The importance of the individual mandate

[Egnever]

http://voices.washingtonpost.com/ezra-klein/2009/12/draft_1.html


Holding the price of insurance equal, insurance is gamble on both sides. From the insurer's perspective, it's a better deal to insure people who won't need to use their insurance. From the customer's perspective, it's precisely the reverse.

Right now, the insurer sets the rules. It collects background information on applicants and then varies the price and availability of insurance to discriminate against those who are likely to use it. Health-care reform is going to render those practices illegal. An insurer will have to offer insurance at the same price to a diabetic and a triathlete.

But if you remove the individual mandate, you're caught in the reverse of our current problem: The triathlete doesn't buy insurance. Fine, you might say. Let the insurer get gamed. They deserve it.

The insurers, however, are not the ones who will be gamed. The sick are. Imagine the triathlete's expected medical cost for a year is $200 and the diabetic's cost is $20,000. And imagine we have three more people who are normal risks, and their expected cost in $6,000. If they all purchase coverage, the cost of insurance is $7,640. Let the triathlete walk away and the cost is $9,500. Now, one of the younger folks at normal cost just can't afford that. He drops out. Now the average cost is $10,600. This prices out the diabetic, so now she's uninsured. Or maybe it prices out the next normal-cost person, so costs jump to $13,000.
<snip>

In a world with an individual mandate, insurance has to be affordable. If it's not, there's a huge political backlash. That gives Congress a direct incentive to focus on cost. Remove the individual mandate and ... eh. If insurance isn't affordable, people simply go uninsured. It's exactly what happens now. Same incentives, or lack thereof, to make the system better.


This is called an insurance death spiral. If the people who think they're healthy now decide to wait until they need insurance to purchase it, the cost increases, which means the next healthiest group leaves, which jacks up costs again, and so forth.

[Matariki]

1. FUCK INSURANCE COMPANIES

Universal Single Payer. Medicare for everyone.

Insurance Companies are the problem, not the solution.

[Egnever]

2. Single payer is a mandate

and is government insurance.

Yay for your poutrage though!

[Oregone]

15. But apples aren't oranges. No matter how much you want them to be.

Single payer is a government service that is funded by taxes. Much the same as the police, fire department, education, etc. Everyone must pay for those things...it is the taxation that is mandated, and it is according to your ability to pay (based on earnings)

This is mandating people to enter a marketplace and engage in commerce as an individual, which is a whole other animal. Are you forced to pay for a specific section of the road, securing the contractors yourself with your own cash? Or does the government take care of this efficiently (or not) with buying power and leverage?

Being provided a social service IS NOT comparable with being forced to buy something.

[Egnever]

21. not exactly

individuals are put into the exchange where the cash is pooled giving the individual the same power as the large organizations. Also alowing the individual to choose from a range of plans based on the one that fits their needs the best.

My point however was either way its a mandate you pay taxes or you pay premiuims. I would argue that in the system proposed its actualy a better deal for those who choose to opt out as the penalties proposed are likely much smaller than the tax they would be forced to pay under a single payer system.

[Oregone]

22. LOL. As if all people will be in the exchange

As if buying into it while mandated, even in the exchange, is the same as being provided a social service.

"I would argue that in the system proposed its actualy a better deal for those who choose to opt out as the penalties proposed are likely much smaller than the tax they would be forced to pay under a single payer system."

What value do you get for your money when you pay a penalty? Those taxes actually fund something. Whats the better deal? Paying for nothing is a better deal than paying more for something all of a sudden?

Fiction for a ficticious comparison. Ill take single payer any day over this corrupt cess pool

[Egnever]

26. So paying for health insurance is not paying for something?

either way you are paying, something you clearly want to ignore. Single payer is government insurance its not a social service.

So your position seems to be that people cant afford to buy pay the premiums to private insurers but they would magicaly be able to pay taxes to the government.

You opinion of what would be the better deal means nothing, the bottom line is the same either way people will have to pay. You have absolutely no way of knowing which would end up with the better outcome for the consumer.

