Inaffordable? Unaffordable.

This whole issue has two problems:
1) The market is not a free market. There is little competition. It is riddled with mandates and regulation. Out of state companies cannot compete for my business. This is a major cause of high prices.

2) Ezra et al are unwilling to share any of the responsibility with the individual. It is *your* resposibility to make sure you are insured if you drive. The same responsibility should apply to health insurance. Instead, liberals want no personal responsibility in this issue.

If these two problems could be resolved (simultaneously), this would not be the issue it is today.

All pointless without community rating.

It is *your* resposibility to make sure you are insured if you drive.

Which is why part of my car insurance payment goes to protect me against an uninsured driver. It's great they you're supposed to get your own insurance, but lots of people simply don't.

Recognizing that we're not going to let the people who don't go entirely without care, it makes sense to pro-actively ensure that they are enrolled in some insurance program.

It is *your* resposibility to make sure you are insured if you drive. The same responsibility should apply to health insurance.

That little 'if', of course, is where Vajima's dumb analogy falls apart.

The information problem is true of individual insurance markets, but maybe not for group-based. It's probably naive to think that insurance companies haven't figured out how to profit off all but their sickest clients - after all, most of health care spending goes towards folks with chronic illness. So long as insurers can get in on that money, while passing their costs on to others (government, employers, doctors, et cetera) they actually need sick people in their plans. The steps Zirkelbach proposes are basically ways for insurers to tap into the money spent on sick people while passing the costs to someone else.

there are dauntingly hard battles ahead to fight.

i hope the righteous wind will be at our backs.
there has been so much greed,bad karma, mismanagement and corruption, it is overtaking our physical and spiritual health
and how we all care for one another.

the cry for change started at the lowest eshelons this time.....we came out in great numbers for change that we can believe in.
we did the work
with great trust
for the possibility of hope.
for better karma and a cleansing of the past.
we will make the sacrifices
if we are inspired by right action.
there is a sacred trust here.
i hope they hear us.
i hope they see us.
i hope they dont forget us.

Michael Moore's "Sicko" was all about people who DID HAVE insurance policies but couldn't get proper medical attention.

"Ezra et al are unwilling to share any of the responsibility with the individual. It is *your* resposibility to make sure you are insured if you drive. The same responsibility should apply to health insurance. Instead, liberals want no personal responsibility in this issue."

El V, you seem to have some kind of reading/learning difficulty, perhaps because the RNC is to focused on internal matters to send out the email to tell you what to think.

Ezra *supports* individual mandates to purchase insurance.

The talking point you want is "liberals will take away your choice whether or not to buy health insurance, it's a stealth tax making you give money to the health insurers". Something along those lines should pop in your email box late January/early February, if you don't feel confident riffing on that theme without a cheat sheet.

HTH.

Great post and good observations. I agree that the know needs to be cut from both sides. The real key here...as you mentioned...is that the insurance industry stepped forward with this offer at all. Clearly indicates they expect something to happen and they want a voice. This is a positive step.

Thanks for some thoughtful analysis about insurance that goes beyond the well-known and obvious. It is maybe too easy to demonize insurance companies, who manage to be frustrating and wrongheaded even for those with good insurance.

(Pity that ElViajero doesn't recognize the obvious: unregulated insurance, for exactly the reasons Ezra lays out, would have a WORSE outcome than the present, because the game would tilt more towards companies denying insurance to the risky. Interstate competition is an irrelevant canard floated by McCain at his most clueless. I see no reason it would change the national healthcare equation, which is currently under discussion, though it might let some people in states with solid regulation buy shoddy policies from fly-by-night insurers and be even more disappointed. Besides, letting credit card companies flee to states with no usury laws has worked out SO well, right?).

Without community rating, this is going to make the Medicare drug benefit look like the wisest, most frugal legislation ever.

Does anyone have good experience with how well mandates actually work? They must be part of some state programs, and other countries, but I have trouble imagining how they could be effective.

The issues of undocumented aliens, people who don't get paychecks, the self-employed, children, travellers from other countries, etc. all seem to make mandates hard to manage and enforce. It is easy to corner people who file tax returns, but the number who don't is pretty large. The efficiency and simplicity of single-payer systems funded by general tax revenues would put aside just about all of those concerns.

That is why the fight with the insurance companies is important. Any system that includes them cannot work as well as those that make them unnecessary. By "as well" I mean cannot cover as many people, cannot provide preventative and early illness care as reliably, and would be less effective at controlling costs.

i'd prefer to just put them on the menu to be complete honest

Does El Viajero not know that the reason most people have automobile liability insurance is not necessarily because they act responsibly but because the law requires that they have it?

"It is *your* resposibility to make sure you are insured if you *WANT TO LIVE."

Fixt.

...the reason most people have automobile liability insurance is not necessarily because they act responsibly but because the law requires that they have it?

Exactly!

Each year you must show proof of health insurance when you file your taxes *or* pay a hefty fine also to be collected by the IRS.

