Lots of people I know have individual health insurance, yet it's often misunderstood.

First off, in most states, you cannot get individual health insurance unless you're in good or even perfect health. This is well known. Many people believe however that once they've been accepted and so long as they continue to pay, that they're "covered" indefinitely. While this is technically true, the shocking reality is quite different as will be explained shortly.

Health insurance companies, like any other insurance company, do not like paying claims. However, unlike, for example, life insurance, when/if you get a serious illness, individual health insurance companies can as a matter of practice get rid of you, leaving you without any insurance at all. How?

When you buy an individual health policy you are put into a group under your policy's brand name. For example: "Healthcare XYZ Plan 2000". This plan will be sold for typically about 3 years and then it's closed. No new members can then enter.

Because your risk is shared with people of this group, as claims start to come in, the premium starts to rise. Those who are healthy start to leave because they can get the same coverage cheaper in another new health insurance plan. However, those who developed a serious illness or condition, cannot get a new individual health policy. They are trapped. Premiums in this closed group start to increase exponentially, as only sick people remain. More people leave, often because they cannot afford the higher premiums. This in turn just causes those who remain to have to pay even more. The plan goes into a "death spiral." The insurance company has in effect transferred all risk to an ever-smaller and sicker group. (Traditional employer group insurance doesn't work in this manner at all- but that's another subject.)

The process is repeated again and again. Keep in mind this not per se the insurance company's fault- the insurance regime is regulated by each state and the companies selling in a given market intensely compete with each other given the rules of the system. For a company not to force the "death spiral" means they'd be at a competitive disadvantage; they go out of business.

If you are self-employed and have individual health insurance, you may not realize that you are probably at serious, almost inevitable, jeopardy of losing your ability to get health insurance at some point in life- once you lose your "good health" status. Then you have almost no options, short of working for a tradition employer or purchasing a plan in your state's high-risk pool, if available- which normally costs more than a typical home mortgage.

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.

See Georgetown University's information on health insurance:
http://www.healthinsuranceinfo.net/

Health insurance regulations are highly state-specific. In my state, individual health insurance has guaranteed renewability, and the state limits the amount insurers can surcharge due to a person's health condition.

OP: good article. Laws vary by state, but your points are well-taken. You correctly observed that health insurers regularly keep "reshuffling the deck chairs" by frequently re-branding certain types of insurance coverage groups.

It's a truly barbaric system focused on extracting maximum revenue out of sick individuals. It will probably take another generation before Congress repeals the McCarran-Ferguson Act of 1945 which has prevented Uncle Sam from imposing nationwide standards on health insurance sales and coverage practices.

Another argument for a single-payer basic plan. Since private companies are forced to compete on the basis of cherry-picking to retain their profitability, problems like these are inevitable.

It's also crazy that a person should have to become an expert on their state's insurance law in order to figure out what risks they run getting policy type A instead of type B.

Are there any good pieces readily available that discuss OP's issue in more detail? I am self-employed, and have an individual HDHP, and would be curious to read more.

definitely a stacked deck...

Bad Faith: Fraud in the Insurance Industry

EricGo said:DaveHanson said:Another argument for a single-payer basic plan.Insurance plans encourage abrogation of personal responsibility as a rule, and especially so in healthcare. Even catastrophic illness that is presumably the domain of HD insurance is usually a culmination or result of poor choices.


What a bunch of libertarian crap. Will you still say this when YOUR spouse or kid gets seriously sick?

The day is soon coming when a simple test will determine your genetic probability of getting cancer, parkinson's, ahlzeimers, etc.
Insurance companies will want to cherry pick otherwise healthy people, based on their genetic profile. That's when pressure will grow finally for some kind of national health insurance--when healthy, middle class, white people find themselves uninsurable.

revheck, you raise a good point, but I don't think you're interpreting EricGo fairly.

As I read him, he's just making the sensible point that insurance ought to give us financial incentives to taking care of ourselves, so that our poor health decisions aren't just fobbed off on third parties.

There is no reason this need be incompatible with a single payer system. Indeed, I think it would make doing so easier, and I support both EricGo's point here and a (carefully designed) single payer system.

I'll let the data speak for themselves.

Published on Monday, February 23, 2004 by the Los Angeles Times

In Health, Canada Tops US
Our neighbors to the north live longer and pay less for care. The reasons why are being debated, but some cite the gap between rich and poor in the US
by Judy Foreman


Want a health tip? Move to Canada.

An impressive array of data shows that Canadians live longer, healthier lives than we do. What's more, they pay roughly half as much per capita as we do ($2,163 versus $4,887 in 2001) for the privilege.


