From the comments, and a bleg for Baucus information

by on September 18, 2009 at 11:02 am in Medicine | Permalink

This is from Bill:

I am worried that the insurance companies will dump bad risks in the
public pool. They can do this by designing plans that have no value to
sick people, the way the do for Medicare Advantage programs. Here's how
you do it: have a high sticker price, but offer discounts for the use
of a gym or health club. (Non-ambulatory need not apply). Or, offer
special benefits to new mothers and well baby programs (over 50 persons
need not apply–unless you're pregnant)

I've been worrying about that for a while and of course there are many more dimensions of quality competition beyond what Bill mentions.  It's possible I don't understand the plan well enough and this isn't a real risk.  If so, I'd like someone to explain it all to me.  (Here is a related post by Matt.)  But as it stands I've soaked up all the lessons about how private insurers want to dump the high-risk individuals.  Under the reform, if you can't ever cut them off or "resciss" them (is that the verb?), won't you try much harder to avoid them in the first place?  Is there some provision in the bill which actually prevents this by regulating quality competition in just the right way?  Given that heterogeneous consumers, and employers, choose across plans on the basis of what they want, is such regulation even possible?  Right now I'm still worried.  Oddly, this is perhaps less of a problem in the states with more concentrated insurance markets.

Of course if there is no public plan these people end up somewhere in the private sector, they just are treated very badly in terms of quality of service.  Which makes the mandate an even less good deal for many of them.

Richard Haas September 18, 2009 at 11:12 am

Oh, is that paranoia setting in Tyler? The time for partisian racist bickering is over! The government will take good care of you and will come up with a good plan. Obama is finally going to stick it to the insurance companies! We need to save the 47 million people without insurance, your mean spirited arguments show how little you care for the poor.

a student of economics September 18, 2009 at 11:25 am

Other nations that successfully cover all citizens without a single payer system apparently heavily regulate insurance companies (e.g. Switzerland, Belgium), so your concern appears to be well-founded.

Of course, it should be noted that the current system also includes a great deal of “dumping” of bad risks onto the government and others. However, currently, its done via the emergency room and a hodgepodge of other institutions, in a grossly inefficient, expensive and low-quality process.

Virtually any change would be an improvement.

nicole September 18, 2009 at 11:36 am

It’s “rescind.”

a student of economics September 18, 2009 at 11:45 am

Yancey: Pick any health care system used by any other advanced nation. It doesn’t matter which one. And we’d probably be better off be changing to it.

That is scary, and sad.

Yancey Ward September 18, 2009 at 12:05 pm

Student,

Show me the “how we change” first.

Andrew September 18, 2009 at 12:07 pm

http://en.wikipedia.org/wiki/Health_insurance

“In 2006, there were 47 million people in the United States (16% of the population) who were without health insurance for at least part of that year.[34] About 37% of the uninsured live in households with an income over $50,000.[34]”

$50,000. That’s almost in the “rich” category in the Democrat playbook. These people are either irresponsible, very rational gamblers, or in between jobs- a frictional problem. And, we know that the reason insurance is tagged to employment, the main market inefficiency, is thanks to FDR and the Federal government. For those between jobs there is Cobra.

The truly irresponsible could be assessed a fee for service when their gamble doesn’t pay off, but considering half the medical bills are incurred by 5% of the people, the math just doesn’t support most young and healthy people paying for old-age care.

The rest are a very small problem, and they need welfare. They have nothing to offer private insurance companies or their customers, so of course we don’t want them in our risk pool. Their is no risk, only certainty of loss. People just need to decide whether they want medical welfare or not and how to keep everyone from having their hand out once we add another reward to low productivity. Not only is this not surprising, why would we want it any other way?

Joe September 18, 2009 at 12:17 pm

Tyler,

I don’t follow specific bills, but I believe a few of them tackle this through a punitive tax on abnormally healthy risk pools, which is redistributed to the unhealthy risk pools based on how many bad risks they take on. Obviously, there are issues with calculating the size of the tax and the actual risk of the pool, which I’m not qualified to speak on.

jimbino September 18, 2009 at 12:25 pm

Andrew at 11:38 repeats the canard that the uninsured unfairly feed at the public tit.

