"I mean, people have access to health care in America. After all, you just go to an emergency room.".
Why the Republican idea "To Allow Individuals and Businesses to Buy Insurance Across State Lines" would WORSEN the pre-existing condition problem, and is in all likelihood based on a trick by certain insurers in the advice they are giving Republicans to allow freer predation on people. Click here to get there.
WHY IS LEAVING THE HANDLING OF PRE-EXISTING CONDITIONS (Statewise High Risk Pools, Statewise Community Rating, etc.) AS IN ALL REPUBLICAN PLANS A VERY QUESTIONABLE IDEA? is explained by me a little below. Click here to get there.
DON'T INSURERS HAVE TO COVER ME, REGARDLESS OF PRE-EXISTING CONDITIONS, AS LONG AS I'VE HAD FULL COMPREHENSIVE HEALTH INSURANCE CONTINUOUSLY? NO, in all but the 5 community-rated and modified community-rated states (MA,NY,NJ,ME,VT). In the special case when you are coming off of an employer-based plan, there is a trickily worded false HIPAA protection, that they have to cover you, but "can charge you whatever they want extra due to your pre-existing condition". (Heck, I'll cover you for 5 million dollars a year!.) In many states (but far from all), if you are coming off an employer plan, they will at least give you a state high-risk-pool, which costs up to $25,000 a year per person.
DID ANY OF THE REPUBLICAN ALTERNATIVE PLANS CHANGE FROM THE CURRENT PRE-EXISTING-CONDITION SCREENED SYSTEM? NO, ALL THE REPUBLICAN PLANS KEEP THE PRE-EXISTING-CONDITION SCREENED SYSTEM? ( I verified this 9/2009 and again on 2/11/10 examining the plans in the footnotes on the copy of the here="GOP solutions for America" carefully. These 8 plans are all just minor patches that will continue to leave many people uncovered and/or destined for bankruptcy, either when they make just a little more, or have a little more assets, than free Medicaid allows, or when they have a pre-existing condition.
Further, many of the Republican proposals have very deceptive wording, to make it look like they're solving the pre-existing-condition problems. Details below. Click here to get there.
GROWTH OF HEALTH CARE COSTS, AND LIFE EXPECTANCY, AROUND THE WORLD Click here to get there.
"BUY INSURANCE ACROSS STATE LINES"??
This was an insidious proposal whose effects are probably above the heads of most of the Republican Congress People--I think they're mostly lawyers with no head for economic mechanisms. They are probably being advised to do by some people at the nastiest of the health insurance companies.
From a Republican's policy speech:"Let's also talk about letting families and businesses buy insurance across state lines. I and many other Republicans believe that that will provide real choice and competition to lower the cost of health insurance."
What this provision would do (unless insurance market reforms stopping pre-existing-condition-exclusion AND a strong national minimum coverage standard AND a strong national enforcement mechanism are added -- so far the combination -- being equivalent to the Democrats' "national health insurnce exchange" -- rejected by all Republican Senators) is defeat state regulations that (in some states) offer some protections to people with pre-existing conditions. By allowing people without pre-existing conditions to get insurance across state lines, it would drive the premiums for people with pre-existing conditions (who can't get insurance in those other states) way, way, up. (This effect alone would ruin insurance prospects for people with substantial pre-existing conditions in the 5 community-rated and modified community-rated states, plus a number of other states that limit what can be called a pre-existing condition in various ways.)
Further, this "across state lines" proposal would destroy the funding mechanism for many high-risk pools that already exist in many states, which is to add a charge to support the high risk pool onto the policies of people without pre-existing conditions. (To find those states, go to this Kaiser table, and look for where the "Financed through insurer assessments" column is "Yes". I count 28 states.) That funding, for the high risk pools, would be wrecked, since people without pre-existing conditions, can avoid that charge, and get a cheaper policy without that charge, by buying a policy out of state. That's right This proposal actually makes it worse for people when they have pre-existing conditions in almost all states!!! But what it does do is help the insurance industry sell cheap, not-very-good policies to only people without pre-existing conditions (i.e. cherry pick), in states where they are currently obstructed from doing this by state law.
