In the current system, insurance companies add negative value, which is to say, they make health care worse, not better.

Bingo.

Now all we need is a Congressional delegation not beholden to insurance industry campaign contributions ...

Ideally people would buy a term health insurance policy with an annuity for their child while the child is still in the womb. This would be to avoid the problem of an expensive congenital condition and the annuity would provide sufficient funds to pay for latter in life medical expenses that are likely to come for most people.

Further IMHO no matter what the insurance companies do with IT they still need more help from the insured than they currently get with low deductible and low co-pay policies? So we need higher deductibles and higher copays.

Let me add to my post otherwise a system like in Great Britain would be good. With a NHS plus paid for care.

"That's why we pay insurance premiums so we can one day get chemotherapy, rather than simply paying for chemotherapy."

Your upper middle class perspective is growing tiresome. Most of us will never know if we have cancer or not, will never have chemotherapy, and will die at home in our old age, never having taxed the system.

Now get your presumptuous sense of personal privilege off my back.

*YOU* pay for it.

By the time government contrived an artificial market that simultaneously outlaws negative economic incentives which cause private insurers to provide less for more, and creates new incentives to hopefully make them do the opposite, it would be a Rube Goldberg market.

But instead of serving the comic narrative of landing a cartoon safe on Tom instead of Jerry, this Rube Goldberg health contraption serves the political-economic narrative of free markets and private industry.

Only the safe is breast cancer landing on your sister. Not funny.

It would be far simpler to just let government provide the health insurance itself.

With respect to point 3, it seems that insurance companies need to profit more from ensuring a healthy person than a sick person so they have an incentive to keep their insured healthy...

hmmmm...

Your upper middle class perspective is growing tiresome. Most of us will never know if we have cancer or not, will never have chemotherapy, and will die at home in our old age, never having taxed the system.

Oh, trust me, you're taxing the system. It's you're own delusional self-image and sense of entitlement that allows you to believe something so absurd.

You're also taxing the patience of people who like to approach the world rationally. That's one tax I would definitely like to see cut, but I doubt it'll happen soon.

Ezra,

Very, very much agreed.

I'd just point out that the electronic medical record is not a good example of the negative incentives for insurers. If you look at the 100 or so RHIOs in the US, many of them have participation and funding (in some cases) from local insurers. The problem with EMRs has been physician resistance for the most part. In highly simplified terms, physicians take on the costs of implementation (even with a free system), where as insurers are the ones most able to benefit economically. Insurers have been fairly receptive to EMRs, its the docs that have been resistant.

It would be far simpler to just let government provide the health insurance itself.

You hit on a good point, AAtos. Is the headache of trying to set up this market worth the presumed benefits of using the free market in finding efficient ways to deliver care? I'm not sure.

Almost the only way to remove the disincentives that insurance companies have for good health and overarching need to maximize profits is through a single payer system. Having experienced these systems in Panama, France, England, and Sweden it is much preferable to the existing "profit care".

Ezra,

You appear to make a living at this blogging thing, and a good portion of your blogging is about healthcare. At any point do you ever intend to learn what your talking about before you post foolish ideas like this?

“they make health care worse,”

Insurers don’t provide healthcare, they have minimal to no impact on the quality of the care. What a perfect example of not seeing the forest for the trees. There are 1 million and 1 changes to care delivery from providers that would immediately and directly improve care and you propose attacking insurers. Medical Records, electronic scripts, Nurse practitioners, more GPs just to name a few would save billions of dollars and 10,000s of lives, but you want to change insurers. That’s political cowardice, evil HMOs are a popular target, telling the family physician he needs to drop the pen, shell out $500 and write e-scripts doesn’t get you patted on the back, but would save thousands of lives and billions, but that’s not your real goal.

“They are very innovative in their attempts to do this. But there's nothing good about those attempts.”

That argument is easily refuted by anyone that knows the system and has passed a HS economics class. You even partially refute it your self with you universal demands. I don’t smoke, rarely drink, and am not obese. I take better care of myself then other individuals and thus have lower expected healthcare needs. I expect to pay less in insurance premium then someone who does smoke, drinks every day and is obese because I am less of a risk. So if the fat smoker lies on his insurance application to get cheaper rates that adversely effects my rates. Any actuary in the business would tell you enforcing your underwriting guidelines is not only a good idea but a necessity to stay in business. Only a progressive would allow clients to pick their own rate regardless of risk and expect that to work out in the end.