I would like to see some statistical evidence sometime, but I know that some 50% of healthcare dollars are spent by the Feds, implying that any uninsured patient who shows up at the emergency room has already paid half the fee through his taxes.

Furthermore, to the extent that the uninsured use far less healthcare in the course of their lives, they may well be subsidizing the insured!

John Thacker September 18, 2009 at 12:39 pm

Pick any health care system used by any other advanced nation. It doesn’t matter which one. And we’d probably be better off be changing to it.

Can I pick Singapore?

Here’s how you do it: have a high sticker price, but offer discounts for the use of a gym or health club.

I thought that discounts for gym/health club memberships was part of that preventative care that the President is so big on?

BM September 18, 2009 at 12:51 pm

Insurance companies dump bad risks onto the public plan? Great! Sign me up!

That will lower the cost of private-insurance plans (good!) and turn the government plan into, effectively, a taxpayer-supported catastrophic/chronic insurance plan (also good!). The overall cost-per-consumer stays about the same—a decrease in out-of-pocket costs for private insurance, plus an increase in taxes for the catastrophic coverage.

It looks like a wash financially but a big gain in human justice. What’s not to like?

Seward September 18, 2009 at 1:00 pm

What really few people have discussed as far as I can tell are the other aspects of liberty that this will effect; including efforts to micromanage our diet, whether or not we exercise, who we have sex with, etc. All these will be up for grabs more than they are today as a result of greater government control. And despite claims by many liberals, they are simply not reliable partners on issues related to what we might call “lifestyle freedom.”

nmg September 18, 2009 at 1:09 pm

People have grossly mis-characterized the current system. It’s not nearly the disaster we are told it is. Virtually everyone can afford insurance, especially disaster-level health insurance. I have one employee and I pay her insurance, it’s $70/month. I insure my family of four for $333 a month. People with pre-existing conditions can get into a group plan when they find a job. People with pre-existing conditions who lose their job are able to get onto to COBRA for 18 months. If they’ve been in their group plan for at least 6 months the insurance companies are FORCED to offer them an individual plan (at least in california where I live) . It’s not a great plan but at least they’ll get their cancer treatments.

Rescission is hardly the problem the hysterical reporting makes it out to be. Where are the numbers? They are miniscule and in most cases legit. For the very few cases that are fraudulent, bad actors on the margin simply aren’t a reason to revamp the whole system. Plus, I’d love to have my insurer fraudulently rescind my policy after I come down with a condition. I can’t wait to see how much the jury awards me.

So, the only people in our current system who truly are screwed are those who had a job with benefits, came down with a bad condition, lost their job, failed to get onto COBRA and now can’t get insurance. This is admittedly sad and can easily be solved by transitioning away from employer-provided group plans. Non-portability of employer-provided insurance is frankly the biggest problem, and it is caused by the government.

But in short, our system is NOT a catastrophe so don’t just blithely accept the premise presented by the reform advocates. There’s room for improvement but none of the solutions require a public option or single-payer or an insurance mandate or any of the terrible ideas floating around congress right now.

nmg September 18, 2009 at 1:46 pm

@rob: yes, they are.

Seward September 18, 2009 at 2:03 pm

nmg,

One of the things that any of these bills will not do is “get the greedy corporations.” The corporations in situ will benefit tremendously, and ossify the current situation as much as possible.

Anonymoose September 18, 2009 at 2:43 pm

*sigh*

The level of complexity in thinking and knowledge displayed in this thread isn’t exactly thrilling to see.

To Tyler’s original point: Each of the proposals includes some form of community rating limiting the amount of price discrimination, some definition of required defined benefits for each plan, and some form of regulation for the adverse selection issue.

Community Rating is handled through the various proposed reforms by largely preventing different premiums from being based upon anything other than age, geographic location, and family size. The Baucus bill also allows for higher premiums for tobacco users, so long as the plans include programs and treatment to help users quit. The proposals also differ on the ability to price discriminate by age, the House bill(s) cap differences in premiums at a 2:1 ratio for the older population compared to the young adult population, while the Baucus plan allows for a 5:1 ratio. This will likely make insurance cheaper for younger purchasers compared to the House plan, while almost assuredly increasing the cost for people in the 55-64 age bracket.

