U.S. Politics

[Apathete]

Yeah - France probably has the best system. And you're absolutely right that costs are going up everywhere. They're just starting at a higher point than the US by a long shot. Curbing health costs remains one of the great challenges of the next few decades for the industrialized world.

Only if you ignore the fact that France (and most of Europe) is probably going to have to default on it's health care/pension commitments in 20 years time when everyone gets old.

[The Iceman of the North]

More than one. They have their employer sponsored plans (sometimes one, maybe more depending on the size of the employer) and plans from the individual market.

So how many options does an individual need to have for health insurance not to be a monopoly?

More than one competitive option. How competitive are the plans in the individual market compared to employer sponsored plans? (Recall that I'm not American, so these are not rethorical questions.)

[Swift]

More than one competitive option. How competitive are the plans in the individual market compared to employer sponsored plans? (Recall that I'm not American, so these are not rethorical questions.)

Employers usually offer significant subsidies for their plans. The subsidies will vary based on industry and other factors - basically how rich the company is and their benefits strategy (whether or not employee retention is part of the overall strategy).

Because of that, few employees will venture into the individual market. So most employees do see themselves with few options. That is not because their are not other plans available, but because their employer is paying so much of their premium. I don't see how the exchanges are supposed to create more competitive options if an employee does not qualify for federal premium (varying degree of subsidies bases off of income)

I also think that most individual market plans are more catastrophic in nature, so they will have high deductibles and high out of pocket maximums. These plans may have lower premiums than more rich employer sponsored coverage, but since the employer will not pay any of the premium, the employer coverage will be cheaper to the employee.

So I do agree that employees typically have few options available to them, but I don't how this constitutes the industry as monopolistic. If Aetna for example was the only carrier for the the entire country, then that would be a monopoly. But if all we're going to do is argue whether or not "monopolistic" is an appropriate term, lets' not waste our time :)

[Former Lord of Winterfell]

Because health insurance is generally chosen by employers, it is generally the number of options an employer has that determines whether or not there is a "monopoply". And the answer to that is that they have lots of choices.

Btw, isn't a single payer plan a monopoly by defition?

[Former Lord of Winterfell]

And I do know how to spell "monopoly"....

Fucking remote access.

[Shryke]

Because health insurance is generally chosen by employers, it is generally the number of options an employer has that determines whether or not there is a "monopoply". And the answer to that is that they have lots of choices.

Btw, isn't a single payer plan a monopoly by defition?

Single-payer isn't concerned with turning a profit though.

[TerraPrime]

Because health insurance is generally chosen by employers, it is generally the number of options an employer has that determines whether or not there is a "monopoply". And the answer to that is that they have lots of choices.

Does this really hold true?

At my work, for instance, we had 2 options. Recently, due to state regulations and political issues, we're possibly facing having only 1 choice in the region. The ultimate fate is not known, as the state legislature and the state supreme court has been delaying implementations and changing laws on the go. On a pragmatic side, I feel rather disempowered in choosing my health insurance, in the sense that I will get what's available after my employer has chosen and narrowed down to a set, whether that set be containing 1, or 2, options.

Perhaps my employer is just the oddball in this situation? If so, then at least it's a big oddball, since it is the state government.

Btw, isn't a single payer plan a monopoly by defition?

Monopoly over payment, yes, but not over the delivery of services. Back where I grew up, we have single-payer at a universal level, and then people can also pay out of pocket for private consultations, or purchase insurance plans for specific needs. We have both government-paid hospitals, as well as private hospitals and clinics. So even though there's a single payer, there're multiple options for service, and users can choose the mode that suits them the best, whether it's near-zero cost of government hospitals, low cost of private clinics, or higher cost of private hospitals. Our family has used all 3 forms, at different times, and for different needs.

[Former Lord of Winterfell]

Does this really hold true?

At my work, for instance, we had 2 options. Recently, due to state regulations and political issues, we're possibly facing having only 1 choice in the region. The ultimate fate is not known, as the state legislature and the state supreme court has been delaying implementations and changing laws on the go.

Heh. That's a function of being a state employee. It's the government, not private industry, that is limiting choices in your case.

On a pragmatic side, I feel rather disempowered in choosing my health insurance, in the sense that I will get what's available after my employer has chosen and narrowed down to a set, whether that set be containing 1, or 2, options.

That's a different question that whether or not there is a monopoly, though. Now personally, I support eliminating virtually all insurance mandates so that insurers have the freedom to offer lots of different policies at different price points. I could understand the government regulating to ensure that an insurer has enough money to pay it's obligations, and there should be causes of action for bad faith denials of coverage, Other than that, I think the market should be much more free than it is. And I support the expansion of HSA's and other mechanisms to give individuals the ability to choose insurance independent of their employer.

Perhaps my employer is just the oddball in this situation? If so, then at least it's a big oddball, since it is the state government.

