislation needs to look like. -
Not sure where this falls into the discussion - but I noticed this article today about new rules for Health Reimbursement Accounts and loosening on other rules for obtaining health insurance
https://issuesinsights.com/2019/06/19/trump-just-revolutionized-health-care-and-nobody-noticed/ -
The main reason that's the case is because the people receiving that care aren't directly paying for it. If people had medical savings accounts to cover their healthcare costs, that they contributed to their entire working years and the money in those accounts could be invested and passed on as an asset when the person dies you'd see a lot more people choosing to forego those end of life medical decisions.PurpleThrobber said:You really want to put some sanity into providing affordable health coverage, you’d consider declining benefits towards end of life.
What is the stat? Something like 75% of medical cost incurred in the last three weeks of life....that’s just fucking stupid to pump that kind of jack into keeping granny around for another couple days. Actuarially, somebody is covering those costs and it sure as fuck isn’t the old dead people - it gets passed on to the rest of the insurable pool.
What's the incentive for someone to not spend as much money as possible in their last few weeks of their life now? It's not coming out of their pocket. -
Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services. -
Think about it, if during the course of your work life you were able to put away $50,000 in HSA savings. That's a little over $100 a month for 40 years of working. You'd have saved over $100,000 making just a 3.5% return on your investment.
Now if you knew you could use that money to extend your life for a few weeks at the end of your life or leave to your kids or wife what would you choose?
How many people would save even more than that if every dollar you put in up to a certain dollar amount was pre-tax money? You need to give people incentives to curb their medical care expenses and right now there are none. -
You’d have to separate health insurance (at least the HSA) from the employer benefits so they could take it with them when they switch jobs.salemcoog said:Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
-
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss. -
Imagine how much cheaper care would be when consumers are connected to the cost of care as well. All of a sudden price becomes important to the value proposition again.SFGbob said:Think about it, if during the course of your work life you were able to put away $50,000 in HSA savings. That's a little over $100 a month for 40 years of working. You'd have saved over $100,000 making just a 3.5% return on your investment.
Now if you knew you could use that money to extend your life for a few weeks at the end of your life or leave to your kids or wife what would you choose?
How many people would save even more than that if every dollar you put in up to a certain dollar amount was pre-tax money? You need to give people incentives to curb their medical care expenses and right now there are none. -
I don't understand any of this. I know I blew up terrorists for a number of years, and that netted me some healthcare. Fuck yeah. I would have blown up terrorists for free, but throw in health care? FUCK YES.
Now, let's not talk about my "quality" of health care...
edit: Sorry about your second cousin @PurpleBaze but he really shouldn't have been in that Toyota -
Just set it up how 401k's currently work. You can either leave it untouched for a given amount of time in the same fund or transfer it to your new one.USMChawk said:
You’d have to separate health insurance (at least the HSA) from the employer benefits so they could take it with them when they switch jobs.salemcoog said:Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
-
The VA is the best example of why the US shouldn't have state run healthcare...Swaye said:I don't understand any of this. I know I blew up terrorists for a number of years, and that netted me some healthcare. Fuck yeah. I would have blown up terrorists for free, but throw in health care? FUCK YES.
Now, let's not talk about my "quality" of health care... -
Hmmm... So you're saying that making insurers return excess reserves wouldn't save the insured money???UW_Doog_Bot said:
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting. -
I agree and think it could easily be done. Instead of the employer paying the insurer directly. Have the employer pay the employee whatever they currently pay to the insured to the employee and the employee pays the insurance company directly. This further increases competition and lowers costs all on it's own.USMChawk said:
You’d have to separate health insurance (at least the HSA) from the employer benefits so they could take it with them when they switch jobs.salemcoog said:Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
-
Idk, do you think auto-insurer's should be forced to do the same? Why do you think it's any different?salemcoog said:
Hmmm... So you're saying that making insurers return excess reserves wouldn't save the insured money???UW_Doog_Bot said:
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting.
Providers only have patients held hostage because Obamacare eliminated the private market for insurance. You either get your insurance through your employer or the government now which often leaves you with few choices.
Less regulation, broader market, more competition, lower prices, more choice. Those are the hallmarks of free markets, not highly regulated government markets. -
I think the biggest problem is who defines a "fair market rate"? You'll have a slow reacting government agency, probably HHS, trying to dictate prices that are already opaque.salemcoog said:
Hmmm... So you're saying that making insurers return excess reserves wouldn't save the insured money???UW_Doog_Bot said:
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting.
