The Battle Over Health Care At America's Medical Schools

[VA Hopeful Dr]

The poster above who proposed "compete across state lines" needs to take some remedial economics. A corporation exists to maximize profit. An insurance company issuing policies nationwide will maximize profit if it cherry picks the healthy patients and excludes the ill, so that premiums paid end up as profits to the shareholders. Going across state line solves absolutely nothing.

My apologies, had I only consulted you and your omniscience then I would know exactly what the future holds and all of this would be pointless.

Since when has additional competition been a bad thing? I freely admitted that the anti-trust exemption might make this idea fruitless, but its not a bad idea conceptually.

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[PostLessOne]

My apologies, had I only consulted you and your omniscience then I would know exactly what the future holds and all of this would be pointless.

Since when has additional competition been a bad thing? I freely admitted that the anti-trust exemption might make this idea fruitless, but its not a bad idea conceptually.

You failed mathematics. To an insurance company, the expected return from a known sick person is a large negative number. No rational corporation is going to add them to the rolls without charging enormous premiums or because the government forces them to. Your "solution" would leave corporations free to exclude the known sick who lost their coverage, often due to no fault of their own.

 

[MOHS_01]

The poster above who proposed "compete across state lines" needs to take some remedial economics. A corporation exists to maximize profit. An insurance company issuing policies nationwide will maximize profit if it cherry picks the healthy patients and excludes the ill, so that premiums paid end up as profits to the shareholders. Going across state line solves absolutely nothing.

Perhaps someone should have taken more than remedial economics.

When new markets are opened, entities will enter the market to fill the void (assuming the potential for a marginal return exists. If no such potential exists, the government moves in, confiscates from the citizenry, and assumes the provision of the unprofitable service / product). There are several problems with the logistics of reconciling the piecemeal regulatory and legislative environment of the different states, but the above argument does not enter the picture as this occurs irrespective of the geographical expanse of the product sold.

You failed mathematics. To an insurance company, the expected return from a known sick person is a large negative number. No rational corporation is going to add them to the rolls without charging enormous premiums or because the government forces them to. Your "solution" would leave corporations free to exclude the known sick who lost their coverage, often due to no fault of their own.

The bolded statement does not follow. Government mandates force a company either out of business or into "irrational" business dealings. They have little choice to comply -- which will result in an increase of the utilization of community rating and a redistribution from the healthy to the old. The $$$ has to come from somewhere.

 

[PostLessOne]

You're correct, MOHS. However, the earlier poster was stating that the problem of the uninsured could be solved NOT be government mandating that insurance companies take all applicants and that everyone has to buy insurance, but instead by allowing insurance companies to compete across state lines. I was pointing out that this solves nothing : the sick who are uninsured are NOT an "untapped market" from the point of view of the insurance company.

And yes, redistribution from the healthy to the ill is what insurance IS. However, as a living being with faulty genetic coding, you will inevitably eventually become ill at some point in your lifetime.

 

[MOHS_01]

I agree that insurance at its core is a de facto redistribution. The difference, as I see it, is that in a non-community rated situation everyone enters the pool on equal footing and largely pays according to their risk cohort. What this bill (and community rating in general) does is force a more directed redistribution.

Again, there are no easy answers. We were not all dealt the same genetic hand. Many (expensive) ailments are not related to personal choice. These uncontrollable circumstances of fate make community rating and the banning of pre-existing condition exclusions, not to mention banning the horrible process of rescission, seem like a good idea. Perhaps they are to an extent -- but that balance is the real devil.

 

[PostLessOne]

Well one idea would be to allow them to risk pool people based upon controllable factors. You know, like if you smoke or are fat, they could pool you accordingly.

Actually though, supposedly the latest research is that the risk factors don't really affect lifetime healthcare costs. If you are fat, you'll die much sooner from heart failure, and won't require expensive nursing care for dementia. Same if you are a smoker : lung cancer care is actually quite cheap, evidently, because a lot of times there's not much that can be done but to let the patient die.

 

[VA Hopeful Dr]

You're correct, MOHS. However, the earlier poster was stating that the problem of the uninsured could be solved NOT be government mandating that insurance companies take all applicants and that everyone has to buy insurance, but instead by allowing insurance companies to compete across state lines. I was pointing out that this solves nothing : the sick who are uninsured are NOT an "untapped market" from the point of view of the insurance company.

And yes, redistribution from the healthy to the ill is what insurance IS. However, as a living being with faulty genetic coding, you will inevitably eventually become ill at some point in your lifetime.

I said no such thing nor did I suggest that the sick uninsured are an untapped market. In fact, I never did say what the goal of such a plan would be.

 

[PostLessOne]

I said no such thing nor did I suggest that the sick uninsured are an untapped market. In fact, I never did say what the goal of such a plan would be.

You were very much implying that by allowing insurers to compete across state lines, this would fix the uninsured problem without requiring the changes that were passed in the health care reform bill.

 

[VA Hopeful Dr]

You were very much implying that by allowing insurers to compete across state lines, this would fix the uninsured problem without requiring the changes that were passed in the health care reform bill.

Point out where I implied that. I believe that the state line issue would reduce the cost of insurance, you disagree which is fine. That being said, don't put words in my mouth.

 

[PostLessOne]

Republicans want change, just not a huge package that costs a fortune. I still fail to see (and have failed to see since last year), why we couldn't just start with allowing insurances to compete across state lines. That would've passed in half a minute. After that, fix the children with pre-existing conditions and/or lifetime maximum parts. Most everyone thinks those are worthwhile, and I think the right wouldn't have fought those hard if at all. Incrementally changing things and then watching to see what happens seems a great idea to me. Why Pelosi/Obama disagree is beyond me.

"why we couldn't just start with allowing insurances to compete across state lines"

Implying that the pre-existing conditions trap is no problem at all, no siree. No big deal that your health insurance protection crumbles away the second you run out of cash to pay your expensive premiums and/or lose your job, which tends to happen if you suddenly find yourself seriously ill.

 

[VA Hopeful Dr]

"why we couldn't just start with allowing insurances to compete across state lines"

Implying that the pre-existing conditions trap is no problem at all, no siree. No big deal that your health insurance protection crumbles away the second you run out of cash to pay your expensive premiums and/or lose your job, which tends to happen if you suddenly find yourself seriously ill.

I implied nothing. That post you quoted was an attempt to suggest what I think might have been a better way to fix some things (certainly not every problem with one little change) - piecemeal rather than all at once. The post directly above your's here describes exactly what I meant and nothing more. If I'm waiting tables in Charlotte and BCBS of South Carolina can offer me a better deal for health insurance than anyone in NC with comparable benefits, why shouldn't I be allowed to purchase it? So fine, I'll issue a clarification - selling across state lines could make insurance cheaper for some. Is that better?

The other 2 points you make are certainly valid, and I don't really have an answer for them. Perhaps require a grace period from insurers while increasing disability coverage thus avoiding the hole between losing insurance and qualifying for government aid?

Seriously, you're reading too much into my posts.

 

[PostLessOne]

I guess I interpreted your quote as "the house may be burning to the ground, but let's not put out the fire. Let's make a piecemeal chance and maybe pee on the fire"

 

[dAnthony1918]

personally i think drjojo.. has no credibility since he is only a medstudent and has no idea what the real world is like and if this wasn't SDN.. he would be getting scutted out of his life arguing against attendings that have much more life experience than him.

No opinions given but you have nothing to back up your emotional typical political game ranting all over the forums. Try being objective instead of playing little girl games. I don't disagree with what you say but your emotional bias is everywhere.