Monopoly over payment, yes, but not over the delivery of services. Back where I grew up, we have single-payer at a universal level, and then people can also pay out of pocket for private consultations, or purchase insurance plans for specific needs. We have both government-paid hospitals, as well as private hospitals and clinics. So even though there's a single payer, there're multiple options for service, and users can choose the mode that suits them the best, whether it's near-zero cost of government hospitals, low cost of private clinics, or higher cost of private hospitals. Our family has used all 3 forms, at different times, and for different needs.

People have the option here as well to pay out of pocket for private care.

[Swift]

I do not believe that an HSA ist a mechanism to allow individuals to more easily get insurance from outside of their employer. If that was the intention of the creation of the HSA, I don't see how it would accomplish such. An HSA just allows you to put money way pre-tax to be used with certain health plans (high deductible), which can still be employer-sponsored. There has been a decent amount of movement over the past several years of employers offering high deductible plans with HSAs.

Could you elaborate on what you mean?

[Former Lord of Winterfell]

I do not believe that an HSA ist a mechanism to allow individuals to more easily get insurance from outside of their employer. If that was the intention of the creation of the HSA, I don't see how it would accomplish such. An HSA just allows you to put money way pre-tax to be used with certain health plans (high deductible), which can still be employer-sponsored. There has been a decent amount of movement over the past several years of employers offering high deductible plans with HSAs.

Could you elaborate on what you mean?

You can get high deductible plans other than through your employer. If you sign up for a qualified plan, you can use and HSA to pay the premiumm

[TrackerNeil]

Nevermind

[TerraPrime]

Heh. That's a function of being a state employee. It's the government, not private industry, that is limiting choices in your case.

Eh? Only in part. The reason why the state government is making these changes is because the private insurance companies and cherry-picking their markets and not offering comparable coverages. So, plans that are offered to state employees in Chicago are not made to, say, people in Carbondale. So the state government said that if you're not going to offer comparable plans, then you are not going to be our vendor, at all.

That's a different question that whether or not there is a monopoly, though. Now personally, I support eliminating virtually all insurance mandates so that insurers have the freedom to offer lots of different policies at different price points.

You mean how, absent mandates, rural areas were going to get the basic coverage in telecommunications, because there's oh-so much profit in those markets?

Other than that, I think the market should be much more free than it is. And I support the expansion of HSA's and other mechanisms to give individuals the ability to choose insurance independent of their employer.

Lack of options is not a problem I see in the U.S. system. Lack of affordable options is the problem. Yeah, I can go out and buy individual plans, with what money now? HSA allows me to use pre-tax money to pay for these plans, but you know what, my employer is paying 78% of my premium, if I use the plans that my employer chooses, so I am going to take that 78% over, what, 5% or so, savings in tax. Until the employer-subsidized plans are the same price point as private insurance plans, your market argument is moot. No amount of deregulation will get us to that prince equilibrium, unless employers don't pay for specific health plans and instead, pay into a national pool that then goes toward paying for universal health care.

People have the option here as well to pay out of pocket for private care.

That's so.... Marie Antoinette.

[Brienne the Beauty]

Only if you ignore the fact that France (and most of Europe) is probably going to have to default on it's health care/pension commitments in 20 years time when everyone gets old.

Socialized healthcare is perennially in crisis, resolved, and in crisis again. It's a neverending political issue in the countries that have it. That doesn't mean it's going away, any more than the fact that the roads have potholes mean they are unworkable. The potholes are filled and other roads develop potholes, and so on. I guess you could compare it to the military in the US - perpetually needing more money, getting it, getting cuts, soldiers complaining because of lack of equipment, and getting more money again, in a never ending cycle. The fact that the millitary always needs more money than it gets given does not mean that it is going to be disbanded!

Since private health insurance is even more expensive than social health insurance, privatising it would actually make the situation worse! They won't default, short of some dark postapocalyptic future coming to pass. I guess the worst that could happen is reduced services for non-life-threatening complaints (e.g. knee replacements, fertility treatment) which could be filled by extra private health insurance. Private health insurance is actually cheaper in countries with socialised medicine, as they have the state system to fall back on in case of catastrophe (they don't have to cover the most expensive complaints.)

[Former Lord of Winterfell]

Eh? Only in part. The reason why the state government is making these changes is because the private insurance companies and cherry-picking their markets and not offering comparable coverages.

Why aren't they? If the reason is because the experience (in the insurance sense) in those markets is different, why should the plans and premiums be the same? Insurance companies routinely adjust premiums based on the experiences of different employee groups, which is part of the process of coming up with premiums that are competitive.

So, plans that are offered to state employees in Chicago are not made to, say, people in Carbondale. So the state government said that if you're not going to offer comparable plans, then you are not going to be our vendor, at all.

Then that's a decision being made by the state.

You mean how, absent mandates, rural areas were going to get the basic coverage in telecommunications, because there's oh-so much profit in those markets?