And what's to stop the numerous workarounds? Providers aren't going to just eat the loss, they'll order more tests, procedures, whatever and bill for more volume. When insurance companies and providers set all costs based on fake numbers, trying to manage those fake numbers is a fruitless task. -
Auto and Health insurance are not apples to apples. In Oregon, you have a choice between roughly 600 providers. If a provider is charging too much money you can shop and switch immediately. If an auto insurer is holding an inordinate amount of reserves, they won't be competitive for long as they will have to raise rates to keep those reserves and will lose customers.UW_Doog_Bot said:
Idk, do you think auto-insurer's should be forced to do the same? Why do you think it's any different?salemcoog said:
Hmmm... So you're saying that making insurers return excess reserves wouldn't save the insured money???UW_Doog_Bot said:
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting.
Providers only have patients held hostage because Obamacare eliminated the private market for insurance. You either get your insurance through your employer or the government now which often leaves you with few choices.
Less regulation, broader market, more competition, lower prices, more choice. Those are the hallmarks of free markets, not highly regulated government markets.
For Health insurance you have one chance per year and then you're stuck with it. And in network provider has been around at least 25 years before Obamacare came around. -
And why do you think one market is highly competitive and the other market is an oligopoly?salemcoog said:
Auto and Health insurance are not apples to apples. In Oregon, you have a choice between roughly 600 providers. If a provider is charging too much money you can shop and switch immediately. If an auto insurer is holding an inordinate amount of reserves, they won't be competitive for long as they will have to raise rates to keep those reserves and will lose customers.UW_Doog_Bot said:
Idk, do you think auto-insurer's should be forced to do the same? Why do you think it's any different?salemcoog said:
Hmmm... So you're saying that making insurers return excess reserves wouldn't save the insured money???UW_Doog_Bot said:
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting.
Providers only have patients held hostage because Obamacare eliminated the private market for insurance. You either get your insurance through your employer or the government now which often leaves you with few choices.
Less regulation, broader market, more competition, lower prices, more choice. Those are the hallmarks of free markets, not highly regulated government markets.
For Health insurance you have one chance per year and then you're stuck with it. And in network provider has been around at least 25 years before Obamacare came around. -
Insurance is already regulated at the State level. Every year insurers are required to submit their books for review and are then told how much they can raise rates. The amount they hold in reserve is part of that process.GreenRiverGatorz said:
I think the biggest problem is who defines a "fair market rate"? You'll have a slow reacting government agency, probably HHS, trying to dictate prices that are already opaque.salemcoog said:
Hmmm... So you're saying that making insurers return excess reserves wouldn't save the insured money???UW_Doog_Bot said:
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting.
And what's to stop the numerous workarounds? Providers aren't going to just eat the loss, they'll order more tests, procedures, whatever and bill for more volume. When insurance companies and providers set all costs based on fake numbers, trying to manage those fake numbers is a fruitless task.
https://www.thebalancesmb.com/how-insurance-rates-are-regulated-4091196 -
I think we're talking about two different things. You're talking about rates charged to consumers, I'm talking about the prices that are billed from providers to insurance companies for services performed.USMChawk said:
Insurance is already regulated at the State level. Every year insurers are required to submit their books for review and are then told how much they can raise rates. The amount they hold in reserve is part of that process.GreenRiverGatorz said:
I think the biggest problem is who defines a "fair market rate"? You'll have a slow reacting government agency, probably HHS, trying to dictate prices that are already opaque.salemcoog said:
Hmmm... So you're saying that making insurers return excess reserves wouldn't save the insured money???UW_Doog_Bot said:
Everything you said after this I disagree with. You are attempting to micromanage a market and haven't thought through any of the secondary effects of what any of your policies would create.salemcoog said:Good post. My solution is basic(shocker) and is along your lines of thinking.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting.
And what's to stop the numerous workarounds? Providers aren't going to just eat the loss, they'll order more tests, procedures, whatever and bill for more volume. When insurance companies and providers set all costs based on fake numbers, trying to manage those fake numbers is a fruitless task.
https://www.thebalancesmb.com/how-insurance-rates-are-regulated-4091196
I can't say for certain what the regulations are for the latter, but AFAIK those prices are largely determined on an individual negotiation basis between each provider and the insurance company. And none of those prices are based on a reliable fair value because no free market exists to even set prices in the first place. -
DM to @Baseman this is part of how I would fix healthcare.
Expect a future tense discussion on education. What else you want? -
Good shit from everybody in this thread. Look forward to the education discussionUW_Doog_Bot said:DM to @Baseman this is part of how I would fix healthcare.
Expect a future tense discussion on education. What else you want?
