Whither Obamacare?

[Admiral Yi]

There's nothing bad about it.  But it won't do much of anything anyways.  An insurer still has to set up a whole local network to get business.

I don't see why this is.  People can buy health insurance online, or if they absolutely have to look at a human face they can go to independent insurance agents.

[MadImmortalMan]

He means networks of care providers.

[Admiral Yi]

asoka

[celedhring]

In Spain the way it's ended up working is that nationwide healthcare providers offer the same prices everywhere, using their large customer pools to offset regional pricing differences. So rural customers end up subsidizing urban customers. Of course the US is so large that differentiated regional pricing might be sustainable, but I'm sure GOP voters would love to pay up for newyorker's healthcare

[Admiral Yi]

In Spain the way it's ended up working is that nationwide healthcare providers offer the same prices everywhere, using their large customer pools to offset regional pricing differences. So rural customers end up subsidizing urban customers. Of course the US is so large that differentiated regional pricing might be sustainable, but I'm sure GOP voters would love to pay up for newyorker's healthcare

What is there to stop a competitor from stepping in and undercutting prices in the low cost areas?

[Berkut]

It is pretty much ridiculous that we are still arguing about this.

At this point, being anything other than a supporter for single payer health care provided by the government can only possibly be supported by faith in some ideology. The *facts* are very clear.

In every single general way you can measure it, those similar countries to the US that do single payer health care

1. Pay a LOT less for health care than Americans,
2. Have radically better coverage, and
3. Get better results overall.

We pay a LOT more, not matter how you measure it, then our peers. We actually pay more in public funds into health care, then similar countries that provide public health care.

I simply cannot believe that. It seems impossible to be true.

No matter what you think about how terrible the government is, our current system (and the system we had prior to Obamacare) costs us MORE than just straight up single payer public health care.

And *then* you can add in how much we all spend for *private* coverage, and the numbers become truly, insanely, broken.

All for outcomes that are overall average at best, compared to other peer countries. We spend a LOT more, and get average results.

However, we do have a huge health care economy that creates massive revenues for a lot of giant corporations, so that is one thing we would lose out on if we went with single payer.

[celedhring]

In Spain the way it's ended up working is that nationwide healthcare providers offer the same prices everywhere, using their large customer pools to offset regional pricing differences. So rural customers end up subsidizing urban customers. Of course the US is so large that differentiated regional pricing might be sustainable, but I'm sure GOP voters would love to pay up for newyorker's healthcare

What is there to stop a competitor from stepping in and undercutting prices in the low cost areas?

As I said, Spain is a much smaller market than the US. Regional providers do exist, but they're really small and can't leverage scale enough to compete in price.

That's why I think that regional pricing might survive even if state borders are abolished in the US market. You're so much larger.

[Admiral Yi]

As I said, Spain is a much smaller market than the US. Regional providers do exist, but they're really small and can't leverage scale enough to compete in price.

That's why I think that regional pricing might survive even if state borders are abolished in the US market. You're so much larger.

OK, but that doesn't explain why one or more of the nationwide insurers doesn't differentiate to undercut the competition and gain market share.

[celedhring]

As I said, Spain is a much smaller market than the US. Regional providers do exist, but they're really small and can't leverage scale enough to compete in price.

That's why I think that regional pricing might survive even if state borders are abolished in the US market. You're so much larger.

OK, but that doesn't explain why one or more of the nationwide insurers doesn't differentiate to undercut the competition and gain market share.

To do so, it would need to offset with higher pricing in urban areas. Margins are already razor-thin. It's not worth it.

The Spanish insurance market is fully commoditized, there's nearly zero differentiation. Of course since we have universal public health is probably hard to compare with the US. If you try to squeeze customers too much, they'll just drop you.

[Zanza]

By the way, the socialist paradise of Germany does not have universal healthcare.

Our individual mandate only applies if you earn less than about 57.000 Euro annually and are not self-employed. Self-employed people can opt into the public healthcare providers and people earning more than 57.000 Euro can also opt in. If you are insured via the public health insurance providers, your spouse and children are also insured (unless they have their own income, then they need to pay). There are few out of pocket expenses, usually related to dentistry, glasses, contact lenses, physiotherapy, minor co-payment for prescription meds etc.

All of that costs you about about 10.3% of your gross income (capped at about 400 Euro) and your employer pays another 7.3% of your gross income (capped at about 375 Euro), so the maximum that it costs you and your employer per month is about 775 Euro.

[DGuller]

OK, but that doesn't explain why one or more of the nationwide insurers doesn't differentiate to undercut the competition and gain market share.

To do so, it would need to offset with higher pricing in urban areas. Margins are already razor-thin. It's not worth it.

The Spanish insurance market is fully commoditized, there's nearly zero differentiation. Of course since we have universal public health is probably hard to compare with the US. If you try to squeeze customers too much, they'll just drop you.

Okay, so charge higher prices in urban areas.  If everyone in urban areas goes to competitors, bad for your competitors.  The fact that the market is fully commoditized actually makes it much easier to compete on appropriate price differentials, that's when insurance markets are at their most efficient.

[DGuller]

So they aren't able to get the cross-state thing in it.

Question: What is bad about being able to buy insurance across state lines?

There's nothing bad about it.  But it won't do much of anything anyways.  An insurer still has to set up a whole local network to get business.

It could be quite bad if we still have insurance regulation on a state level.  We may wind up with a situation where selling insurance across state lines really becomes selling insurance everywhere from the Delaware of health insurance.  I'm going to guess that the Delaware of health insurance will be a state chosen by insurers rather than insureds.

[CountDeMoney]

It could be quite bad if we still have insurance regulation on a state level.  We may wind up with a situation where selling insurance across state lines really becomes selling insurance everywhere from the Delaware of health insurance.  I'm going to guess that the Delaware of health insurance will be a state chosen by insurers rather than insureds.

Yup.  The state with the weakest regulators, the friendliest environment for insurers and the weakest oversight for the consumer will be the go-to for the industry.  Welcome to Wild, Wonderful West Virginia.  And dirtball fuckstick Mississippi.

[celedhring]

OK, but that doesn't explain why one or more of the nationwide insurers doesn't differentiate to undercut the competition and gain market share.

To do so, it would need to offset with higher pricing in urban areas. Margins are already razor-thin. It's not worth it.

The Spanish insurance market is fully commoditized, there's nearly zero differentiation. Of course since we have universal public health is probably hard to compare with the US. If you try to squeeze customers too much, they'll just drop you.

Okay, so charge higher prices in urban areas.  If everyone in urban areas goes to competitors, bad for your competitors.  The fact that the market is fully commoditized actually makes it much easier to compete on appropriate price differentials, that's when insurance markets are at their most efficient.

Urban consumers are still more profitable and easier to acquire. Costs are higher, but this same higher level of rent makes them more likely to purchase better plans than low rent areas.

I guess having different plan tiers accomplishes part of what regional pricing would accomplish?

Also, I suspect that they dropped regional pricing because fraud (I sign up as living in Albacete but actually go to the doctor in Barcelona), would be difficult to eradicate.

At the end of it, Spanish health insurance market is very mature, and very fragmented (last time I looked market leader had sub-20% share). If nobody has undercut prices in low rent areas, there's probably a reason for it.

[CountDeMoney]

Higher premiums for acting like medieval monkeyfucks and getting gored during bouts of animal abuse?