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Thread: Health Care "Exchanges"

  1. #1
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    Health Care "Exchanges"

    As you know the health care bill passed and now we have "health care exchanges" starting in 2014. The idea is that you pool together a bunch of people who otherwise would not have insurance (small business or whatever...no job maybe..self employed) and you get the cost "benefits" of say, a fortune 500 companies health care plan. These benefits are basically spreading the costs of the high dollar people over the pool. So on face value, one of the smarter ideas in the bill.

    So what are you thoughts on this aspect of the bill?

    Here is some reading material:
    http://www.urban.org/UploadedPDF/901...s_coverage.pdf
    Employers Rapidly Shifting Health Care Costs to Workers | Crooks and Liars
    What Are Health Insurance Exchanges in the Health Care Reform Bill? - Associated Content - associatedcontent.com
    The Rationale for a Statewide Health Insurance Exchange | The Heritage Foundation
    A Federal Health Insurance Exchange Combined with a Public Plan: The House and Senate Bills | The Heritage Foundation

    I take the position that this was noble idea but misses the boat in terms of what our health care problem is. Small businesses can't afford to pay their employees ANY health care insurance. So if we go from really high costs to just high costs comparable to a big business then the small business still suffers and the benefits will basically end up going to the insurance companies and big business now that they competition is not competitive anymore.

    I think the exchanges are not a bad idea but they should have been done differently if we were to get them. Below is a list of much better ideas many of which aren't needed or are not well explained but you get the basic idea

    1. End insurance offered by employers
    2. Set ranges indexed to health care inflation for health care plans (ie make you force the spreading of some of the costs but not all) - Or do something with exchanges that effectively does this
    3. While costs are spread still give the option to increase premiums if a person is unhealthy...but not by much, say 10-15% max
    4. If insurance companies think you are lying then allow them to pay for tests on you...once you are insured though they have to suck it up
    5. Don't deny pre-existing conditions outright but do allow for higher premiums but no higher than the range discussed earlier - may have to be modified if people try to just get insurance when they need it
    6. Offer rebates for low income families
    7. Create fine for children uninsured for families over a certain income level...not sure how you enforce that though
    8. all health care insurance across state lines


    The above won't reduce premiums a who heck of a lot but it will remove the burden on companies and the even greater burden on small businesses. It also eliminates one of the advantages large companies have.

    I think mandating insurance could be avoided.

    Your thoughts?

  2. #2
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    Quote Originally Posted by Steeeeve View Post
    [*]While costs are spread still give the option to increase premiums if a person is unhealthy...but not by much, say 10-15% max
    [*]Don't deny pre-existing conditions outright but do allow for higher premiums but no higher than the range discussed earlier - may have to be modified if people try to just get insurance when they need it
    [*]Offer rebates for low income families

    Your thoughts?
    Wow!! And who will decide these nubers like 10- 15%, the rebates? The government?? You want government run healthcare??? Are you crazy? You want the government between you and your doctor? The government cannot run anything, not even the Post Office! This is socialism, tyranny, Adolf Hitler. Kill your bill!!!
    We're #37, We're the USA

    http://www.dailykos.com/storyonly/2009/9/16/781839/-Late-afternoon-early-evening-open-thread

  3. #3
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    Quote Originally Posted by modulus View Post
    Wow!! And who will decide these nubers like 10- 15%, the rebates? The government?? You want government run healthcare??? Are you crazy? You want the government between you and your doctor? The government cannot run anything, not even the Post Office! This is socialism, tyranny, Adolf Hitler. Kill your bill!!!
    Did you have an actual comment on health care exchanges or not?

  4. #4
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    Quote Originally Posted by Steeeeve View Post
    Did you have an actual comment on health care exchanges or not?
    Avoiding mandatory insurance is not feasible.

    a) If something happens to somebody we will not turn him away from an emergency rooms. It is only fair if he makes a contribution.

    b) If insurance is not mandatory there will not be enough revenues to cover those with pre-existing conditions.
    We're #37, We're the USA

    http://www.dailykos.com/storyonly/2009/9/16/781839/-Late-afternoon-early-evening-open-thread

  5. #5
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    Quote Originally Posted by modulus View Post
    Avoiding mandatory insurance is not feasible.
    They should make it mandatory like car insurance is in my states then. The thing is, the exchanges aren't a huge help for people that can't afford it. We are still going to have ridiculously high costs and an unfair advantage for those working at large employers while at the same time placing a huge burden on all businesses.

