Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

I don't think it's going to be easy to take control out of the hands of states.

It's been done before, credit card companies, Delaware business registrations, lots of ways to skirt states.

The Federal govt, especially under Trump, is NOT interested in regulating the healthcare industry, nor do the predominately unhealthy, low income red states want the control wrested out of their hands. Just think about the backlash by the red states when the Feds implemented No Child Left Behind, and how they backed Common Core. Which states were the ones that pulled out of CC? The ones where the people of the state were the least healithiest, and least educated. Which ones were early adopters? The ones where the state governments wanted to implement some for of universal healthcare and have higher median income.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

I don't think it's going to be easy to take control out of the hands of states.

It's been done before, credit card companies, Delaware business registrations, lots of ways to skirt states.

Anonymous wrote:

Anonymous wrote:Insurance companies need to change their model. Currently they have little incentive to push costs down because they get a cut.

...so why would they want to change their model?

Because nobody is making them. Congress is beholden to donors from the pharma and insurance sectors. While all of you whine and complain about your increasing premiums guess what, that's where the money is going - toward lobbyingm campaign contributions and marketing (propaganda). And that problem will only get worse now that folks with a "yahoo! deregulate!" and "yahoo! free market profiteering!" mentality have swept all federal offices. There are no checks and balances anymore.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Paying for health care for employees is a significant burden on US businesses. They shouldn't have to pay it (and European branches of US businesses do not). That's why Obamacare works for businesses.
I lived in other countries and although sometimes you have to wait a while to be seen for a non-emergency, the health care was excellent and free. Why more Americans and American businesses don't lobby for single-payer is based on a mix of reasons:
1. We've been told our system is the best in the world and we don't want to rock the boat. In a better world, we'd have something like the German system, a mixture of private and public. But generally, we don't look to Germany (for historic reasons), we look to the UK and France, and their systems are very different and not respected here. So--we're stuck .
2. People lobbied HARD to get medical bills exempt from bankruptcies but the credit card industry lobbied harder. We lost. We have to keep fighting. It's inexcusable that medical bills can cause someone to go bankrupt.
3. Medicare for all. It will come--but only after we've explored every other option. And only when businesses lobby for it.

Europeans get free healthcare. Are you proposing that? However companies and people pay more taxes.

Taxes in the U.S. are not low. But we get very little bang for the buck. That is especially true in healthcare and education. We spend much more money per capita than do many countries that do equally good or better.

Consider that we Americans collectively spend 13 trillion a year on healthcare, and, per capita, we get far less bang for the buck than any other modern nation on the planet for it. That's the stealth tax, exacted by the private sector that we in the US have to deal with.

You would need a federal regulator.

Right now we have 51 insurance regulatory bodies and 51 sets of mandates. Connecticut, which has something like 67 mandates won't allow residents there to buy cheaper insurance from Alabama, which has fewer than 20 mandates. In addition, many of the insurance companies operate in most of the states through subsidiaries, each of which is run as its own company with its own CEO, administrative staffs, buildings and the rest of the overhead, some of which is necessary to insure compliance with the unique insurance laws of each state. Wouldn't there be considerable cost reduction in centralizing all this and allowing the purchase of insurance from a federally chartered insurance companies?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

I don't think it's going to be easy to take control out of the hands of states.

Not only that but the people calling for the sale of insurance across state lines are the same people who rail against the size of the federal government. So if we shift to a national market for insurance, will we be creating a new federal regulatory agency? Or are we just going to throw caution to the wind and let the insurers go without any regulation at all?

Yep. It's just more truthiness.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

I don't think it's going to be easy to take control out of the hands of states.

Not only that but the people calling for the sale of insurance across state lines are the same people who rail against the size of the federal government. So if we shift to a national market for insurance, will we be creating a new federal regulatory agency? Or are we just going to throw caution to the wind and let the insurers go without any regulation at all?

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

Off topic, but term limits are a terrible idea, unless you prefer your laws be written by lobbyists instead of legislators. Legislative term limits shift power to lobbyists and to the executive branch (which has an experienced civil service to rely upon for expertise).

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

Your suggestion is beyond foolish. Do some research about how it all works then come back.

Anonymous wrote:

Anonymous wrote:You can do compacts among states to sell insurance across state lines as a PP described. Far more efficient is to simply be able to sell across the country. This doesn't mean no regulation; it means federal regulation instead of state regulation.

Insurance companies traditionally have been very against federal regulation because they would have limited ability to sway a national regulator. They can easily sway state insurance regulators--often this is a political post and state legislators are very insurance company friendly--in fact many supplement low legislator salaries by being insurance brokers.

It is crazy we do not have a regime for federal regulation of insurance companies at least as an option.