“Indeed, their inattention to actual care is startling.”

You must find the inattention your mechanic shows to your homes plumbing startling? Are you shocked when the pizza delivery guy doesn’t bring your laundry? Why would you expect or even want your insurance company worrying about your care? That is the job of your doctor and yourself. Insurers assume risk Doctors provide care, if you don’t understand that fundamental principal of our current system your beyond help.

“America, for all its technological advancement, has among the lowest adoption of cost-saving, care-improving, electronic records in the world. That is the fault, in part, of our insurers.”

Find one example to back this up! Insurers are pushing E Records. Far from your claim of them impeding them if it wasn’t for Insurers like Kaiser you wouldn’t even know what an electronic record is. Providers and only providers are standing between Americans and Electronic Records. Perfect example being Prescriptions, Insurers have totally automated their end, providers refuse to do their part.

“Not only is it near impossible to insure them at a profit”

Another example of you making stuff up because you think it should be true with no proof to back it up. Managed diabetes is minimal risk. If you actually knew how insurance worked you wouldn’t make stupid claims like this. http://care.diabetesjournals.org/cgi/content/full/26/3/917 says people with diabetes had medical expenditures that were 2.4 times higher than expenditures that would be incurred by the same group in the absence of diabetes. Someone with managed diabetes that is taking care of themselves would barely be more expensive then a person without diabetes. If stated accurately your claim would be “it’s near impossible to make a profit insuring someone that doesn’t take care of themselves and incurs needless expenses.” What a crazy idea, someone that doesn’t take care of themselves is a greater risk and should pay more for insurance. When you make the claim accurately it doesn’t sound nearly as bad does it?

“It is actually counterproductive for insurers to compete on giving us the best care”

You want our insurers to compete on giving the best care and don’t even mention the providers who actually care for us competing based on care. Perfect logic. I wish my auto insurer competed on the quality of the repair job the body shop does instead of you know the cost of the insurance I am paying them for. Maybe if schools would compete more on the quality of the lunches they serve our kids would get a better education?

“It's what we call an insurance death spiral, and it ends with the collapse of the insurer.”

I would assume over the past 40 years of insurance companies suffering these “death Spirals” you could cite a few good examples for us? Maybe even one recent example? We’ll move on while we wait.

“1. Universality: Insurers cannot compete effectively unless everyone is in the pool.”

Um, care to explain the last 40 years? Seems they competed very effectively for 25 years until governments started regulating them out of insurance. In fact the only ineffective plans are those that are universal in nature. Medicare, VA, Medicaid for example.

“Community Rating:, …They offer insurance to anyone who wants it for the exact same price.”

Your free to believe this just the same as everyone that has common since is free to laugh at you. Please make this a cornerstone of any progressive plan, the under 40 and mildly healthy will love the idea of paying the same rate as a chain smoking obese 63 year old. Cost of insurance is supposed to be a force for people to take better care of themselves. If you don’t want high premium don’t smoke, exercise and eat reasonably. Take the motivation away and why bother. People that actually know insurance learn this like the second week in the business. Wonks, Politicians, and Academics apparently never do. You would think after the disastrous welfare programs your ilk created 60 years ago you would know better then to trust the publics altruistic and logical behavior. Why not expand this logic to car insurance, it’s only fair the healthy 18 year old that just got his license pays the same as the 40 year old with a clean record. Why should the value of your home and belongings increase your cost to insure them? How dare we charge an 8o year old more for Life Insurance then a 20 year old, the 80 year old obviously needs it more. Community rating for all I can picture Obama promising it now. When you community rate the steak house down the street you’ll get my support.

