How Confident Are You That Whatever HCR Bill is Passed Will Be a Net Gain?

[Marokai Backbeat]

Finally, healthcare is a state issue IMO, and should stay that way.

Healthcare spending in many areas being delegated to the states is part of the problem. We're lucky we don't delegate all healthcare spending to the states or the entire system would collapse within a decade.

[Franzl]

Well the public option combined with the individual mandate would do a lot more to stimuluate competiton, in my opinion

The thing in Massachusetts is that no other market reforms have been implemented. You are correct that insurance companies have no need to be competitive if people are forced to purchase their products.

If there were nationwide competition, however, under more market friendly rules....which I imagine we largely agree on even, with or without a government option to compete, I believe insurance companies would still be forced to offer a better and more competitive product.

[Vepres]

But you're falling into the typical libertarian trap. Administrative costs are high, therefore, it must be the government's fault because of over regulation. I want you to clearly show where the government is responsible for high administrative costs. The burden of proof is on you.

I concede this, though more regulation wouldn't be helpful.

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Of course the federal government should subsidize insurance for the poor or those with conditions that drive their premiums up to unreasonable levels, but regulation generally should be a state issue.

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Taxation is a necessary evil for necessary services such as public education, public transit, a judicial system, consumer protections enforcement, etc. It provides real benefits

As mint said, states that mandate coverage have higher premiums. States with community ratings have higher premiums. See the pattern A mandate does more harm than good.

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That's fine, but most of what you support will just raise costs in the long term.

Here's an idea, why not let the regulators compete. Let people join insurance pools in other states. As less regulation decreases prices, the states with the least regulation get more money pumped into their economy.

Well the public option combined with the individual mandate would do a lot more to stimuluate competiton, in my opinion

Firstly, it's stimulate competition, not stimuluate competiton

Here's what happens when you have those two reforms. The individual mandate will mean that everybody would have to buy insurance. Insurance companies would compete for the healthy while doing everything they can to avoid risky people. Now, one of two things would happen:

1. If the state (or if it's enacted at a federal level) has so-called "community rankings", it forces insurers to raise costs on everybody. Thus, the healthy will just not get coverage until they're sick because that's the only time it's financially worth it (which presumably they couldn't be denied under the bill), which causes the insurers to raise costs on the sick, which would be an endless cycle until health insurance companies are no longer viable. Then all the sick would go to the government option, which costs a lot of money, obviously.

2. If the state doesn't have community rankings, the sick will be charged so much that they'll be forced to go to the public option. This would mean that there are a disproportionate amount of sick on the public option, which would significantly increase its costs, making it run a deficit.

[Lief 🗽]

Actually, Mint and Vepres, premiums have gone down massively in Massachusetts since they implemented an individual mandate, along with other reforms similar to the ones in the Senate and House bills:

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source: http://voices.washingtonpost.com/ezra-klein/2009/11/massachusetts_provides_evidenc.html

Still higher than U.S. averages, yes, but not because of health reform. In fact, before health reform, Mass. premiums were over three times the national average; now, they are only about 1.7 times the national average.

[Vepres]

Actually, Mint and Vepres, premiums have gone down massively in Massachusetts since they implemented an individual mandate, along with other reforms similar to the ones in the Senate and House bills:

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source: http://voices.washingtonpost.com/ezra-klein/2009/11/massachusetts_provides_evidenc.html

Still higher than U.S. averages, yes, but not because of health reform. In fact, before health reform, Mass. premiums were over three times the national average; now, they are only about 1.7 times the national average.

Only 70% higher

I like the Vermont solution. Emphasize prevention and aid people in their attempts to get fit.

The individual mandate is too authoritarian for me regardless of savings.

Here ya go:

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http://www.cato.org/pubs/policy_report/v29n5/cpr29n5-1.html

Don't dismiss it because of the source please

[Lief 🗽]

Dude, did you even read my post? It was 200% higher before any healthcare reform at all was passed! Healthcare reform made COSTS GO DOWN 40% while costs in the rest of the country INCREASED BY 14%.

