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Originally Posted by host
so I guess it should be ignored while we all wait for Jazz to "give us some insight"....
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host, you obviously are a very smart guy, but you're not an insurance expert. I don't think jorgelito meant any offense towards you when he mentioned me. Then again, maybe I've missed something somewhere and you and I can discuss hammer clauses and short-term nose endorsements. I'm always looking for someone to bounce ideas off of, and someone with your smarts would definitely be a big help to me on a few things.
Just like always, everyone here likes to lump all the blame in one place. Do the health insurance companies share in that blame? Sure. Are they the only ones? Of course not. I don't think they even get the majority of the blame.
We live in a capitalistic society. That's not going to change. There are a couple big problems that I see out there with healthcare and insurance. First, costs are rising. Second, many people cannot get insurance and are forced to self-insure their risk.
Second problem first: in a capitalistic society, you have to allow companies to manage their own risks, including insurance companies. That means that you can't force companies to do things they don't want to do without some sort of trade-off. Ask Florida property owners how making that mistake has been working out for them. The biggest problem here is that individuals and smaller groups actually produce more risk for insurance companies than larger ones. It's a little counterintuitive until you realize that accuaries can predict health care costs for large groups much more accurately than small groups and not at all for individuals. Someone who works for a large company is going to get cheaper insurance than someone who is self-employed, almost regardless of any pre-existing conditions. The risk is going to be factored into the premium charged to the large company from the very outset. There are also a number of things that a company can do to lower their premiums, like taking on some of the risk themselves. It's actually much more complicated than this, so let me know if you want more details. I'm trying to paint with as broad a brush as I can.
Currently, there's no good fix, but I know of several that are being proposed right now. I have a client who is a large benefits agency (health insurance falls under the benefits umbrella). They are current lobbying their state legislature to be allowed to set up what's called a "risk purchasing group" for the self-employed. Their goal is to get several thousand individuals, along with their families, into this pool to allow them to enjoy the benefits of group buying power. This is current illegal in most states (for some very good reasons, actually), but if they can demonstrate the controls that they want to put in place, it could turn into something very interesting.
In a capitalistic system, which again isn't going to change, some people are either going to not be able to afford the coverage or choose not to take it. And that leads me back to my first point, the costs.
There are a whole bunch of reasons why the costs are rising, but I don't think you can really blame the insurance carriers for that one. First, its in their (and your, as the insured) interest to keep costs as low as possible. After all, they will make more money if the costs are lower. Thats why they negotiate the cost of procedures up front with the doctors and hospitals that they work with. You can't even blame the doctors and hospitals since they've already contractually agreed to price things the same way, consistently for all customers of the health care insurer. The variable here are new technologies, which are typically very expensive to bring on line, drugs and the uninsured.
New technologies, especially hardware, are usually exponetially more expensive in medical applications than elsewhere because of the details, whether those be precision, cleanliness or a combination. That exactitude costs more to produce.
Personally, I think that if there's a bad guy it's the drug companies, although I have to admit even they have good reasons to do what they do. Drug companies are moving more and more towards developing long-term drugs rather than ones for short-term use. That means that there aren't nearly as many antibiotics being developed as cholesterol-lowering drugs. After all, you won't take antibiotics for the rest of your life... Another interesting thing to note - whenever you see a drug advertised, you can bet that it will be a long-term drug. You're going to want to pop a woody for the rest of your life, but clearing up that nasty cough is secondary.
The uninsured are the 1000 lb gorilla in the room. Honestly, they force everyone's prices up. In almost any other industry, they'd be ignored because they aren't anyone's customers nor are they necessarily desirable as customers (there are obvious exceptions). Everyone agrees that ignoring them is the wrong thing to do not only from a public health point of view but also from a humanitarian one. There's been talk of "forced placements" with health insurers, where the uninsured sign up with the state and are assigned an insurance company. There's a similar system in place for Workers Compensation insurance, but the fatal flaw here is that most of the uninsured can't afford the premiums for a number of reasons. First, employers typically absorb between 25% and 75% of the cost of the premium, depending on how their plan in set up. The employee contribution typically only pays a portion of the premium, especially if the employer has a large self insured retention and is gambling that there will be little erosion of it. The uninsured, who are mostly poor, can't afford the costs because their underwritten individually, and they are typically in mediocre health at best.
Its my professional opinion that a universal healthcare system will not happen in the US in the next 10 years. Beyond that, it's grows more possible the farther you get away from the present, but the system, as it exists now, is too powerful to overturn easily. It's much more probable that the uninsured will be covered by a quasi-government entity, although I have no idea how that would be funded.