Monday, May 18, 2009

Evolution in Health Care Continued

First off, I am just about done reading that book that I posted on a current reading recently. Some of it does make a lot of sense to me but in the grand scheme of things I really can't get all that excited about the single payer system. In a lot of ways, it is, like Red has said in the past, a government health insurance plan and I'm just not sure I can jump on board that train.

That being said, I have done some other research about the health care debate. Some of which I posted on the previous post entitled The Uninsured. Here are some other thoughts I have come up with during the little bit of research I have done. Keep in mind that this research is ongoing and I may come up with some other ideas as time progresses.

As I see it, here are some of the "key elements" in getting everyone covered (everyone that wants to be that is):

1. Employer Mandates
I think we should make some sort of a requirement for all large companies to offer their employees some sort of health insurance. This would not be a big deal because at present time 62% of our people get their coverage through their employer (according to the EBRI Issue Brief No. 310 October 2007).

2. Subsidies to make coverage more affordable
This would cover the small to mid-size employers to assist them in giving them the option to offer coverage to their employees. According to the same previous study, 94% of companies with 50-199 employees offer coverage, 83% of firms with 25-49 employees offer coverage, of the firms with 10-24 employees, 76% offer coverage to their employees.

Point being, okay maybe a mandate or requirement might not be necessary but if coupled along with subsidies for the smaller companies, it would certainly be a step in the right direction (IMHO).

3. Medicare/Medicaid Expansion
Ok, this doesn't sound all that great when you first hear it but hear me out first.
I think the eligibility requirements for Medicare and Medicaid could be less restrictive. I honestly think that by expanding these programs to cover more of those citizens that want coverage but can not afford it, we can reduce the number of the uninsured by a huge margin. (As stated in the previous post, over 50% of those that are uninsured are not eligible for these programs but too poor to pay for it themselves).

4. Regulation of the Insurance Industry / Insurance Reform
Yeah I know, regulation of industry is considered a bad thing. Sorry conservatives, I am okay with a little regulation of big business.
I think the industry should be regulated so that they don't do things like deny coverage (or make the premiums astronomical) based on a previous illness or deny coverage (or, again, price the premiums so high nobody can afford them) based on a person's credit rating.

These are my thoughts based on what I have read thus far but in keeping with the title of the post, keep in mind that I may come up with more thoughts on it at a later time as my research progresses.


  1. Another good post for discussion.
    1. Requiring most employers to provide insurance is really a tough one. Most of the large employers are self insured, thus free from state regulation or legislation. That one will have to be dealt with on a federal level. It is interesting that the private insurers are starting to talk about providing coverage to all if all will be purchasing insurance.

    Your 4th point of regulation. In most states, insurance companies that sell Medicaid Parts A & B are regulated by the states. Most people do not know this. I am in favor of free markets, but the insurance companies are acting like the AIG's of the world, no transparency and accountability. So I say to the insurance companies, start acting like good business partners or feel the rath of America's voters. They are getting very pissed off.

  2. Right. Federal level that is what I think needs to happen in order to make a requirement for employers to offer coverage.

  3. I don't think that you will need too much of a hammer for the feds to get this done. I think that the insurance industry will push this very hard to compromise being put out of business by a public health plan.

    What will be interesting is that the normal partners against gov't insurance, business and insurance carriers, will be at odds on this idea.

  4. Okay... let's say you mandate that "everyone" (I assume that means 20 million illegals too) has health insurance.

    Now, is this "full coverage" or partial coverage or barely any coverage?

    If it's full coverage with no co-pay or cost for any illness or treatment...

    Then you must require that everyone see the doctor regularly whether they are ill or not as the Obama plan does...

    If they smoke they are kicked out, if they eat unhealthy foods or live a "unhealthy lifestyle" and are overweight are they kicked out too?

    Slippery slope daddy-oh...

  5. Suddenly you end up with the same number of people without coverage and the rest are sitting in line waiting to see the doctor while he is looking at someone who isn't even sick....

  6. I do like the idea of providing tax incentives to companies who provide insurance to employees and support the idea of buying insurance across state lines which would reduce costs dramatically in some cases.

    Good post otter!

  7. It has taken us nearly 50 years to get into this health care mess and it will take a little bit to get us out.

    The insurance industry has been a partner in this mess along with consumers and the fed gov't handling of Medicaid/Medicare.

    The insurance industry for the first time see their future on the horizon as either insignificant/extinct or as a viable partner. I think that the American people are tired and upset about the treatment of the insurance companies. At the same time, we better understand all the problems that will come with a public insurance plan.

    I personally do not want Universal Health Care. It will lead to rationing because of the price fixing that it will bring.

    But the insurance industry needs to become more flexiable and willing to work with policy holders. Currently, they are not held accountable for their actions.

    Similar to AIG and the Wall Street Banks, they will lead the end of their existence if they do not improve how they operate.

    Their latest proposal of offering coverage for all if all buys into the program is really a mandated purchase initated by the insurance company. I do not believe that will resolve any problems either. There is no motivation to provide quality services but just provide something.

  8. Red:
    First of all, thanks for the kudos.

    Remeber these are the thoughts of someone who is just now starting to try and really dig into this problem. I am not a health care expert by any stretch of the imagination but I am trying to understand and make some sense of it all and perhaps come up with some sort of idea to fix the situation.

    So anyway..on your first point......when I am taking about mandating everyone, I made it specific to larger companies for a reason. It is not reasonable or logical to tell EVERYONE that they MUST have coverage or that they MUST go see a doctor whether they are sick or not. If that is part of the Obama plan, that doesn't surprise me because the guy becomes more a moron the more I hear about his ideas.

    Also, the reform I am talking about I (personally) would not include illegals in the system. If you are not in the country legally, you have no rights as an American citizen, and health care would fit in that category. No citizenship, no health care. Sorry.

    As far as what type of coverage it is, I would say it would be the same type of coverage that, for instance, my company offers. Whether or not that is considered full or partial I can't say. I would say it is pretty comprehensive.

    I would also not put any provisions in there about kicking out those with an unhealth lifestyle. There has to be some personal accountability between the provider and the participant at this point. Doctors need to go back to the days when they tried to get their patients to (for example) quit smoking or quit eating crap all the time instead of telling them do what you want and medicating the hell out of them all that time.

    I agree. I think that most insurance companies would certainly favor a program such as this over a single payer or a government-run system.

    I know for one company, the one I work with (oh by the way, I work for a health insurance company), does not want a single payer system or a public health plan. Keep in mind, however, the company I work for is a bit different than most of the insurance industry in that they while they are private, they are not a for-profit carrier. They are, strangely enough, a private, non-profit insurance carrier.