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Government Health Care Option to Include Abortion?

5 August 2009 14 Comments

fetusBy: NCViking

The one stickler not being broadly covered by the media in the “public option-to-single payer” health care debate is the coverage of abortion. Abortion advocates say that the public option plan should mirror most private plans, which offer coverage for abortions. Opposing groups (this author included) feel no federal funds should be provided to subsidize the procedure.

From the AP:

The new federal funds would take the form of subsidies for low- and middle-income people buying coverage through the health insurance exchange. Subsidies would be available for people to buy the public plan or private coverage. Making things more complicated, the federal subsidies would be mixed in with contributions from individuals and employers. Eventually, most Americans could end up getting their coverage through the exchange.

The Democratic health care legislation as originally introduced in the House and Senate did not mention abortion. That rang alarm bells for abortion opponents.

Since abortion is a legal medical procedure, experts on both sides say not mentioning it would allow health care plans in the new insurance exchange to provide unrestricted coverage.

It would mirror the private insurance market, where abortion coverage is widely available. A Guttmacher Institute study found that 87 percent of typical employer plans covered abortion in 2002, while a Kaiser Family Foundation survey in 2003 found that 46 percent of workers in employer plans had coverage for abortions. The studies asked different questions, which might help explain the disparity in the results.

In the Senate, the plan passed by the health committee is still largely silent on the abortion issue. Staff aides confirmed that the public plan—and private insurance offered in the exchange—would be allowed to cover abortion, without funding restrictions.

Under both the House and Senate approaches, the decision to offer abortion coverage in the public plan would be made by the health and human services secretary.

Abortion opponents are seeking a prohibition against using any federal subsidies to pay for abortions or for any part of any costs of a health plan that offers abortion. Such a proposal was rejected by the House Energy and Commerce Committee, the same panel that approved Rep. Lois Capps’ (D-Calif.) amendment that would allow the public plan to cover abortion but without using federal funds, only dollars from beneficiary premiums. Likewise, private plans in the new insurance exchange could opt to cover abortion, but no federal subsidies would be used to pay for the procedure.

But abortion opponents say they can’t accept a public plan that would cover abortion. And they say private plans in the insurance exchange should offer abortion coverage separately, as an option.

“You can have a result where nobody has to pay for other people’s abortions,” said Richard Doerflinger, associate director of pro-life activities for the U.S. Conference of Catholic Bishops.

Abortion is legal, so private insurance has the right to offer coverage but I DO NOT want my tax dollars used to help fund the procedure. I am glad to see at least a compromise is being debated on the issue that hopefully will ensure that this doesn’t happen. Taking time to iron out issues like these, as well as reading the proposed legislation, and even heaven forbid: “testing” before turning the American health care system upside down is good … after all, what’s the rush anyway?



Below is video debate regarding Universal Health Care. I pulled out the John Stossel segment because he echos my views, but I recommend following the additional parts that include pros and cons from many other pundits, including my father’s favorite Paul Krugman. It’s good, reasoned debate on the issue during these days of town halls and angry protesters that everyone should see. I’d love to see something like this on global warming climate change.


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14 Comments »

  • ursula jansing said:

    How many bishops have adopted unwanted children? As a moral issue, abortion should never be taken “lightly”.In my opinion it should be woman’s choice. If the argument is just about $$ I have to say abortion is cheaper than tax $$ paying for uncared for children.

  • NCViking (author) said:

    Hi Ursala, thanks for commenting.

    I am unsure if bishops can adopt, but the Catholic Church has done a wonderful job caring for unwanted children over the years.

    The law is that a woman has a right to chose to have an abortion. Women can get private insurance that will cover this procedure. I pay taxes and do not want them used to subsidize abortion in a public plan, which I along with a majority of the American public feel is morally wrong. One would hope that $$ would never be a factor in a life and death decision, up to and including an execution.

  • The Arch City Madman said:

    I would ask the question, how many potential parents are out there right now.

    My wife and I adopted two children – we waited a total of 4 years for the first one and 2 years for the second one. The problem – not enough birthmothers in the system – and this was Catholic Social Services.

