a variant of this question is why I got into healthcare in the first place. Healthcare is a 'tweener item - it isn't quite a good nor is it quite a right. People who make bad health choices like smoking or drinking that 64oz coke may need to pay more but that means that what little privacy we have has to be surrendered so the payors and the regulators can see that a "pay more" theory is properly administered. What could go wrong??
Healthcare needs to be a mandatory option and all in - no different than comprehensive automobile insurance. If you drive a car, you have to have some form of coverage so that makes some sense to me. What doesn't make sense is "experience rating" both from its intrusiveness and from the baseline thought that really, healthcare is not a good like a car (wishing I hadn't chosen this analogy now). Whether it is an expanded Medicaid or more along the lines of a German still insurance market, doesn't really matter to me so long as we get away from the "private pay" inequities that exist in coverage now and we reduce the amount of time and money wasted on "revenue cycle" and other healthcare administrativia.
Inclusive OR - 6 years ago
I also have an issue with the wording of the poll. I don't think they should be allowed to deny coverage, but paying higher premiums may be appropriate. That's how other insurances work, but I'm not deluded enough to believe that health "insurance" is really insurance at all. In the US, it's some weird mix of insurance and a discount plan (more of a discount plan in my opinion).
Now, does that mean some people will effectively be denied coverage? Yeah, probably, but that's why we need universal coverage.
PFS_Guy - 6 years ago
Our only hope is Medicare for all and allow the supplement secondary market impact the patients out of pocket. Private insurers can have the supplemental market and price products that pay for copays and deductible that Medicare doesn't pick up and if your low income then a Medicaid supplement should exist. If you choose to go without a supplemental insurance then you pay as you go.
Price - Quality - Service...choose any two.
This maxim works in every industry and healthcare is no different. In the US we have historically selected Quality and Service and that gives us no say so in price.
If we want to choose price then it's going to be service that suffers (think VA healthcare or Medicaid funded nursing homes) as I don't think we will ever choose lower quality.
Jeremy - 6 years ago
I agree with Dave that I have a problem with the questioning of the poll. My issue is that it should have only been should you be able to charge more for sicker people. You can look at this either way and come to the same conclusion. If insurance is supposed to be about spreading risk, like other insurance, then your likelihood of using that insurance should be priced into the premiums. If you look at health insurance as some way to spread the cost of healthcare over the population then why shouldn't people that will use more resources pay more in?
We can't control genetic disease like we can't control acts of God like weather, but no one objects to people paying more for homeowner's insurance if they live on the coast or on a floodplain.
Loss Ratio - 6 years ago
No. The only fair way for health insurance to work is for everyone to be insured, take all comers, no pre-existing conditions exclusions. Anyone at any moment could become a casualty of a car crash through no fault of their own and develop a disabling condition. Single payer insurance or Medicare for all solves this problem as long as you don't exclude pre-existing conditions and require full participation.
Dave - 6 years ago
The wording in polls matter. This poll, taken at face value, is can payers charge more for sicker people. In general, I'd vote with the masses as say no. However, the more interesting and nuanced poll question is should payers be allowed to charge more to members with more controllable risk (e.g., smoking, drinking, obesity (where there is no clinically relevant reason. I'm just big-boned is not a clinically relevant reason...)?
As we all pretty well know, health is more about staying healthy through appropriate behaviors (diet, exercise, etc.) whereas the old model is about fixing you when you break down. Since insurance is about managing risk, what if we let them - via premium surcharges for bad behaviors? Now that would be an interesting poll....
a variant of this question is why I got into healthcare in the first place. Healthcare is a 'tweener item - it isn't quite a good nor is it quite a right. People who make bad health choices like smoking or drinking that 64oz coke may need to pay more but that means that what little privacy we have has to be surrendered so the payors and the regulators can see that a "pay more" theory is properly administered. What could go wrong??
Healthcare needs to be a mandatory option and all in - no different than comprehensive automobile insurance. If you drive a car, you have to have some form of coverage so that makes some sense to me. What doesn't make sense is "experience rating" both from its intrusiveness and from the baseline thought that really, healthcare is not a good like a car (wishing I hadn't chosen this analogy now). Whether it is an expanded Medicaid or more along the lines of a German still insurance market, doesn't really matter to me so long as we get away from the "private pay" inequities that exist in coverage now and we reduce the amount of time and money wasted on "revenue cycle" and other healthcare administrativia.
I also have an issue with the wording of the poll. I don't think they should be allowed to deny coverage, but paying higher premiums may be appropriate. That's how other insurances work, but I'm not deluded enough to believe that health "insurance" is really insurance at all. In the US, it's some weird mix of insurance and a discount plan (more of a discount plan in my opinion).
Now, does that mean some people will effectively be denied coverage? Yeah, probably, but that's why we need universal coverage.
Our only hope is Medicare for all and allow the supplement secondary market impact the patients out of pocket. Private insurers can have the supplemental market and price products that pay for copays and deductible that Medicare doesn't pick up and if your low income then a Medicaid supplement should exist. If you choose to go without a supplemental insurance then you pay as you go.
Price - Quality - Service...choose any two.
This maxim works in every industry and healthcare is no different. In the US we have historically selected Quality and Service and that gives us no say so in price.
If we want to choose price then it's going to be service that suffers (think VA healthcare or Medicaid funded nursing homes) as I don't think we will ever choose lower quality.
I agree with Dave that I have a problem with the questioning of the poll. My issue is that it should have only been should you be able to charge more for sicker people. You can look at this either way and come to the same conclusion. If insurance is supposed to be about spreading risk, like other insurance, then your likelihood of using that insurance should be priced into the premiums. If you look at health insurance as some way to spread the cost of healthcare over the population then why shouldn't people that will use more resources pay more in?
We can't control genetic disease like we can't control acts of God like weather, but no one objects to people paying more for homeowner's insurance if they live on the coast or on a floodplain.
No. The only fair way for health insurance to work is for everyone to be insured, take all comers, no pre-existing conditions exclusions. Anyone at any moment could become a casualty of a car crash through no fault of their own and develop a disabling condition. Single payer insurance or Medicare for all solves this problem as long as you don't exclude pre-existing conditions and require full participation.
The wording in polls matter. This poll, taken at face value, is can payers charge more for sicker people. In general, I'd vote with the masses as say no. However, the more interesting and nuanced poll question is should payers be allowed to charge more to members with more controllable risk (e.g., smoking, drinking, obesity (where there is no clinically relevant reason. I'm just big-boned is not a clinically relevant reason...)?
As we all pretty well know, health is more about staying healthy through appropriate behaviors (diet, exercise, etc.) whereas the old model is about fixing you when you break down. Since insurance is about managing risk, what if we let them - via premium surcharges for bad behaviors? Now that would be an interesting poll....