“Risk Adjustment:”

Brilliant idea we should call it something easier to understand though, like “pooling”. Oops that’s already being used? Oh insurance companies have been doing that for a couple hundred years already? The irony of your idea is “risk adjustment” was practiced thoroughly in the self-funded market to allow small employers to cede off risk and manage their liability. Politicians not liking employers self-funding because they weren’t under state controlled and didn’t pay premium tax passed laws limiting their ability to do this. In your quest for reform you will most likely need to repeal these onerous laws which helped create the problem your trying to solve. I can’t help but ask why not just get rid of the rotten laws that caused the problem in the first place?

“Information Transparency…price, outcomes”

Again Insurers don’t have outcomes Hospitals and Providers do. Are you really claiming people don’t have the ability at this time to know the cost of their insurance and other available plans? Most states have so regulated insurance that carriers hand out rate sheets and you check a box. Short of printing the rates in transparent ink and transparent paper they can’t get anymore so.

“One Market: This is contained in the last point, but there needs to be a singular place, or set of them, where individuals can shop around for insurance.”

Sorry but I can’t help but mock your ignorance. What to call this one place where you can shop around for insurance…and what if there was an “expert” there that knew a whole lot about insurance and could answer your questions? What exactly do you consider insurance brokers?

“It's not impossible to imagine a scenario in which insurers actually compete to offer better service, in which the marketplace really does work to the consumer's benefit.”

It’s called employer sponsored plans, self-funding, CDHC and has been around for years, what is impossible to imagine is the lengths Politicians and wonks have gone to destroy these plans with their high consumer satisfaction and efficient delivery of care. The level of lying and distortion individuals such as yourself are willing to engage in to further your political ideals is sickening.

15% of Americans are uninsured!!!

But only 3% don’t already have access to government provided care or make under 75K.

Healthcare Inflation is skyrocketing get rid of the insurers!!!!!

Utilization is driving the skyrocketing cost and eliminating the insurers won’t even address this.

Insurance companies suck away 25% of the dollars spent on insurance!!!!!

Insurance carrier profits run around 6%, less then what they pay in taxes and compliance with government regulation.

Medicare is more efficient then private insurers!!!!

If you ignore the 10% fraud rate, don’t adjust for per capita claims being almost twice those of private insurance, and leave out the cost of CMS and congressional staff

Just like Hillary’s lies and distortions saw the light of day so will all your latest “reform” ideas. You make such terrible arguments, so easily refuted by basic facts, you won’t be able to stand up to the slightest questioning. If you can’t even get the roles of providers and insurers right who’s going to take a chance on believing any of your other assumptions? You really defeat yourself when it comes to grand initiatives like this. You make so many bone headed mistakes any legitimate ideas are tainted and dismissed.

If you really cared about reforming the system you would start with the items that would have the largest, most immediate, and noticeable effects. After proving yourself and validating your concepts you would then push for some of the more confrontational concepts.

Next year require all providers to write scripts electronically, would save billions and thousands of lives. Follow that with a central clearing point for drugs, when a Dr prescribes something they would see/be warned about all your other active Rxs. This would limit adverse reactions and also greatly reduce medicine shopping and abuse.

Public schools for Drs and Nurses. It shouldn’t cost half as much as we spend to train a Dr and nurse. Drs can work off a portion of their loans working in public health clinics for a few years. If we want everyone to have a mammogram and prostate exam only an idiot would insure it, there is no risk to transfer if your going to have it every year. Public Health clinics should provide them free to everyone, including paps, immunizations and other routine care, great chance to humble the providers and teach them some bedside manners as well. Nurses could spend a few years working in our public schools.

The federal reserve clears most ACHs between banks, for this they charge hundredths of a penny per transaction. In healthcare the charge to receive an EDI claim by a payor in the provider centric system Medicare created is $0.40-$0.50 per claim. The differences between the two transactions are the bytes of data per transaction and one system is voluntary while the other almost mandatory. The Fed should issue every provider an ID, this is already being started, and every payor an idea as well. All Claims will be submitted through the new federal system at minimal to no cost. This will save 100s of millions if not more in postage paper and labor. Being that I am neither a wonk like Ezra or a progressive I can see two or more steps head to where the real benefits come in. From a public health perspective the government will have unlimited data to work with after scrubbing away names and identifiable information. The ability to spot pandemics and clusters of illness from industrial or other sources would be unparalleled. Taking it even further by processing the payments back to the providers they can track actual outlays to the most defined detail. Fraud could be detected at the macro level. Tax collection would be more accurate when the government is clearing all your payments.

