SUCKISSTAPLES said:vampyr said:
I've no solutions- this is just a warning so that you know what individual health insurance, in fact, is (and isn't). These health plans are insurance plans for when you're healthy, and that's it.

Ive never heard of this "death spiral" before, but it makes perfect sense. Green for you, OP.

Might one suggestion /solution for people buying their own, is to form their own business and get their OWN business health coverage? I think some insurers accept companies with as few as 2 employees.

Small business group coverage isn't really a solution because the premium directly corresponds to the health and the claims activity of the group members. If the two group members are healthy, then they can get a very low rate- otherwise, it'll be impossibly high. The reason why many small businesses don't offer health insurance is that they simply don't have a sustainable mixture of healthy and unhealthy members which leads to affordable rates.

Traditional large-employer group plans economically work because, due the size of the group, the vast majority of employees have no health problems; only a small minority do. This allows risk to be effectively spread, lowering the per-capita costs. Generally, the larger the group, the lower costs, with some variation for business type. (E.g., a company of oil field workers will have more longterm health problems than an architecture company.)

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I believe the single-payer model is not the solution for the USA. People should have an incentive to stay healthy and to use the medical system only when it's reasonable (not for every sniffle). In addition, the efficiencies and cost-savings of the private market (for-profit) are better in the long run. This is a big topic.. but briefly.. we should have a federalized system with perhaps three types of universal plans. Private insurance companies will sell and administer the plans- this will keep a natural check on fraud. Everyone will be required to have health insurance; the "poor" will get it subsidized by taxes, perhaps on junk food. The system will be fully transportable and no longer tied to a state or to an employer. I think the HSA model (consumer-driven) is the way to go- those who do not exhaust their HSA money get a part of it back at the end of the year.

Here are some problems that would be solved:
1. Health insurance is no longer tied to a job or to a state. Many people are "stuck" in a job because of the health insurance issue. This is bad for our economy, as many people are afraid to take risks- such as starting a business.

2. Everyone can get health insurance, regardless medical status. But everyone who has income must "pay" into it as well. No more monied freeloaders, either. "Risk" is truly spread across everyone in the country.

3. The endlessly complex and expensive state-by-state rules all go away.

4. Consumer-driven HSA-model encourages people to guard their health, shop by price, and use the system more moderately. New rules requiring 100% transparency for medical fees and costs must be instituted. Information technology is crying out to help in this area!

5. Partial funding by taxes from "bad" foods will help subsidize the system and discourage their consumption. Think of this is a new sin-tax against obesity; at least it's a start.

6. Further legal reforms. Medical malpractice needs to be replaced by an arbitration system.


Of course.. making all this happen with the zillions of special interests that exist.. it almost sounds impossible.

vampyr said:Here are some problems that would be solved:
5. Partial funding by taxes from "bad" foods will help subsidize the system and discourage their consumption. Think of this is a new sin-tax against obesity; at least it's a start.So in addition to taxes on cigarettes and alcohol, there should be "sin taxes" on butter, lard, stick margarine (trans fats), cookies, pie, cakes, candy, fried foods.... Think the voters would go for it?

Hope this isn’t too off-topic, but to me it seems relevant.

Regarding Canada’s healthcare system...based on the very recent experience of two close relatives living in Canada, and with all due respect, the Canadian healthcare systems is not all it’s cracked up to be. It’s not a panacea for our own health care problems. My poor uncle and cousin had to wait too long for major surgical procedures. This prolonged their hospital stays considerably and endangered their lives. And their follow up care was not up to our own American standards. The Canadian system too often provides less than acceptable medical care. Granted, it’s considered “free” (which of course it’s definitely NOT) but too often lifesaving procedures are incorrectly prioritized and/or dangerously delayed for one reason or another.

Yes...my opinions are based on anecdotal evidence. So what. After hearing similar stories from quite a few Canadian relatives and friends a picture begins to develop. I’ve been told by a teaching physician (whom I have good reason to respect) that the Israeli healthcare system is the only good example of socialized medicine. However, I have no idea how accurate his contention is. Just bringing it up in case someone else has more information.

I’ve been self-employed for many years and wouldn’t even consider getting individual health insurance. For the good reasons already discussed here. My best deal (NY)–for as long as I can remember--has been the Blue Cross/Blue Shield/Blue Choice system provided by a local Chamber of Commerce group, etc. NY state also has a very good low-income health insurance plan. Unfortunately (or fortunately, depending on your point of view) I don’t qualify, but would bet there are thousands who do qualify but who have not been made aware of this option.

The obscenely high cost of non-employer provided health insurance is a national disgrace.

Susannah said:It's usually possible to find a trade organization or other type of club that offers group insurance. Most of these are regulated by HIPAA, and while it's more expensive to have this type of insurance while you are young and healthy, you do avoid the "death spiral" described here. Since you never know when you're going to get really sick, I think it's best to just always stay with insurance regulated by HIPAA (group insurance at big employers is) if at all possible, to avoid all of the pitfalls associated with private insurance. IEEE (Institute of Electrical and Electronics Engineers) offers group insurance to its members who have been members 3 years or more. I make my husband keep his membership current in case we don't have jobs and need to go on their plans.

I'm not aware of any trade or professional associations other than IEEE that have true group (HIPAA) health insurance; most just source people to individual health plans. ACM use to have group insurance, but now they just direct people to ACM-branded individual health plans, which is not a real solution.

Anyone who has a degree in engineering or science should definitely be a member of IEEE, just for the insurance option, if needed someday!

Do any readers know of specific true group insurance similar to IEEE?

NY may be a comparatively safe state for individual health insurance plans, but I've never seen one worth buying. I'd defintely be interested in learning more, however. I gave up looking for individual plans a couple of years ago after so many dead ends. Like many others, I'm interested mainly in catastrophic health coverage and would accept a high deductible, or whatever the health insurance term is.