Not to mention that without a mandate (opposed by Republicans as "socialism"), rates are too high for people who don't freeload (and pick up coverage just when they get sick).
My assumption is that the strongest impetus within the Health Insurance Industry for this proposal is from certain of them, whose predatory business model is based on finding only very healthy people, and selling them cheaper insurance, for which premiums they pay out only maybe 65% in actual medical bills -- the company keeps the rest. These ultra-predatory companies typically are not found in the 5 community-rated states, and they often have names that suggest patriotism or goodness or some such thing, to create an image in the mind of the most credulous folks.
[Republicans basing their reform on this miserable destructive proposal is not new, and I'm not the only one to notice its horrible implications. It was part of the McCain/Palin platform. (I'll give McCain/Palin the benefit of the doubt and assume they didn't themselves understand the implications of this plan that the Insurance Industry wrote for them.) At the time, Nobel economist Paul Krugram warned us (here), as did many others. For completeness on the Krugman article and McCain plan, here is the article from Contingencies that Krugman mentions. Here also is my copy of the old McCain/Palin Campaign Health Insurance page. (It's actually kind of funny, well, tragi-comic, to see the Republicans push during the election and again now for health insurance deregulation that thinking-through would show would really mess things up. This right on the heels of when their deregulatory President had deregulation of the financial system screw up on us so badly (brink of a worldwide depression) that he even had to announce the failure publically 7 weeks before a presidential election. I assure you, the last President would have waited till after the election if he could have!) ]
8/12/09: Controlling health care costs without reducing care quality: two informative audio discussions from PBS Newshour. The first one (audio here), is a discussion of the "coordinated-care" way of delivering health care: all physicians salaried, under one roof working together with a complete set of specialties, and not given incentives to order unnecessary procedures. This is the way it is done at the Cleveland Clinic and Mayo Clinic, where health care costs for the same health outcomes are 25% less. (NOTE the 25% is more than enough to get the 16% of uncovered US citizens covered.) The next is a discussion hosted by Judy Woodruff with the president of the Cleveland Clinic, (audio here).
For the Following Graphs, NOTE Our Relative Costs per Person are Even Higher Because We Deny Coverage to 1/6 of our Population
Site Key:
7/23/09: MAYO Clinic (known for very good, cost-effective coordinated "whole-patient" treatment): It's CEO discusses the current intitiative (video here) and how to incorporate efficiency into the system. He indicates satisfaction with the recent White House insertion into its plan the proposal of setting up a body of national health-care experts to remold the health-care system into high efficiency and quality. He indicates, from meetings with them, that Obama Budget Director Peter Orszag and key Obama Health Adviser Ezekial Emmanuel both understand how to achieve efficiency in the health-care delivery system. He indicates approval of the plan to get everyone covered now, set up a body of MEDICAL experts to gradually make U.S. Health Care much more efficient. (I note that, though some Congressional Republicans have cited Mayo as disapproving of the Democratic plans (a)This was before the administration inserted the medical experts (b)that the Republicans begin to shout "Washington bureaucrats deciding your medical care" and "socialism" whenever anything like what Mayo wants is talked about.)
WHY US HEALTHCARE IS SO EXPENSIVE Wonderful video documentary and transcript Money-Driven Medicine(here) features lots of smart and decent Doctors talking about the waste and excessive care in our system. [I might add that though it is dispiriting that so much dumbness, rabble-rousing and rabble has been brought out by the health care debate, it is nice to see, that if you watch the best of television, you find that intelligent people, who know the health care system, and are committed to decency, have also come out. Not only that, many of them have been working quietly all along.]
7/11/09:WONDERFUL Bill Moyers (watch, read transcripts, and informative links here), showing cases of insurance companies not paying claims to policyholders, after people get sick based on searching for pre-existing conditions in their old records (this is in the first 10 minutes). The rest of the show has an ex industry insider from the Health Insurance Industry (PR Executive) discuss the current manipulation of the public by the industry (which is working really well for them).