Emphasizing prevention is good and so is aiding people in their attempts to get fit, but an even better way to emphasize prevention is to make sure that people can afford to go to the doctor for yearly checkups in the first place, so that they don't come in at the last minute when they're short of breath, dying of a heart attack.

[Vepres]

Dude, did you even read my post? It was 200% higher before any healthcare reform at all was passed! Healthcare reform made COSTS GO DOWN 40% while costs in the rest of the country INCREASED BY 14%.

Emphasizing prevention is good and so is aiding people in their attempts to get fit, but an even better way to emphasize prevention is to make sure that people can afford to go to the doctor for yearly checkups in the first place, so that they don't come in at the last minute when they're short of breath, dying of a heart attack.

I did, prices went down, great. I hesitate to say that an individual mandate would lower the country as a whole. Keep in mind as to how high Mass. insurance was before.

Couldn't that drop have more to do with the exchange established in the same bill?

[Lief 🗽]

Dude, did you even read my post? It was 200% higher before any healthcare reform at all was passed! Healthcare reform made COSTS GO DOWN 40% while costs in the rest of the country INCREASED BY 14%.

Emphasizing prevention is good and so is aiding people in their attempts to get fit, but an even better way to emphasize prevention is to make sure that people can afford to go to the doctor for yearly checkups in the first place, so that they don't come in at the last minute when they're short of breath, dying of a heart attack.

I did, prices went down, great. I hesitate to say that an individual mandate would lower the country as a whole. Keep in mind as to how high Mass. insurance was before.

Couldn't that drop have more to do with the exchange established in the same bill?

Surely, that's part of it, but it's just intuitive and logical that an individual mandate would lower prices, by expanding the risk pool and having a greater amount of people pay into the system.

[Mint]

Depending on the data, there might have been a temporary decrease in premium costs... But now the rates are projected to rise 7 to 12 percent. And the CBO's figures are disputed even by UHC advocates, PNHP for example found an increase of 9.4% since compulsory insurance was instituted. That might be a slowed increase, but it's still an increase.

[Lief 🗽]

Depending on the data, there might have been a temporary decrease in premium costs... But now the rates are projected to rise 7 to 12 percent. And the CBO's figures are disputed even by UHC advocates, PNHP for example found an increase of 9.4% since compulsory insurance was instituted. That might be a slowed increase, but it's still an increase.

Even increases of 7 to 12 percent or 9.4% percent, and the article says that the increase in costs has been attributed to "greater use of medical services by aging baby boomers and higher bills from doctors using more costly technology and prescribing more expensive drugs", not compulsory insurance or exchanges or more regulation or anything, that's still less than the national average of 14%. And the Senate bill especially has many other measures, in addition to the mandate and the exchanges, to bend the cost curve that Massachusetts did not.

[Sbane]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

[Torie]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

On that, I totally agree. That is not a close issue in my mind.

[○∙◄☻¥tπ[╪AV┼cVê└]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

On that, I totally agree. That is not a close issue in my mind.

However, a mandate without any regulation, reform, or competition for the health insurance companies is a total give-away to them. The Senate bill is exactly what they want. They win. Everyone else loses.

[Torie]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

On that, I totally agree. That is not a close issue in my mind.

However, a mandate without any regulation, reform, or competition for the health insurance companies is a total give-away to them. The Senate bill is exactly what they want. They win. Everyone else loses.

No one is proposing that. There needs to be means tested subsidies, and transparency, and competition on a national basis, and some way of dealing with pre-existing conditions when the premiums get really high, and transportability. Most of those reforms are not that controversial.

Some of this is really about the man behind the curtain: how to ration medical care on a triage basis for seniors, which without will lead to insolvency under any system. No one wants to talk about this, but that is what this is really about. We can't have it all, even if we raise taxes on the "rich" to 60%. It just doesn't pencil.

[Lief 🗽]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

On that, I totally agree. That is not a close issue in my mind.

However, a mandate without any regulation, reform, or competition for the health insurance companies is a total give-away to them. The Senate bill is exactly what they want. They win. Everyone else loses.

