yeah, the insurance companies that insure everyone are normally govt subsidized and non profit... see BCBS.

Single-payer healthcare NOW.

Moan about it all you want, it would be hard for such a system to be more bass ackwards than what we have now.

Can you clarify if you agree or disagree with what I'm saying? I can't quite follow you here.

disagree...

companies should be "companies"

also, the people who get insured privately often have their medical options limited

In rebuttal to my own post,

Suppose there existed the government Commission on Adequate Care, where a dedicated team of scientific experts drawn from around the medical profession and economists drew up a giant chart of sanctioned medical care according to some quality-of-life score. Little Suzy has terminal bone cancer and wants government insurance to cover her new $30,000 experimental treatment. Before the fact, I'll tell you that none of the current medicines can possibly work. The government denies her petition based on its excellent accountability scheme.

1. Is this situation fairer than our current one? Remember, you are dealing with government bureaucrats, so you have democratic accountability, but little financial accountability.

2. Is this solution financially stable? What happens to the finances when many Suzies when the new Democrat-elect campaigned so that she receive her timely treatment?

3. Is this solution politically stable? Should Suzie's families protestations mean anything? Is it better receiving the "no" from a cold-hearted government, or a cold-hearted private company?

Because even healthy pregnant women sometimes have complications, and the insurers, by and large, simply don't want to expose themselves to that risk. It's not the insurer's "fault", but it still leads to a big gap in health insurance coverage, ie, market failure. (yes, I know, the market just didn't do what I wanted it to, blah blah...well, pregnant women still can't buy insurance no matter what you call it, and this is still a problem that needs to be solved no matter what you call it, unless your solution is "well, pregnant women just damn better have existing coverage when they get pregnant, ldo".) It's not purely speculative, it's already happening. Google something like 'health insurance Huntington's' and you'll find plenty of stories of people not wanting to get tested for exactly this reason. That's not a good thing.

Not sure what you mean. This is a tautology and doesn't seem to argue against anything I said.

Well, yes. Having unlimited medical options is so expensive that virtually no one would pay the premiums, so you can't buy unlimited medical options. What's the point?

One argument I'll never accept is that the government would be able to keep real costs down without waiting lines. From that almost everything follows.

A good point and why I don't like Canadian or British UHS, either.

Ok, i have quite a bit of experience working in real hospitals, and treatment options that needed, MRIs, some Rxs, transplants etc, are often limited by insurance. Someone dying bc insurance was ****ing around isn't a myth.

Second, the "companies" that you cite as providing coverage for everyone aren't really companies. They are government subsidized pseudo agencies, often not even working for a profit

First of all, let's try to avoid a market failure/not market failure debate because we know where that's going. I'm not saying you're wrong for bringing it up, but if we just go back and forth with "Markets can't fail!/Oh yes they can!" we'll both get nothing out of it.

I don't particularly like the idea of preggos not having health insurance, either. But what are the ways to deal with it?

1. We could rely on the "market solution", falling back on notions that if we observe this phenomenon in a market then that gap in coverage is just part of the optimal result. I know you don't agree with this, and don't think there's any point in going down that road, so can we agree to not even discuss this?

2. We could give money to the preggos to either buy them insurance or pay for their health care costs as they emerge. We can either do this implicitly by forcing the insurer to cover them and raise everybody's rates, or we can do it explicitly by establishing a charity where the preggos could apply to get money to help with health care costs. What is the benefit of hiding this charity in the insurance rates?

A couple of points on this as well.

1. I was saying that your conclusion that everyone under the sun with a tendency to have higher costs would be excluded from coverage rather than just getting allocated to a higher insurance rate class. You have no basis to assert that insurers will start excluding everbody with one of the listed conditions.

2. If people are refusing to get tested for conditions because the don't want to be excluded from coverage, what you end up with is the whole insured population including these "risky" people with higher rates for everybody. This is the exact situation you are asking for.

I know it sucks honey, but having no prenatal care for your kid is just part of the "optimal" solution because you didn't get HI before you got pregnant. its all your fault, you dumb *****, so now lets punish your kid

In both of these paragraphs you seem to be conflating "insurance companies as they are in the regulatory environment they are forced to operate in right now" with "insurance companies in an open insurance market". I am suggesting that the latter would be good, not defending current insurers.

fine There isn't any, but it's not particularly worse than making all pregnant women apply for Medicaid (basically what the 'explicit' proposal is), an existing government bureaucracy that isn't really set up to deal with that situation and isn't very efficient to begin with. I'd rather simplify life for the pregnant woman at the cost of complicating it for the insurance company, which *is* in the business of insuring people and can handle it better. If the hybrid result is a government subsidy to the insurer, a tax cut, or a direct payment to the hospital, fine, whatever, I'm all for the most efficient one of those. It's definitely already starting to happen, though. Huntington's patients are not getting health insurance. Neither are 18 year old schizophrenia carriers and neither is anyone with the breast cancer genes. How many people out there have some kind of really bad genetic condition? If you include Alzheimer's and the cancers we don't have tests for yet, I think it's most of the population once you're old enough. But that's what's happening now as it is, and that's clearly not an optimal situation (at least, I can't imagine how having the option to test yourself but being financially unable to do so is optimal). What are you proposing to fix this?