Unfortunately, sky high medical care costs make self-insuring virtually impossible.

I know this has been mentioned before, but people could always look for employers that offer insurance for part-time employment. I have a contract job that pays me way more by not taking benefits $36/hr vs. $57/hr. For me it was a no-brainer. I just had my wife work part time for the state, to make up for my lack of taking insurance.

MVV, I perused the company you linked to. I have to first admit a strong bias against religious organizations in general, christian in particular, and most of all any company that highlights testimonials in the marketing pitch.

Anyway, from their disclosure required by some seven states across the US (my bolding): "This publication is not issued by an insurance company nor is it offered through an insurance company. This publication does not guarantee or promise that your medical bills will be published or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. This publication should never be considered a substitute for an insurance policy. Whether you receive any payments for medical expenses and whether or not this publication continues to operate, you are always liable for any unpaid bills."I would also empahasize that if this company has not negotiated *substantial* discounts of the list cost of medical services in your area where you want to go, it's utility at best is poor.

EricGo said:Single payor still strike me as a spreading risk device; and unless it is very stricly limited, I think will fail over time for the reasons I outlined above. I have great respect for your views on this issues, EricGo,--thanks for addressing my post. I'm puzzled as to why you think "single payer" is more likely to fail than other forms of insurance...? Surely it does "risk spread", but isn't that precisely the point of insurance...?

Is your concern that it doesn't offer incentives to take care of yourself? If so, couldn't that be addressed through mandatory co-pays and the like? Is this what you mean by a "significant co-insurance component"?Drawing rigid lines where basic stops is a nightmare, by the way. I'd hate to set something up that only benefits lawyers.A fair point.

Back when it was introduced in the late 80s-early 90s, I followed Oregon's plan pretty closely. I wonder what you think of their experience as a model for carving out where "basic" should stop. They certainly spent less per person after changing their Medicaid model from one that insured fewer people (those WAY below the federal poverty line) to one which covered fewer services. And interestingly, their system came to enjoy broad political support by the end of the 90s. There is an interesting piece on their experience here. This may not be the right thread, but I look forward to reading your ideas on this.I certainly don't want to take this over...vampyr has done an excellent job highlighting an important point. If this discussion develops in a way that brings us much off topic, I'll try to move it elsewhere.

vampyr said, I believe the single-payer model is not the solution for the USA. People should have an incentive to stay healthy and to use the medical system only when it's reasonable (not for every sniffle).Why would a single payer model not have such incentives? I think it should, and there certainly is no reason it couldn't...? In addition, the efficiencies and cost-savings of the private market (for-profit) are better in the long run.Actually, no. We spend 25% of every health care dollar on private market overhead (marketing, administration, attempts to "cherry pick", and the like. That's not to say that Medicare is an ideal alternative either. But the huge overhead expense, mind-numbing complexity of billing/paperwork/eligibility standards, and very spotty coverage that the private system provides does us no favors. we should have a federalized system with perhaps three types of universal plans. Private insurance companies will sell and administer the plans- this will keep a natural check on fraud.Why a "natural check on fraud"? With an additional layer of middlemen, the fraud potential increases... Also, with just three types of universal plans, what's the point of having private folks "sell and administer" them? That's more marketing and overhead expense than such a simplified system would need (and I'm with you as far as simplifying the system). Everyone will be required to have health insurance; the "poor" will get it subsidized by taxes, perhaps on junk food. The system will be fully transportable and no longer tied to a state or to an employer.That all sounds good, and it would be a huge step forward.

Unfortunately, the IEEE is no longer accepting new applications for its Comprehensive Health Care Plan.

LOL EricGo. the quotes are indeed a pain. Incentives to stay healthy aside for the moment, my main thought is that cherry picking such as that practiced in the private arena *does* act as a brake to complete disregard for personal responsibility. A single payor (and presumably mandatory insurance) would not have this.Gotcha--I see. So to the extent that cherry picking promotes responsibilty, it's a feature, not a bug.

I find it very, very hard to believe that cherry picking would actually motivate people to live healthier lifestyles than they would otherwise. At a minimum, people would (a) have to draw a causal link between their own behaviors and the resultant insurance company behaviors, and (b) have that link be necessary and sufficient for them to alter said behaviors. I just don't find either (a) or (b) very likely.

OTOH, one reason people hate and mistrust insurance companies is because when they develop illness through no fault of their own, they get shafted ASAP, as per the OP's point. I think this is one reason people would be more likely to think, "that's just the insurance company screwing me" than, "I should change my lifestyle habits so they won't screw me." My unproven suspicion is that a level charge in premiums and co-pays will not be be enough to encourage healthy lifestyles; I think expensive care will have to cost the patient more -- at least up to a pretty high ceiling. Co-insurance does this, by making the patient pay a percentage of the bill.

I am associating mandatory participation and flat fee based care with the 'single payor' system, because in all the countries I am aware of that have national health systems, those social structures are included.Again, thanks for clarifying.

I think you raise a good point here. I'd like to see a single payer system provide some free preventative care and wellness benefits, like many HDH plans do. But beyond that, co-insurance in many cases would be a good idea.

If a single-payer program did this, it would draw a much clearer link, I think, between unhealthy behavior and out-of-pocket costs. As it stands, with so many conflicting private plans--many which also charge flat fees--I don't think that message gets through.
Lastly, the amount of beauracracy and systemic stupidity that medicare has spawned is a sight to behold. I find the notion of the government being the sole vendor, and therefore regulator,payor/judge and jury all rolled into one a sobering thought. I'd like to hear more about the ways in which you think medicare is broken. I don't know nearly as much about its details as I do about SS, but my impression has indeed been that it isn't working as well.