Saturday healthcare blogging pt. 1

Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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16 Responses

  1. zic says:

    Often enough, if you’re in your twenties or thirties, unless there’s some sort of catastrophe, people don’t have that much need for comprehensive medical insurance, and a very basic preventative service plus catastrophic coverage may be enough.

    That should be the standard for all people, with additional coverage purchased on top as needed by your health needs, without exclusion, and subsidies for those in financial need.

    By the time they start a family, they’re usually employed and receive somewhat more comprehensive coverage anyways.

    I still think people will be better off when they’re not dependent on their employers for comprehensive coverage. Beyond the health debate is the economic debate, and separating health coverage and employment would benefit entrepreneurialism and innovation from creative people now locked in jobs they might not want for health benefits.Report

  2. EngineerScotty says:

    Here’s an idea I haven’t seen before, won’t cost much if anything, and might help some folks who have been wiped out by medical expenses:

    Legislate a way for expedited cleansing of credit records for those with bankruptcy, foreclosure, etc. which are primarily due to medical expenses. Obviously, separating wheat from chaff might be difficult (one expense might be the need to hire auditors or examiners), but if a credit history shows that unpaid debts consist of a) medical expenses, b) reasonable and customary debt incurred prior to the medical event, and c) necessary non-medical debt incurred elsewhere–it might be sound policy to permit persons in such circumstance to have their credit reports cleansed. Obviously, frivolous or careless spending, or significant non-necessary debt incurred after a medical debt was incurred, would be disqualified from such cleansing.

    (Speaking of which, here’s an unrelated plug for the proposition that ones credit report ought to be subject to the same legal protections as ones medial records–I’m all for a “CIPPA” law tightens further present abuses in credit reporting. In particular, I’m for the proposition that nobody ought to be able to demand your credit report unless they plan to extend you credit of some sort. So there. 🙂

    The unabashed liberal in me wouldn’t mind seeing health care reform itself, made retroactive to some extent–persons who have (in recent years–there would have to be a time limit, naturally) been wiped out by medical expenses, or creditors of same who have lost money, might be able to apply for a government credit to settle these debts, or to help purchase a new home to replace the one that they lost. (If nothing else, a tax credit meted out over several years, in case issuing a check sounds too much like welfare for the right). The conservative in me is a bit skeptical of this, mainly because of the extreme potential for fraud, but it’s another idea I haven’t seen expressed before…Report

    • I’m all for revamping the credit-report system. It’s complicated, there’s no transparency, and it holds far too much sway over peoples’ lives. That is certainly one area where consumer protections, simplifications, etc. would really come in handy and be – I think – overall very good for the economy and for individuals.Report

  3. Nob Akimoto says:

    Given that the rate of employers providing healthcare coverage is declining in very alarming numbers, not to mention the degree to which decisions about benefits constrains labor mobility, I’m not so sure having a mandate is such a bad idea when coupled with the NHX and subsidies, as well as guaranteed issue AND price spread caps. The point being more that younger people will be paying a bit more in their 20s so that their family is covered into their 30s and 40s without being captive to large employers.

    Also, correct me if this is incorrect, but I’m under the impression that Baucuscare has something of an “opt out” for low risk individuals that basically amounts to buying catastrophic coverage and nothing else to keep their premiums really really low. (Which was actually considered a bad thing because that’ll screw up the risk pool.)Report

  4. Katherine says:

    Five. Thousand. Dollars. A. Year?!

    I have never been so glad to live in a country with national health care. I couldn’t possibly pay that; if I lived in the States I’d be one of those young people without health insurance, and wouldn’t know what to do if I was required to pay that much for mandated coverage. This is why mandates without a low-cost public option are a terrible idea.Report

    • Mark in reply to Katherine says:

      Well hold on a sec. In Canada, your health care costs you zero dollars a year…Except it doesn’t. The money you pay for it disappears in taxes before you ever see it. And it’s the same for anyone who has employer health insurance in the US that’s paid for by the employer – it’s a pre-pre-tax payment that never even shows up on your paycheck. But the cost of health care cuts down your net pay in both Canada and the US.

