Health Reform

[Rex Ryan]

Originally Posted by ebradford

Hi Rex,

I totally understand this skepticism. I agree most insurance companies would not be comfortable taking on this kind of risk.

However the flip side is that in work comp we provide this kind of insurance right now on a smaller scale. It's first dollar, no copay, no deductible, no limit for the rest of your life coverage (and they pay you for not working to boot). There is no limit or cap of any kind on work related injuries.

I would argue that workers comp costs too much as well. Poor discounts, malingering, rate increases,... The reason it is not slated for government take over is only because not as many people are impacted. I would expect workers comp could be eliminated by single payer too and it would be a lot more efficient. Of course, you could still get to insure lost wages.

[Rex Ryan]

Healthcare should move to accountable care organizations and consumer driven health plans.

The other problems have to do with an obesity epidemic that causes diabetes, heart disease and cancer. Alcoholism and drug use are also societal issues that impact the cost of healthcare. Finally, you have new technology and specialty drugs that drive up cost. So a culture of wellness could help, and then maybe you need to ration expensive new treatments or just not cover them or put a cap on reimbursement so that companies have no profit motive for innovation. That way society can pay less for care and expected mortality can stop improving. After all, old people are not productive, hurt unemployment and are a drain on the economy.

[Chuck]

Originally Posted by Rex Ryan

We should, but this is not the solution. It is not an insurance problem, it is a social issue that is already over-regulated with too many mandates, any willing provider laws, inability to carve out mental health, drug and substance abuse, pregnancy, and allowing providers to balance bill and charge whatever they want.

The problem with health insurance is not underwriting. It is people being able to afford the premium. Your solution, if anything, would make premiums more expensive by being a lump sum for life. People already can't afford a claims paid policy, they certainly can not afford claims made diagnosis policy.

As for the idea of paying providers on a case rate by diagnosis, that does happen sometimes.

All of the points you raised are important issues that should also be addressed.

But there is also an insurance issue that the OP proposal addresses that you do not. The problem is greater than just affordable premiums (while that is very, very important). It is the ability to keep your coverage inforce. Until you address the problems of anti-selective cost spirals on closed blocks, people losing their coverage when they lose their jobs or companies getting out of markets, etc, then the industry is still going to be exposed to political takeover.

We certainly want to lower costs by eliminating costly mandates, regulations, etc, but if you mainly lower costs by having a system that only keeps costs low and coverage maintainable for those who remain healthy, then that's not a good way to keep costs down.

We need to underwrite upfront to avoid moral hazard costs, but we should not be able to "effectively" underwrite on inforce business with maneuvers that chase away those that become sick while inforce.

Insurance needs to protect you when something unforeseen and bad happens to you. That's basic. For health, that something bad is getting diagnosed with the disease.

Chuck

[Rex Ryan]

Originally Posted by Chuck

All of the points you raised are important issues that should also be addressed.

But there is also an insurance issue that the OP proposal addresses that you do not. The problem is greater than just affordable premiums (while that is very, very important). It is the ability to keep your coverage inforce. Until you address the problems of anti-selective cost spirals on closed blocks, people losing their coverage when they lose their jobs or companies getting out of markets, etc, then the industry is still going to be exposed to political takeover.

We certainly want to lower costs by eliminating costly mandates, regulations, etc, but if you mainly lower costs by having a system that only keeps costs low and coverage maintainable for those who remain healthy, then that's not a good way to keep costs down.

We need to underwrite upfront to avoid moral hazard costs, but we should not be able to "effectively" underwrite on inforce business with maneuvers that chase away those that become sick while inforce.

Insurance needs to protect you when something unforeseen and bad happens to you. That's basic. For health, that something bad is getting diagnosed with the disease.

Chuck

I'm not dismissing that there are no other issues. I'm saying the issue as stated pales in comparison to the broader issues I delineated. I also said the solution proposed wouldn't work.