Sorry, but those things are all in the bill. To the degree that you and I want? Probably not, but there's still plenty new regulation and reform, and the public option, the one the House had passed in its bill and the Senate was going to pass, wouldn't have done jack for competition.

And the idea that "everyone loses" is so goddamn ridiculous, and I have been incredibly disappointed that intelligent people, people who I usually agree with, have been using that idiotic line for the past few days. The thirty million new people who will be able to buy health insurance? They win. The people who can get insurance now, even with a pre-existing condition? They win. The people between 150% and 400% of the poverty line, who were having a hard time affording health insurance or couldn't at all and now get $100 billion in subsidies per year? They win. The 10 million new people on medicaid? They win. The seniors who will be able to spend less of their fixed incomes on medicine, because the Part D donut hole was closed? They win.

This isn't a mutually exclusive us-versus-them battle. Yes, the insurance companies will get new customers and probably make more money (though there'll also be new regulations on them, taxes, and laws mandating that they use most of the money from premiums for healthcare), but millions and millions of people will be better off. Should we not have passed the stimulus, because the construction companies won? Should we not have passed the bailout, and let the economy tailspin into an actual depression, because the banks won? Should we not pass cap and trade, because the windmill companies and nuclear power companies and car companies will win? Unless you're proposing nationalizing the entire economy, then to improve the well-being of the populace, sometimes you're going to need to give government money to private entities.

[Vepres]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

No, it makes the situation worse:

[quote]
Here's what happens when you have those two reforms. The individual mandate will mean that everybody would have to buy insurance. Insurance companies would compete for the healthy while doing everything they can to avoid risky people. Now, one of two things would happen:

1. If the state (or if it's enacted at a federal level) has so-called "community rankings", it forces insurers to raise costs on everybody. Thus, the healthy will just not get coverage until they're sick because that's the only time it's financially worth it (which presumably they couldn't be denied under the bill), which causes the insurers to raise costs on the sick, which would be an endless cycle until health insurance companies are no longer viable. Then all the sick would go to the government option, which costs a lot of money, obviously.

2. If the state doesn't have community rankings, the sick will be charged so much that they'll be forced to go to the public option. This would mean that there are a disproportionate amount of sick on the public option, which would significantly increase its costs, making it run a deficit.

[Sbane]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

No, it makes the situation worse:

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Point number 1 makes literally no sense. If there is a mandate then people would be forced to get insurance when they are healthy and thus can help pay for the sick, thus reducing costs on them. The mandate will solve the exact problem as spelled out in the first point. Seriously, wtf?

[Vepres]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

No, it makes the situation worse:

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Point number 1 makes literally no sense. If there is a mandate then people would be forced to get insurance when they are healthy and thus can help pay for the sick, thus reducing costs on them. The mandate will solve the exact problem as spelled out in the first point. Seriously, wtf?

Ok, I worded it wrong, it doesn't make sense

Do you know what community ratings are? They force insurance companies to charge everybody the same for premiums. Thus, the healthy are forced to overly subsidize the sick, which means that they will in fact lose money, and they'll be forced to.

[Sbane]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

No, it makes the situation worse:

You must be logged in to read this quote.

Point number 1 makes literally no sense. If there is a mandate then people would be forced to get insurance when they are healthy and thus can help pay for the sick, thus reducing costs on them. The mandate will solve the exact problem as spelled out in the first point. Seriously, wtf?

Do you know what community ratings are?

Yes I do. Why is that relevant? Your point says "Thus, the healthy will just not get coverage until they're sick because that's the only time it's financially worth it" and that this will raise costs on the sick. The mandate forbids people from doing exactly this.

[Sbane]

An individual mandate is absolutely critical for health care reform. Or else we will have the healthy not buying insurance and since the sick will be able to purchase insurance now, it will raise costs on the rest of us who are responsible and buy insurance.

No, it makes the situation worse:

You must be logged in to read this quote.

Point number 1 makes literally no sense. If there is a mandate then people would be forced to get insurance when they are healthy and thus can help pay for the sick, thus reducing costs on them. The mandate will solve the exact problem as spelled out in the first point. Seriously, wtf?