  6. #6
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    Quote Originally Posted by Steeeeve View Post
    As you know the health care bill passed and now we have "health care exchanges" starting in 2014. The idea is that you pool together a bunch of people who otherwise would not have insurance (small business or whatever...no job maybe..self employed) and you get the cost "benefits" of say, a fortune 500 companies health care plan. These benefits are basically spreading the costs of the high dollar people over the pool. So on face value, one of the smarter ideas in the bill.

    So what are you thoughts on this aspect of the bill?

    Here is some reading material:
    http://www.urban.org/UploadedPDF/901...s_coverage.pdf
    Employers Rapidly Shifting Health Care Costs to Workers | Crooks and Liars
    What Are Health Insurance Exchanges in the Health Care Reform Bill? - Associated Content - associatedcontent.com
    The Rationale for a Statewide Health Insurance Exchange | The Heritage Foundation
    A Federal Health Insurance Exchange Combined with a Public Plan: The House and Senate Bills | The Heritage Foundation

    I take the position that this was noble idea but misses the boat in terms of what our health care problem is. Small businesses can't afford to pay their employees ANY health care insurance. So if we go from really high costs to just high costs comparable to a big business then the small business still suffers and the benefits will basically end up going to the insurance companies and big business now that they competition is not competitive anymore.

    I think the exchanges are not a bad idea but they should have been done differently if we were to get them. Below is a list of much better ideas many of which aren't needed or are not well explained but you get the basic idea

    1. End insurance offered by employers
    2. Set ranges indexed to health care inflation for health care plans (ie make you force the spreading of some of the costs but not all) - Or do something with exchanges that effectively does this
    3. While costs are spread still give the option to increase premiums if a person is unhealthy...but not by much, say 10-15% max
    4. If insurance companies think you are lying then allow them to pay for tests on you...once you are insured though they have to suck it up
    5. Don't deny pre-existing conditions outright but do allow for higher premiums but no higher than the range discussed earlier - may have to be modified if people try to just get insurance when they need it
    6. Offer rebates for low income families
    7. Create fine for children uninsured for families over a certain income level...not sure how you enforce that though
    8. all health care insurance across state lines


    The above won't reduce premiums a who heck of a lot but it will remove the burden on companies and the even greater burden on small businesses. It also eliminates one of the advantages large companies have.

    I think mandating insurance could be avoided.

    Your thoughts?
    It would have been simpler to enact a "level cost" plan.

    First, insurance companies have for years gouged individuals and small businesses and given sweetheart deals to big businesses because they actually WANT that businesses. Landing Boeing is a profitable gain, landing the corner gas station with 3 employees....who cares???

    They have claimed that they can offer the bug businesses better rates because of a bigger risk pool.

    Bulldroppings.

    An insurance companies risk pool is not everybody who is part of a specific corporate group. Their risk pool is EVERYBODY THEY INSURE. PERIOD. Anybody who tells you differently is lying their butt off so they can sell you overpriced insurance.

    Steeeeve, you are an accountant. Can you imagine the anal raping that would occur if insurance companies tried to turn out quarterly reports based on individual groups instead of treating all their insured as a single risk pool? It would be insane. People would go to prison.

    All they needed to do in order to deal with this was make law requiring that insurance companies provide retail plans and retail pricing for everybody. Then in order to get the business at boeing they also have to be competing to get the business of anybody else who wants their coverage.
    If ye love wealth greater than liberty, the tranquility of servitude greater than the animating contest for freedom, go home from us in peace. We seek not your counsel, nor your arms. Crouch down and lick the hand that feeds you; May your chains set lightly upon you, and may posterity forget that ye were our countrymen. —Samuel Adams

  7. #7
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    Quote Originally Posted by daewoo View Post
    It would have been simpler to enact a "level cost" plan.
    Which is basically what I was getting at...although it almost is a solution is search of a problem.