All the Other Countries Cover Everyone
Per-Capita Health Costs Around the World (2003)
Life Expectancy and Per-Capita Health Costs Around the World (2000)
(Administration and experts correctly cite URGENT NEED FOR MAJOR OVERHAUL because of cost to government Medicare and Medicaid) and business affecting COMPETITIVENESS and American ECONOMIC RECOVERY and subsequent ECONOMIC SURVIVAL. [U.S. health care costs are 50% to 100% higher than all other developed countries as in the three plots above (taken from here and here), and here) with U.S. health care no more effective, and often less effective, even though not all of us are covered! Even though medical bankruptcy, occurring nowhere else in the developed world, occurs every 30 seconds here! The plot below is Congressional Budget Office projected Medicare, Medicaid, and Social Security spending as a percent of GDP. You should note that total Federal spending on everything, including defense, is about 22% of GDP. You see that Social Security is basically not the problem, is it's growth is in control, and it can be bounded with small cuts. The problem, which is rising to consume the entire 22% is Medicare and Medicaid, and will cause an eventual crisis, which will make the current financial one seem like small potatoes, if not stopped. Plot is based on Congressional Budget Office data, taken from this page. You can find similar graphs all over the internet, including this one from Ross Perot.
U.S. Medicare, Medicaid, and Social Security Projected Spending (% of GDP)
Obama Administration and Health Care Reform Now-- THIS PAGE
To: By-State Sources and DANGERS
Directly to State In That Table:
AL
AR
AK
AZ
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
MA
ME
MD
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
General Information on Health Insurance and Pre-Existing Conditions
Very Nice Frontline TV Video Show 3/31/09)
Highly Recommended Showing People who have been hit by pre-existing conditions problems when between jobs (and have gone broke, and in one case, died). Many other issues on my pages here are discussed and illustrated, included the case of insurers issuing policies, but then, when bills come in, investigating and cancelling the policy due to (often trivial) omitted pre-existing conditions. There is also discussion of the basic need to mandate people hold coverage, to make the system work, and to fund adequately and restructure the system to cut out waste. (The video team goes to Mass, and finds some problem for people with incomes around $60,000 a year due to failures in those latter 2 points.)
See alsoViewer Responses to the show (mostly pretty-informed-viewer thoughts).
Health System Failure to be more Wasteful and Unafordable with More Feeloading due to the 2008 Genetic Non-Discrimination (GINA) Law
(click here for details)
"I mean, people have access to health care in America. After all, just go to an emergency room." (click here)-- G.W. Bush, 7/10/07
Is Employer Coverage Secure? See The Walmart Memo
GDP on Healtcare--Comparing Countries (at Kaiser)
Life Expectancy, Sytems, and GDP on Healthcare--Comparing Countries (at NPR)
Q & A here.
Obama-administration-connected Physician Ezekiel Emanuel discusses his plan and others in the video here.
"In an exact sense the present crisis of western democracy is a crisis of journalism."
-- Walter Lippmann, 1920
The election back in November was closer than most people realize -- Pre-existing condition problems would have gotten MUCH WORSE under the McCain Proposal (Due to destruction of whatever pre-existing-conditions protections exist in each state.) Republican instincts to remove government involvement are correct in many cases, but in the Health Insurance case they are not thinking through the actual technical details of the situation, and are being unthinking ideologues.)
See here, if interested
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BOOK TV--It's Really Good. Archived free BookTV program video feeds Watch live (weekends) (C-SPAN 2)
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SOME CAMPAIGN DECEPTIONS (happen to be by McCain Campaign) which I am keeping around now, well after the election, as examples for us to study of how the government is getting taken away from the people by the special interests (and making us sick, broke, and otherwise miserable).
Factcheck.org on both candidates on Presidential debate # 3. [Note: factcheck.org isn't perfect, but it's stilll pretty good. Notably, I find they are good with exact facts, but sometimes miss conspicous aspects when economic or other analysis is involved.]