As for the issues of preventing affordable but ineffective “insurance in name only” plans that covers little but meets the requirements of the reform bill for having “insurance coverage” each proposal demands that insurance plans cover certain services. Specifics of this can be found on on page 4 of the 18 page framework regarding the Baucus plan, and section 122(b) of HR 3200. In order to avoid the issue of insurance that offers these benefits but does not provide adequate cost sharing to make the insurance effective, each proposal also sets floors for maximum allowable cost sharing, which is done by requiring a maximum amount that plans can make the consumer responsible for in two ways. The first is a cap on total out of pocket expenses, the House flatly caps out of pocket expenses at $5,000 for an individual and $10,000 for a family regardless of income, whereas the Baucus framework is graduated, a family at 100-200% of FPL will have a maximum of out of pocket cost of $3,900 while those from 200-300% will top out at about $5800- and sets up a limit of income spent on premiums at 13% for those between 300-400% of FPL (at the top end of 88k a year for a family of four, this is ~11k). The second is that the minimally acceptable plan provides benefits equal to 65% (Baucus) or 70% (HR 3200) of the annual actuarial value.

Lastly, in order to prevent insurers from simply selecting the healthy people without pre-existing conditions, any insurance offered on the proposed exchanges will be offered on a guaranteed issue basis. That is, the insurance companies will have to provide coverage for anyone selecting their plan, regardless of preexisting condition. Similar requirements already exist in many large group plans and for self-insuring companies.

While I don’t expect these proposals to be taken with a glad heart by the readers- or the authors- here, I had hoped that those commenting would at least have a passing familiarity with the issue considering that the House proposals and Senate HELP proposal been out since before the end of July, and the Baucus plan is substantively similar in construction to them. The people drafting the legislation are not unaware of the issues of price discrimination impact, benefit levels, or adverse selection. They’ve been working on this particular plan in earnest for nearly a year now (Last November Baucus released a white paper discussing possible ways forward on health care- http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf), and since the start of the new Congress, 5 different committees have held hearings, received analysis and policy suggestions from various parties, and 4 of the 5 committees have reported out a health care reform bill for the consideration of their branch of congress. Whether or not the proposals work at adequately limiting the problem is a question that can be raised once there’s an understanding of what’s actually been proposed.

Sources:
HR 3200 http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf.
Baucus Framework: http://voices.washingtonpost.com/ezra-klein/BaucusFramework.pdf

Anonymoose September 18, 2009 at 3:07 pm

“They aren’t just backing it, they wrote a huge chunk of it.”

Considering Karen Ignagni’s involvement in the creation of the Baucus framework, it’s actually a lot better than you could expect. You can most see her fingerprints in the absence of a public option and the castrated co-op alternatives, and in the setting of the minimum actuarial benefit at 65%. You really can’t say that they dig the 35% excise tax on the most expensive plans, especially given that it’s indexed to CPI and not health care costs, that will cause them some real pain down the road.

AHIP isn’t fully behind Health Care Reform. They like the Baucus plan because they get probably 20-25m more customers without having to compete with a public option or large co-op scheme. They strongly dislike the House and HELP plans because they all include public options. In general, they’re mainly angling for the best bill they can get for themselves, which would probably be something with generous subsidies to afford health care and as low a % of minimum benefits as they can get. They made a calculation at the start of the year that they probably couldn’t block health care reform, so rather than get stuck with a bill we don’t like after failing to kill it they worked on pushing for the best bill they could get.

Lefty Freak September 18, 2009 at 3:14 pm

“People have grossly mis-characterized the current system.” People being “those who are in it”.

“It’s not nearly the disaster we are told it is.” I already have private insurance, I don’t need to be told what a disaster it is, I can see it first hand. I can see the effect it’s had on my family and friends.