Correct.. sometimes, state Insurance Commissioners are in cahoots with the insurance companies that they are supposed to be regulating, and end up working for them:

https://www.washingtonpost.com/investigations/drinks-junkets-and-jobs-how-the-insurance-industry-courts-state-commissioners/2016/10/02/1069e7a0-6add-11e6-99bf-f0cf3a6449a6_story.html?utm_term=.9af9604a0076

"Benafield [AK insurance commissioner] ultimately decided the case in United Healthcare’s favor — a 2008 ruling that stood to save the company millions of dollars. Nearly two years later, by the time a judge vacated the commissioner’s orders because there was “an appearance of impropriety in the proceedings,” Benafield had moved on: She was working for United Healthcare, having joined at least three of her predecessors representing insurers in Arkansas."

But Blue Cross of Nebraska doesn't WANT to enter the insurance market in Sarasota. They don't know the providers or that particular market. They can't negotiate lower rates for the 176 Sarasotans who (inexplicably) decide BC of NE is the right plan for them. It's high risk for them. They'd much rather try to get more Nebraskans to enroll.

Anonymous wrote:

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

I don't think it's going to be easy to take control out of the hands of states.

Anonymous wrote:Insurance companies need to change their model. Currently they have little incentive to push costs down because they get a cut.

...so why would they want to change their model?

Anonymous wrote:Insurance companies should operate across state lines. Increase market size. Will reduce costs. Only thing about trump I agree with. In addition to term limits

No. Allowing insurance companies to operate across state lines will not increase the "size" of the market and it will not reduce costs.

Insurers reduce costs in large part by negotiating with providers. The only way to negotiate lower prices with providers is to have leverage, or market share. That means covering a lot of people. Then you can say to GW Hospital, " if you want to be in my network and have all my enrollees use your hospital, then you have to agree to a 10% across the board reduction in payment. Otherwise, you are out of network and my enrollees go elsewhere."

Having many more insurers, each enrolling a relatively small number of people, means each insurer has less market share and less leverage. GW says to a small insurer, "Nope, we don't need your enrollees. Go ahead and try to get cheaper prices from Georgetown." Small insurer finds that no one cares if they are in that network. Small insurer goes back to GW and agrees to higher prices.

But we don't need to theorize--some states have already allowed insurers to operate across state lines. Hasn't lowered health care costs. This is one of those truthy things that sounds smart but is espoused by no one who actually knows anything about the market for health insurance. Well, no one who is being honest, that is.

Anonymous wrote:

Anonymous wrote:Paying for health care for employees is a significant burden on US businesses. They shouldn't have to pay it (and European branches of US businesses do not). That's why Obamacare works for businesses.
I lived in other countries and although sometimes you have to wait a while to be seen for a non-emergency, the health care was excellent and free. Why more Americans and American businesses don't lobby for single-payer is based on a mix of reasons:
1. We've been told our system is the best in the world and we don't want to rock the boat. In a better world, we'd have something like the German system, a mixture of private and public. But generally, we don't look to Germany (for historic reasons), we look to the UK and France, and their systems are very different and not respected here. So--we're stuck .
2. People lobbied HARD to get medical bills exempt from bankruptcies but the credit card industry lobbied harder. We lost. We have to keep fighting. It's inexcusable that medical bills can cause someone to go bankrupt.
3. Medicare for all. It will come--but only after we've explored every other option. And only when businesses lobby for it.

Europeans get free healthcare. Are you proposing that? However companies and people pay more taxes.

Taxes in the U.S. are not low. But we get very little bang for the buck. That is especially true in healthcare and education. We spend much more money per capita than do many countries that do equally good or better.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Why has the business community not lobbied harder for a single pay healthcare system?

Because the business community is in the business of doing business and not lobbying for social welfare programs.

They should have been pushing for better healthcare options that individuals can get for themselves rather than having healthcare tied to employment as it was for so long. For many years it was a perk of employment but that was always an unsuitable and unsustainable arrangement.

I am just not sure what "better healthcare options that individuals can get for themselves" is (I am not snarky, just genuinely curious). I come from Europe, never saw a medical bill until I came to the US. with a system where people get private insurance (though work or in the open market) I don't see how they can get a better option by themselves. insurers are for profit and they simply do not insure people who are sick or likely to get sick. in the open market I cannot see how an individual can get a good option unless the individual is 25 and perfectly healthy. and this is what has been going on in the US, people who were sick could not get insurance, or could get a very limited coverage for outrageous prices. I frankly agree with OP, this is something business should have lobbied for. they would not have to pay for their workers, and having people who do not have to worry about going bankrupt or losing the house because they get sick is a good thing for a business IMO.

This. I am also from Europe and I find American system insane. The first time I found out my insurance only covers me for the year and not till the end of my life I was stunned. What is the point of insurance if it only covers you when you are healthy enough to work? It's just totally insane.

Other things I notice: there is a lot of paperwork and you get very little face time with a doctor.