    Comparing the cost of an abortion to the cost of raising a child seems to be a very harsh way of looking at the abortion issue. How much does is cost to counsel those women who have had abortions and feel the heavy weight of regret? Just asking on that one.

    I think I’ve veered off the real subject of the post – public or private financing of abortions. I err on the side of Viking as I do not want to pay for these things either.

  • The Windy City Windbag said:

    If I may add to this (so all us legos can chime in)…

    As the resident Catholic on this blog, I would have no better knowledge of any official position, but it is safe to assume that priests and bishops do not adopt because of their unique position of celibacy. Priests also can not marry, which differs from many Protestants who feel their ministers can both marry and have children.

    A few years ago, a radical priest in Chicago named Father Michael Pfleger (now famous because of his comments about Hillary thinking she was “white” and “entitled” to the presidency) adopted three children. This ruffled feathers within the Archdiocese, but Fr. Pfleger has been given a long leash in the past. This is not standard practice for the church.

    After I typed most of the above, I found this interesting blog where this question was asked. Although it is not one of the most detailed or satisfying answers, it does get to part of the point. “Father Greg” answers the question:

    I have only heard of one priest who adopted a child: a priest from Chicago who received special permission from the Pope to adopt.

    My understanding of why, in ordinary circumstances, a priest cannot adopt a child is because the celibate priest possesses no one person or thing. I recognize that there are married priests (former Protestant ministers who have become Catholic) with children; they present a different situation. But, the discipline of clerical celibacy, which dates back to apostolic times, is in place so that the priest is free to give his time, attention, energy, and love to ALL of God’s children who are under his care. The celibate priest is to love everyone the same; in other words, he is to love as God loves.

    Back to the abortion question, this is not a question of personal choice or morality, but rather taking money from the general population to do something that the majority of the people feel is a repugnant act. I, too, would not want to pay for someone else’s abortion. I personally feel that it is immoral, and robbing a unique individual of his or her right to live. I may not get my way, but no one should be able to force me to pay for it for others.

    On the other hand, like many issues, the government unconstrained by the Constitution but still governing at the will of its people can tax and spend any which way it wants.

  • Charles Bronson said:

    But it’s legal. The majority and the minority both live in a country where it is legal and has been held up by the highest court in the land. You don’t get to pick where your tax dollars go. I disagree with many federal laws but I still pay taxes because I believe in this country and believe in our capacity to change laws based on rational arguments and thoughtful reflection. Sorry for the pun, but don’t throw out the baby with the bathwater.

  • Mike said:

    And meanwhile, back at the original topic…

    Relax. Most private health insurance plans do not cover abortions except in very narrow cases when the life of the mother is at risk. That narrow.

    Abortion is elective and almost no elective surgery is ever covered by health insurance plans.

    If I were a bit cynical I would say that the “public-plan-will-cover-abortions” is the latest talk radio scare tactics.

    Just FYI, abortions are not covered for *money* and not moral reasons.

    While we are debating health care, think about the problem of rescission. That is when you are really, really sick, private insurance drops coverage. According to Don Hamm’s (CEO of Assurant) when he testified before congress, they decline coverage for about 50% of really, really sick people. (i>yeah, I can post a link.)

    Now, I am not saying that public is the only option. I am saying that private is broken.

    To answer some of your questions in advance,

    – no, I don’t want Canada or UK’s plan. There shouldn’t be a sole payer.

    – every plan has rationing (which is what rescission is). Medicare has by far the least.

  • The Windy City Windbag said:

    Ah, but Charles Bronson (that must be your real name), the difference between taking my money to fund a duck pond in California (as in Porkulus) or taking my money to commit an act of infanticide is quite different. I may not like the first, but the second one is immoral. On the other hand, as I said in my other response… a government not restrained by the Constitution, but still governing with the tacit approval of its citizens can do what ever it wants.