“Virtually everyone can afford insurance, especially disaster-level health insurance. I have one employee and I pay her insurance, it’s $70/month. I insure my family of four for $333 a month.” Really? News to me. Who’s your provider and what do you get for that? My family of three costs me $1100/month in NY, so I’m really curious as to what you’re getting in CA for almost a quarter the price. For that price, I would expect you’d get a white card that with the words “bearer has insurance” stamped on it and nothing else.

“People with pre-existing conditions can get into a group plan when they find a job.” A) And, if they don’t? In case you hadn’t noticed, we’ve got us a recession going on, jobs are fairly scarce these days. B) Maybe in CA, but not the rest of the country. There’s no guarantee you’ll get into a group plan with a pre-existing condition. C) What about those who have a job, a group plan and are dropped by that plan when they get really sick? Don’t say it doesn’t happen, it happened to my sister.

“People with pre-existing conditions who lose their job are able to get onto to COBRA for 18 months.” Hopefully you can beat the cancer in that time…assuming you can afford the now higher cost of your insurance on the much lower unemployment…not to mention the copays. But, hey, good luck with all that.

“If they’ve been in their group plan for at least 6 months the insurance companies are FORCED to offer them an individual plan (at least in california where I live) . It’s not a great plan but at least they’ll get their cancer treatments.” Again..for six months. My mother and sister’s cancer treatments went longer than that.

“I’d love to have my insurer fraudulently rescind my policy after I come down with a condition. I can’t wait to see how much the jury awards me.” That’s assuming you have a few of hundred thousand socked away to cover the legal costs of proving your case, not to mention the decade or so it’ll take for you to get your judgment. Insurance companies have the advantage there: they just have to outlive you, and since you’re the one with the condition…

“So, the only people in our current system who truly are screwed are those who had a job with benefits, came down with a bad condition, lost their job, failed to get onto COBRA and now can’t get insurance.” Oh, well, as long as only a FEW people die so the shareholders of the insurance companies can keep their income, it’s ok. BTW, these are the people Obama wants to cover with the public option.

“This is admittedly sad and can easily be solved by transitioning away from employer-provided group plans.” Wait…weren’t you in favor of group plans a moment ago?

“Non-portability of employer-provided insurance is frankly the biggest problem, and it is caused by the government.” No…health care being a for profit system, with profits first and lives second, is the biggest problem and it’s caused by greed and a naivete that “a free market can solve all problems” despite the fact that it’s never happened before.

“But in short, our system is NOT a catastrophe so don’t just blithely accept the premise presented by the reform advocates.” Yes, accept the advice of an anonymous poster on a forum who has no idea what he’s talking about.

“single-payer” “or any of the terrible ideas floating around congress right now.” Um, despite what Fox “News” tells you, most people living under single-payer systems wouldn’t trade what they have now for what we have. Canadians, for example, who are drawn as dropping like flies because of their health care system a) have longer lives b) higher quality of life c) pay less for their insurance (the average Canadian pays about 5% more in income tax than the average American, but the same American pays 12-15% of their income on insurance, as I do) and d) according to a recent survey, 90% of them are happy with their health care system.

Andrew September 18, 2009 at 3:32 pm

Baby jim,

What statistics do you want to see exactly?

I’ve been posting them all week.

Whatever you are talking about it’s not my canard, Student of Economics brought up emergency room non-payers. I simply pointed out that it is the government that created that situation, as they also created the situation of employer-linked insurance.

Andrew September 18, 2009 at 3:41 pm

Actually Anonymoose, I was wanting to scold Tyler for his posts about this bill, but now I’ll say in general, all these details, even if they do stay in place are really just bullshit.

The way you deal with nanny state interventions into our private choices is exactly what the government will stamp out, freedom of association within your risk pool.

I may agree that a lot of people, including those pushing the nonsense don’t understand what is going on. I also know they are going to attack HSA/Catastrophic, which is THE solution. Beyond that I really, truly don’t need to know a damn thing about the bill.