[Oregone]

30. I think you are confused, because you mentioned paying penalties for no insurance being better deal

than single-payer insurance:

"I would argue that in the system proposed its actualy a better deal for those who choose to opt out as the penalties proposed are likely much smaller than the tax they would be forced to pay under a single payer system."

"You have absolutely no way of knowing which would end up with the better outcome for the consumer."

Well, if having no insurance would always produce a better outcome than being insured (at the per capita rate single-payer nations have), then this debate would be a non-issue. Thats not the reality. Now, that automatically rules out that paying a fine for nothing would have a better outcome than being covered efficiently.

Horseshit. You honestly don't have an argument so you are pulling shit outta your ass.

And yes, it is a social service, and yes, it is government insurance. They are not mutually exclusive concepts.


"So your position seems to be that people cant afford to buy pay the premiums to private insurers but they would magically be able to pay taxes to the government."

Yes. If you make no money, you pay no taxes.

[Egnever]

31. But the mandate is also based on your ability to pay

the same as your taxes would be there is no difference.

[Oregone]

32. "there is no difference" -- If you repeat a lie enough, its still a lie

Mandating individuals to engage in commerce in the marketplace IS NOT the same as requiring citizens to pay taxes.

[Egnever]

38. Either way you are forced to pay

[Oregone]

39. So, they have similarities, like a dog and a cat, but they are not the same

[Egnever]

40. Whats the difference?

[Oregone]

41. Cats say meow, and dogs bark

Its like saying a Volvo is the same as a Hummer because they both have wheels.


Ludicrous crap you gotta believe to swallow this horseshit

[Egnever]

44. And cows go moo

but if there are mandated levels of coverage and if the houses provision that 85% of each dollar in premium must go towards care remains intact then wouldnt we end with better results in the long run from a competative market where multiple companies are working to drive down costs on the health care provider end as oposed to the consumer end?


If you have 5 companies to chose from as oposed to one arent the chances high that each company will work to find ways to make their particular service more apealing to consumers in order to secure a larger portion of the pools income?

[Oregone]

51. " wouldn't we end with better results in the long run from a competitive market"

What innovation in the insurance industry has come about within the last few (hundred) years through competition to make a better product for consumers?

Competition is a red herring to this entire debate. There is not a lick to be gained through the magic process of competition in the insurance industry. Its not rocket science. Collect enough money to cover your expenses (and then some), and then disburse it accordingly. Damn man...they don't use NASA based nanotechnology to seal their envelopes.

[Egnever]

55. No but they do negotiate payments to doctors

and to pharmacies, and there has not been any real incentive for them to truely compete before.

As it stands now they basicaly cover a company and they have a captive market for the most part. under an exchange in theory they would no longer have that captive market as all the providers in that exchange would have equal access to each dollar in the pool with the end user deciding which company to choose from inside that exchange. That changes the playing field and it has worked in massachusets to ahcieve exactly the result I describe.

This conclusion is consistent with evidence from Massachusetts. In their December 2007 report, AHIP reported that the average single premium at the end of 2006 for a nongroup product in the United States was $2,613. In a report issued just this week, AHIP found that the average single premium in mid-2009 was $2,985, or a 14 percent increase. That same report presents results for the nongroup markets in a set of states. One of those states is Massachusetts, which passed health-care reform similar to the one contemplated at the federal level in mid-2006. The major aspects of this reform took place in 2007, notably the introduction of large subsidies for low-income populations, a merged nongroup and small group insurance market, and a mandate on individuals to purchase health insurance. And the results have been an enormous reduction in the cost of nongroup insurance in the state: The average individual premium in the state fell from $8,537 at the end of 2006 to $5,143 in mid-2009, a 40 percent reduction, while the rest of the nation was seeing a 14 percent increase.

[Oregone]

56. And find me a private insurer that historically negotiates lower rates than governments

Government rates are often too low to tell you the truth. Hell, I just had an operation done for $80 bucks that the doctor used to clear $800 at in the US (this he told me). Competition will not produce lower rates. Competition will produce spiffy TV ads paid for with mandated premiums


That all aside, regulating how much profit a private insurer can take from premiums creates incentives to INCREASE negotiated rates. 10% of 100 is more than 10% of 10. Think about it.


