Author Topic: Obamacare/Trumpcare  (Read 11621 times)

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Re: Obamacare/Trumpcare
« Reply #120 on: March 20, 2017, 05:45:23 PM »

Offline mmmmm

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Honest question, what's the argument against allowing insurance companies to sell health insurance across state lines? Why is that a restriction to begin with? What's the downside or proposed downside to lifting that restriction?

I don't agree with the ideas that it would solve most problems with health care costs, but I don't understand what the downside is to it. There must be something though since it hasn't happened yet.

One argument is that it turns into a "race to the bottom" - health insurance companies will flock to whichever state deregulates the most heavily and base their plans on that state's regulations. Similar market pressures are why many financial companies are based in Delaware, and many insurance companies (non-health) in Nebraska. This would probably make the plans cheaper, but would probably also reduce coverage and could enable more fraud/deception.

The more principle-based argument is that this effectively nullifies states' abilities to set their own rules for health insurance coverage, making it federal overreach. People who believe this typically have far bigger objections to the stipulations of the ACA, of course.

And practically, the difficulties of negotiating network coverage and prices with doctors, hospitals, clinics, etc in all 50 states + DC would be onerous enough that smaller providers might not be able to compete with larger companies. The argument is that it'd reduce the market to a handful of national providers and smaller region- or state-based companies would effectively disappear.

I don't really know enough about insurance to strongly agree or disagree with the validity of most of these, but those are the counterarguments I've personally seen.
Which reminds me of when there were small banks in every town and even the largest banks were regional(this is some 25-30 years ago). The competition amongst all these smaller banks made banking a situation where you got a decent return on passbokk savings accounts and didn't have to pay the bank for checking accounts and other smaller things that put more money in the customer's picket, including excellent customer service.

Today, there are mostly only national banks, you have to pay them to use your money, customer service is awful and return rates on anything but investment banking sucks. I could see healthcare going this route if they open competition across state lines. Maybe in a different way but the results will be the same.

Perhaps, but in some states the markets would open up substantially. For instance, in Maine individuals can only buy plans from a very small handful of companies. Before joining my wife's plan, I literally only had two options, I think, and neither were particularly good or affordable. A broker found me short-term insurance from (I think) Minnesota, which was substantially cheaper.

In places where competition is plentiful, buying across state lines would have minimal effect. In other venues without adequate competition, however, it would make a huge difference.
Short term, you are probably right, Roy, but long term as the smalker insurers can't compete and larger insurance companies merge and grow larger things will worsen. Less competition will occur. Only large insurers will remain. Rates will skyrocket as service is minimalized. Thats what happened in the banking industry. I can see the same thing happening in health insurance if interstate competition is allowed

It shouldn't happen simply because interstate competition is allowed.  That's not necessarily a direct cause-and-effect equation for the consolidation that occurred in the banking industry.

You can't talk about the reasons for massive bank consolidation without looking at the effects of extended periods of minimalist oversight or regulation on the banking industry.

Allowing health insurance pools to cross state lines would make them subject to federal oversight.  Yes, I know, the current administration and legislature would be philosophically inclined to just let that crash and burn with little or no oversight.

But in an actually planned and managed implementation, there should be oversight and regulation applied (eliminating the 'race to the bottom' issue) including trade protection oversight to prevent monopolies.

The fact is, the current balkanized-by-state model already creates regional near-monopolies and massive inefficiencies.
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Re: Obamacare/Trumpcare
« Reply #121 on: March 20, 2017, 06:38:01 PM »

Online saltlover

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Honest question, what's the argument against allowing insurance companies to sell health insurance across state lines? Why is that a restriction to begin with? What's the downside or proposed downside to lifting that restriction?

I don't agree with the ideas that it would solve most problems with health care costs, but I don't understand what the downside is to it. There must be something though since it hasn't happened yet.

I've always wondered this as well.  Fragmenting markets by state seems counter to the desire to have larger insurance pools.

A primary reason the industry wants to sell across state lines, in my opinion, is reserve requirements.  Insurers all are required to have reserves, so they can pay out claims.  State insurance commissioners set between an 8-12% requirement for health insurers (they've all currently agreed on a formula -- look up the National Associaiton of Insurance Commissioners if you want some bedtime reading material).  Anyway, health insurance is a huge industry (I think total premiums were well over $1 trillion last year).  State insurance commissioners are pretty dull and conservative folks, and when the decision is collectively made at the national level, it's a tough sell to lower the reserve.  But imagine you could get just one state to change the formula and lower the reserve by a single percentage point -- doesn't sound like a big deal, but 1% on $1 trillion is $10 billion.  That's $10 billion that health insurers, collectively, could not have sitting in the bank earning a low interest rate.  Instead, they could put that money in higher yield (and higher risk) investments.  If they're able to earn 10% instead of <1% on that, it's nearly $1 billion in extra revenue for insurers to pay their executives and shareholders. 

