Suppose you run the "ACME Health Insurance Company"

[SoCalDem]

Right now you are raking in the bucks, by excluding the sickest, oldest potential "customers", and by canceling those who prove to be "expensive" for you to have as customers.

Congress passes a law that requires you to now cover, and to continue to cover the very people you have built your business-model on, by excluding.

Do you:

A) take a pay-cut?
.......1. because you will have to hire more people to minister to the new customers you may get
.......2. because these new customers will definitely cost you more money (in services paid for)
.......3. because the ones you would have canceled, must now be kept

B) raise your rates significantly to cover your added costs

C) stop writing health care policies completely?

People in Florida & the Gulf Coast learned how devious insurance companies can be. They willingly accepted premium payments for decades, but when a really bad hurricane season came along, many of them just said "Sue me!", pulled up stakes & bailed.

People who have just lost everything are often financially unable to carry on protracted legal battles, just to get what they thought they had been paying for. (some did, but most did not).

Watch for health care insurers to land on their feet, by jacking up rates..or to just "leave the building".

A "New Rule", that says you cannot "deny" coverage, gives a lot of wiggle-room for insurers. What happens if they "offer" you coverage, but at a price you cannot afford? Did they deny you?. They offered you a policy. It's not their fault you cannot afford it.

If 30% is going to be the benchmark number for insurance cost vs gross pay, that means that at $66K gross, if a company "offers" you coverage costing $19,800 a year, you could not "opt-out", and take advantage of a "public option".

and...

No one..not even the US Congress can FORCE a company to stay in business.

If their business plan says "We're gonna lose our shirts here, folks", they will close up shop, and bail.

[Donnachaidh]

worked for the Dept of Insurance in Los Angeles and saw this ALL the time.

The CEOS and upper management line their pockets, steal anything that isn't nailed down, and head for the hills, leaving everyone else to clean up the mess.

I certainly hope we have journalists who will cover the wild parties the insurance industry is going to have in celebration of their windfall.

[mike_c]

1. if I have to take on an additional 30 percent expense I'll be homeless...

eom

[krispos42]

2. Option D: form a cartel and price-fix n/t

[Donnachaidh]

5. no -- form a co-operative or an exchange and price fix. n/t

[SoCalDem]

7. We just need Medicare-Part E

for everyone IN..

with a sliding scale for younger folks.

Workers are now paying 1.45% worker/1.45% employer, into medicare

Why not just make it ?

50-64 10% worker-10% employer
26-49..5% worker-5% employer
birth-26..SCHIP

at 80-20% coverage, people could still buy their "supplemental" policies to help with the 20%..

disabled people could still use Medicare like they currently do (and SSI)

We could probably ELIMINATE medicaid by doing this, and by dedicating the soon-to-expire rich folk's Bush tax cuts to fund the "new " medicare part E, until all the hitches were worked out.

[Trillo]

14. About those age levels and different prices

I think for the purposes of healthcare, it makes more sense to account upon a human lifetime basis, instead of year to year. We now have powerful computers and a populace that generally know how to use them.

If someone has paid in while they're younger, and didn't need much expensive care, so they didn't use it much, then why when they need more care, because they're older, do they need to pay more? The ideal of helping your neighbor when they're sick so you can be helped when you're sick is undermined by age-based pricing.

It just strikes me that year-to-year accounting is more convenient for corporate, and entity which has no definite lifespan. Humans live about 70-80 years, yeah, there's some variance, but that's thinking in terms of years, instead of "a life".

Corporate has no "life". They could die tomorrow, or they might live for centuries. They change, they get bought up by another company, they merge, so accounting by a short time period makes some sense, from their perspective.

All I'm saying, is reframe our culture to the perspective of a Human: We're born, we live, we die. One life. Not 70-80 yearly lives of some financial rebirth every year. One life. When it's gone, do the accounting and adjust charges accordingly.

Perhaps corporate taxes should be adjusted based upon how old they are? As they get older on a year-by-year basis, their tax rate goes up? Seems absurd, no?

So then why think that way for Humans?

[SoCalDem]

15. Bear in mind, that now, those 50-64 agers are paying a LOT more

than 10%, and with the additional paid into medicare, they would now NOT have to pay those insurance premiums...and to raise the rates for the youngers would mean that a lot of them who now pay NOTHING into any insurance coverage, would now be participating..

Employers would win..and so would employees..and we already have the money-collecting system set up.

people who are not on "payroll", would have to have a work-around, but most people get a paycheck.

[T Wolf]

3. They will not leave because there is too much money to be made. They can not deny coverage under

the proposed plan, which means they have to enroll you and take your premium.

But there is NOTHING that says they have to honor a claim. They will simply continue to deny claims for individual care items. The patient will be forced to pay that cost.

Add in your scenarios of the increase in premiums to outrageous levels and you have a perfect system for the corps. For patients, not so good.

[valerief]

4. And what does coverage mean? Take the premium or pay the claim? nt

[T Wolf]

6. Those pushing this faux-reform refuse to define that term. They are counting on

people interpreting it to mean paying the claim when it actually only refers to enrolling in the plan.

Another reason why a simple, single-payer, universal coverage plan would have been easier to present and certainly not any harder to defend.

But the insurance corps could not be protected under that system.

[sandnsea]

9. There will be requirements in the plans

and they will be required to pay out a certain percentage of their premiums to guarantee they are making those payments.

[valerief]

16. Hmm, interesting. I wonder who will oversee and what criteria will be allowed to not pay claims.

Oh, well, I hear Mexico has affordable healthcare.

[SoCalDem]

18. never fear.. there will be a whole new agency created

for oversight, and the cost of running it will probably equal or exceed the money they "save"..

[sandnsea]

8. Sub-Si-Dies - hello - Subsidies

That's why the subsidies that make the premium affordable to everyone is THE MOST IMPORTANT thing to be talking about.

[SoCalDem]

10. The thing that bothers me is this.

Setting up subsidies requires monetary outlay, and lots of people who will become the "minders & watchers".

Why not just do it right the first time.. The more layers we add, the harder it gets and the more we need constant "fixing"..

My plan:

Medicare-Part E....for EVERYONE in..

with a sliding scale for younger folks.

Workers are now paying 1.45% worker/1.45% employer, into medicare

Why not just make it ?

50-64 10% worker-10% employer
26-49..5% worker-5% employer
birth-26..SCHIP

at 80-20% coverage, people could still buy their "supplemental" policies to help with the 20%..

disabled people could still use Medicare like they currently do (and SSI)

We could probably ELIMINATE medicaid by doing this, and by dedicating the soon-to-expire rich folk's Bush tax cuts to fund the "new " medicare part E, until all the hitches were worked out.

[sandnsea]

Gosh. Because the old people are already freaked out

And if people don't want to be forced to give money to an insurance company, why can't they understand there are others who don't want to be forced to give that same money to the government.

[valerief]

17. Well, that's the right way, of course. But this is a plutocracy. nt

[TheKentuckian]

11. I'm just as concerned with coverage levels and out of pocket costs

I went ballistic when I saw Baucus' coverage levels. Sticking the lowest income people with 65% coverage is unacceptable as hell and leaves such a big ass hole that a supplement would cost almost as much as the primary coverage or would still leave people not seeking treatment because they can't pay the uncovered amount.

In my opinion, anything that doesn't cover 80%+ is a pig in a poke.

[sandnsea]

13. Agreed. That's where we need to focus n/t

[branders seine]

12. B, then C

I am apalled at Obama's naivete.