Where is a little common sense when you need it?

[Egnever]

59. WTF is your problem?

I haven't called you an asshole yet but you keep asking me to do so. Cant you discuss this without spewing in every post?

As far as common sense? how does it benefit an insurer in a pool of other insurers to raise their negotiated rates when their competition in the pool would be trying to undercut them. You are making no sense whatsoever here.

You are trying to imply that company a would try to pay doctors more to increase their expenses so that they could charge more all the while company B could provide more services for the same dollar thereby allowing them to capture more of the exchanges pool. Company A would be slicing their own throat for short term gain.

[Oregone]

65. You are assuming that all the insurers do not know...

That with regulating overhead, higher rates are necessary for more profit. It is the primary responsibility of all corporations to deliver profit to shareholders, so they will simply figure out whether racing to the bottom or collectively raising the ceiling will bring home the goods more. Its not tough to figure out.

"You are trying to imply that company a would..."

No, I'm implying that both companies would agree (uh oh, we need an anti-trust exemption overturned!) together to raise rates to ensure future profitability. If they raced to the bottom, everyone is fucked. Insurance companies are not stupid.

[Egnever]

68. Yet that flies in the face of the reality created in massachusets

I quoted above. At this point you are arguing what you think will happen based on what I can only percieve as a deep mistrust of the insurance companies. Not that I trust the insuraqnce companies ,I dont. But if they are forced to compete for the same dollar everyone else is I think they will do their damndest to do so, it is as you say their mission to make as much money for their shareholders as they can.

This conclusion is consistent with evidence from Massachusetts. In their December 2007 report, AHIP reported that the average single premium at the end of 2006 for a nongroup product in the United States was $2,613. In a report issued just this week, AHIP found that the average single premium in mid-2009 was $2,985, or a 14 percent increase. That same report presents results for the nongroup markets in a set of states. One of those states is Massachusetts, which passed health-care reform similar to the one contemplated at the federal level in mid-2006. The major aspects of this reform took place in 2007, notably the introduction of large subsidies for low-income populations, a merged nongroup and small group insurance market, and a mandate on individuals to purchase health insurance. And the results have been an enormous reduction in the cost of nongroup insurance in the state: The average individual premium in the state fell from $8,537 at the end of 2006 to $5,143 in mid-2009, a 40 percent reduction, while the rest of the nation was seeing a 14 percent increase.

[Oregone]

69. It has nothing to do with a mistrust of insurance companies but common sense

And Mass has the highest family premium in the entire nation, at almost $14000 a family. Thats fucking absurdity to hold up as your poster child.

Regulating premiums being spent on health requires more gross revenue to create more profits. Thats the bottom line. There is no anti-trust laws on insurance companies to avoid this pitfall.

[Egnever]

73. Fair enough

I need to sleep have a good night.

[ThePhilosopher04]

75. Exactly...

Insurance companies will negotiate with doctors to jack up the rates if the 85 or 90% ratio is adopted...instead of charging $100 (hypothetically) for a service, they'll jack it up to $1000, and make $100 profit versus $10, to use an example.

Bottom line is the "profit" motive is what makes the entire system break down.

[Raineyb]

78. The difference is that when you pay taxes it's dependent on what you make.

The insurance bill is based on what the insurance company wants and if you have to become homeless and stop buying food to pay it, they don't give a damn they still want their 20 pounds of flesh.

In addition, when it's a government service everyone gets it and the government doesn't deny claims in order to meet some goal for the quarter's profit reporting.

The insurance companies are THE PROBLEM this bill does nothing but entrench them in the system and turn us all into slaves working to pay off the ever increasing insurance rates. Only with the added threat of a fine (that you probably can't afford) to punish you for being unable to pay for the insurance in the first place.

[enlightenment]

24. Yes, it is a mandate. No, it is not insurance.

And leave the juvenile insults behind - it only makes you look like an arse.

[Oregone]

27. Single-Payer is insurance and no, its not the same type of mandate at all

The only mandate is that you pay your taxes, as you always have for social services

[enlightenment]

34. Single payer is not necessarily insurance, Oregone.

Maybe it is where you live - but it doesn't have to be.