Anonymoose September 18, 2009 at 3:47 pm

Srp,

It’s neither elegant nor simple nor in keeping with many if any libertarian principles. But what it needs to be judged against is the status quo. What both conservative/libertarian and single-payer advocates need to deal with is that their solution- no matter how clear, effective, or sensible they are- has any shot in hell of ever passing in the near future. Thus, the question isn’t “what we should do” it’s “what we can do.” Because if we do nothing, we’re beyond boned. Ideological purity is cold comfort when everything collapses around us.

Bill September 18, 2009 at 3:49 pm

To anonymouse,

I hope you are relying on more than guaranteed issue. You need to have it that there is a bread and butter plan that is uniform across all carriers. They have to offer it. If they want to offer add ons, the add ons should not be conditioned on purchasing their base plan. (Otherwise, you can play the game of high cost base plan and rediculously low or even free add ons that attract the healthy and adversely select against the non-healthy). Probably would deny discounts for bundled purchases–you get a discount for buying health if you buy auto, because you got to be ambulatory to buy auto.

What one could do, using a forum like this, is propose solutions to the adverse selection problems. I occaisionally teach a graduate school marketing course on pricing, and how to price discriminate between end user classes based on bundling, product design and other strategies. This is an interesting problem of how to prevent an insurance company from undermining community rating plans and separating the healthy from the unhealthy in a mandated offering, and similarly price discriminating. Very interesting problem.

Floccina September 18, 2009 at 3:56 pm

No, people go to the emergency room and don’t pay.

According to John Cogan (http://www.econtalk.org/archives/2006/07/cogan_on_improv.html) unrembursed emergency room care is very small relative to all care. Note: Just because one does not have insurance does not mean one will not pay. Hospitals will give you terms.

Anonymoose September 18, 2009 at 4:28 pm

Bill,

I’m not passing judgment one way or another on the Baucus or other proposals, I’m merely attempting to provide information. And there are a lot of things I could have missed in my reading of HR 3200 and the Baucus proposal and the Senate HELP committee proposal (summary available here: http://help.senate.gov/Maj_press/2009_07_15_b.pdf)- I didn’t look much beyond the guaranteed issue in terms of forcing insurers to accept pre-existing conditions/more risky customers.

I do think some of your concerns are partially addressed by the standard minimum benefits packages, HR 3200 and BaucusCare’s required minimum coverage is listed below, HR 3200 also has a Health Benefit Advisor Panel which establishes “a private-public advisory committee which shall be a panel of medical and other experts … to recommend covered benefits and essential, enhanced, and premium plans,” and Assuming these can’t be turned into “add ons,” they’d apply to every single plan regardless of price. Of course, in that case it’s still open to regulatory capture that results in minimum coverage being defined down.

This issue is, I believe, one part of why proponents of a public option want it, but it still doesn’t solve the adverse selection issue because it just creates an incentive to dump less healthy people onto the public plan.

HR 3200, sec 122:
“(b) Minimum Services To Be Covered- The items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.”

Baucus:
“All plans sold in the non-group and small group market would be required to cover the following benefits: preventive and primary care, physician services, outpatient services, emergency services, hospitalization, day surgery and related anesthesia, diagnostic imaging / screenings (including x-rays), maternity and newborn care, pediatric services (including dental and vision), medical / surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that meet minimum standards set by federal and state laws.”

Addendum to Srp: The Baucus plan offers catastrophic insurance for “Young Invincibles,” though how that’s defined as a consumer group is left undefined. It also requires coverage for preventative care below the catastrophic amount.

Seward: At the same time, these co-ops are stunted things constrained in size and ability by regulation. It’s the worst of both worlds!

Bill September 18, 2009 at 4:54 pm

Anonymoose,
You are doing a service by providing details that address the problems.

Thank you.

Jacqueline September 18, 2009 at 5:24 pm

“Or, offer special benefits to new mothers and well baby programs”

This specific incentive is very unwise if the goal of health insurance companies is to appeal to demographics that cost them less.

There is nothing scarier to an insurance company than a pregnant woman. Premature babies are EXTREMELY expensive. As medical technology improves, we’re able to save babies born earlier and earlier, but at greater and greater cost, not just for saving them at birth but for their health care for the rest of their lives because premature babies frequently have life-long health problems.

