ObamaCare’s Relentless Creation of Second-Class Citizens (5)

[HiPointDem]

93. wrong.

In the German system, about 85 percent of residents purchase heavily regulated, non-profit insurance referred to as Gesetzliche Krankenversicherung (Statutory Health Insurance, GKV), approximately 10 percent buy private insurance, and the remaining 5 percent fall into other insurance schemes.

Krankenkassen (Sickness Funds) are heavily regulated, non-profit insurers who are legally required to accept all applicants and are permitted to sell health insurance (GKV).

http://www.aicgs.org/issue/structure-of-the-german-health-care-system/

There is no competition on products on services between the funds. All provide the same services as defined by the G-BA (Gemeinsamer Bundesausschuss)...

Private insurance covers nearly the same services but allows additional benefits (e.g. first class service) – there is competition between private insurers.

In ambulatory physician care, a regional physicians’ association negotiates a collective contract with a single sickness fund in the form of a quasi-budget for physician services. The association distributes the funds among general practitioners (GPs) and specialists who claim reimbursement mainly on a fee-for-service basis...

Hospitals are financed on a dual basis: investments are planned by the governments of the 16 Bundesländer, and subsequently co-financed by the Bundesländer as well as the federal government, while sickness funds finance recurrent expenditures and maintenance costs.

http://www.ispor.org/htaroadmaps/germany.asp

The krankenkasses are not private for-profit businesses. They aren't private companies that have a sideline in public insurance -- they are public corporations, and they began as worker or employer-funded insurances, not private for-profit insurers.

Or historically, 'friendly societies':

A friendly society (sometimes called a mutual society, benevolent society, fraternal organization or ROSCA) is a mutual association for the purposes of insurance, pensions, savings or cooperative banking. It is a mutual organization or benefit society composed of a body of people who join together for a common financial or social purpose. Before modern insurance, and the welfare state, friendly societies provided financial and social services to individuals, often according to their religious, political, or trade affiliations...

Credit unions and other types of organization are modern equivalents.

http://en.wikipedia.org/wiki/Friendly_society

The first bill that had success was the Health Insurance bill, which was passed in 1883....The program was established to provide health care for the largest segment of the German workers. The health service was established on a local basis, with the cost divided between employers and the employed. The employers contributed 1/3, while the workers contributed 2/3s.

Individual local health bureaus were administered by a committee elected by the members of each bureau, and this move had the unintended effect of establishing a majority representation for the workers on account of their large financial contribution. This worked to the advantage of the Social Democrats who – through heavy Worker membership – achieved their first small foothold in public administration.

http://en.wikipedia.org/wiki/Otto_von_Bismarck#Health_Insurance_Bill_of_1883

Similarly in Japan:

National health insurance emerged in Japan as the result of a gradual process that can be traced back to 1905, when the Kamegafuchi Textile Company provided limited benefits for its employees. In the decades that followed, more and more corporations began offering benefits through mutual aid societies. A health insurance law enacted in 1922 was inspired by the German system established by Chancellor Bismarck in 1883. As in Germany, this first law extended health insurance coverage to industrial workers and miners but excluded the self-employed and employees in companies with fewer than five workers.2 This law, implemented in 1927, established the practice of mandating coverage by enterprises and created an important government role in the provision of health insurance to those individuals not covered by employers. In 1938, health insurance was extended to...other groups not covered by the 1922 law.

In 1958, the 1938 law was revised to include the remaining 30 percent of the population not previously covered. This revision broke the precedent of extending health insurance to occupational groups by calling for universal coverage on the basis of residence. Every government jurisdiction, whether city, town or village, was required to provide health insurance to every uncovered resident by 1961. Since 1961, virtually all Japanese have been covered by either employers or the government.

Ignoring some administrative complexities and small beneficiary groups, health insurance plans for employees may be categorized into four groups:

Government-managed plans - These plans provide coverage for the almost 30 percent of the population comprised of employees (and their dependents) of small enterprises with more than five but fewer than 300 employees. These plans are managed by the government's Social Insurance Agency through a network of some 300 local offices. Premium contributions are set by law at a fixed rate (8.2 percent of monthly income before taxes) and evenly split between employees and employers.

Society-managed plans - Known as health insurance societies, more than 1,800 company plans provide coverage for 26 percent of the population. These health insurance societies are managed jointly by representatives of labor and management in enterprises with more than 300 employees. Society-managed plans can be also established by several enterprises employing 3,000 or more employees. Payroll taxes for such plans range from 5.8 to 9.5 percent of gross monthly income.5 Employers are required to pay at least half of these contributions, and some pay as much as 80 percent.

Mutual aid association (MAA) insurers - Covering almost 10 percent of the population, these include 27 plans for government employees in the national public service, 54 plans for local government employees, and one plan for quasi-public employees like teachers and other school employees. The average payroll contribution of these plans in 8.5 percent of the employee's wage.

Plans for day laborers (for those who work less than two months during the year) and seaman - These independent plans cover only 0.1 and 0.4 percent of the population, respectively.

In addition to the employee groups noted above, employees in enterprises with fewer than five workers, the self-employed and retirees are covered either by municipal governments or by national health insurance societies

Most of Japan's health insurance plans are private organizations in terms of administrative law; in practice, they have a quasi-public status insofar as they are largely bound to provide uniform benefits and to cover all eligible beneficiaries.

Employers have little freedom to alter premium levels, which range from 5.8 to 9.5 percent of the wage base.7

The self-employed are required to contribute premiums to health insurance plans that are administered by local governments or trade associations.

And all of these premiums are taxed to finance the national fund which, along with government subsidies, finances national health insurance for the elderly.

...This has limited private insurance to coverage of copayments. There is, however, a small market for supplemental benefits that pay for amenities like private rooms.

http://www.nyu.edu/projects/rodwin/lessons.html#II



IOW, these 'insurers' are not private for-profit insurance corporations.