[Egnever]

36. what would it be? if not insurance?

insurance is a pooling of resources to spread risk how is single payer different?

[Oregone]

37. Uh, then maybe its not single-payer. Maybe there is another word for it.

As far as I understand, single-payer refers to socialized health insurance. Correct me if Im wrong.

[enlightenment]

Perhaps they call it insurance in Canada, Oregone - but

it isn't, is it? It's health CARE.

Do you check to see if you've paid off your deductible before you go to see your doctor? Do you read the fine print of your insurance 'plan' before you agree to a course of treatment, to make sure it's covered - and if so, what percentage? Or do you pull your card out of your wallet and be done with it?

Single-payer refers to a system of socialized, usually nationalized, health care.

Philosophically, of course the tax/fee/whatever you pay each month could be considered payment to 'ensure' that you will have access to health care - in that sense, it is 'insurance'. And if you have some sort of dual system (or a system of state-run insurance) you may deal with actual insurance . . . but fundamentally that is not what single payer is about.

And you know it.

[Oregone]

49. No, no. You don't understand. Its insurance. Its not health care

Its government insurance. Its pays PRIVATE (or sometimes public) doctors who treat you in PRIVATE facilities and provide care.

"Single-payer refers to a system of socialized, usually nationalized, health care."

It is very different that socialized health care. While one can argue that socialized care is the cheapest and most efficient means to distribute care to a population, single-payer is popular as a concept in the US because you can implement it and make ZERO structural changes to health care delivery (its the mere socialization of the insurance end). It creates, for millions of different facilities, one single payer and one single pool.

"but fundamentally that is not what single payer is about.

And you know it."

Im sorry. I think you are confused. Unfortunately, people in the states just don't understand these concepts enough, and its sad because it creates no basis to debate them fairly.

If more people understood what single-payer actually was, it would probably have far more ground to gain in the US because of how easy it is to implement the system and how it makes no real changes to the delivery end. No, single-payer is not nationalized health care, sorry.

[enlightenment]

77. No, I'm not confused.

We have simply chosen to use different definitions of an admittedly ill-defined term.

However, what MOST people mean when they say single payer is what you call 'socialized health care'.

That's the reason it won't make headway in this country - everyone defines it the way they want, including calling it insurance.

[Oregone]

79. Im not sure about "MOST people"

Do you have a poll to prove that? Are you sure you aren't just projecting your own misunderstanding of the term?

Socialized insurance is a damn dream these days with the corrupt politicians. Socialized care is beyond a fantasy at the moment. Id tend not the think most people percieve this term as that far leftist dream. Maybe if everyone actually understood the term and fought together on it, socialized insurance would be more reachable.

[Egnever]

50. You are confusing benefits with payments

Your "tax" paid to the government under single payer is no different whatsoever to premiums collected under insurance. In both cases the money is used to pay for the services offered.

Under the house bill and the senate finance committees proposed bill you would not have to question your coverage either as they both provide for mandatory levels of coverage the effect is the same as single payer in that you wouldnt have to wonder what level of coverage you have.

[Oregone]

54. Another lie

"Your "tax" paid to the government under single payer is no different whatsoever to premiums collected under insurance. In both cases the money is used to pay for the services offered."

First off, it is an actual tax (or variety thereof). Secondly, the tax is based on the tax code, rather than your age/conditions/whatever the fuck else. Thirdly, some portion of it will not be distributed, in dividends, to a private shareholder who was lucky enough to be born rich, but rather spent in an efficient system with an overhead of under 3% or so.

Sounds different to me.

[Egnever]

57. Are the personal attacks necessary?

I am not attacking you though if you wish to continue down that path am am more than able to oblige if you wish.

You do bring up an interesting point though that it would be a tax based on income rather than age and i concede your point. Although no such single payer system has been introduced so you are making a large assumtion on how that tax would be structured. There is no way to know what that tax would be based on but if it were based purely on income then I would conced that it would be different.

Having said that what do you base your 3% overhead figure on?

Again the house bill calls for 85% or more of every premium dollar collected to be paid out towards health care so the rich shareholder whatever is somewhat addressed.