If you want to appeal to a cheap demographic, design an insurance plan that appeals to young men (under 30 or 40). They don’t get pregnant, they rarely get sick, and the health care costs they do incur tend to be from relatively inexpensive-to-treat injuries. Also, even when they do get sick or injure themselves, young men are more likely than other groups to just tough it out rather than seek treatment.

MBP September 18, 2009 at 6:18 pm

Tyler – This is slightly oof point, but the original question from Bill contains a common misperception. Medicare Advantage (the program under which private insurers participate in Medicare) no longer creates an incentive for insurers to select the healthiest seniors. In fact, it’s quite the opposite – many Medicare Advantage plans now prefer to enroll the sickest seniors, because their payments are risk-adjusted.

All seniors are assigned a risk score based on their health status (as determined by the individual seniors’ medical claims and age). The average risk score for all people in Medicare is 1.0 (and is re-set to 1.0 each year). Sicker seniors have risk scores above 1 and healthier seniors have risk scores below 1. Health plans’ payments from the fed gov’t are the same for every senior in a given county and then are multiplied by the risk score. So if the base rate in Broward County FL is $1,200 and senior A’s risk score is 2, then the health plan receives $2,400, because this is what it costs the fed gov’t to care for that senior, on average.

Now, health plans believe they are better at managing complex and chronic diseases than the fed gov’t. If all 75-yr old diabetics cost have a risk score of 2.0 in Broward, the health plan believes that theey can make a profit by better managing this senior’s health. Essentially there is more room for the health plan to make a profit on sicker members. It’s hard for the health plan to do much better than the government on a healthy, active 65 year old, so they are happy to sign up sicker members.

When Medicare Advantage payments were not adjusted for risk (in the 1990′s) then plans were paid the same amount for all members. In this scenario they tried to find backdoor ways of signing up health people, such as offering gym meberships (as mentioned above) or even worse, putting their offices on the 3rd floor of a building without an elevator so the less mobile seniors couldn’t reach it.

Seward September 18, 2009 at 6:21 pm

Anyway, I’d be willing to go with some sort of Swiss style universal coverage if we got rid of the drug war and all subsidies, and created open borders. My demands don’t seem terribly unreasonable.

Anandakos September 18, 2009 at 8:20 pm

@NMG,

“People who have existing conditions can get insurance when they get a job”. Not true, unless they forgo any care for the condition for 18 months or had HIPAA-compliant coverage within the previous six months.

A diabetic cannot forgo her or his blood sugar medication for eighteen months. Someone with a heart condition cannot forget about the beta-blockers and doctor visits to monitor them for eighteen months.

Now maybe a person who had cancer a few years before and has a clean bill of health immediately before signing up can forgo checkups for 18 months, but it’s pretty risky. The cancer could come roaring back during that time. And then the person is dead.

PLM September 18, 2009 at 8:40 pm

Megan McArdle has suggested that an assigned risk pool could be mandated, just as it is done in the case of automobiles with all insurers paying a pro rata share. The price to the higher risk consumer would be higher (just as it is in assigned risk auto policies) but not out of reach for at least the middle class. The poor could be subsidized for this a la Medicaid, or perhaps on a sliding scale.

mulp September 18, 2009 at 10:32 pm

As I am not in any employer group, don’t think its likely I ever will be before I automatically qualify for government run single payer, I’m going to start campaigning to convince employers to drop their health benefits. I figure the places to convince to terminate their policies first are:
- Microsoft
- Cisco
- Oracle
- HP
- Google
- Intel
- GE
- Toyota
- Honda
- ….

I would hope that libertarians, conservatives, and even liberals would take principled stands and lobby their employers to terminate the employee group health benefit because employers shouldn’t be sacrificing profits on social programs. Besides, it is egalitarian in that the engineer making $100K and up will be in the same individual insurance market as the single mother with two part-time $10 an hour jobs.

Happy Camper September 18, 2009 at 11:16 pm

Most glad that Irving Kristol has joined hell.

He truthfully deserves the company of the devil and of Hitler.

