Buying/Selling Insurance Across State Lines

[MDM4AU 321]

2 hours ago, maxwere said:

Why do you say that?  (I agree with you in that its a step forward, just want to know why you came to that conclusion) More skin in the game = patients making wiser decisions. Portable. Can take it with them where ever they go regardless of employment. There are some catches but I'm talking generalities. Tax deferment. These are just a few of the reasons.

You are arbitrarily assuming how network providers would act given different price structure. Not untrue.  The point is, aside from non compete agreements, there is a price at which they would accept different networks.  Also, if BCBS loses network providers or customers you can be sure they will adjust rapidly.  ALFA is rhetorical, but you made the point.  Alabama company, very hometown, local good customer service etc.  ...and no, they hardly have AL majority market share, they don't even have you.  You went out of state, probably b/c of price.

HMOs were built on the fallacy (among others) that increasing preventative care would decrease more costly long term care.  It destroys the doctor/patient relationship.  That turns out to be a pretty central relationship in the health of the whole thing. 

Regulation always helps the big guys restrict competition. Agreed.  It's designed to.  How much did Humana, UHC, Cig spend on lobby in 2008-2011?

Rest assured, the community rating concept is alive and well.  In fact, these aren't insurance companies, they are healthcare companies.  Fundamental to insurance is underwriting discrimination and risk classes.  (Well people will never want to pay for sick people... they will act against the interest of the whole)  This gets reflected in the cohort experience.  Think of these categories as cells.  The concentration is always skewed to the sickest boundary of the cell.  (Sorry if inside baseball, but its actually pretty interesting phenomena.)  Bottom line is the more cells you have the greater value it is for everyone (eventually some of the sick will actually work harder to improve to a better cell... the well don't go uninsured).  You can test this out with property insurance.

This necessarily means that we have to come to grips with the fact than a person with a pre-existing condition has a higher present value medical liability than those without. Absolutely.  That liability is unfunded. Agreed  Government does a poor job of disclosing UALs (they never do).  ...whole other conversation.  BUT, I personally believe evidence suggests that retail healtcare costs are between 95-99x inflated.  So even if the insurance company negotiates 66% discount, the prices are still 5-10x what they should be. 

This whole thing rests with the providers IMO.  If doctors would get some entrepreneurial sense (most don't have it), many would bail to cash only general practice pretty fast.  This would create the needed competition overnight.  The future as is, sees them take home less and less.  Skyrocketing med school debt, admin, lower reimbursements etc.  Remove the third party all together.  (HSAs work to this effect btw)

You and I are somewhat on the same page. My OP was just my opinion based on my limited knowledge and wanted to put it out there for discussion. Thanks for your input. I'm all for competition I just have my doubts that "cross state lines" is the answer many see it as.

 

2 hours ago, maxwere said:

 

 

[maxwere 82]

Just now, MDM4AU said:

I'm all for competition I just have my doubts that "cross state lines" is the answer many see it as.

Yep, political oversimplification.  It's improvement, yet DC will probably find away to claim the interstate commerce clause now gives them the right to socialized the whole thing.

HSA puts the power of choice and the question of "if I go through with this, how much is this going to cost me?" back in the hands of the consumer.  The fact that the IRS regulates you can't spend your own money on Y only X still has terrible problems.  Expect increase cost in X.

 

[AURex 1,983]

I'm not sure why anyone thinks that the ability to shop for insurance across state lines will improve anything. These are national insurance companies. If you break the state barriers, they will simply revise their policies the next day to assure that they can achieve even more profits and larger dividends fore their stockholders. Anyone who thinks these insurance companies are really interested in providing quality healthcare for reasonable prices is living in fantasy land. Anyone who thinks that this plan would result in lower costs due to "competition" is living in Kansas-like fantasy land. Insurance companies are interested in one thing, and one thing only. Profits. And they funnel huge amounts of money into the pockets of Republicans to assure that they make those profits.