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Thanks, Obama.

WakeandBake said:
Heath benefits need to be untied from employers. That is the whole problem IMO.

But of course, group plans keep premiums low. And the bigger the group, the better.

How do we keep a group plan model, keep it big, and get the employer out of the equation???



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Actually, group plans are usually more expensive and bigger isn't cheaper. With the influx on the uninsured this fall, you will see massive increases in the individual market over the next few months as carriers file their rates in key states. Its all about the underlying costs/risk of the population. The State Health Plan is a greta example of this. Biggest employer in NC. Very expensive group.

Single payer lowers overall cost b/c it sets a price per unit and manages utilization. Medicare does the first, not the latter.

There's also a ton of research out there which shows how important the employer can be in controlling costs, setting sticks/carrots, innovating in design. This model has its flaws for sure but we need to be careful about killing it as it has opportunities that are hard to recreate.

I don't think our country is ready for this anytime soon. We like our health care too much.
 
If everyone had to pay for their own insurance individually and cost was escalated on a scale of healthiness there would suddenly be a lot more people interested in staying healthy.

There would also be a lot is far poor people in MS without insurance because they couldn't afford it. We have to figure out a way to encourage accountability without withholding care for the lower income brackets.
 
CHDeac said:
Actually, group plans are usually more expensive and bigger isn't cheaper. With the influx on the uninsured this fall, you will see massive increases in the individual market over the next few months as carriers file their rates in key states. Its all about the underlying costs/risk of the population. The State Health Plan is a greta example of this. Biggest employer in NC. Very expensive group.

Single payer lowers overall cost b/c it sets a price per unit and manages utilization. Medicare does the first, not the latter.

There's also a ton of research out there which shows how important the employer can be in controlling costs, setting sticks/carrots, innovating in design. This model has its flaws for sure but we need to be careful about killing it as it has opportunities that are hard to recreate.

I don't think our country is ready for this anytime soon. We like our health care too much.
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I know you are in the private insurance biz so I will defer to you on specifics, but are you arguing that premiums are lower for a 45 year-old in an individual plan than in a group plan?

Are you arguing that group plans are raising what the average family pays for health insurance?
 
Wrangor said:
If everyone had to pay for their own insurance individually and cost was escalated on a scale of healthiness there would suddenly be a lot more people interested in staying healthy.

There would also be a lot is far poor people in MS without insurance because they couldn't afford it. We have to figure out a way to encourage accountability without withholding care for the lower income brackets.
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I've said it several times before, but (in addition to the paid voluntary sterilization), we need a massive targeted tax, like 100% to 200%, on all fast food, soda, potato chips, and other unhealthy items. The proceeds from that tax then go to pay for medical school for students who agree, in exchange to going to medical school for free, to work for at least 5 years in state-run health clinics that are free to use by any citizen. That would meet the goals of forcing accountability and healthiness, providing a baseline level of care, and increasing access to care, while all the while keeping the existing insurance system generally intact because a lot of people are simply not going to want to go to those clinics.
 
If everyone had to buy their insurance individually no one would be insured, and ERs would still be filled with sick and injured people that would be treated on someone else's dime. sigh

What about the guy who eats everything right and doesn't smoke, drink, fuck, ride a motorcycle, nothing - and he gets cancer? Or falls off the ladder at work? You selling him some health insurance? What about preemies? They are the most expensive of the whole lot.
 
WakeandBake said:
If everyone had to buy their insurance individually no one would be insured, and ERs would still be filled with sick and injured people that would be treated on someone else's dime. sigh

What about the guy who eats everything right and doesn't smoke, drink, fuck, ride a motorcycle, nothing - and he gets cancer? Or falls off the ladder at work? You selling him some health insurance? What about preemies? They are the most expensive of the whole lot.
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That doesn't make any sense. The insurance company is still pooling the unknown risk within itself, just like auto insurance. They lose money on some people and make money on others, but most properly-run companies make money overall.
 
2&2 Slider To Leyritz said:
That doesn't make any sense. The insurance company is still pooling the unknown risk within itself, just like auto insurance. They lose money on some people and make money on others, but most properly-run companies make money overall.
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It makes perfect sense. Of course when I say "no one" I mean there would be a glut of uninsured, not literally no one.
 
Deacon923 said:
I note that the founder of this illustrious thread has moved on to greener pastures now that the rest of us have put our ideas on the table.
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Apparently he didn't fall into the "willing to listen" category. Guess he doesn't talk to himself.
 
WakeandBake said:
I know you are in the private insurance biz so I will defer to you on specifics, but are you arguing that premiums are lower for a 45 year-old in an individual plan than in a group plan?

Are you arguing that group plans are raising what the average family pays for health insurance?
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In most states (some states have odd regs), individual rates are lower than group rates, in some cases, much lower, and people do in fact buy individual coverage. In NC alone, 450k people do.