    Mike, my only thing I want to add to your comment is that rescission is not bad in all cases, but was horrible in many of the cases describe in front of the Congressional Committee. Insurance is “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril”. Generally these perils and contingencies are financial burdens that the insured can not take on their own if the loss was to occur. The insured, along with thousands of other pool their money together for the greater good. These folks all face similar risks, so their chance of loss is very similar to the others pooling their money with them. This is ensured by the underwriters and the insurer takes the risk of group catastrophe, basing their premium collected on the knowledge that some of their insureds will likely face a loss and they will have to pay. They set their premium to cover the losses, their expenses, and add profits to the top.

    On the other hand, health insurance in the modern sense is not insurance at all, but rather some kind of account people feel they’re owed based upon paying a large dollar amount every month out of their paychecks. We have the sniffles, so we slap down $15 and go to the doctor. A visit that should cost $30-40 winds up costing significantly more, and is billed for an even greater amount. This is so insurance forms can be filled out, defensive medicine can be practiced, and the game of insurers and medicare paying less than the billed amount is played. Doctors employ extra staff to fill out charts, submit forms, and do all those things that need to be done because of the system. It would be like having “Oil Change Coverage” on your auto policy, and going to Jiffy Lube, while the service manager fills out 3-4 pages of forms and submits them to State Farm. Instead of $25, we would be paying $70 an oil change, and Jiffy Lube would be carrying expensive liability insurance to cover any little thing that went wrong with your car.

    People do not feel that they are responsible for their health maintenance, or for their lower costs (like oil, gas, and other maintenance items on a car).

    Rescission is necessary for health insurance, if it is insurance, because a company should not be responsible for preexisting conditions… if that condition is known. For example, if someone buys a policy for $400 per month knowing full well that they have some terrible disease, why would anyone take them on? Why would they be responsible? Why would your $400 down payment be worth BC/BS shelling out $60K for surgery? [Why would the other insureds also paying a premium be responsible for a risk outside of the defined risk pattern that was underwritten?] We don’t ask any other company to do that. It would be like me not having auto insurance and walking into a the agent and saying I want to buy collision coverage. After binding the coverage, I then drive my severely damaged car to the body shop and say, go ahead fix it. Why would the auto insurer be responsible.

    On the other hand, the cases of people having the same coverage for 20+ years and then getting cancer, and the insurer using that clause seems on its face to be immoral, repugnant, and indefensible. I am pretty sure that would be the exception, not the rule, and not very common at all.

  • The Windy City Windbag said:

    Finally, one way to fix health insurance is to remove the non-catastrophic, day-to-day procedures from the coverage… add a deductible, like a $100 per occurrence. That would save doctors the trouble of filling out forms, and would lower the costs of premiums for insureds and employers. Second, implement some form of tort reform. Malpractice insurance costs, lawsuits, and defensive medicine jack up prices and add unnecessary burden to providers and their patients. Third, have the Feds run the Departments of Insurance, and nationalize the regulation. Companies spend way to much money with different coverage forms and trying to protect the companies from 50 separate DOIs. This would save a ton of money, and allow insurers to sell over state lines. More competition means better prices.

    These three solutions will help a whole lot. It should reduce cost and increase choice. People will start going to capitalistic clinics all over the place… like Wal-Mart, or other creative places. A doctor visit paid out of pocket will cost significantly less, and better service will occur because more competition will be available.

    Now that I have all of that figured out…

  • Mike said:

    WCW,

    If all of these rescission decisions were based on consumer fraud, then insurance companies would have been able to state: “We only rescind based on identifiable consumer omission of facts.”

    Instead what they said was (from an article in the WSJ):
    At a committee hearing this week, executives from UnitedHealth, Assurant Health and Wellpoint said that they wouldn’t pledge to limiting the practice of dropping coverage to cases of policy holders who lied or commited fraud to get policies.

    Obama has said he wants to eliminate insurers’ practice of denying coverage to those with pre-existing health conditions, a goal that earned him a large round of applause when he addressed the American Medical Association on Monday.

    Insurance companies are effective as screening individuals. Few individuals present themselves to an insurance company without their medical history. Your height, weight, and current PCP are known from a causal credit report, as would be prior diagnosis.