[Oregone]

67. 3% to be safe...similar single payer programs have a lower over head than that..

Canada is at 1.3%

http://content.nejm.org/cgi/content/short/349/8/768

Medicare is damn low too.

15% being burned on execs, TV spots, and shareholder profits, as opposed to the alternative that I pointed out, doesn't seem like a good deal to me in comparison. Doesn't seem to be the "same thing" at all.

And pointing out a truth is not an attack.

[Egnever]

70. Calling me a liar is certainly attack

as were several of your other comments but lets forget that at forge ahead.

I don't disagree that we could certainly in the short term save money on overhead with a single payer system. However a single payer system isn't going to happen and you know it isn't for a myriad of reasons.

What I am not convinced of is that in the long run we would get better results under a single payer system.

Once a single payer system is in place then benefits are set and there is little chance of them changing or improving. If we can create true competition between the insurance companies through an exchange pool I think in the long run we would constantly improve the level of services offered.

People hold up the VA and medicare as examples of government run single payer, However Medicare is in danger of exploding our deficit and the VA, well walter reed with mold on the walls doesn't exactly inspire confidence.

Having said all that I started this thread because mandates are necessary no matter what we do be it through taxes or premiums and pretending we can do either of them without them is foolishness.

[Oregone]

71. "not convinced of is that in the long run we would get better results under a single payer system"

I guess it all depends on how you define "results". The WHO may not ultimately agree with you. To each their own.

Some people think you gotta drop a load on something fancy before its can be any good.

[ThePhilosopher04]

3. You just gave the reasons...

for a universal, government-run, non-profit, single-payer system...insurance companies are nothing more than legalized mobsters who profit by denying coverage...I for one will not stand for being mandated or forced to contribute to a racket against my will...period!!!

[Egnever]

29. Except that

The mandate comes with the provision that coverage can no longer be denied.

[ThePhilosopher04]

46. Bullshit...

what good does it do if you can't afford the coverage? Or if the coverage sucks? Bottom line is you don't have a choice in the matter, and there's no meaningful measures that I have seen that will guarantee that premiums and total costs to individuals will be affordable and the coverage provided will be of any quality. There's a "but" and a "loophole" for everything in this bill, and at the end of the day, the private insurance companies win. Don't believe me? Hide and watch.

[Egnever]

52. if you cant afford the coverage how would you afford single payer?

You have to pay either way. Both the house and the proposed senate bills provide for a basic level of coverage.

I dont understand why people think single payer is this magical thing that makes everything better or that it would somehow be free. Single payer would come with predetermined levels of coverage exactly the same as the current bills proposed do. The difference would only be the government controls the payments as oposed to insurance companies and you would pay "taxes" instead of premiums.

[ThePhilosopher04]

58. Easy...

Single payer is a fixed tax based on income, while insurance is a premium which could vary based on where you live, your credit history, age, etc...big difference. Additionally, single payer would be managed by the federal government with no profit margin built in which would lower costs dramatically.

[Egnever]

61. How do you know what single payer would be based on?

Its fictional. There are no single payer bills on the table you have no way whatsoever of knowing what the rates would be based on.

[ThePhilosopher04]

72. It's not fictional...

we have plenty to go on to estimate what the costs would be...we know what the current costs of healthcare are, which factors in the massive profit margins by the insurance and drug companies...a single payer would be substantially cheaper without question...why do you think the insurance companies are fighting the public option so hard?

[Egnever]

74. Of course its fictional

there is no bill, there is nothing you can point to that says if we have single payer a person makin 60k a year would have to pay this much more in taxes or that it would even be based on income.

When there is a bill then you can use it as your argument. There is no doubt it would be cheaper short term at least overall to have a single payer system. That doesnt take away from the fact that it would require mandated taxes to pay for it nor does it guarentee how those taxes would be structured.

[Vinnie From Indy]

4. You are missing the point

The fact is that the without a government option/real competition the health insurance companies will devise ways to deny coverage. It is all about profit. A national mandate to buy insurance without competition is a fools errand and will not work.