In many cases, yes, people would get a better rate buying individual plans than group plans. Of course, there is employer contributions that mask the actual cost along with the well known tax break we give group but not individual buyers.

I think Wrangor's point is a good one and worth discussion. The only factor that can change rates in 2014 for individual buyers and all group is smoking. And its self reported. This will cost the tax payers a ton over the long run and folks OOP max will be capped. We need sticks and carrots here. Employers wield those.

Last, when looking at the uninsured, lets remember some are poor and cant afford any premium, some are real sick and cant get coverage and some opt not to buy because its a bad deal. We solved th problem for the first 2 but not the third. So we will see a big spike in premiums coming as the first two buy and the third group sits out...
 
Your point may hold water for single or recently married 25-35 yos. I seriously doubt 40+ yos pay less on their own than they do with large companies. This would be even more true if anyone in their family has an ongoing condition.
 
June, what's your stance on substantive due process? Just curious.

Also I like to look at our 21st century society through a lens which conveys the Constitution within a context of said society rather than in a 1789 context.
 
CHDeac said:
In most states (some states have odd regs), individual rates are lower than group rates, in some cases, much lower, and people do in fact buy individual coverage. In NC alone, 450k people do.

In many cases, yes, people would get a better rate buying individual plans than group plans. Of course, there is employer contributions that mask the actual cost along with the well known tax break we give group but not individual buyers.

I think Wrangor's point is a good one and worth discussion. The only factor that can change rates in 2014 for individual buyers and all group is smoking. And its self reported. This will cost the tax payers a ton over the long run and folks OOP max will be capped. We need sticks and carrots here. Employers wield those.

Last, when looking at the uninsured, lets remember some are poor and cant afford any premium, some are real sick and cant get coverage and some opt not to buy because its a bad deal. We solved th problem for the first 2 but not the third. So we will see a big spike in premiums coming as the first two buy and the third group sits out...
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good post. While I have no doubt that what you say is true (actual per insured cost of group more than individual), I am guessing that actual out of pocket cost to the insured, after tax benefit/cost is factored in, makes individual more expensive because you are buying without employer contribution and with after tax dollars. Do you think that is generally correct?
 
Wakeforest22890 said:
Also I like to look at our 21st century society through a lens which conveys the Constitution within a context of said society rather than in a 1789 context.
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[Scalia/] Sorry, this is not allowed, unless you are trying to define "arms", in which case AR-15s must be included. [/Scalia]
 
CHDeac said:
In most states (some states have odd regs), individual rates are lower than group rates, in some cases, much lower, and people do in fact buy individual coverage. In NC alone, 450k people do.

In many cases, yes, people would get a better rate buying individual plans than group plans. Of course, there is employer contributions that mask the actual cost along with the well known tax break we give group but not individual buyers.

I think Wrangor's point is a good one and worth discussion. The only factor that can change rates in 2014 for individual buyers and all group is smoking. And its self reported. This will cost the tax payers a ton over the long run and folks OOP max will be capped. We need sticks and carrots here. Employers wield those.

Last, when looking at the uninsured, lets remember some are poor and cant afford any premium, some are real sick and cant get coverage and some opt not to buy because its a bad deal. We solved th problem for the first 2 but not the third. So we will see a big spike in premiums coming as the first two buy and the third group sits out...
Click to expand...

Just to clarify, what do mean by bad deal for the third group?
 
Deacon923 said:
good post. While I have no doubt that what you say is true (actual per insured cost of group more than individual), I am guessing that actual out of pocket cost to the insured, after tax benefit/cost is factored in, makes individual more expensive because you are buying without employer contribution and with after tax dollars. Do you think that is generally correct?
Click to expand...

It really depends. The state health plan has seen a huge exodus of dependents chasing a lower premium, even net of the tax savings. This is the case since the state stopped making a meaningful contribution to dependent coverage.

On the employee side, the average employer contribution is ~75% so that coupled withe the tax savings makes employer coverage cheaper for a lot of folks. But note that it has nothing to do with the "size" of the pool. On an actual cost basis, individual will be cheaper almost every time.

Its a shame the DOL has essentially ruled against employers from funding individual policies. Its gonna create a market disruption where employers will want to provide something but can't.
 
ONW said:
Just to clarify, what do mean by bad deal for the third group?
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There's a lot of folks whose risk/expected claims are so low why would they ever buy insurance. They can afford it but opt out of the market. And the new mandate is so weak and the ability to get coverage if you get sick is relatively easy, why would they? Im not sure I would...
 
One last thought....The federal exchange application period ends at the end of the month. I think we will see some interesting rate increases coming out. The White House is already gearing up....They publicly argue costs are going down which is absurd. The taxes alone are adding more than 7% to costs!
 
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