    It is possible that an individual that never went to the doctor, smoked and is chronically overweight may somehow now feel the need for a $60K surgery. I think you would find that scenario unlikely.

    Insurance company rescission policies are a pure “market” play. The market is efficient at extracting profit from activity. In the classic textbook market place it may turn out that free markets efficiently allocate resources. Unfortunately for health care, sick people are inefficient.

    The remainder of your post was a proposal for reducing health care costs by suggesting catastrophic health insurance as an option. It wasn’t clear whether you wanted people to buy this on their own or if you had imagined this as an option for a government run program.

    I would say that taken together with your pre-existing conditions comment your solution offers no relief to health care. People with pre-existing conditions today cannot purchase insurance at any price.

    Catastrophic insurance exists today. The solution offers no new ground. The uninsured either cannot afford it, or are gaming the system by hoping nothing major happens.

    I would say that not providing for office visits defeats preventive medicine. A regular checkup with regular blood work costs upwards of $250. That is a cost of $1,000 for a family of four.

    This gets into who pays for health care, you or someone else. In a perfect world, you should pay for your own health care. There is a very good reason why you don’t. Individuals are routinely scrutinized in a way that group policies are not. The only way some people can get insurance is by being in a group. That has evolved, beginning in the 1940’s to employer paid insurance.

    A solution would have to allow everyone to buy insurance regardless of pre-existing conditions. If everyone buys, then I am no more a risk to insurance companies than I would be if I bought through a group plan.

    The problem we have is that private insurance doesn’t cover the sick very well.

  • The Windy City Windbag said:

    Mike, I feel a lot more comfortable on this topic than GW or some others, as I have been a “villain” for 15 years.

    If all of these rescission decisions were based on consumer fraud, then insurance companies would have been able to state: “We only rescind based on identifiable consumer omission of facts.”

    Instead what they said was (from an article in the WSJ):
    At a committee hearing this week, executives from UnitedHealth, Assurant Health and Wellpoint said that they wouldn’t pledge to limiting the practice of dropping coverage to cases of policy holders who lied or commited fraud to get policies.

    Obama has said he wants to eliminate insurers’ practice of denying coverage to those with pre-existing health conditions, a goal that earned him a large round of applause when he addressed the American Medical Association on Monday.

    These are two different statements. “Lied or committed fraud” is different from “identifiable ommision of facts”. Insurers exist based upon proper identification of risk and proper classification of that risk. Ommision can include that of good faith. For example, I am applying for a policy and disclose two items, but forget a third. That is material, but ommitted in error, not because of fraud. Congress should not try to compel private “insurers” to take on that undisclosed risk. Rescission may be the only fair option for the company, which would force the insured to reapply with full disclosure. I personally do not like what I have heard in some cases… of long-term insureds being denied after dozens of years of premium collection. That is not right. It is also not right to deny based upon an previously unknown condition. Just like the Tornado hitting a house two days after binding coverage, that is a risk an insurer takes. but we don’t force an insurer to cover a house that has already been hit by the tornado and just has not collapsed.

    Doctors at the AMA would cheer, because they are not about assuming the risk. They are about treating the patient and getting paid. They are not concerned if a private company is out of money.

    Insurance companies are effective as screening individuals. Few individuals present themselves to an insurance company without their medical history. Your height, weight, and current PCP are known from a causal credit report, as would be prior diagnosis.

    It is possible that an individual that never went to the doctor, smoked and is chronically overweight may somehow now feel the need for a $60K surgery. I think you would find that scenario unlikely.

    I don’t disagree with you that it is unlikely, but Congress was looking for an absolute answer: you will vow to never deny anyone. Rescission is the exception, not the rule. Has it been abused, probably… we have all heard some of the testimony.

    Insurance company rescission policies are a pure “market” play.

    Working for insurers for 15 years, I know how we go out of our way to grant coverage to our policy holders, not the opposite. That does not mean that all companies do it. There are some bad apples, and they should be removed. I would not ruin health care for everyone because a small minority of people have been mistreated. You fix the system that works for the great majority of the people. I offered some simple, cheap market based solutions in my last response.