Of course, reserves are there to pay out claims.  If there is a sudden financial collapse like in 2008, more money in riskier securities could lead to much less financially sound insurers, causing either a collapse of the health insurance market (which could in turn hurt the health services market as doctors and hospitals don't get paid) or another major government bailout.  And if you only need to convince one state-level insurance body to change the requirement, it's not too high of a hurdle.

There are other reasons too (it will lead to consolidation in the industry, which will lead to a combination of higher prices for policyholders and lower payouts for medical providers -- that's pretty basic economics).  But insurers are supposed to be risk-reducing -- however, as risk-reduction is at odds with short-term profit maximization in most years, regulation is needed to keep them on track.  Selling across state lines can eliminate this regulation, as the Secretary of Labor appointed by the Governor of South Dakota, for instance, can now make a "small" change to reserve requirements to induce the entire health insurance industry to set up shop in Sioux Falls.  And no one will notice until it all breaks in 20 years.  The collaborative approach created by the individual state markets offers a very strong check on this problem.

Re: Obamacare/Trumpcare
« Reply #122 on: March 20, 2017, 08:22:23 PM »

Offline mmmmm

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Honest question, what's the argument against allowing insurance companies to sell health insurance across state lines? Why is that a restriction to begin with? What's the downside or proposed downside to lifting that restriction?

I don't agree with the ideas that it would solve most problems with health care costs, but I don't understand what the downside is to it. There must be something though since it hasn't happened yet.

I've always wondered this as well.  Fragmenting markets by state seems counter to the desire to have larger insurance pools.

But imagine you could get just one state to change the formula and lower the reserve by a single percentage point

The moment it becomes a cross-state industry, it becomes subject to federal regulation.  Ideally, you would not be using the most lax (nor the most tight) state regulations as the model.

But yeah, I understand that is not likely given the current control of the white house and congress.
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Re: Obamacare/Trumpcare
« Reply #123 on: March 20, 2017, 09:30:27 PM »

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Honest question, what's the argument against allowing insurance companies to sell health insurance across state lines? Why is that a restriction to begin with? What's the downside or proposed downside to lifting that restriction?

I don't agree with the ideas that it would solve most problems with health care costs, but I don't understand what the downside is to it. There must be something though since it hasn't happened yet.

I've always wondered this as well.  Fragmenting markets by state seems counter to the desire to have larger insurance pools.

But imagine you could get just one state to change the formula and lower the reserve by a single percentage point

The moment it becomes a cross-state industry, it becomes subject to federal regulation.  Ideally, you would not be using the most lax (nor the most tight) state regulations as the model.

But yeah, I understand that is not likely given the current control of the white house and congress.

You make rules for the world you live in, not the one you idealize.  I'd be okay with a single agency in theory that handled all insurances nationwide.  But that's in theory. In practice, our independent agencies have become more and more politicized, either reversing rules every time there's a transfer of power, or paralyzed and not enforcing rules (hello FEC).  So I'll settle for what we've got now.  It's better than the alternative we'd get, even if there are better alternatives in theory.

Re: Obamacare/Trumpcare
« Reply #124 on: March 20, 2017, 09:44:59 PM »

Offline BDeCosta26

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Honest question, what's the argument against allowing insurance companies to sell health insurance across state lines? Why is that a restriction to begin with? What's the downside or proposed downside to lifting that restriction?

I don't agree with the ideas that it would solve most problems with health care costs, but I don't understand what the downside is to it. There must be something though since it hasn't happened yet.

I've always wondered this as well.  Fragmenting markets by state seems counter to the desire to have larger insurance pools.

But imagine you could get just one state to change the formula and lower the reserve by a single percentage point

The moment it becomes a cross-state industry, it becomes subject to federal regulation.  Ideally, you would not be using the most lax (nor the most tight) state regulations as the model.

But yeah, I understand that is not likely given the current control of the white house and congress.

You make rules for the world you live in, not the one you idealize.  I'd be okay with a single agency in theory that handled all insurances nationwide.  But that's in theory. In practice, our independent agencies have become more and more politicized, either reversing rules every time there's a transfer of power, or paralyzed and not enforcing rules (hello FEC).  So I'll settle for what we've got now.  It's better than the alternative we'd get, even if there are better alternatives in theory.

I keep saying, the best thing that could come out of a Trump presidency is for the American people to realize that we could easily have a much better system, they just need to use the power of the ballot box to make it happen.

We shouldn't pay twice as much as the rest of the world for health care that leaves tens of millions in the cold and costs the rest of us an absurd amount out of our pockets. Could single-payer (or even a German or Australian model) really be worse than what we have now?

Re: Obamacare/Trumpcare
« Reply #125 on: March 23, 2017, 11:30:18 AM »

Offline kozlodoev

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Re: Obamacare/Trumpcare
« Reply #126 on: March 23, 2017, 12:45:33 PM »

Offline kraidstar

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Honest question, what's the argument against allowing insurance companies to sell health insurance across state lines? Why is that a restriction to begin with? What's the downside or proposed downside to lifting that restriction?