    First, insurance companies have for years gouged individuals and small businesses and given sweetheart deals to big businesses because they actually WANT that businesses. Landing Boeing is a profitable gain, landing the corner gas station with 3 employees....who cares???

    They have claimed that they can offer the bug businesses better rates because of a bigger risk pool.

    Bulldroppings.

    An insurance companies risk pool is not everybody who is part of a specific corporate group. Their risk pool is EVERYBODY THEY INSURE. PERIOD. Anybody who tells you differently is lying their butt off so they can sell you overpriced insurance.

    Steeeeve, you are an accountant. Can you imagine the anal raping that would occur if insurance companies tried to turn out quarterly reports based on individual groups instead of treating all their insured as a single risk pool? It would be insane. People would go to prison.

    All they needed to do in order to deal with this was make law requiring that insurance companies provide retail plans and retail pricing for everybody. Then in order to get the business at boeing they also have to be competing to get the business of anybody else who wants their coverage.
    I think it is less "pooling" and more the fact that you have to pay someone to handle an account for 3 people.

    My main point that I failed to get out was that the problem has more to do with cost and less to do with bringing down the cost for individuals to big business levels (which are still not affordable).

    But at least this wasn't the worst idea from this bill and I think we should all celebrate that ...ha

  8. #8
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    Quote Originally Posted by Steeeeve View Post
    Which is basically what I was getting at...although it almost is a solution is search of a problem.

    I think it is less "pooling" and more the fact that you have to pay someone to handle an account for 3 people.
    As opposed to paying hundreds of people to handle an account with thousands of people in it.

    If there is ANY increased administrative cost I would be shocked, but IF there is, it would be done away with by standardized coverage.

    My main point that I failed to get out was that the problem has more to do with cost and less to do with bringing down the cost for individuals to big business levels (which are still not affordable).

    But at least this wasn't the worst idea from this bill and I think we should all celebrate that ...ha
    Any plan that was focused on bringing down the cost of insurance is doomed to ultimate failure.

    The worst part of the bill, IMO, is the requirement that insurance companies pay out 80-85% of gross revenues or refund the difference.

    This may sound good to a lot of people, but I have been in business my entire life and I promise you that right now the insurance companies have some of their best and brightest working on how to INCREASE the cost of medical care so they can pump their profits.

    This is what makes the bill so mind numbingly stupid. What they have essentially legislated is universal care, BUT they have included a SIGNIFICANT incentive for those running the program (the insurance companies) to make it as expensive as possible.

    What I DO see as being potentially good is that now that the first step has been taken it will probably be easier to pass health care bills in the future.
    If ye love wealth greater than liberty, the tranquility of servitude greater than the animating contest for freedom, go home from us in peace. We seek not your counsel, nor your arms. Crouch down and lick the hand that feeds you; May your chains set lightly upon you, and may posterity forget that ye were our countrymen. —Samuel Adams

  9. #9
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    Quote Originally Posted by daewoo View Post
    As opposed to paying hundreds of people to handle an account with thousands of people in it.

    If there is ANY increased administrative cost I would be shocked, but IF there is, it would be done away with by standardized coverage.
    Yeah there is from what I've seen and heard..granted I haven't been to many health insurance places looking at the books..just hospitals . It is kind of a moot point though...if you can't afford the $5,000 (for the sake of argument) per employee for health care offered to big business then who cares if small business has $6,000. Small businesses just earn less, give smaller salaries, and have smaller margins or less profits. Big companies are better off but still have a huge administrative burden.

    What I DO see as being potentially good is that now that the first step has been taken it will probably be easier to pass health care bills in the future.
    I hadn't read that provision you speak of yet but don't count on what I quote here. We see how well that worked out for Medicare and SS. Basically just patch work from here on out.

  10. #10
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    Sigh,

    Is this forum like normal America where we can't discuss things that require a little bit of thought? Is Daewoo really the only other one on this forum capable of thinking outside what they read on Huffington Post/Drudge Report?