    The market is efficient at extracting profit from activity. In the classic textbook market place it may turn out that free markets efficiently allocate resources. Unfortunately for health care, sick people are inefficient.

    You will need to explain why sick people are any less efficient than any other want or need in the market place. Health care is burdened with defensive medicine and a ton of cumbersome regulation. That is what makes inefficiencies, not their diseases or ailments. But in spite of that, the American medical market has developed the greatest health solutions the world has ever seen. Michael Barone sums it up pretty well:

    As Scott Atlas of the Hoover Institution points out, the top five American hospitals conduct more clinical trials than all the hospitals in all other developed countries. America has outpointed all other countries combined in Nobel Prizes for medical and physiology since 1970.

    American theoretical health research financed by the National Institutes of Health and by American market-oriented pharmaceutical companies outshines the rest of the world combined. And the rest of the world tends to get the benefits at cut rates. American taxpayers finance NIH, which reports results publicly to the whole world.

    Pharmaceutical companies that produce benefits for patients and consumers get the profits that support their research disproportionately from Americans, because other countries refuse to spend much more than the cost of producing pills, which is trivial next to the huge cost of research and regulatory approval.

    The remainder of your post was a proposal for reducing health care costs by suggesting catastrophic health insurance as an option. It wasn’t clear whether you wanted people to buy this on their own or if you had imagined this as an option for a government run program.

    I would envision a free market system where folks would buy their own coverage or have it as an employer based benefit.

    I would say that taken together with your pre-existing conditions comment your solution offers no relief to health care. People with pre-existing conditions today cannot purchase insurance at any price.

    There are short term solutions to the problems with pre-existing conditions. Afterwards, people would be able to afford the catostrophic coverage and pay for their day-to-day health through HSAs, FSA’s and other self-pay mechanisms.

    Catastrophic insurance exists today. The solution offers no new ground. The uninsured either cannot afford it, or are gaming the system by hoping nothing major happens.

    It is because everything is inflated. Get defensive medicine out, then this is a solution. We can require people to have health insurance just like we do auto coverage. It is new ground when coupled with reform. It is not revolutionary, but then what is it… 85% of people are satisified with their health care as it is today. We don’t need an overhaul… just a fix. Where in the world do we take something where people are 85% satisfied with the status code and blow it up?

    I would say that not providing for office visits defeats preventive medicine. A regular checkup with regular blood work costs upwards of $250. That is a cost of $1,000 for a family of four.

    That just increases the cost. People can make wise decisions when they are required to make the decision. It is not the government’s job to ensure than everyone eats fruit and gets their prostate checked.

    This gets into who pays for health care, you or someone else. In a perfect world, you should pay for your own health care. There is a very good reason why you don’t. Individuals are routinely scrutinized in a way that group policies are not. The only way some people can get insurance is by being in a group. That has evolved, beginning in the 1940’s to employer paid insurance.

    Becoming employer based was probably not the best strain of this evolutionary path, but group policies have helped people obtain policies they may have never been eligible for in the first place. The goal is to get people health care coverage that is affordable and transferable, and then set up the system around that. If a person with stage three cancer leaves their current job and goes to a job with another health insurer, they may or may not face a threat of no coverage. I am really not sure. But requiring that people carry catastrphic health insurance would then eliminate the need for those who choose not to have insurance when they are most likely healthy, and then pre-existing conditions can be shared by the insurers that cover them over time.

    A solution would have to allow everyone to buy insurance regardless of pre-existing conditions. If everyone buys, then I am no more a risk to insurance companies than I would be if I bought through a group plan.

    If you require insurance, then everyone needs to get it. Forget allowing, it should be required. If you can not afford it, then other options can be created… but I can say that my employee based catastrophic health insurance is only $22 per pay period for the employee. It can be affordable.

    The problem we have is that private insurance doesn’t cover the sick very well.

    I disagree with that. It covers the sick very well. We have the best heatlh care in the world. Without a doubt. The best doctors, the best clinics, the best innovation, the best treatment… bar none. We have some problems with coverage and with the exceptions which do not require us ruining our leadership in the world to accomplish it.

