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Iowa insurance market collapse could ground young entrepreneurs' dreams

desmoinesregister.com

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Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#41

Post by gwbas1c »

anovikov wrote: post #7
s73ver wrote: post #2

Basically, do we want to send the signal that entrepreneurship is for everyone, or just the rich and healthy?

Entrepreneurship is not for everyone. It is for people who take risks. And yes it takes being healthy, because it is a stress which even most absolutely healthy and young people can't endure. And preferably rich because it sucks being left at the mercy of investors.

When I quit my job to run a company, I was very healthy. I just couldn't buy health insurance on the open market because I had a pre-existing condition.

This was prior to ACA, so I ended up paying through the nose for COBRA.

Pre-existing conditions aren't always debilitating. They can be things that, when treated appropriately, don't impact your ability to start a company at all: diabetes, amputation, cosmetic issues like severe hair loss, sleep apnea, amputation, ect, ect.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#42

Post by humanrebar »

mikeash wrote: post #16
awareBrah wrote: post #5

Obamacare, the proposed trump care, its all a failure. Get rid of the employer sponsored plans, that makes no sense at all and makes me hesitant to lose my job because my health relies on it? That is simply absurd. Get rid of this. I'm so frustrated with the healthcare here and I don't understand how Washington can't come up with any real solutions

The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a publi…

> For example, the main, perhaps only reason the ACA didn't include a public option is because Joe Lieberman, Senator from a state where the health insurance industry is huge, refused to vote for a bill that included it and his vote was required for passage.

...there were 40 other senators who were not voting for the ACA. The bill didn't, and still doesn't, have enough popular support. You can't blame one play on a lost game and you can't blame one voter for a lost ballot.

Doubling down on employer provided healthcare with additional mandates didn't help their case.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#43

Post by theseatoms »

toomuchtodo wrote: post #32
shard972 wrote: post #26

Earlier quoted context omitted.

That's a fair argument but I'm more interested in how much R&D happens under single payer systems.

Does the NIH and NSF not provide a pipeline for drug research in the US? Did you know the CEO of Mylan, the company that makes epipens made $98 million last year? Is that reasonable? http://money.cnn.com/2017/05/31/investing/epipen-mylan-chair...

Reminds me of a good SSC post.

> The problem with the pharmaceutical industry isn’t that they’re unregulated just like chairs and mugs. The problem with the pharmaceutical industry is that they’re part of a highly-regulated cronyist system that works completely differently from chairs and mugs.

http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-dr...

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#44

Post by vsipuli »

madengr wrote: post #3

That's probably the main factor preventing me from quitting and working for myself. Crazy high medical insurance for a family of 4. That and educational savings for kids. "Free" medical and college would cause a hell of a disruption that corporations would not like.

Do employers really negotiate that much lower health insurance rates compared to what a self-employed can get?

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#45

Post by chimeracoder »

creaghpatr wrote: post #35
avs733 wrote: post #17

Earlier quoted context omitted.

Single payer works well in the US. Despite claims and the continuously driven narrative of government inefficiency and waste, Medicare and Medicaid are easily the most efficient and effective health care options in America. It would take a one line act of congress...removing the income cap...to make America a defacto single payer state. The only problem is that it would disrupt a huge capitalist market, and our socie…

Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. Hospitals that have too high of a proportion of Medicare patients get a bonus subsidy from the government to cover up the fact that the coverage alone can't financially sustain the provider. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... If we implemented single-payer in the form of Medicare as it is now,…

> Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. If we implemented single-payer in the form of Medicare as it is now, the healthcare industry would quickly collapse.

In addition to everything you said (which is true), Medicare's apparent success is also boosted by the portion of Medicare patients who receive their non-pharmaceutical Medicare benefits through a private insurer.

Original Medicare (which is the part of Medicare that is purely government-run[0]) has dramatically lower ratings for both medical outcomes and patient satisfaction scores[1] than Medicare Advantage, which is privately run. Medicare Advantage also consistently outperforms Original Medicare on cost as well.

Unfortunately, when statistics are cited for Medicare as a whole by laypeople and in mass-media, Original Medicare and Medicare Advantage are lumped together, giving the impression that Original Medicare is much more effective and well-liked than it actually is.

The same applies to Medicaid, but because that's state-run, the exact details vary from state-to-state. Overall, though, nearly ever state has some form of private management for Medicaid plans, and those consistently outperform the state-run counterparts, for reasons which are immediately clear to anybody who's experienced both firsthand.