Curious, isn't it, that individual insurers never advertise their "payout rates". (This is the percentage paid out in claims for every premium dollar paid in.) Not only don't they advertise, but they won't even tell me when I ask lately, and often pretend never to have heard of such a term. You would think that it is a fundamental number that the consumer needs to know, like pixels in a digital camera, or fuel-burning efficiency in a furnace, both of which are always prominent when you look to buy it. But with health insurers, the product is so complicated that the company selling you insurance has an information advantage that the consumer isn't knowledgeable enough to break. And if they did give you a number, which would usually be in the 65% to 75% zone, and you compared to employer plan numbers, around 90%, or government Medicare efficiency (98%), you'd really know you were buying a wasteful, inefficient product.
10/24/08: Plans for government aid to Insurance Companies (besides AIG) in the works Due to Financial Crisis!(According to several guests on PBS Lehrer NewsHour). |
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Frontline with Full Video on 5 Country's Systems
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WHY IS HEALTH INSURANCE DIFFERENT FROM OTHER INSURANCE LIKE FIRE AND AUTO?, |
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"YOU JUST GO TO AN EMERGENCY ROOM."
--G.W.B. (yes--he said it--see below)
From researching the (often simply incompetent) provisions at the state level to keep the middle class from going into medical-related poverty, I am afraid I believe now that only Universal Coverage at the National Level would substantially solve the problem. (There are just too many ways for people to freeload on the rest of us otherwise. Often, the freeloading is involuntary -- good people not freeloading pay extra for health insurance to support the freeloaders, then they find that the insurance system that they thought protected them has left them without assets, and they have to start freeloading themselves.) Universal coverage seems possible in a few years, but the country may blow it again -- and it may continue that only the very poor, the exceptionally well off, and the imprisoned can count on stable, reliable, continuous health insurance.
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WHY ULTIMATELY, EMPLOYER-SELF-INSURED EMPLOYEE HEALTH INSURANCE WILL NEED TO BE DONE AWAY WITH
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DOES THE CURRENT INSURANCE SYSTEM MAKE IT HARDER FOR OLDER PEOPLE, AND LESS HEALTHY PEOPLE, TO GET JOBS?
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TWO GENERAL SOURCES OF SOME BY-STATE AND CROSS-STATE INFORMATION:
is the Georgetown University All-States Health Insurance Site. |
Who am I? I am Norm Spier, a mathematical statistician who has spent most of his life in Metro NYC, Upstate New York, and Connecticut. Recently (3/2010), I moved from Vestal, in Upstate New York, to the Five Colleges area of Massachusetts.
If you have any comments, or want to point out an error or oversight, please email me at norm@nastechservices.com
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MISCELLANEOUS OTHER SITES OF MINE REFLECTING OTHER INTERESTS |
Plug for Questia:
For those not familiar with it, Questia is a digital academic-type library with about 60,000 fully searchable academic-level books, and some articles.
The collection has some older, out-of-print books, but also many recent books. Though it is not as complete as a decent university library (by far), I've subscribed to this for a few years, and find it an invaluable reference when trying to, say, get some criticism on a novel, or get some details on a historical, social scientific, or philosophical item. The library is not strong on science, but it is decent throughout the humanities. And the full-text searchability -- over all books, or within a book, is really useful.
Thus, I am disappointed at the Questia marketing strategy of gearing towards college students, which strategy becomes apparent as soon as you log onto the sign-up site. I am not disappointed at Questia, but rather that the real world has made it such that a partly-adult-geared strategy won't work. That is, mostly, the people are after the books on the Questia site so that they can go through college. And mostly, they are going through college so that they can get a better job.
Anyway, as a 50-year old man who went to college and grad school some years ago, I recommend the site for the intellectually curious. Note Questia often has a free full-service trial.
This page contains (above) information on:
Obama pre-existing conditions
Obama Health Plan
Baucus Health Plan
pre-existing conditions obama
Fixing pre-existing conditions
Pre-existing conditions and health insurance