US health care question

[Iormlund]

He's not talking about people. He's talking about procedure or drug coverage. As I understand now insurers have to cover certain minimums there. He's asking for those to be removed.

[Admiral Yi]

He's not talking about people. He's talking about procedure or drug coverage. As I understand now insurers have to cover certain minimums there. He's asking for those to be removed.

But I think you have a misconception about the mandates he's referring to.  I'm pretty certain that they don't cover things like cancer, or MS, or Iormlund's Syndrome.  Take my "autism discimination" as an example.  Currently there's no cure for autism.  The only thing that makes sense is that they are lobbying for a mandate to cover some kind of assistance that makes the parents' lives easier.

[Sheilbh]

But I think you have a misconception about the mandates he's referring to.  I'm pretty certain that they don't cover things like cancer, or MS, or Iormlund's Syndrome.  Take my "autism discimination" as an example.  Currently there's no cure for autism.  The only thing that makes sense is that they are lobbying for a mandate to cover some kind of assistance that makes the parents' lives easier.

Having a look round it's to do with occupational, behavioural and speech therapy.  Apparently in 14 states insurers are required to cover it, in 36 states they just don't cover it and they want it to be required according to the bill

Edit:  So as far as I can tell it's to do with enabling kids, especially, with autism to do better in education and so on

[Admiral Yi]

I was close!:woot:

[DontSayBanana]

It strikes me that the very fact that it's an insurance model for healthcare is self-defeating, because the insured's at almost 100% risk, and in fact, using health insurance for health maintenance appointments is considered better practice than not doing so. It seems totally backwards, when you consider that all other insurance models try to reward the outcome where nothing happens to the insured.

[DGuller]

It strikes me that the very fact that it's an insurance model for healthcare is self-defeating, because the insured's at almost 100% risk, and in fact, using health insurance for health maintenance appointments is considered better practice than not doing so. It seems totally backwards, when you consider that all other insurance models try to reward the outcome where nothing happens to the insured.

I agree that health insurance is not a real insurance, it's really more of a pre-paid plan.  Health insurance as we know it doesn't satisfy the definition of insurance.

[DontSayBanana]

Well, to retain the prepaid model, we need to find some way (apparently sans government intervention) to reconcile the higher costs of the chronically ill with their lower earnings potential. I just don't see that happening without a systemic overhaul; how do you turn a minus into a plus overnight?

[Baron von Schtinkenbutt]

As for public option, I'm actually in the camp with those who were highly suspicious of it.  Various forms of "public options" in insurance markets have a way of becoming the only option.  I don't think it was a critical piece to a useful healthcare reform.

Like windstorm insurance in Florida.

[Baron von Schtinkenbutt]

An advantage of universal mandatory coverage is a lot of problems can be prevented or ameliorated if discovered early - leading to lesser costs in long term or ER care if everyone has cheap access to a doctor.

Actually, a number of studies have shown that preventative care would be at best break even, probably more expensive.  It would certainly improve health, but would cost more.

Does Preventive Care Save Money? Health Economics and the Presidential Candidates

Congressional Budget Expert Says Preventive Care Will Raise -- Not Cut -- Costs

[An NPR segment I heard a few weeks ago that I can't seem to track down]

[Iormlund]

Interesting study. However, I was not referring to screening of healthy patients. More like early diagnosis when there are already minor symptoms but the affected person doesn't have affordable access to consultations/tests.
For example, I had several, very minor symptoms years before I experienced any major problem. Had I gone to the specialist and done a barium swallow 7 years ago I might have avoided hospitalizations and surgery.
Now, in my case that was my fault. I didn't give it importance. Didn't go to see a doctor until pain had kept me awake for several days and it cost me dearly.
But I imagine many people for whom access to these services is a significant expense could be deterred by it. And these people are probably the most likely subset of the population to develop a chronic problem, as well.

[DGuller]

As for public option, I'm actually in the camp with those who were highly suspicious of it.  Various forms of "public options" in insurance markets have a way of becoming the only option.  I don't think it was a critical piece to a useful healthcare reform.

Like windstorm insurance in Florida.

That's exactly the example I had in mind.  However, there are many others out there, unfortunately.

[alfred russel]

Now, what kind of insurer you think would aim for me?

The one that sells annuities.

Okay, so here's a question. What kind of incentive could be provided that would make insurers want to take on high-risk customers then? Tax breaks? Outright subsidy? Liability limitation from externality or malpractice damages? Maybe the latter combined with tax writeoffs for covering the treatments. That would make a fairly predictable expense model for the insurer maybe, but I don't see how it could get the premiums down for the patients.

If you run the probabilities of the future medical costs of Iormlund, you will have to compensate an insurance company so that they take in more than those costs. Basically, if an actuary calculates expected costs in the next year of $30k, the premium will be more than $30k (the insurance company needs to eat too). In short, he is uninsurable as a private citizen.

However, if Iormlund had a job at a company with a healthcare plan mandating coverage for everyone and sets premiums for all new entrants, the insurance company will charge far less. That is because adverse selection will be overcome through the mandate for insurance coverage. In a company of 10,000 people, of course some will have expensive medical problems, but an insurance company will be able to distribute individual crises over all employees.

[alfred russel]

There are a lot of problems with employer provided health care--basically people without jobs at big companies get left out. But if there isn't a strong individual mandate for insurance in any health care reform, messing with the tax breaks for health care costs could backfire.

[Caliga]

Our healthcare system is a complete disaster and, after spending quite a bit of time mulling it over, I'm now in favor of socialized medicine... as difficult as it is for me to say so, given my libertarian leanings.

The thing is, as I've said before when this topic has come up, we already have it in the form of supplemental state funding for hospitals to cover writeoffs from patients who have no coverage and can't afford to pay their ER bills.  If some welfare dude comes in with gunshot wounds, they're not going to refuse treatment due to lack of coverage.  The Hippocratic Oath(TM) won't permit that.

[DGuller]

There are a lot of problems with employer provided health care--basically people without jobs at big companies get left out. But if there isn't a strong individual mandate for insurance in any health care reform, messing with the tax breaks for health care costs could backfire.

I agree, this is it in a nutshell.