General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsHealth Care Reform葉he Charade of Regulation
Advocates of HCR claim that a fresh new regulatory regime will control costs to the point where imposing mandates on everyone to buy overpriced underinsurance would be justified. This claim rests mainly on four features
An end to refusing policies and price discrimination for people with pre-existing conditions
An end to recissions of existing policies when people get expensively sick
Immediate sunshine on price gouging to discourage excessive price increases by insurance companies through review and disclosure of insurance rate increases
Requiring premium refunds if insurance companies exceed a specified medical loss ratio (MLR)
Unfortunately, none of these proposals, however helpful in and of themselves, will have any effect whatsoever on controlling health care costs.
Ending pre-existing condition discrimination
There is nothing in the legislation to restrict insurance companies from using this as a justification to jack their premiums sky-high for everybody. Older people can be charged 3 times more, and age certainly has to qualify as a pre-existing condition. Also, there is no mention of what recourse you have should you be turned down for, say, having a bad credit record.
Ending recissions
That would be nice, and I really wish that the legislation as written actually said that. What it does say is that recissions will be eliminated except in the case of fraud. Can somebody please explain why the insurance companies will not be able to drive a whole fleet of very large trucks through that loophole? And there is no mention of what happens when you get dropped because you are unable to afford the premium one month.
Another huge problem is that it leaves regulation to the states, which for all practical purposes is not regulation at all. California has a law against recissions already, but they are not enforcing it at the moment because they cant afford to.
The sunshine provision
Its astonishing that anyone could call this regulation and still keep a straight face. What it amounts to is a list of very naughty boys and girls. And theyd better watch out, because if they dont straighten up and fly right, theyre going to wind up on that very same list again next year.
Medical loss ratio requirements
Unfortunately, 15 states either have these requirements now or have had them in the past(1), and they have not had even the slightest effect on escalating health care costs. Of course its helpful for some people to get premium rebates, but despite that, the cost of premiums keeps on skyrocketing, 45,000 a year keep dying for lack of the money to pay for health care, and 300,000+ keep going bankrupt due to medical bills (the majority of whom had insurance that was mostly better than the strictly catastrophic "bronze" underinsurance that will be mandated under reform).
Locking the barn door after the horse gets away is not regulation in any sense of the word, as demonstrated by the following real life example.
Dear Mr. and Mrs. Sarkisian:
We were sorry to hear that your daughter Nataline died because CIGNA denied your claim for her liver transplant. However, you will be glad to know that we have analyzed CIGNAs medical loss ratio and that all of their customers are entitled to premium refunds. Isnt that wonderful?
Yours truly,
Dr. Pangloss
Another possibilityallowing lawsuits against insurance companies for claims denial
HCR does not have any restrictions whatsoever against denials of particular claims, and it is this practice that is a major cause of so many deaths and bankruptcies. People are not allowed to sue companies for denying claims. Representative Jim McDermott (WA-07) is drafting an amendment which would allow such lawsuits. I think its a very good idea, but it suffers from the same problem as attempting regulation by mandating specific medical loss ratiosthe remedy comes too late to do any good. Mr. and Mrs. Sarkisian would undoubtedly appreciate the money if they sued CIGNA and won, but they would surely prefer that their daughter had gotten the treatment she needed in the first place.
In addition, legal remedies generally increase health care costs. This is already true of medical malpractice lawsuits (even though the cost increases as a cause of our high per capita medical costs are vastly overrated by the tort reform crowd). In no other developed country do people constantly make use of the legal system to get the money needed to pay for the ongoing medical bills necessitated by poor medical outcomes. Note that this motivation to sue is exactly the same regardless of whether or not such outcomes were caused by actual malpractice. The reason for this is that those extra costs are automatically paid by societies which guarantee health care as a right, and therefore there is no need for anyone to initiate a tort lawsuit in order get the money to pay them.
(One of the reasons that we lead the developed world in medical error rates(2) is that private employer-based insurers are constantly forcing people to change providers with their endlessly mutating preferred provider lists. Nothing in the proposed legislation deals with this issue.)
Real regulation
Because the largest risk pools will always be the cheapest, health insurance will always trend toward being a monopoly. Wherever natural monopolies exist, society absolutely must regulate them so that citizens do not get ripped off for huge sums of money. We learned this more than a hundred years ago with respect to electrical power grids. At that time, many publicly owned utilities were established and the remainder were put under strict regulation by public utility commissions. When historical amnesia finally set in during the last years of the 20th century, deregulation insured that Enron and Reliant were able to rob energy consumers on the west coast of billions of dollars during a fake energy crisis. The corporate-controlled media rarely pointed out that cities with municipally owned utilities didnt have any brownouts during the crisis. All American health insurance companies are Enron. Just as Enron withheld energy from the market to drive up prices and profits, so do insurance companies deny care in order to increase profits.