    In any event, Obama talked about how the exchanges were a Heritage Foundation idea. It was fact checked below. I generally agree with what Politifact says although Obama did make it misleading for someone that just heard it in passing.
    PolitiFact | Obama says Heritage Foundation is source of health exchange idea
    Heritage responded as well:
    Heritage President Ed Feulner Responds to President Obama?s Claims | The Foundry: Conservative Policy News.

    As many of you know Exchanges were used in Massachusetts. I haven't studied too much about what happened in Massachusetts but they do have ridiculous premium prices. Some say it is the highest in the country but according to this it is about the same as states around it..or a little higher:
    http://www.ahipresearch.org/pdfs/200...inalReport.pdf
    Still one of the highest in the country.

    Of course in Massachusetts almost everyone is covered but that also means everyone covered doesn't mean reduced share by those already paying insurance.

    So it gets back to the real problem which is we have exchanges but this does nothing to reduce costs and exchanges don't appear to have any effect on anything!

    Feel free to care about whats in the bill everyone.

  11. #11
    JPSartre12 Guest
    IMO, we should have a program analogous to the assigned risk pool for auto insurance. We can cap maximum premium levels and have the insurance companies take on new clients from these assigned risk pools according to the number of policies they have in effect. If you have 20% of the policies in force, you take 20% of the assigned risk pool.
    Now, that addresses the availability, I don't believe that we can legally force anyone to buy healthcare insurance. That being the case, those without healthcare insurance should pay out of pocket for routine care or simply don't go to the doctor. Like McDonald's, nobody is forcing you to buy a Big Mac, it's strictly a voluntary cash transaction.
    I do believe that we should absorb critical care for indigents. IMO, that's the price we all pay for having ERs in our neighborhood.
    Oh, and insurance companies should be able to compete nationally and we need to enact national tort reform. The current healthcare law cancels out all of the individual state tort reform and is a bonanza for trial lawyers and their clients. By creating national standards of care, we can eliminate many frivilous lawsuits and more would be eliminated if we adopted the UK system of no contingency lawsuits.

  12. #12
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    Quote Originally Posted by JPSartre12 View Post
    IMO, we should have a program analogous to the assigned risk pool for auto insurance. We can cap maximum premium levels and have the insurance companies take on new clients from these assigned risk pools according to the number of policies they have in effect. If you have 20% of the policies in force, you take 20% of the assigned risk pool.
    Now, that addresses the availability, I don't believe that we can legally force anyone to buy healthcare insurance. That being the case, those without healthcare insurance should pay out of pocket for routine care or simply don't go to the doctor. Like McDonald's, nobody is forcing you to buy a Big Mac, it's strictly a voluntary cash transaction.
    I do believe that we should absorb critical care for indigents. IMO, that's the price we all pay for having ERs in our neighborhood.
    Oh, and insurance companies should be able to compete nationally and we need to enact national tort reform. The current healthcare law cancels out all of the individual state tort reform and is a bonanza for trial lawyers and their clients. By creating national standards of care, we can eliminate many frivilous lawsuits and more would be eliminated if we adopted the UK system of no contingency lawsuits.
    This risk pool thing with exchanges just seems a little overblown. You might have some arguments for risk pools and exchanges that would remove the huge spike in premiums should you get something that isn't treatable over one year (such as cancer) and thus your premiums would be too much to pay but overall it seems to miss you boat on costs. It doesn't appear that Massachusetts benefited from any "exchanges" other than have most people covered. There is also some evidence that it hurt small businesses and stunted growth (granted it hasn't been that long so I'm not totally convinced)

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    In 2014..

    Health Care "Exchanges" passed by the jury and is getting started in 2014, it's a great news but we have to see how much successful it is going to be?
    http://puppiesndogs.com/

  15. #15
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    Hi Steeeeve,
    I wish health care exchanges works successively for people health and life.
    Though I have heard this news but know many other facts through this threat. Thanks to all who have replied and make this threat more informative.
    Orem recreation center
    Last edited by Angel; 05-21-2011 at 01:08 AM.
    Angel

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