lennavan: 1. Deregulate the state exchanges, while capping subsidies.2. Slowly shift Medicare patients into the exchanges.3. Let more people buy insurance on their own rather than through their employer.4. Move Medicaid patients into the exchanges.It's actually 3 steps, as 2 and 4 are the same. Also, steps 2 and 4 have nothing to do with Obamacare. Medicare existed before Obamacare.As for #3, does the author think people are prevented from purchasing insurance on their own? Of course not, what the author really meant was "don't force employers to give their workers health insurance." It seems the author thinks an employer who saves $10,000 a year on health insurance costs is just going to pay that person $10,000 more a year. They won't. They'll keep it for themselves.
The Reverend Smith: HeartBurnKid: Nah, FreeMarketCare is what we had before ObamaCare.Not in the least.
entropic_existence: mrshowrules: Conservatives want free-market insurance. Liberals want single-payer. It is like one side wants to go swimming and the other side wants to mountain climbing so the natural compromise is either go swimming in your mountain gear or climb the mountain in a bathing suit.I think liberals want affordable Universal coverage, but not necessarily single-payer. There is definitely a large-component that prefer single-payer, as the obvious model that they see to compare against is Canada's, but it has never seemed to me that they are generally 100% set on that model.
Lawnchair: Zasteva: and the efficiency and risk distribution of private insurance for the more "exotic" stuff.Then answer... would you make that *extra stuff* universal issue? Would you force companies to sell at community-rated rates to everyone, including people who are or are likely to be sick?
nekom: 1. Deregulate the state exchanges, while capping subsidies.I understand those words, but what on Earth does that even mean?2. Slowly shift Medicare patients into the exchanges.Why? What's wrong with Medicare as it is?3. Let more people buy insurance on their own rather than through their employer.Why? Employers can pool insurance and negotiate for much lower rates than an individual can. Part of the reason I still work where I do is because of my awesome benefits package.4. Move Medicaid patients into the exchanges.How is this different than #2? Is this idea so novel that it needed mentioned twice?
DeaH: FreeMarket care is always going to suck, and it's going to suck in two main ways:1) The insurance model will always lead to the highest cost for the least service.Insurance companies (like all free market businesses) want high profits and low costs. This makes them really bad gate-keepers to the health care system. And, that is their own health care job - acting as a gate keeper.2) Our current education and licensing system for doctors encourages them to seek high profits, sometimes at the detriment to the patient.Doctors leave medical school with huge debts. One of the quickest ways to change the debt into profit is to invest in testing and equipment. Unnecessary medical tests and unnecessary medical procedures make big money for medical corporations.The odd thing is that these two factors ought to have checked each other, but they don't. What usually happens is that patients end up holding the bag for any uncovered costs. Medicine should not be a free market business, and the gate keeper for medicine also shouldn't be free market.
entropic_existence: Zasteva: Sorry, In my earlier response I meant to add that I agree that preventative care is one of the most important parts of any health plan.But since everyone needs it, and everyone gets it, what does insurance add? Only a middleman with profit motive who adds costs. They don't provide the health care, they just add overhead.A single payer system is a far better way to handle things that everyone needs.Arguably similar outcomes can be achieved for a similar cost using different approaches. Again just compare the Swiss model, which is insurance-based, with say the Canadian model, which is single-payer. Similar outcomes, fairly similar costs, totally different approaches. Insurance-based isn't necessarily bad, but it needs to be tightly regulated. In the Swiss health-insurance market, in order to be legally allowed to offer health insurance you have to offer a government mandated "basic" package. This basic package is well-described and is your baseline universal coverage of everything. By law this package cannot be sold at a profit by the company. Insurance providers are then able to create all sorts of premium packages that do generate profit. But the premium packages don't really give you better care, or access to different treatments or shorter wait-times. They just make you more comfortable in hospital stays and things.So it works, but you have to be willing to have tight regulations on the market.
cameroncrazy1984: The Reverend Smith: HeartBurnKid: Nah, FreeMarketCare is what we had before ObamaCare.Not in the least.It's what Somalia has.
entropic_existence: The Swiss system that they compare to in the article (I'm not sure the author of TFA really understands the Swiss-model, since deregulation isn't in line with how the Swiss do it) doesn't fit any of those three groups and is considered Universal coverage. Residents are mandated to buy insurance by law, the kicker is that in order to provide health insurance a company has to be registered with the proper Swiss authorities, and by law the "basic" coverage, which they must offer, can not have a profit. So many of the insurance companies are actually non-profits in Switzerland. You are allowed to build "premium" packages that offer more amenities, etc. And those can make a profit.
nekom: 3. Let more people buy insurance on their own rather than through their employer.Why? Employers can pool insurance and negotiate for much lower rates than an individual can. Part of the reason I still work where I do is because of my awesome benefits package.
Lumpmoose: make me some tea: ObamaCare is already FreeMarketCare. I don't support the idea of putting Medicare into the mix. Leave it alone.Yeah, if you want universal health care you must pick 1) "a windfall for the insurance companies" via the mandate, 2) competition against a public insurance option or 3) the end of private health insurance as we know it. In order to get some sort of healthcare reform passed, Obama compromised and picked #1, which was mostly a GOP idea that they then refused to vote for because they are premium grade assholes.
Gwyrddu: An actual intelligent comment to the articleMarket forces work well in health care in many respects, but there is an 800-pound gorilla here which the Swiss understand (as does Avik Roy) but the author here seems to forget. Much of what goes into a health insurance premium is what the insurer has to pay the doctors and hospitals for services for its enrollees. When lots of insurers are trying to compete in a market with a few dominant hospitals, for example, the hospitals can essentially act as monopolies ("You insurance company X, I won't take your subscribers unless you pay me $100,000 for a hip replacement surgery,"). Research has shown that premiums are actually lower in the US when you have fewer insurance companies competing for exactly this reason - they have more negotiating power vs. the hospitals.Switzerland has solved this problem (as has Medicare and Medicaid) by setting hospital and physician prices. They also set a basic benefit package. That frees up the insurers to compete on service, efficiency and lower administrative costs. In the US, until we solve that issue, dumping Medicare and Medicaid folks into the exchange will raise costs enormously because Medicaid pays hospitals and docs half of what private insurers do (and Medicare, about 3/4ths).Of course the commenter was rather generous to assume the author every understood anything about what he is talking about, but it's certainly yet another reason why this is a terrible idea.
Dinki: nekom: 1. Deregulate the state exchanges, while capping subsidies.I understand those words, but what on Earth does that even mean?I think it means that the states would be able to offer as many or as few services as they want, and the Federal government would have a hard limit on how much support they would provide. So just imagine what the exchange would look like in places like Alabama and Mississippi.
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