There is no such thing as health care reform without strict regulation of health care costs. It can be done by outright government ownership of the health care delivery system (Britain, Scandinavia), government monopoly of health insurance (Canada, Taiwan), or strict government regulation of private insurance (the Netherlands, France, Japan). The third method can certainly work as well as the first two in practicetoo bad that nothing in current reform comes remotely close to that.
Real regulation of mandated private insurance in the Netherlands results in policies that cost 100 euros/month/adult ($95-$145 depending on exchange rates), with no deductibles, no co-pays and no age rating. In addition, many countries regulating private health insurance also directly control provider prices. In 1996, my husband got an emergency root canal in the Netherlands for 100 guilders, or $25 American. In Japan, an overnight hospital stay costs the equivalent of $20. And yes indeed, the number of zeros in those prices are perfectly correct, though they could probably stand to be raised and in fact may have been by now.
(1)http://www.familiesusa.org/assets/pdfs/medical-loss-ratio.pdf
(2) http://www.truthout.org/111908HA
dkf
(37,305 posts)regardless of the odds of use?
The regulation of rates is this. They can charge the old 3 times more than the young. So if the old have six times more claims then they raise the rates on the young and poor to cover it. Thank you young people. Get to work!
dkf
(37,305 posts)I bet this is what the numbers required to make it work.
Again thanks to all you young folks. And thanks for Social Security too.
HiPointDem
(20,729 posts)Health insurance is private insurance, and the principle is that people pay according to their risk factors, same as with car insurance. If you are more likely to be sick you pay more, just as if you are likely to have more accidents you pay more.
Social security doesn't work like private insurance. The people receiving it today paid into it as workers, and the workers paying into it now will receive it when they get older (unless they stupidly buy into the propaganda intended to destroy it).
Social Security taxes are not apportioned according to "risk group," but according to amount of wage income.
I don't see any reason to particularly thank young people for Social Security when I have paid into Social Security all my working life. As did my parents before me.
CAPHAVOC
(1,138 posts)But now only a couple young people pay in for each who takes out. When it started over a hundred paid in for each one who took out. It now needs to start cashing in the bonds to pay the benefits back. They took all the money we paid in and got bonds with it. Supposedly there are enough Bonds to pay us back. There better be.
As far as health insurance. There isn't any. There are just payment schemes. I support Medicare as the single payment scheme. For everybody. I would say the time has come for a real change in the way we do these things.
HiPointDem
(20,729 posts)beneficiary. In 1965, there were 4.
Social Security already weathered a much more dramatic change in the worker-to-retiree ratio when it went from 18-to-1 in 1950 to 4-to-1 in 1965 without collapsing.
Compared to that change in just 15 years, the far less dramatic change from todays 3-to-1 ratio to 2080?s 2-to-1 ratio is less daunting. To understand why, we have to look at the bigger picture.
1. The ability of workers to support dependents (young and the old) doesn't require any certain number of workers. It's the productivity of workers and the percentage of the value of their production that they take home as wages that's important, not the number of workers.
Just a one farmer can now produce the food that used to require hundreds, so today's workers can turn out more goods and services than workers in the 50s did -- they're about 4 times more productive. What took a worker of the 50's 40 hours to produce, now takes about eleven. So long as wages keep rising in line with productivity, workers can support more people.
OTOH, if capital keeps taking all the productivity gains and telling us we're now "too poor" to support the elderly, (even though in reality we're richer than ever) -- well, yeah, then workers can't support the elderly. But only because capital is taking all the value of what workers produce and leaving them with 1950 wages.
Output per hour, projected based on 1975-2000 rate of increase; 1995 = 100
http://www.epi.org/publication/ib208/
http://groups.csail.mit.edu/mac/users/rauch/worktime/
CAPHAVOC
(1,138 posts)I thought we had Bonds to cover it. In the trust fund. Not personal ones in our name but Bonds to cover Social Security.
eridani
(51,907 posts)Why not just recommend that people with lousy genes be put in gas chambers? Countries with universal care don't worry about risk factors--they just charge a flat rate for a comprehensive policy. And they spend half what we do on health care.
HiPointDem
(20,729 posts)Social Security.
eridani
(51,907 posts)--or treated the way utilities commissions treat public utilities.
eridani
(51,907 posts)If the kid is lucky, s/he'll get to be 90 one day. FUCK calculating odds. Countries that provide universal health care for the most part have one single basic plan that is the same for everyone, though people have the choice of buying extra bells and whistles. And they take care of EVERYONE for half the cost per capita compared to what we pay.
dkf
(37,305 posts)eridani
(51,907 posts)--all kids ride free, and the math works out just fine.
dkf
(37,305 posts)I'm pretty sure my medical expenses are less than my nieces or nephews.
eridani
(51,907 posts)--and $50-$100/month for seniors on Medicare, takes care of the entire state population. Who gives a shit that some are more expensive than others? If you want to punish sick people financially, what's the matter with gas chambers for these 'useless eaters'?