I don't agree with the ideas that it would solve most problems with health care costs, but I don't understand what the downside is to it. There must be something though since it hasn't happened yet.

I've always wondered this as well.  Fragmenting markets by state seems counter to the desire to have larger insurance pools.

But imagine you could get just one state to change the formula and lower the reserve by a single percentage point

The moment it becomes a cross-state industry, it becomes subject to federal regulation.  Ideally, you would not be using the most lax (nor the most tight) state regulations as the model.

But yeah, I understand that is not likely given the current control of the white house and congress.

You make rules for the world you live in, not the one you idealize.  I'd be okay with a single agency in theory that handled all insurances nationwide.  But that's in theory. In practice, our independent agencies have become more and more politicized, either reversing rules every time there's a transfer of power, or paralyzed and not enforcing rules (hello FEC).  So I'll settle for what we've got now.  It's better than the alternative we'd get, even if there are better alternatives in theory.

I keep saying, the best thing that could come out of a Trump presidency is for the American people to realize that we could easily have a much better system, they just need to use the power of the ballot box to make it happen.

We shouldn't pay twice as much as the rest of the world for health care that leaves tens of millions in the cold and costs the rest of us an absurd amount out of our pockets. Could single-payer (or even a German or Australian model) really be worse than what we have now?

Unfortunately the human Ego often will not allow such realizations. It should be obvious at this point that our overall system is a disaster - fiscally, morally, and psychologically - but people have a hard time admitting they are wrong.

Re: Obamacare/Trumpcare
« Reply #127 on: March 24, 2017, 01:16:34 PM »

Offline Donoghus

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Sounds like Ryan's p.o.s. bill doesn't have the votes to pass Trumpcare.

That's a real shame.

https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?_r=0



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Re: Obamacare/Trumpcare
« Reply #128 on: March 24, 2017, 01:43:06 PM »

Offline hpantazo

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Sounds like Ryan's p.o.s. bill doesn't have the votes to pass Trumpcare.

That's a real shame.

https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?_r=0

Looks like any reasonably sane Republican is realizing that if they vote to support this their career will likely be over once people realize they got screwed.

Re: Obamacare/Trumpcare
« Reply #129 on: March 24, 2017, 02:03:40 PM »

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Sounds like Ryan's p.o.s. bill doesn't have the votes to pass Trumpcare.

That's a real shame.

https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?_r=0

I'm not dancing on its grave until it's actually voted down.

Re: Obamacare/Trumpcare
« Reply #130 on: March 24, 2017, 02:06:40 PM »

Offline chicagoceltic

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Sounds like Ryan's p.o.s. bill doesn't have the votes to pass Trumpcare.

That's a real shame.

https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?_r=0
Who does President Trump blame if/when this fails to be passed?  Ryan? The Freedom House Causus?  Democrats?  Obama?  CNN?
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Re: Obamacare/Trumpcare
« Reply #131 on: March 24, 2017, 02:08:57 PM »

Online saltlover

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Sounds like Ryan's p.o.s. bill doesn't have the votes to pass Trumpcare.

That's a real shame.

https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?_r=0
Who does President Trump blame if/when this fails to be passed?  Ryan? The Freedom House Causus?  Democrats?  Obama?  CNN?

Fake News for not reporting what was in the bill and CBO for doing bad math.  Sad.  (Or something like that.)

Re: Obamacare/Trumpcare
« Reply #132 on: March 24, 2017, 02:13:17 PM »

Online nickagneta

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Sounds like Ryan's p.o.s. bill doesn't have the votes to pass Trumpcare.

That's a real shame.

https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?_r=0
Who does President Trump blame if/when this fails to be passed?  Ryan? The Freedom House Causus?  Democrats?  Obama?  CNN?
Fake Congressional voters imported from Massachusetts by the dozens that escaped the Bowling Green massacre after wire tapping Trump Tower. Those are the people he will blame. Oh and Hillary and Obama. Can't forget them

Re: Obamacare/Trumpcare
« Reply #133 on: March 24, 2017, 02:13:31 PM »

Offline Donoghus

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Sounds like Ryan's p.o.s. bill doesn't have the votes to pass Trumpcare.

That's a real shame.

https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?_r=0

I'm not dancing on its grave until it's actually voted down.

Certainly valid.


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Re: Obamacare/Trumpcare
« Reply #134 on: March 24, 2017, 02:17:31 PM »

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Let's see:
- Insurance companies oppose it
- AARP opposes it
- Emergency Doctors oppose it
- Basically all other doctors oppose it
- The academy of Pediatrics opposes it
- It's bad for almost all patients
- Definitely bad for women
- Definitely bad for poor
- It only benefits people making 250K+ per year, and mostly benefits those making 500K+ per year

This is crap legislation, I can't believe it's even getting a vote.