[grantcart]

6. they cannot deny coverage

They will accept coverage and try to deny claims.

[dkf]

8. And they will price it as high as possible to make it unaffordable for less attractive

members of the populace.

[sandnsea]

9. They. Can't.

The only premium variance allowed is for age.

[dkf]

11. 3x the regular premium.

[grantcart]

5. good luck

I have tried to explain adverse selection 15 times but people don't want to learn


You are correct - single payer systems have mandates.


Somebody will post "No mandates use income tax revenue"!!

[Egnever]

10. Thanks

It amazes me that so many think single payer means they don't pay for it. Whether it is premiums or taxes we will pay the piper and single payer is every bit as much of a mandate as what is being proposed now if not more so as with a single payer system there will be no minimal fines it will be pay your higher tax rate or go to jail!

[grantcart]

13. my earlier attempt

http://journals.democraticunderground.com/grantcart/229

[Egnever]

19. That was an awesome thread

I am sorry I missed it when you posted it before. Thanks for linking it.

[enlightenment]

25. Single payer is a true universal system.

What is being proposed is not.

Single payer mandates payments (taxes/fees/call them what you will) that give individuals access to health CARE, not access to a system that serves as a middleman between the person and the care.

I'd happily pay a tax that would give me access to health CARE - the ability to see a doctor, visit an emergency room, etc - without having to figure out if my deductible for the year was paid, or whether the approved percentage of the approved cost for a particular procedure was covered.

There is a huge difference between a working single-payer system and what is being proposed; you can twist yourself into as many knots as you like and you're not going to be able to turn a system of insurance into a system of care.

As for the rest - you have NO idea what sort of penalty would be proposed for a failure to pay a tax for single payer coverage - since it has never been discussed. Making things up whole-cloth doesn't improve your credibility one iota.

[Egnever]

35. of course it has been discused

it was clearly laid out in the house bill what the penalties would be. No one yet knows what the senate version is going to end up looking like so all we have at the moment is speculation.

The house version also mandated the level of health care you would have access to as I am sure the senate bill will. Or do you seriously believe it is just going to be a mandate to buy insurance? There is clearly no budging at all in the fact that there will no longer be denial of coverage based on pre existing conditions or dropping of coverage because you get sick.

what is the difference exactly between single payer and the system proposed other than the fact that in the system being proposed there would be a choice in plans available? as oposed to a single payer where there is only one plan?

[enlightenment]

42. The penalties for the non-existent, never discussed, shoved off the

table and out the door single-payer system were laid out in the House Bill? Do show me where.

If you don't understand the difference between a true single-payer system and the system of insurance currently under discussion, I can't help you - and I'm not going to waste my time with you, either.

[Egnever]

45. my mistake I thought you were talking about penalties under the system thats proposed

single payer however is a pipe dream its not going to happen why keep pretending it will?

[enlightenment]

47. I'm not pretending anything.

I was engaging in a discussion YOU started.

[Egnever]

62. by holding up a fictional piece of legislation as your argument?

[Waiting For Everyman]

7. With mandates, the triathlete will pay the diabetic's rates ANYWAY.

Top cost will be the NORM. What's to stop them?

The windfall profit from that goes to the top execs's bonuses, and not only that, inflates the insurance companies' stock price so they can play trading games even more on Wall St., and BANG! another bubble busts next year or sometime soon... when no more people have any more money to rip off.

The finance industry got out of the dotcom bubble via the mortgage bubble, and now the mortgage bubble will be replaced by the insurance bubble. Each one gets bigger and worse, while the people get poorer each time. After that, it'll be taking over Social Security, if they can get away with it.

[sandnsea]

12. The 85% pay-out regulation

If they don't pay at least 85% in medical costs, they have to rebate the difference. Yes, everyone will pay the same premium and will continue to as they age, but the premium will have to go to health care costs, not phony stock schemes.

[grantcart]

14. The MLR cap only exists until 2013 completely worthless

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7259615

[sandnsea]

28. That applies to the immediate provisions

When the exchange is enacted, the immediate provisions sunset. Those provisions have nothing to do with what's in the exchange requirements.