  • Mike said:

    WCW,

    Congress is not about to legitimize fraud, period. The practice of denying care for someone who did nothing wrong has got to stop.

    Legislation can be drafted that would define a class of lies and material omissions that would be permit rescission. Companies would save a bundle because they would not have to defend themselves from rescission lawsuits.

    Another way to help insurance companies is to create a risk pool. The pool works as its own insurance policy to pay companies where costs for a person’s care exceeds projected risks. Issues like intentionally lying to get a cheaper rate would be held accountable in some form.

    The problem is not much different than fraud in credit cards and everyone seems to have worked out a system that doesn’t involve an innocent person dying.

    I know how we go out of our way to grant coverage…

    I know you probably work for a very good company, but you are on the income side of the equation. Granting coverage means getting revenue, probably for several years if not decades.

    Rescission is on the outgo side of the company.

    your overall health plan options

    FSA’s only work if people have money to save. It works as a tax free annuity which today pays 2%. It would take you years to save up enough to pay for 1 day at the hospital or a few visits of physical therapy.

    We know that insurance companies understand well the risk of the general population. There are only just so many cases of heart disease, cancer, etc…

    Given that, we can package the entire country’s risk into a model where everyone pays roughly the same. 90% of people who develop a serious condition have been paying into health insurance for years. These are individuals who are likely to be in their late 50s and older and most have really worked and paid health insurance for a long time.

    Everyone would get coverage as a group plan. Once the cost is stable, you can offer deductions for good behavior (keep your weight down, no smoking, etc…)

    With this plan, there is no rescission, no accounting packages.

    your employee based catastrophic health insurance is only $22 per pay period for the employee

    There is no doubt that catastrophic health insurance is affordable. I’d like to see everyone with it. Everyone should be required to get it.

    The problem is that not everyone can get it, or can get it for $22. If you have a pre-existing condition, then all bets are off. You may not be able to get insurance at any price, not even at $10,000/pay period.

    I have no problem with catastrophic insurance. My problem is that it’s currently not available to everyone who wants it.

  • The Windy City Windbag said:

    Congress is not about to legitimize fraud, period. The practice of denying care for someone who did nothing wrong has got to stop.

    And I don’t think I suggested it should. Doing nothing wrong is a loaded statement, but I think I understand your statement to mean that we should not deny without cause. That we agree on. If there is no fraud or omission, and the risk is properly assessed… AND, I would add, a period of time has not passed (almost like a grandfather clause or statute of limitation), then denial of payment can not be done without it being excluded by the policy coverages (for example, face lifts).

    Legislation can be drafted that would define a class of lies and material omissions that would be permit rescission. Companies would save a bundle because they would not have to defend themselves from rescission lawsuits.

    I agree on that. Limited windows of opportunity for rescission… well defined and interpreted to benefit the insured. I think that is the way it is supposed to be. Making laws have unintentional consequences, so hopefully lawmakers won’t make something worse.

    Another way to help insurance companies is to create a risk pool. The pool works as its own insurance policy to pay companies where costs for a person’s care exceeds projected risks. Issues like intentionally lying to get a cheaper rate would be held accountable in some form.

    I know reinsurance exists, although I am not sure it exists in the health field. Insurers are experts in risk management, and they need to use creative instead of defensive thinking. I would not know the advantages or disadvantages of this kind of specific pool… I guess it would depend on its thresholds, limits, available risk pools, etc. I can not see a huge downside, but that does not mean they do not exist. On the whole, I am all about insurers managing their risk better in order to better insure us.

    The problem is not much different than fraud in credit cards and everyone seems to have worked out a system that doesn’t involve an innocent person dying.

    That is the crux in all of this. All of us feel the value of that human life that can be lost because of a wrong decision in health care. I feel strongly if we overturn the current system that it will be much worse than it is now. I see the lines in Canada, the rationing of care in Britain, the lack of innovation in other parts of the world. To paraphrase Winston Churchill… we have the worst health care system in the world, except for all the others.

    I know you probably work for a very good company, but you are on the income side of the equation. Granting coverage means getting revenue, probably for several years if not decades.