Motown_Johnny
(22,308 posts)and there are some things in the law that are first steps toward dealing with the issues you raise. For example:
http://www.healthcare.gov/law/features/costs/rate-review/index.html
^snip^
Rate Review
The Affordable Care Act creates a Rate Review program in your state to help protect individuals and small businesses from unreasonable health insurance rate increases. Starting on September 1, 2011, health insurers must justify any rate increase of 10% or more before the increase takes effect.
Review of Insurance Rate Increases and the Affordable Care Act
Insurance companies must now justify proposed rate increases for your health insurance. Director of Consumer Information and Insurance Oversight at HHS, Steve Larsen, explains this important feature of the health care law.
Find rate increase information for your state with HealthCare.gov's Rate Review tool.
What This Means for You
Your insurance company cant raise rates by 10% or more without first explaining its reasons to your state or federal Rate Review program. All explanations will be posted on HealthCare.gov and your Rate Review program will give you a chance to comment on them.
Your Rate Review program will determine if the rate increase is unreasonable. A rate hike is unreasonable if, for example:
It is based on faulty assumptions or unsubstantiated trends.
It charges different prices to people who pose similar risks to the insurer.
Your state regulator can approve or reject an unreasonable or excessive rate increase, if your state laws give the regulator this authority.
eridani
(51,907 posts)--is NOTHING WHATSOEVER.
Uncle Joe
(58,299 posts)Thanks for the thread, eridani.
Egalitarian Thug
(12,448 posts)Selatius
(20,441 posts)At best, it was called a step in the right direction. Some things that needed to be changed were, but on a whole, the effort was half-hearted, and that was likely the best that particular Congress could do.
You honestly can't expect anything better than ACA as far as health care reform from a Senate so poisoned by corporate campaign contributions.
Egalitarian Thug
(12,448 posts)"You honestly can't expect anything better than ACA as far as health care reform from a Senate so poisoned by corporate campaign contributions" without strong leadership explaining and forcing the issue.
That is my problem with this President. I know that he is a very smart person that understands how things work, so I am left with no choice but to believe that President Obama never wanted, nor intended to bring any significant change. Hell, the dimmest bulb in America understands that, left to its own, Congress can't get a lunch order done, so the idea that leaving it to them to fix a disaster like our health care distribution system without exerting the full force of popular demand, is either foolish or disingenuous.
Barack Obama is not a fool.
BlueIris
(29,135 posts)The term 'affordable care act' is obvious propaganda (no more and no less than calling the international 'support' for the Iraq War a 'coalition of the willing.') It's one of the things about the 'plan' which has offended me the most.
ProSense
(116,464 posts)absurd to post a couple of 2008 pieces, which have nothing to do with the law, to claim that the law is a "charade."
There is federal oversight.
http://cciio.cms.gov/
http://www.healthcare.gov/law/resources/reports/rate-review03222012a.html
These MLR rules have always existed. The problem has always been enforcement.
The enactment and enforcement of medical loss ratio requirements, along with other important measures for holding insurers accountable, can help make premiums affordable for consumers in all 50 states.
http://www.familiesusa.org/summit-watch/medical-loss-ratios.pdf
Here's why the health care law's MLR rule is significant
http://www.democraticunderground.com/1002500237
zipplewrath
(16,646 posts)"Charade" was a strong expression. There is a huge distance between charade and "significant". The law doesn't significantly do anything to control health CARE costs, even the White House admits as much. It's primary concern was, as part of reform, to ensure that health INSURANCE rates were controlled. If we were going to mandate insurance (and not just for individuals but through employers) they wanted to do what they could do to ensure that the premiums were controlled.
The MLR rule is a piece of the legislation. The larger legislation does have the effect of changing the insurance industry in significant ways to the industry. There is a very good chance that many of the current players in the system may get out. There may be some consolidation. You may see some sales to other companies. Some are suggesting that health care systems (hospital chains basically) may get into the insurance business. They won't care so much about MLR rules, their primary profit will be in the health CARE delivery and there isn't alot of control over that side. They can do some cost shifting to stay in the 15% region and move profits over to the health care delivery aspects.
This legislation did significantly change the health insurance industry. How the industry reacts to it has yet to be determined. In terms of controling health CARE costs, it is very short on methodologies, which is why costs are predicted to rise at 7% for the foreseable future. The regulatory frame work has yet to be worked out, and much like utility regulation, one shouldn't expect it to be too onerous on the the industry. And much of the early regulation will increase the cost of health care, mostly because of the items which must be covered at 100%.
But there isn't anything to "ensure" that premiums are "affordable". They'll do what they can, but as care costs rise, so will premiums.
CAPHAVOC
(1,138 posts)If a Republican ever gets elected again he will appoint a secretary to rewrite it.
There are some limits, but you're basically correct, the more restrictive aspects can be undone by the next regulators. The 15% is a bit stiff, but they can allow more things to be classified as "health care costs".
eridani
(51,907 posts)--what happens to an insurer who flunks the rate review? Nothing, as far as I can tell.