There are already laws that protect you if you lose your job: COBRA, HIPPA, portability, Medicaid, Medicare, high risk pools,.... That isn't the real problem that troubles everyone. The real problem is 18% of GDP or whatever it is, and how it keeps increasing faster than the rest of the economy. Claims made or claims paid isn't addressing that. Workers comp is not the solution. But I guess when a workers comp actuary has a hammer, he sees every problem as a nail. Seems naive to me to step into another practice area, presume I know more than the people who work in it and preach about knowing the solution, but what would I know. Just my opinion.

[Chuck]

Originally Posted by Rex Ryan

I'm not dismissing that there are no other issues. I'm saying the issue as stated pales in comparison to the broader issues I delineated. I also said the solution proposed wouldn't work.

There are already laws that protect you if you lose your job: COBRA, HIPPA, portability, Medicaid, Medicare, high risk pools,.... That isn't the real problem that troubles everyone. The real problem is 18% of GDP or whatever it is, and how it keeps increasing faster than the rest of the economy. Claims made or claims paid isn't addressing that. Workers comp is not the solution. But I guess when a workers comp actuary has a hammer, he sees every problem as a nail. Seems naive to me to step into another practice area, presume I know more than the people who work in it and preach about knowing the solution, but what would I know. Just my opinion.

If you think COBRA, Medicaid, or high risk pools are adequate solutions, then you probably have not had people you care about subjected to those solutions. Medicare is not any help if you are not old enough.

Maybe my ideas are naive and maybe you can come up with better ones - but I can recognize a basic problem and if those working in the practice area dismiss those problems as not even a priority or if they think there are already adequate solutions to those problems, then they'll all eventually go the way of the DB pension actuary. Sometimes you need to get out of the weeds in your practice area and see a bigger picture. But that's just me I guess.

[JMO]

Originally Posted by Chuck

If you think COBRA, Medicaid, or high risk pools are adequate solutions, then you probably have not had people you care about subjected to those solutions. Medicare is not any help if you are not old enough.

Been there, done that, with respect to my husband and myself on one item and with respect to may parents on another. But I haven't had the pleasure of dealing with high risk pools.

[Dr T Non-Fan]

Originally Posted by Chuck

If you think COBRA, Medicaid, or high risk pools are adequate solutions, then you probably have not had people you care about subjected to those solutions. Medicare is not any help if you are not old enough.

Solution: lower the age minimum for Medicare. This is easy, but it certainly will not be inexpensive.

[Interesting Post]

Originally Posted by Dr T Non-Fan

Solution: lower the age minimum for Medicare. This is easy, but it certainly will not be inexpensive.

Medicare for all. Problem solved.

I think we will go there if Obamacare fails.

[Rex Ryan]

Originally Posted by Chuck

If you think COBRA, Medicaid, or high risk pools are adequate solutions, then you probably have not had people you care about subjected to those solutions. Medicare is not any help if you are not old enough.

Maybe my ideas are naive and maybe you can come up with better ones - but I can recognize a basic problem and if those working in the practice area dismiss those problems as not even a priority or if they think there are already adequate solutions to those problems, then they'll all eventually go the way of the DB pension actuary. Sometimes you need to get out of the weeds in your practice area and see a bigger picture. But that's just me I guess.

Medicare can help some people who might not be old. Have you heard of ESRD? If you had ESRD, it might be hard for you find insurance.

If I lose my job, can I get another one? If so, according to HIPAA, my coverage is portable to my next employer.

Are you saying I can no longer work? Well then, maybe I need disability insurance. Or should the government pay for that too?

Anyway, I thought the OP proposed a solution which I found untenable. Furthermore, it is not THE big problem. I'm sure there are problems with worker's comp insurance, I would not presume to opine on them. I would not accuse worker's comp actuaries of having their heads in the weeds, I mean why else is worker's comp not covering people without workers comp. You mean a small employer with workers comp claims does not see any rate increases?

Last I checked, DB pension actuaries still have jobs, but that's just me. I guess they all had their heads in the weeds too. Not all of us can see the big picture like people in worker's comp.

[JMO]

Originally Posted by Dr T Non-Fan

Solution: lower the age minimum for Medicare. This is easy, but it certainly will not be inexpensive.

Just a reminder - Medicare doesn't cover everything. NTTAWWT