[grantcart]

33. Not according to this congressional analyst think tank

They are saying that it wasn't in the original bill but was added in the final House bill - they wonder if it might be a mistake.



http://www.opencongress.org/articles/view/1357-The-Most-Important-Health-Care-Reform-Provision-You-ve-Never-Heard-Of

This really doesn’t make a whole lot of sense. What’s the point of including it in the legislation if it’s not going to apply once the bulk of the bill takes effect? Webb wonders if there is some kind of error — either in how he is reading the bill (the same way I read it), or how the language of the bill has been drafted. “In their zeal to get certain protections in place right away they swept Sec 116 which clearly is focused on a future Exchange and tried to enforce its requirements on the current market,” Webb writes. This sunset language was not included in the health care bills that went through the three House committees this summer, but it is included in the final version that was passed by the House.

[sandnsea]

48. They lie

That section is specifically targeted at the provisions that take affect immediately, like the pre-existing conditions pool that will also sunset when the exchange is enacted.

I don't know how these people get so much wrong. Why did Howard Dean say the Senate bill was going to increase premiums on people with pre-existing conditions - while quoting the section about age variations. I don't know.

They lie.

[grantcart]

60. lol They might be wrong but they are not lying

They are very specific saying that the language has been changed from the original 3 house bills when they were combined.

They say that they might be reading it wrong but it is curious why the language is changed in the first place.

And they admit that it might have been changed in error.


None of these statements are consistent with people who lie.


If you watched Dr. Dean it was clear that he got a little flustered and was mixing his antecedents. In trying to give a short version he may have been taking what he thought were acceptable short cuts to make it more sensible.

In anycase the MLR and the language of when they have will be effective has been changed, maybe innocently.

However this is such a key point and would help turn back criticisms from the left, and would have such a big blow to the insurance companies, that you wonder why no one is talking about it. It should be the headline.

You would agree that if a permanent MLR is not in the final bill out of conference that it would dramatically weaken the bill.

[Fumesucker]

16. Triathletes get injured.. A lot..

We have a top level competitive strength athlete here on DU that was recently injured to the tune of tens of thousands of dollars..

Edited for speling.

[bluestateguy]

17. Right, that's why we have to impose price controls on the premiums

The companies are very graciously being allowed the privilege of staying in business. They should not be allowed a profit larger than what we tell them.

[Egnever]

64. Agreed!

The house Bill apeared to have done that though grantcart is bringing up interesting questions on whether it realy does.

We dont actually know whats in the senate bill yet.

[PSPS]

18. He's right - universal coverage requires everyone "buy" insurance

Otherwise you have a risk-adverse risk pool. That's not the problem. The problem is a system where the private insurers run it as a racket -- selling policies only to those least likely to ever make a claim while foisting the rest onto a government plan. This can't work. The best model is one risk pool (all citizens) with cost spread across the entire pool. It should be funded out of the general fund and paid for through a progressive income tax like everything else. This is the way every other country does it.

[Egnever]

20. Arent the exchanges meant to be that pool?"

Or am i reading them entirely the wrong way. People buy into an exchange and pick thier plan no? Forcing competition for the health care dollar available through the exchange.

[Oregone]

23. No one has to buy insurance in many UHC systems

Its provided to them as a social service, funded via taxation.

[grantcart]

43. 81 minutes after you started this thread another poster asked Why Mandates?

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=70659&mesg_id=70659

[Egnever]

66. Well we all know how that one thinks.

Thanks for the link to the discussion of the MLR BTW

[grahamhgreen]

53. YOU COULD NOT BE MORE WRONG. The mandate does not guarantee that anyone will be covered by the scam

artists you refer to as insurance companies.

Your logic only shows why for profit insurance is immoral and can not work and why single payer is our only option.

[BzaDem]

63. Where is your evidence that we have ANY chance of EVER getting single payer in our lifetime?

Do you have any historical evidence at all to back up your claim?

Why do people keep thinking that just because they really, really want something means that they are actually going to get it (or anything close to it)?

[grahamhgreen]

76. And a black person will never be president. WE MAKE SHIT HAPPEN. Join us.

Please.

We need you.

All of you.