May humanity be better without him and his bastard son.

HC

vga-kabel September 19, 2009 at 2:56 am

If these bills can get away with offering poor services to someone, how does this actually end recission? Won’t they just offer poor services until the person gives up and finds a new plan? Or will that person just get stuck with shitty service?

srp September 19, 2009 at 4:44 am

Anonymoose isn’t making sense. We’re doomed if we don’t restrict the growth of Medicare spending. That has nothing to do with the rest of these “reform” bills. Just fix Medicare first if it’s the fiscal problem at issue. What I don’t see is how any of the Democratic proposals will address this issue at all–if anything I think they will exacerbate cost growth, unless the death panels (the equivalent of NICE in the UK) are really pushed aggressively. In a US political context, I don’t see that happening.

Personally, I’d like to see us go to a system where insurance is not purchased through employers, where pre-existing conditions are subsidized on a disability-like basis (separating true insurance from redistribution), and where HSA/catastrophic plans are the norm But none of that is necessary for fixing the Medicare problem.

Andrew September 19, 2009 at 6:24 am

srp,

We are on the same page on the policy. I think that the Democrats must be thinking they can hold people hostage with the doom-saying of Medicare cost controls to get their other ideas passed.

But, I disagree with you on one thing. We are not all doomed. They are doomed. They are projecting their concern for their sacred central government onto those of us who’ve been warning them of the budgetary problems for years or decades. They have mistaken analysis for concern. I’m actually quite enjoying watching them twist in the wind.

If my problem is lack of unsustainable transportation, and someone else’s problem is a lack of cash and they want to sell me a Yugo, I don’t have to buy it. I don’t even have to listen to their sales pitch, not matter how much they want to sell it. In fact, I should make a strong effort not to listen to them. It’s a Yugo. Listening to them will only increase the likelihood I will make a mistake. This is the Yugo of medical reform proposals.

BP Beckley September 19, 2009 at 9:05 am

@nmg:
Plus, I’d love to have my insurer fraudulently rescind my policy after I come down with a condition. I can’t wait to see how much the jury awards me.

I assume you’re not in favor of “tort reform”, then?

Mark September 19, 2009 at 10:25 pm

Tyler: I think the answer to your question would be most easily found by looking at countries that have tight regulation of insurance and an individual mandate, rather than speculating as though we were entering totally uncharted territory.

Bernard Yomtov September 19, 2009 at 11:04 pm

Seward,

I have no problem doing that. Libertarians are an incredibly principled bunch;

First, I don’t believe you. And even if you are telling the truth, I don’t believe other libertarians would agree if the occasion arose, no matter what they say when they are healthy.

Second, how the hell are ER personnel supposed to figure out whether you can pay or not when the EMT’s bring you in from a car wreck,say? Are they supposed to stop and check your credit rating, or what? Stop with the macho fantasies and think.

Page 3 September 21, 2009 at 5:51 am

If you are looking for some amazing page 3 party pics, then I would suggest you to visit: http://www.desimartini.com/DM/ht-city/page-3-photos/0-0-0-506.htm

Matthew September 23, 2009 at 11:26 pm

Tyler,

At least three of the proposed bills include a risk pooling/risk adjustment mechanism to deal with this very problem.

I’m a bit surprised you thought the policy makers overlooked this scenario. (Otherwise, why worry?)

理想を貫く強 March 10, 2010 at 9:48 am

lcz
「自分自身を発見し、理想を貫く強い意志を持つこと」。new balance1918年、ボストンに小さな店をオープンしたティンバーランドの創業者airmax 95 、ネイサン・シュワーツが残したシンプルな企業理念は、アメリカのみならず、ティンバーランドのその名が世界的に知られるまでになった現在でも、経営陣から社員一人ひとりにまで浸透していますtimberland ブーツ。ティンバーランドには利益を上げることと同様に力を傾けている大きな目的があります。それは、より多くの方に新しい自分を発見していただけるような物を作ること。たとえば、大自然に囲まれての野外活動において、その愉しさを周囲の人々と分かち合えば、その喜びはきっと増すでしょう。timberland 6インチそうした目的を実現させるための商品作りにティンバーランド全員が取り組んでいます。
また、1989年、あるコミュニティ活動組織にブーツを50足寄付したことから始まり、ティンバーランドは現在までさまざまな社会貢献活動に携わってきました。そして今、timberland 6インチそれらの活動は世界中の人々とティンバーランドのスタッフがつながる重要な手段となり、さらには、私たちと協力することでお客様の社会貢献活動を実現していただくという理想的な関係が保たれています。ものづくりだけに執着することなく、顧客、社会との関わりを深めることで、ティンバーランドがどのような企業体なのか理解していただけると私たちは信じているのですtimberland 6インチ。