      Assuming the Baucus plan passes and the public exchanges aren’t completely hamstrung, the real remaining problem in the US is the garbage insurance that most people get from their employers. Huge out-of-pocket payments, fees that can’t be determined in advance and garbage like lifetime maximums and higher premiums for small companies. That all has to go.Report

      • Katherine in reply to Mark says:

        As things stand, I don’t pay much tax because I don’t make much money (actually, when you include the sales tax rebate I probably get more money from the government than I pay to it). And when I’m finished my education and making more money, I’ll have no problem with paying higher taxes to fund healthcare. Income tax isn’t even substantially higher here than in the US; for some tax brackets (the top ones) it’s lower.

        Five thousand a year is just plain unaffordable for a lot of people.Report

        • Mark in reply to Katherine says:

          I think you missed the point here. You would either be on your parents’ plan as a student (approx. $2000 a year, possibly less) or you would get low-cost health insurance from your educational institution (it was something like $300 for the year when I went to Berkeley.) If you were working, had student debt, and you made less than $20k per year, you’d probably qualify for Medicaid or the subsidies in the US. There are all kinds of convoluted rules for people under 24, so it’s not clear where your health insurance would come from, but it would come from somewhere cheap.

          ED is talking about single working people in their 20s in the, say, $40k per year range. At over 400% of the federal poverty level, they would qualify for nothing and be forced to buy insurance in the exchange. He comes up with a number of $5000/year, which I think is at least double what a public option policy would need to cost if you pooled all 20-30 year-olds.

          The other thing that ED misses here is that it’s not like people in their 20s really want to go without health insurance. It’s being framed as though people just say fuck it, I don’t need to be able to go to the doctor. Total bullshit. If people had the choice of a job that paid $40k with no health insurance or $37600 with it, there’s no question they would take the one with insurance. Hell, they’d probably take $35k with health insurance, even if the value of the insurance was only $2000. So why such a big deal is being made about people in their 20s having to get insurance is beyond me.Report

          • Isaac in reply to Mark says:

            at 22 yrs, I’d rather take an employer that paid more and didn’t give me health insurance over an employer that paid less and did. Employer provided insurance gives my employer a reason to stick there noise where it doesn’t belong, and further puts me in the position of losing all coverage at the companies discretion. This is especially true if we are talking about “at-will” employment.Report

  5. Zach says:

    I totally agree that this bill is basically paid for by basically taxing young people. I think that’s basically what happened in MA, too. If you mandate coverage and limit pricing premiums based on age, young people aren’t getting what they (well, we) pay for and are basically subsidizing everyone else.

    This is politically convenient because of overwhelming support for reform amongst the young.Report

  6. Mark says:

    ED – where did that $5000 a year come from? If you look at the full price of the federal government individual health plans, less than 25% cost $5000 a year, and none of the basic HMOs they offer (ie – excluding plans known as “high self”) cost $5000 a year. The federal plan also doesn’t do community rating, so a 24-year-old pays the same price as a 64-year-old. If the best the insurers can do is $415 a month to insure the healthiest people in the country, wouldn’t that present a huge opportunity for any insurer to offer lower-benefit lower-cost plans and clean up in that part of the individual market?

    I still think the Baucus plan will cost individuals way too much money, but if it can’t do better for young people than what Blue Cross charged me as a 26-year-old in 2003 inside a small business HMO ($206/month) it doesn’t speak volumes for anyone’s ability to provide health insurance at a price commensurate with its actual cost.Report

  7. Pat Cahalan says:

    Er, if young people are required to get insurance (and they don’t get insurance now), and thus they start contributing to the insurance pile, yes… that’s money “out” of the service industry.

    However, assuming we don’t allow insurance companies to take all that money and roll around in it, it stands to reason that (if the profit margin remains about the same), the premiums are going to go *down* for all those people who are on the same carrier. So, those people will have that extra money (minus a vic for the insurance company) to pay into the service industry. Even the vic for the insurance company winds up back in the economy.

    The economy is an engine, the only real changes come from trade and exports. Moving money around inside the system isn’t necessarily a loss.Report

    • Jaybird in reply to Pat Cahalan says:

      Well, at that point, it’s wealth redistribution. (Which, of course, is not in itself wicked.)

      But that feels like using the political process to take money from this particular constituency (the younger folk) and giving it to that particular constituency (the older folk). Indeed, the younger folk will be covered in case of catastrophe.

      But if you bust out your actuarial tables, you’ll see “holy cow”, this is a transfer of wealth from a group that, as a whole, doesn’t have quite as much to a group that, as a whole, tends to have more. The moral language about the children coats that fairly bitter pill with some sugar, but…Report