    Rescission is on the outgo side of the company.

    I actually do. Most companies are, including the health care companies. They are making the best decisions they can, but mistakes are made. Unfortunately, it is not as if they over charge a person for their bread, mistakes at BC/BS could cause a person their life (to take it to an extreme). Rescission and denying coverage is all part of the equation. If insurers say yes to everything, then their are no limits. In some cases, rescission is the proper thing to do. In others, it is out of line. The cases that make the news and testimony in Congress are by far the exceptions to the rule. Every day in hospitals across this nation, people have babies, surgery, tests, and even die. In the great majority, people are taken care of seamlessly.

    FSA’s only work if people have money to save. It works as a tax free annuity which today pays 2%. It would take you years to save up enough to pay for 1 day at the hospital or a few visits of physical therapy.

    Those would not necessarily be things covered by an FSA or HSA. If you get the forms and defensive medicine out and competition in, costs will drop and service will go up. If costs are down, you will not need to pay $180 for a doctor visit, but likely a whole lot less, maybe $30-40 in a Wal-Mart or other store. One can afford that for day-to-day health. Infrequent prescriptions for low prices and OTC drugs. PT and hospital visits would be covered by the insurance, minus a deductible. Share the risk, share in the success.

    Given that, we can package the entire country’s risk into a model where everyone pays roughly the same. 90% of people who develop a serious condition have been paying into health insurance for years. These are individuals who are likely to be in their late 50s and older and most have really worked and paid health insurance for a long time.

    Everyone would get coverage as a group plan. Once the cost is stable, you can offer deductions for good behavior (keep your weight down, no smoking, etc…)

    With this plan, there is no rescission, no accounting packages.

    Your example is the type of person that should not, in a portable coverage world, ever be cancelled. Health insurers and companies already offer discounts for good behavior.

    There is no doubt that catastrophic health insurance is affordable. I’d like to see everyone with it. Everyone should be required to get it.

    The problem is that not everyone can get it, or can get it for $22. If you have a pre-existing condition, then all bets are off. You may not be able to get insurance at any price, not even at $10,000/pay period.

    Not everyone has it available, but it could be. My reform offered is a tweak of the system, not an overall. These needs can be met. The portability of a policy needs to be addressed.

    I have no problem with catastrophic insurance. My problem is that it’s currently not available to everyone who wants it.

    I think that is a reform we can all hope for…

  • Mike said:

    WCW,

    We agree on a great deal. I see issues with just granting catastrophic insurance. This option is currently available but denied to many.

    My comments on managing and reducing risk were aimed at eliminating the denial of health care insurance that is currently in the system, removing rescission, and making insurance less risky for insurance companies.

    I think your plan needs to incorporate elements that provides coverage for all, regardless of pre-conditions.

    Costs can be reduced by limiting risk, paperwork, and legal fees.

    Ultimately, if having access to care is universal, then the choice of catastrophic v. more comprehensive plans is a personal choice based on spending priorities.

    Your comments on government health plans is based on the perception that it is going to be like Canada or the UK. None of the planned reforms seem to me to even come close to creating a single payer plan.

    But we have yet to address the real challenge in health care, which I’ll describe later today when I have time.

  • Mike said:

    Whether we have single payer or not is hardly the most important factor in health care. The greater factor is innovation.

    Canada could have shorter waiting times. All it needs is investment in facilities. The problem is not that the Canadian Government rations health care, nor that it is too expensive. The problem is there isn’t sufficient staff.

    A second part of the waiting list problem is the low ratio of doctors to population. Roughly 2.1:1000.

    In the US, getting more people insured through a Government or Private program will not change the innovation equation. What will change it is if reimbursements change, for example, if payments drop.

    This payment drop gap has been occurring at a significant rate in the US. Hospitals have been getting a great deal of pressure from private insurance to drop prices.

    The only pressure to not drop prices and reimbursements below a certain threshold is the threat of a law suit. If a doctor could have done something for you and didn’t, etc….

    This money side needs more attention and is getting none. Everyone is focused on Canada, but the real focus should be elsewhere.

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