Issue guidelines for required procedures, if a provider follows the guidelines they are immune from malpractice suits. We need to agree on what level of care should be expected from providers. We can’t hold them responsible for being human and need to get rid of those that suck. Firm guidelines would save billions of dollars and thousands of lives.

That is what real reform looks like. Precise, measurable, and attainable changes that immediately save billions of dollars and thousands of lives. Unlike Progressive packages that consist of “give us control over trillions of dollars and we promise things will be better.”

Let's add risk equalization to the essential reforms needed. I linked to a story this a.m. from Ireland about an EU court that upheld a decision against a private insurer complaining about risk equalization. The court said it was a valid principle.
Risk equalization, which is part of the regulatory landscape across Europe, says that insurance companies that have an excess of young, healthy subscribers must transfer funds to companies that cover more old, sick people. It's brilliant, effectively removing the incentive to compete by cherry picking.
Whether you have a single-payer system or not, you need adequate regulations on the insurance market to ensure that it is operating to enhance, rather than negatively effect, the common good.

You don't need #1, #2, OR #3 if insurance is properly underwritten and priced.

If you underwrite well and price at expected cost + margin, there's no cherry-picking problem.

So let insurers price at expected cost + margin, and if the premium exceeds 20% of income, the government pays the excess. It would be far simpler and far more enforceable.

Hello; I have a legal international question I am hoping that you can provide some insight on. If not perhaps you know a anti-smoking tobacco lawyer, articling student or a emeritus that could offer some encouraging advice for me. I am looking for a possible means to launch a class action lawsuit against the Canadian Federal and Provincial governments. Why has the Federal government failed to put in place an Implementation Act to enact within Canada the WHO-FCTC Treaty for all Canadians affected.

The question I would like to get answered is on the World Health Organization Framework Convention on Tobacco Control Text (WHO-FCTC) ( www.fctc.org/docs/treaty/fctc_en.pdf ). Part V1: Questions Related To Liability, Article 19:1. This states in part "including compensation where appropriate" would this include redress to the tobacco farming community and by whom? Under 19:2.b would "pertinent jurisprudence" include the civil rights of the tobacco farming community for redress for the affect of high draconian tobacco taxation spawning a tremendously profitable illicit trade which is against Part 1V: Article 15 (3). This also undermines Article 16: Sales to and by minors. Why has the government(s) created a new bankable profit source for the tobacco manufactures. Should the governments not be liable for their actions and inactions for manufacturing the access of a whole new generation of children smoking. A new generation of smokers now have access to historically very low priced cigarettes. Sold for/at their convenience everywhere cannot be to overstated, even delivered to your front door. This is not factored into the Canadian governments youth smoking rate drop statistics data released in the press. An estimated 30 million pounds of raw tobacco can not possibly be supplied out the back door by Canadian tobacco farmers, but by the manufacturers. Also why would an attorney not hold the government(s) responsible when someone gets injured or killed during the thief of tobacco products, are they not culpable by the high tobacco taxes they cherish.
Article 19:3. "afford one another assistance in legal proceedings relating to civil and criminal liability". Does this mean that a civilian can ask the WHO-FCTC to help out with legal advice and financial assistance with class action litigation.

I have rambled on and made more that one statement and asked more than one question that I need answers for. Again I am hopeful you can help me in some capacity for the time being.

Kind Regards,

John E. Cowan,

1202 HWY. 24 E, R. R. # 1 Vittoria,

Ontario, Canada N0E 1W0

Ph: 519-426-4803

fax: 519-426-4174

jjcowan@kwic.com

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FYI: www.tobaccofarmersincrisis.org

FYI: www.joeprestonmp.ca/EN/3634/47486

Bonjour; j'ai une question internationale juridique j'espère que vous pouvez fournir un peu de pénétration sur. Si pas peut-être vous connaissez un avocat de tabac antifumant, articling l'étudiant ou un honoraire qui pourrait offrir un conseil encourageant pour moi. Je cherche un moyen possible de lancer un procès d'action de classe contre les gouvernements canadiens Fédéraux et de Province. Pourquoi a le gouvernement Fédéral a manqué de mettre un acte d'Implémentation en place pour statuer dans le Canada QUI-FCTC le Traité pour tous les Canadiens a affecté.