No, I'm not talking about telecommunications mandates. Different kettle of fish because generally, the state used its power of eminent domain to give the TC companies the ability to build their lines. If, as a condition precedent to granting those companies that land use, they required those companies to serve those rural areas as well, I don't see a problem with that because it essentially is the price for the land. On the other hand, if a TC company acquires that land without using the state's power of eminent domain, I think those mandates are bogus.

Lack of options is not a problem I see in the U.S. system. Lack of affordable options is the problem. Yeah, I can go out and buy individual plans, with what money now? HSA allows me to use pre-tax money to pay for these plans, but you know what, my employer is paying 78% of my premium, if I use the plans that my employer chooses, so I am going to take that 78% over, what, 5% or so, savings in tax.

That's why the law should be changed to allow an employer to provide the equivalent subsidization to private employees using HSA's, with the same tax treatment as if the employer was paying premiums directly.

That's so.... Marie Antoinette.

Hey, you're the one who initially touted a system because it permitted people the option of paying out of pocket. I just pointed out that if you consider that a virtue, then we do the same here.

[TerraPrime]

Why aren't they? If the reason is because the experience (in the insurance sense) in those markets is different, why should the plans and premiums be the same? Insurance companies routinely adjust premiums based on the experiences of different employee groups, which is part of the process of coming up with premiums that are competitive.

Competitive? Or profitable? Both?

Then that's a decision being made by the state.

In response to the insurance companies' decisions.

Different kettle of fish because generally, the state used its power of eminent domain to give the TC companies the ability to build their lines. If, as a condition precedent to granting those companies that land use, they required those companies to serve those rural areas as well, I don't see a problem with that because it essentially is the price for the land. On the other hand, if a TC company acquires that land without using the state's power of eminent domain, I think those mandates are bogus.

Which rather sidesteps the over all point that products (insurance plans) will only be developed for markets where there's profit, if we do not use mandates. This means that some populations in our country will have little to no realistic choices for health insurance, due to the geography and population density of certain areas.

That's why the law should be changed to allow an employer to provide the equivalent subsidization to private employees using HSA's, with the same tax treatment as if the employer was paying premiums directly.

This still ties health care to employment. Not a goal I can support.

Hey, you're the one who initially touted a system because it permitted people the option of paying out of pocket. I just pointed out that if you consider that a virtue, then we do the same here.

Except that you're ignoring the other part of the example, which is the part where I said we also had universal health care so that we can decide when and if we can/should pay extra for private care out of our own pockets.

[Crazydog7]

More Iran as the Middle East bogeyman is on the way.

So what are the odds this is U.S. belligerance designed to provoke Iran to give an excuse to invade?

I say 45%. Its on the Axis of Evil and its the one that doesn't have nuclear weapons and is therefore the easier target. Bonus points for the white men bringing "freedom" to the Arabs.

[Shryke]

Iran is dick-waving after their many recent set backs.

While some people in the US would really love to invade, the Obama administration I doubt has any interest in that. No reason to drop a political turd on an already excellent foreign policy record right before an election. When you've got "President that killed Osama Bin Laden" on your record, you don't need to invade Iran to prove anything.

Israel on the other hand ..... Well, they are itching to do something to Iran these days. They have no interest in letting Iran get away with researching nukes. How far they can drag the US into that mess is the real question.

[Aemon Stark]

Our model(Canada that is) might not be a good one to emulate anyway, or at least not in its current form. While certainly less expensive than yours, costs are going up and controlling those costs is a big problem that our country will have to face in the future. As much as it pains me to say it a mix of public and private health care might be the only way to go for us, ala France.

We already have a "mix of public and private health care" and always have. In fact, we have more private health care than France, Germany, or the UK. The nature of the mix is different, certainly - in Canada, almost all physician services and most hospital services are publicly-funded - but we pay out of pocket or through private insurance for most drugs (unless you're low-income or elderly), dental care, all ancillary services like physio, as well as most medical devices and equipment, private hospital rooms, some private imaging and diagnostics, and, of course, hospital parking.

[Shryke]

Yeah. Both the Israelis and the Iranians seem to be pushing this whole nuclear program thing to a head and who the fuck knows what is gonna happen in many respects.

[ants]

That's why the law should be changed to allow an employer to provide the equivalent subsidization to private employees using HSA's, with the same tax treatment as if the employer was paying premiums directly.

A big issue with this is that unless you put in some of the other ACA reforms, this creates two classes of citizens. Those who are healthy and can get a good price, and those who are not who wouldn't be able to. If you're going to allow insurers to descriminate on health (and personally I think that is bonkers) then you almost have to have some mechanism to get around this like employer pools. Of course, employer pools to get around this issue is a bloody ridiculous way to fix it in the first place. Be that as it may, removing that without new protections pretty means a big FU to anyone whose health is poorer (or their family).