I acknowledged that the "market answer" wasn't worth discussing because none of us want pregnant women to have no health care, so picking it out as the one thing in my post to criticize isn't very productive. I'm trying to play nice with the non-libertarians, even though I'm a "market guy" on health care.

This is the one really good argument for gov't-provided health insurance. Some people, through bad genetic luck, simply are sick and will incur very large, uninsurable health-care costs. Government is a good way to "insure" against the risk of being one of these people (at least from the financial side).

Possible policy solution: government-provided bad-genes supplemental insurance, which covers huntington's, cystic fibrosis, breast cancer for people who can't get coverage because of genetic screenings, etc.

I think it's a terrible idea to throw the burden on the insurers with regulation, because the effect is that the insurance business is less appealing to get into, so you are discouraging people from providing the service that you want there to be more of. It seems to me that it either has to be a supplementary charity or a supplementary government program (I think you need to leave the insurers alone at their "most profitable" so that more people will get into the profitable insurance business and provide more insurance - then you deal with what's left).

I have a lot more confidence in charities than government programs. I would much, much rather give money to my local United Way to support local uninsured pregnant women than have government increase taxes and who knows what they do with it.

It has to be the same as for pregnant women - if you interfere with private insurers you just discourage private insurance and compound the problem. If you don't like the "market" outcome, then supplement the market with charities or government programs for the excluded. I prefer charities.

Major slippery slope issue: If the government will supplement the "genetically uninsurable", what about the "genetically unemployable", or the "genetically unable to get into university"? Are we just going to say "Whatever unfortunate aspects of you life can be attributable to genetics, we will institute government reimbursements so you need not suffer"? The gov't can't pay all these supplemental benefits for free - they can only pay for it by reallocating resources from the "genetically lucky". Do we even have the capability to sort the genetically good from the genetically bad? Do we even want to?

You're supposed to link these and definitely not post the whole article btw...

Anyway, there are many reasons for this. Here's one. Control variables people! Seriously.

http://www.forbes.com/forbeslife/200...orldfat_2.html

This slope is not very slippery, because it's not clear how we would compensate people for being dumb. Progressive taxation? Unemployment insurnace? We already do those things for different (or possibly the same) reasons.

As for whether this is something we want to do, I would say yes. First, I think it is unfair that someone could be born with basically no chance to succeed because they have to pay a lot of HC expenses because of a random condition. Second, a credible position is that industrialized nations should pay for 100% of health-care, so I think my plan is a reasonable compromise.

Pregnant women can qualify for Medicaid rather easily. There are several different levels of Medicaid coverage. The lowest is "pregnancy related" medical and is very easy to qualify for. If the women is married and they both work she may not qualify until she stops working. It covers all prenatal care, delivery, any complications, and the baby is automatically covered for the first year regardless of the parent's income and resources.

The system is screwed up, but in my two years working in it I never encountered a pregnant women who needed help that didn't get it.

I'm tired of hearing about these mythical pregnant women and children that have no health coverage. Medicaid is health coverage.

It is conceivable that virtually every disease has a genetic component to it, they range every where from occurrence of genetic abnormality X -> 100% result in condition Y to the combination of genes a, b and c leads to a predisposition of n% to condition d. Where are you drawing the line? How can you justify providing care for someone who has a 65% chance of getting ill due to their genes but not to someone who has a 64% chance?

Well, I disagree because I think that when you open the door to compensation for poor genetics, it's wide open. But, I acknowlegde your position as not insane, so let's move on.

Slippery Slope Number Two: If government agrees to insure everything that is not picked by private insurers, then Adanthar's nightmare of only the least risky being insured with definitely evolve as insurers designate more and more people as "uninsurable" and make them the government's problem.

QFMFT! If we make it a goal to mandate insurance for everyone, and the government starts by choosing the riskiest, you can bet insurers will try to shuffle off all but the most profitable of their clients - that is, the healthiest. Unintended consequences, huh?!

If you have the right to exclude market failure discussion, I claim my right to exclude charities. I want this stuff guaranteed from a known source, not haphazardly available for people that happen to dial the right number.

But yes, a government program for high-risk insurance is obviously going to be swamped by insurers sloughing off more and more 'high risk' people that happen to have broken an arm playing a sport or something. So, in the long run, that isn't a solution, either. Now what?