Ok, I worded it wrong, it doesn't make sense

Do you know what community ratings are? They force insurance companies to charge everybody the same for premiums. Thus, the healthy are forced to overly subsidize the sick, which means that they will in fact lose money, and they'll be forced to.

Yes and this is PRECISELY what I want and what is needed. Everyone has car insurance but this does not mean everybody uses it. I mean this is what insurance is all about. I really don't get your point.

[Ogre Mage]

We have been trying to pass health care reform since Harry Truman.  The last time was with Bill Clinton in 1993-94.  Before that, Carter in 1977-78.  I am not willing to wait another 16 years (approx. 2025) if we fail this time.  Costs are spiraling out of control and have been for some time.  And the number of uninsured and under-insured is not improving.

As far as the left is concerned, I say -- when Social Security was passed, it wasn't the expansive program it is today.  It took many years to evolve and eventually became very popular.  You must start from somewhere, even if the start isn't a great one.  Or to quote a cliche -- Rome wasn't built in a day.

The bill will succeed if it controls costs and raises quality.  I am not qualified to say if it will do that over the long-term.  But I think the serious minds around the table working very hard on this (not Joe Lieberman) will keep hammering away on that goal if the bill passes.

And it will be insolvent in less than a decade

False.  If no changes are made, the Feds estimate that Social Security will be bankrupt in 2037. 

MEDICARE will be bankrupt in 2017 (less than a decade).   That is the program truly in crisis and one of the reasons why it is critical we act now.  Health care reform cannot wait.

http://online.wsj.com/article/SB124212734686110365.html

http://www.nytimes.com/2009/05/13/us/politics/13health.html

[Beet]

Vepres, I really don't get your point. Your point #1 seems to describe precisely the problem that occurs without a mandate. And without a mandate, there is no justification for health insurance reforms that prevent companies from denying you for a preexisting conditions, because they would just be responding to people who deliberately wait until they get sick to get covered.

As for your point 2, there is no public option in the Senate bill, so I don't see why it's still relevant.

[Marokai Backbeat]

Vepres seems like the type that has already come to a conclusion in his mind so he spends his posts trying to support his pre-determined position on any given issue instead of arguing each one individually on the evidence for each side.

[MK]

Great time to start looking at a career in the heath insurance industry.

[Vepres]

We have been trying to pass health care reform since Harry Truman.  The last time was with Bill Clinton in 1993-94.  Before that, Carter in 1977-78.  I am not willing to wait another 16 years (approx. 2025) if we fail this time.  Costs are spiraling out of control and have been for some time.  And the number of uninsured and under-insured is not improving.

As far as the left is concerned, I say -- when Social Security was passed, it wasn't the expansive program it is today.  It took many years to evolve and eventually became very popular.  You must start from somewhere, even if the start isn't a great one.  Or to quote a cliche -- Rome wasn't built in a day.

The bill will succeed if it controls costs and raises quality.  I am not qualified to say if it will do that over the long-term.  But I think the serious minds around the table working very hard on this (not Joe Lieberman) will keep hammering away on that goal if the bill passes.

And it will be insolvent in less than a decade

False.  If no changes are made, the Feds estimate that Social Security will be bankrupt in 2037. 

MEDICARE will be bankrupt in 2017 (less than a decade).   That is the program truly in crisis and one of the reasons why it is critical we act now.  Health care reform cannot wait.

http://online.wsj.com/article/SB124212734686110365.html

http://www.nytimes.com/2009/05/13/us/politics/13health.html

There's a difference between bankruptcy and insolvency.

Anyway, an individual mandate w/o a public option just makes it easier for the health insurance companies to do anti-competitive things. Additionally, what of those who would lose money under a mandate? Isn't that essentially raising taxes.

Found this article:

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http://blog.heritage.org/2009/06/16/the-case-against-individual-mandates/

The mandate is an attack on civil liberties, will be very expensive to enforce, and won't solve all the problems anyway.