La question à laquelle je voudrais être répondu est sur la Convention de Cadre d'Organisation Mondiale de la Santé sur le Texte de Contrôle de Tabac (QUI-FCTC) (www.fctc.org/docs/treaty/fctc_en.pdf). La Partie V1 : les Questions Liées à la Responsabilité, l'Article 19:1. Cela expose dans la partie "en incluant la compensation où approprié" inclurait-il la réparation à la communauté d'agriculture de tabac et par qui ? Sous 19:2.b "la jurisprudence appropriée" incluent les droits civils de la communauté d'agriculture de tabac pour la réparation pour l'affec de la haute taxation de tabac draconienne engendrant un commerce illicite extrêmement profitable qui est contre la Partie 1V : Article 15 (3). Cela sape aussi l'Article 16 : les Ventes à et par les mineurs. Pourquoi a le gouvernement (s) a créé une nouvelle source de profit escomptable pour les fabrications de tabac. Si les gouvernements pas être responsable pour leurs actions et inactions pour fabriquer l'approche d'une nouvelle génération entière de tabagisme d'enfants. Une nouvelle génération de fumeurs a maintenant l'approche à historiquement très bas priced les cigarettes. Vendu pour/à leur avantage partout ne peut pas être à exagéré, même livré à votre porte d'entrée. Ce n'est pas mis en facteurs dans le jeune de gouvernements canadien fumant des données de statistique de goutte de taux libérées dans la presse. Environ 30 millions de livres de tabac brut ne peuvent pas peut-être être fournis de la porte arrière par les fermiers de tabac canadiens, mais par les fabricants. Aussi pourquoi un avocat pas tenir le gouvernement (s) responsable quand quelqu'un est blessé ou a tué pendant le voleur de tobacco les produits, sont ils non coupable par les hautes taxes de tabac qu'ils caressent.
Article 19:3. "permettez l'un l'autre l'assistance dans les poursuites judiciaires vous rapportant à la responsabilité civile et criminelle". Fait cela signifie qu'un civil peut demander QUI-FCTC de tirer d'embarras avec le conseil juridique et l'assistance financière avec les litiges d'action de classe.

Je me suis baladé sur et ai fait plus qu'une déclaration et ai posé plus qu'une question pour laquelle j'ai besoin des réponses. De nouveau j'espère que vous pouvez m'aider dans un peu de capacité en ce moment.

Égards Gentils,

John E. Cowan,

1202 HWY. 24 E, R. R. * 1 Vittoria,

Ontario, N0E du Canada 1W0

Ph : 519-426-4803

fax : 519-426-4174

jjcowan@kwic.com

Remarquez : Ce courrier électronique contient des renseignements donnés le privilège et confidentiels. Si vous n'êtes pas le destinataire voulu, ou la personne responsable de le livrer au destinataire, vous devez savoir que n'importe quelle révision, divulgation, distribution ou duplication de ce message sont interdits. Si vous avez reçu ce message par erreur, notifiez s'il vous plaît l'expéditeur selon le fax de retour et détruisez ce message sans le lire ou copier ou n'importe quels attachements.

Hey Nate, your comment is wonderful except that you really don't understand how chronic disease works.

Sure smoking causes lung cancer but what about all the people who smoke and remain healthy? Obesity is tied to diabetes but some diabetics are as skinny as you, presumably, are. Its in your genes.

You just haven't discovered what your chronic disease is. When you do I am willing to bet that you will want to be able to purchase comprehensive health insurance at a reasonable cost. the problem is that you won't be able to do so because all the healthy young studs will buy cheap plans and only sick old geezers like you want comprehensive insurance. It will be too expensive.

If you'd like to see real economics applied to this topic review http://wonksanonymous.com/2008/02/04/what-type-of-health-insurance-do-you-want.aspx.

Much as I might like to see you in this situation it will also happen to the rest of us.

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