The reaction to my suggestion has been interesting. Only the issue about personal responsibility got attacked. Oh, yeah, there were all kinds of reasons why no one has to be responsible.

The simple fact that the crowd zeroed in on that one part is telling. Libs want a nanny-state.

Yeah, EV, revel in the fact that the core of your argument "personal responsibilty" as a substitute for legal mandates, got demolished. But note also that I pointed out that in car insurance, mandates exist and are clearly necessary. Actually both your foolish points got demolished. Congratulations.

See...this is what you get from 'New York'.

What a cesspool.

David Dewhurst, the lieutenant governor of Texas, where I live, said just recently that the economy in Texas is strong....that the state has a surplus of money....that the housing crisis has hardly touched us....and to prepare for the horde of rats running to Texas from other states....like New York. Texas has no income tax.

In fact, all of the states in real trouble are the ones that are heavily Democratic and have been saddled with heavy taxes, heavy regulation and unions.

Good Luck to "David in New York".

THE ONLY REASON THIS IS HAPPENING, THIS GOVERNMENT ENFORCED INSURANCE, IS TO GAIN CONTROL OF EVERY PERSON IN THE UNITED STATES. FIRST THEY FORCE YOU TO BECOME COVERED, THEN THEY CAN REQUIRE ANY TEST, PROCEDURE, VACCINATION, ETC THEY WANT! IF STUPID AMERICANS DON'T WAKE UP AND SEE THE NWO FORMING ALL AROUND THEM, THEN THEY DESERVE WHAT IS GOING TO HAPPEN TO THEM! WORLD GOVERNMENT IS COMING, AND THIS INSURANCE PLAN IS ONLY DESIGNED TO CULL THE MASSES! IF THERE IS A ROCKEFELLER SUPPORTING AND PUSHING THIS, YOU BETTER KNOW IT IS NEVER FOR THE GOOD OF MANKIND!

unregulated insurance, for exactly the reasons Ezra lays out, would have a WORSE outcome than the present, because the game would tilt more towards companies denying insurance to the risky.
No, no, you're not thinking outside the box. Don't deny *insurance* to the risky - just insure them and then deny their claims.

What, you don't want to be hit with lawsuits for bad-faith claim denial? Well, first of all, you lobby to get that written out of the law. Nobody likes a trial lawyer!

Second, if that doesn't work, you hide fine print in the risky people's contracts that excludes the things they're at risk for. Some of them will notice and not buy your insurance, but the rest are pure gold. By the time they realize how screwed they are, you've already made your profit.

With mandates this gets even better: even the people who *know* you're not covering their needs *have to buy from someone anyway*, and it might be you.

Of course, there are many points of disagreement on healthcare reform and numerous difficult decisions and compromises to be hammered out. But there’s also widespread agreement on at least two critical reform requirements.

-- Electronic health records (EHR). Bringing together the major medical systems has been a priority of current HHS Secretary Michael Leavitt, and will likely be backed by his probable successor Tom Daschle. EHR adoption is still low, so the opportunity is real and big.
-- Evidence-based medicine. Stakeholders agree that all efforts and systems should be based on sound medical science and published literature. The new systems need to assure and deliver quality, consistent care, incorporating the best diagnostic and quality care guidelines. These guidelines need to be available at the patient’s bedside as well as throughout payer and provider organizations.

These two concepts give us a starting point for the emerging health reform compromise. I'm looking forward to seeing more points of agreement emerge as the reform conversation gains volume.

Possibilities? www.healthcaretownhall.com

"See...this is what you get from 'New York'."

We'll take you're going off the subject as an admission you were wrong.

Ezra, you often have good analyses of health care and health insurance. This is not one of them. You either still don't understand how private insurance works in relation to risk, or you keep forgetting the big picture in the rush to villify insurers that, despite your own warnings, you keep falling into.

Bottom line: Health insurers require risk to exist. Without risk, no one needs to buy their products. Not only do they depend on risk, but they depend on medical expenses to exist. It is medical expenses that drive premiums far more than anything else. If we had 1/10 of the medical costs, we would have 1/10 of the premiums.

Health insurer profit margins have a long-term average in the 3-5% range. This is not a high profit industry, and never has been. It is NOT like big Pharma in this respect, though everyone seems to think so.

You rightly remind people that insurers avoid risk in situations where they can't predict the risk but the one getting insured knows it and chooses to buy insurance accordingly. I agree with you that we need a system that removes this problem, but you write as though this describes our entire insurance system. It's not even 25% of our private insurance system.

The vast majority is commercial group insurance, and the majority of that isn't insured by the insurance company. Why ignore group coverage and self-insured corporations, where a very different attitude towards risk applies? Health plans in those cases don't want to avoid risk. In the first case, they want to accurately assess it and price accordingly, and are happy to take on a client with a lot of sick members if they can experience rate it. In the second case, the only incentive they have in relation to risk is to manage it if disease management and other services are purchased by the employer. If a claim is denied, blame the employer who set the rules. The "insurer" would be happy to follow rules as permissive as the self-insuring employer wants.

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