[0] except for drug benefits under Part D

[1] In 2015, Original Medicare's patient satisfaction scores were lower than the very worst Medicare Advantage provider - they were literally the bottom of the rung.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#46

Post by humanrebar »

jballanc wrote: post #29

I always wonder why, in all the coverage about health care and insurance groups "pulling out" of the marketplace, no one seems to want to state the obvious: * Insurers are not pulling out of the insurance market . * Insurers are pulling out of selling to individuals . * This is happening because selling to large groups (like entire companies) is easier/more profitable. * It is easier to sell to larger groups because…

It's a big leap to say 400 million pools of one is inefficient therefore the best option is one pool of 400 million.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#47

Post by pc86 »

mikeash wrote: post #16
awareBrah wrote: post #5

Obamacare, the proposed trump care, its all a failure. Get rid of the employer sponsored plans, that makes no sense at all and makes me hesitant to lose my job because my health relies on it? That is simply absurd. Get rid of this. I'm so frustrated with the healthcare here and I don't understand how Washington can't come up with any real solutions

The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a publi…

> study the systems of other first-world countries and incorporate the things that work best into ours

The problem with this line of thought is that the US is orders of magnitude larger, more diverse, and more complex than most European nations. For any single European nation I'd wager at least two of those are the case.

But we have a way to do this already without massive Federal overhauls - allow individual states to do what they want. This means the decisions are made closer to the people, so California can do what California wants while Mississippi can do what Mississippi wants. It also has the side benefit of California not paying for services in Mississippi.

Personally if one of the US states offered non-employer-based, single-payer healthcare I would move there in a heartbeat. If it's as successful as proposed, it would not take very long to most states to offer something similar. At that point, depending on individual implementations, it would be much easier to extend it to the Federal level.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#48

Post by avs733 »

creaghpatr wrote: post #35
avs733 wrote: post #17

Earlier quoted context omitted.

Single payer works well in the US. Despite claims and the continuously driven narrative of government inefficiency and waste, Medicare and Medicaid are easily the most efficient and effective health care options in America. It would take a one line act of congress...removing the income cap...to make America a defacto single payer state. The only problem is that it would disrupt a huge capitalist market, and our socie…

Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. Hospitals that have too high of a proportion of Medicare patients get a bonus subsidy from the government to cover up the fact that the coverage alone can't financially sustain the provider. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... If we implemented single-payer in the form of Medicare as it is now,…

I agree my comment was an oversimplification but I think it is fairer to say that "the health care industry as we know it would change"

I think you are unlikely to see immedaite adoption but over time you would have many other/new/different problems to address just as we have many problems now. It is worth mentioning that it would like cause significant employment reductions in the non-governmental insurance providers which are not without an impact.

But for starters, both medicare and medicaid are effectively a concentration of very high risk/high cost customer pools (the elderly and the low income). Opening it up would likely positively impact that cost calculation as well

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#49

Post by kaitai »

creaghpatr wrote: post #35
avs733 wrote: post #17

Earlier quoted context omitted.

Single payer works well in the US. Despite claims and the continuously driven narrative of government inefficiency and waste, Medicare and Medicaid are easily the most efficient and effective health care options in America. It would take a one line act of congress...removing the income cap...to make America a defacto single payer state. The only problem is that it would disrupt a huge capitalist market, and our socie…

Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. Hospitals that have too high of a proportion of Medicare patients get a bonus subsidy from the government to cover up the fact that the coverage alone can't financially sustain the provider. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... If we implemented single-payer in the form of Medicare as it is now,…

But this is because Medicare reimbursement rates are set by a panel of specialists (I believe there is one internal medicine doc and then every specialty is represented, so getting a stent sure does get reimbursed well while counseling a diabetic about keeping that A1c down or working on the toe of a homeless guy get reimbursed approximately not at all) who don't necessarily care if Medicare is that fair.

Tangentially, note Medicare spends about 3% on overhead, compared to private industry's previous 30%. (There are now caps on overhead expenditures -- trying to keep it to 20% or less.)

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#50

Post by pc86 »

humanrebar wrote: post #42
mikeash wrote: post #16

Earlier quoted context omitted.

The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a publi…

> For example, the main, perhaps only reason the ACA didn't include a public option is because Joe Lieberman, Senator from a state where the health insurance industry is huge, refused to vote for a bill that included it and his vote was required for passage. ...there were 40 other senators who were not voting for the ACA. The bill didn't, and still doesn't, have enough popular support. You can't blame one play on a l…

> you can't blame one voter for a lost ballot

You can't do this in popular elections but you can absolutely do it in the legislature where everyone has a different constituency, policy portfolio, campaign contribution history, etc. Lieberman wouldn't vote for a bill with a public option, full stop. The math worked out such that Lieberman was necessary. Ergo, Lieberman killed the public option if there was no other Senator for whom the existence of a public option would have changed their Nay to a Yea. There was not, so you can absolutely lay the lack of a present day public option for health care in the US at his feet.

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