The summary of the evidence has to be that national health insurance has improved the health of Canadians and is responsible for some of the longer life expectancy.

Dr. Steffie Woolhandler, an associate professor at Harvard Medical School
Exactly why Canadians fare better is the subject of considerable academic debate. Some policy experts say it's Canada's single-payer, universal health coverage system. Some think it's because our neighbors to the north use fewer illegal drugs and shoot each other less often with guns (though they smoke and drink with gusto, albeit somewhat less than Americans).

Still others think Canadians are healthier because their medical system is tilted more toward primary care doctors and less toward specialists. And some believe it's something more fundamental: a smaller gap between rich and poor.

Perhaps it's all of the above. But there's no arguing the basics.

"By all measures, Canadians' health is better," says Dr. Barbara Starfield, a university distinguished professor at Johns Hopkins Medical Institutions. Canadians "do better on a whole variety of health outcomes," she says, including life expectancy at various ages.

According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S. (Japan's is 81.9.)

"There isn't a single measure in which the U.S. excels in the health arena," says Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle. "We spend half of the world's healthcare bill and we are less healthy than all the other rich countries."

"Fifty-five years ago, we were one of the healthiest countries in the world," Bezruchka continues. "What changed? We have increased the gap between rich and poor. Nothing determines the health of a population [more] than the gap between rich and poor."

Gerald Kominski, associate director of the UCLA Center for Health Policy Research, puts the Canadian comparison this way: "Are they richer? No. Are they doing a better job at the lower end of the income distribution? For lower-income individuals, they are doing a better job."

At a meeting last fall of the American Public Health Assn., Dr. Clyde Hertzman, associate director of the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver, analyzed data showing that Canadian women outlive American women by two years and men, by 2 1/2 years.

During the last quarter-century, he says, all income groups in Canada also showed gains in life expectancy. During much the same period in the U.S., death rates widened between America's rich and poor, according to a 2002 study in the International Journal of Epidemiology by American and Australian researchers.

Infant mortality rates also show striking differences between the U.S. and Canada.

To counter the argument that racial differences play a major role, Hertzman compared infant mortality for all Canadians with that for white Americans between 1970 and 1998. The white U.S. infant mortality rate was roughly six deaths per 1,000 babies, compared with slightly more than five for Canadians.

Maternal mortality shows a substantial gap as well. According to the Paris-based Organisation for Economic Co-operation and Development (OECD), a 30-nation think tank, there were 3.4 maternal deaths for every 100,000 births among Canadians, compared with 9.8 deaths per 100,000 Americans.

And more than half of Canadians with severe mental disorders received treatment, compared with little more than a third of Americans, according to the May-June 2003 issue of Health Affairs.

"The summary of the evidence has to be that national health insurance has improved the health of Canadians and is responsible for some of the longer life expectancy," says Dr. Steffie Woolhandler, an associate professor at Harvard Medical School and staunch advocate of a single-payer system.

Of course, some causes of death, such as homicide, wouldn't be much affected by having a single payer system. And the U.S. has "the highest homicide rate of all the rich countries," says Bezruchka.

"Other things might be differences in seat belt usage," adds Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "We are also disproportionate consumers of illegal drugs, much more than Canada, so it's cultural."

The health of Americans would be better with universal healthcare, he says.

"But there are some things that a single-payer system wouldn't fix — but which would leave one country looking healthier in the statistics."

In some respects, the healthcare system is "the tail on the dog," says Dr. Arnie Epstein, chairman of the department of health policy and medicine at the Harvard School of Public Health.

"It's other aspects of the social fabric of different countries that seem to have a major impact on how long people live," he says.

In the U.S., African Americans and Latinos "face problems of housing, stress and low income, which have nothing to do with a single-payer system." Canada has a large number of Asian immigrants, he says, but they, like Asian immigrants in the U.S., tend to do well on healthcare measures.

The bottom line is that Canada is doing something right, even if "the reasons are not totally understood," says Kominski of UCLA.

I'm having trouble understanding what you're even trying to say: "Your tabloid views of
genetic testing harming the great white whale betray you." huh? what?


Can you put together a coherent argument based on any data, rather than name calling and repeating yourself?

revheck said:Can you put together a coherent argument based on any data, ?Yawn.

I could, but I doubt you would listen. But go ahead and prove me wrong. Google up the leading ICD 9 codes to account for 90% of the mortality in the fourth through seventh decades of life, and then ask any decent physician to identify for you those that are at least 90% caused by lifestyle, 75% lifestyle, 50% lifestyle, and at least 25% lifestyle. Then compute a weighted average.