となり日本を沸 March 10, 2010 at 11:43 am

lxq
どのジャージにおいても、タテに走るネイビー色のラインは生地に直接染めてありますNIKE ジャージ。
レプリカジャージはナイロンメッシュ生地です。NIKE ジャージほぼ同じ倍率にも関わらず、メッシュ穴の大きさが他の2つに比べて、小さく非常にきめ細かに入っていることがわかります。またナイロン独特のテカつきがあるのも特徴ですNIKE ジャージ。
一方、スウィングマンジャージはポリエステルメッシュ生地で出来ていますNFLジャージ。レプリカジャージよりもメッシュ穴が大きく、目を凝らすと生地の織り目まで見えます。オーセンティックジャージ(≒実使用)にも同じ生地素材を採用してい用いるチームが多いため、より選手が着用する実使用の物に近い仕様になっております。また、手触りはレプリカジャージと異なり、reebok ジャージザラザラしているのも特徴です。
オーセンティックジャージは、reebok ジャージ同じチームでもホーム・アウェイ・3rd(現オルタネート)の種類ごとに生地の素材が異なる場合が多く、レイカーズ ジャージ今回は偶然にも、スウィングマンジャージの生地素材と同じでした。見た目はほとんど変わりませんが、オーセンティックジャージの方がメッシュ穴がきめ細かに入っています。また、触った感じではオーセンティックジャージの方が厚手に感じられます。

となり日本を沸 March 10, 2010 at 11:46 am

lxq
どのジャージにおいても、タテに走るネイビー色のラインは生地に直接染めてありますNIKE ジャージ。
レプリカジャージはナイロンメッシュ生地です。NIKE ジャージほぼ同じ倍率にも関わらず、メッシュ穴の大きさが他の2つに比べて、小さく非常にきめ細かに入っていることがわかります。またナイロン独特のテカつきがあるのも特徴ですNIKE ジャージ。
一方、スウィングマンジャージはポリエステルメッシュ生地で出来ていますNFLジャージ。レプリカジャージよりもメッシュ穴が大きく、目を凝らすと生地の織り目まで見えます。オーセンティックジャージ(≒実使用)にも同じ生地素材を採用してい用いるチームが多いため、より選手が着用する実使用の物に近い仕様になっております。また、手触りはレプリカジャージと異なり、reebok ジャージザラザラしているのも特徴です。
オーセンティックジャージは、reebok ジャージ同じチームでもホーム・アウェイ・3rd(現オルタネート)の種類ごとに生地の素材が異なる場合が多く、レイカーズ ジャージ今回は偶然にも、スウィングマンジャージの生地素材と同じでした。見た目はほとんど変わりませんが、オーセンティックジャージの方がメッシュ穴がきめ細かに入っています。また、触った感じではオーセンティックジャージの方が厚手に感じられます。

cheap mbt shoes March 25, 2010 at 4:50 am

Three golf clubs of different classes,wholesale Nike Air Jordan,wholesale Nike Basketball,wholesale Nike Shox Shoes,From left to right are a driver,Golf Driver Wood,New York Rangers nhl jerseys,nhl jerseys china,A hybrid is any iron that features a head,wholesale chanel sunglasses,Dolce Gabbana Handbags,Louis Vuitton Handbags,very similar to a fairway wood,ed hardy china wholesale,The most excellent customer service!

Comments on this entry are closed.

Previous post:

Next post: