Wouldn’t the younger/healthier employees opt out of their employer plans for their own individually priced coverage? If so, what will that do to the cost of the employer sponsored plans? If employer premiums rise due to adverse selection, this would then hurt the economy.
I’m not a fan of socialization – just seems like this is a flawed approach.
I can see where McCain is coming from, but it does seem a little flawed. I’m not much of an economist so I don’t know if the pain would be temporary while the market adjusted (I hope it would) or if this would just be another fatally flawed system that would lead to more of what we have now.
I do know that I like the looks of this plan over what Obama and Clinton are pushing – and I’m not voting for McCain.
I would hope this would come with some type of “take all comers” and the elimination of the “pre-existing” law. Those pre-existing exclusions are just downright evil.
In reply to Mark. I do not like the pre-existing exclusions either, but how would you prevent people that would only apply for the coverage when they need it and then drop it until coverage is needed again? That is the main concern as most people would only purchase it when they needed the coverage and that would happen when you have immediate coverage without pre-existing exclusions.
What none of the candidates have addressed because it could cause concern by those effected. The reason health costs are out of control is not because insurance companies, doctors or attorny’s are making to much. Medicare, Medicaid and care for Indigents/Uninsureds/Illegals/Uninsurables amount to about 70% to 80% of the expenses for Hospitals and Doctors who end up raising rates for the 20% to 30% of patients that have ability to pay. Until these costs are brought under control, there is not a program that can solve problem.
In all reality there is no solution to healthcare cost in America. Insurance companies aren’t making a mass amount of money from healthcare as cost are sky rocketing. Plus, how can you tell a doctor that went to school for so many years they can only charge so much. You can’t band all malpractice suits, especially if you’re asking a doctor to cut his prices when his only recourse is to see more patients per day to make up for it. If you do, then you’ll lose good doctors in the future as college students will pick law instead of med school to make good money (or become politicians). Seeing ball players making millions per year and doctors not, just doesn’t make scense. I understand the entertainment part of it, but people don’t sue a team or a player if they lose, but yet they’ll sue a doctor for missing something in your exam. Too many Americans go to the doctor because they have a cold or the flu, which waste insurance money. Maybe the companies need to stop paying for doctors visits and only for major medical and that will keep people from going to their doctor for everything (and yes I understand the cost is lower if something is found out sooner to treat). Or just provide major medical and allow one wellness check a year and if you need to go to the doctor outside of that, you pay for it. Other than that, there really is no solution! (And no government backed plans for you socialists. I’m sick of paying taxes just for the government to hand out to whomever says, “This happened to poor me…,” as I’m sure we all are.)
The solcialist don’t seem to be able to learn from history, or even current solcialized health programs, these are all doomed to fail. Someone needs to look at reducing costs of the medical providers, not just the insurance companies. If doctors and hospitals could only be paid what a free market could bear then they would figure out a way to reduce cost and still make good money. Example: Maybe more nurse practitioners working for doctors could give the preventive care and doctors could make a profit off them like all other employers do off their employees. But as long as we have a “unlimited payer” system there is little incentive to be innovated from the provider side.
What if we used the MRI machine for every patient to detect tumors before they were symtomatic….the machine would cost less per user; preventive care would be cheaper than stage 3 cancer care.
What if everyone went on a diet and quit smoking, and got some exercise, saved some money and took some personal responsiblity for their lives.
Then, we could talk about how much a doctor should earn, or how much profit a company should make. But we just keep pointing the finger to the other guy to make a change in his life.
And yes, McCain’s idea would lead to adverse selection. I just had to shut down an association group health plan because of adverse selection and it is a really sad state of affairs when that happens.
The big cost issues; insuring the un-insured, Deal with the cost shift from Medicare and Medicaid fee schedules, Reduce the cost of defensive medicine with some form of Tort Reform, restrict the unlimited research and development open insurance checkbooks provides, and push managed care/ wellness practices.
Wrap up reform in the Essential Services Benefit by the following.
The un-insured:
Now to get most residents insured, I agree we must change the individual market to a Guaranteed Issue, but to avoid what occurred in Washington, we must implement a system where most are insured. Have all residents prove by certificate of credible coverage they have a benefit package no less than a defined Essential Services Benefit, or they’re automatically enrolled in the States Essential Benefits Package. (This package isn’t a rich package, but is low cost, and when I say low cost plan, I don’t mean high deductibles, I mean a managed care plan that limits or excludes as many lower-value health care services or practices as possible.) This affects no one with current major medical, only those without. Those without, will miss out on a Tax Credit, AND be automatically enrolled in a no frills plan, which includes enrollment with a PCP and some participation in wellness and managed care. Those without coverage from an employer who have not purchase the minimum insurance on their own end up paying their portion by not receiving a tax credit. Now we have substantially increased those participating in an insured environment lowering the cost to the rest who currently are, AND those currently covered will have an option of buying a low-cost plan, not currently an option.
How do we capture those not enrolled? All children registering for school must not only prove immunizations, but also certificate of credible coverage, or they’re enrolled in the Essential Benefits Package. Their parent/s or guardian/s must also prove they’re covered, or they’re enrolled. All receiving public health services must also prove credible coverage, or will be enrolled in the EBP. All those receiving any public service to residents must prove residency with evidence of picture ID or State Photo Driver’s License. Those attending a clinic or ER (or any access point) must prove credible coverage or will be enrolled in EBP on the spot.
Medicare, Medicaid Cost Shift:
Have the EBP pay providers on a fee schedule we do this now with Worker’s Compensation. We also do this on auto insurance, where Personal Injury Protection (PIP) is limited by statute how much it will pay for the insured’s injury claim. Why not have a fee-schedule and adjust up or down in area’s the fee schedule needs to go? (up for PCP’s for example willing to see EBP patients, down for say specialists?)
Tort reform:
Have tort caps for all services provided under the OEBP too, again, same as with Worker’s Comp, where Worker’s Comp is the sole remedy, and for the most part, subject to no more than $250,000. Many States have Tort Caps of $200,000 or more; why not subject EBP to that cap too? We have the Federal Tort Claims Act immunity for community clinics, why not something like that for EBP? If we lack providers, there are community clinics up and running? Support them in some way to deliver EBP, or contract out to TPA’s?
Unlimited funding of research and development:
There is little or no rationing or restricted certificate of need. With 7 MRI’s in a local small town, and no 24/7 access, we have excess in expensive services, equipment and supplies. Have the EBP allow for say only the first three MRI’s to be covered by the Essential Benefits Package, the others may be covered by private pay or any willing insurer covering beyond the OEBP. Have too many specialists? Only certain few are covered by the EBP. This should result over time in a dramatic price difference between EBP and coverage beyond EBP, building up a market force to keep costs down, yet allowing for choice, innovation, etc.
Managed care:
Require the EBP benefits payable be done in a Managed Care environment. Monitor insurers for enrollment in use of wellness programs, see that insurer pay providers more for better outcomes and manage subsidies for those limmited income.
RAD and Whimp Stomper have got it pegged correctly! I’ve been an agent for 29 years now and am getting tired of my long time customers that have not been paying for health insurance come crying to me about how they are now in the 50s, are having health problems and will lose everything they have accumulated unless they can fool some insurance company into giving them coverage. If they had been paying into the system like responsible people then, they wouldn’t be in this mess. It was more important for them to spend their health insurance money on non-esstential ‘toys’ that the average person doesn’t have. I understand that not all non-insured people can afford coverage and just don’t want to spend the money but, far too many do. The ones that can’t are usually already on Medicaid. The pre-existing condition fear factor is the best tool I have to get them to start a health insurance plan and keep it in force. If necessary, I refer them to the state health plan offered here in Texas but, it has high deductibles and premiums – PAY NOW or PAY LATER is my motto.
It will take years to get everybody insured. I say make people that has health problems and can’t qualify for normal plans enroll in either state sponsored plans or Medicaid BUT, make them pay high rates and have high deductibles during a penalty period.
I agree with Whimp Stomper that we must get the kids insured at an early age.
Bottom line – the biggest problem is everybody needs to pay into the health care system one way or another to keep the costs down – it simply gives us a bigger pot of money to pay claims with. Tort reform is also a must. And yes, it concerns me that my doctor drives new and expensive cars – I personnally think he is making too much money regardless of the length of his education.
John McCain – I’m voting for him because he is the best qualified to be our commander-in-chief but, I don’t agree with him on health care. Besides, the senators and house repres have more say so in drafting health insurance laws – not the president.
Wouldn’t the younger/healthier employees opt out of their employer plans for their own individually priced coverage? If so, what will that do to the cost of the employer sponsored plans? If employer premiums rise due to adverse selection, this would then hurt the economy.
I’m not a fan of socialization – just seems like this is a flawed approach.
I can see where McCain is coming from, but it does seem a little flawed. I’m not much of an economist so I don’t know if the pain would be temporary while the market adjusted (I hope it would) or if this would just be another fatally flawed system that would lead to more of what we have now.
I do know that I like the looks of this plan over what Obama and Clinton are pushing – and I’m not voting for McCain.
I would hope this would come with some type of “take all comers” and the elimination of the “pre-existing” law. Those pre-existing exclusions are just downright evil.
In reply to Mark. I do not like the pre-existing exclusions either, but how would you prevent people that would only apply for the coverage when they need it and then drop it until coverage is needed again? That is the main concern as most people would only purchase it when they needed the coverage and that would happen when you have immediate coverage without pre-existing exclusions.
What none of the candidates have addressed because it could cause concern by those effected. The reason health costs are out of control is not because insurance companies, doctors or attorny’s are making to much. Medicare, Medicaid and care for Indigents/Uninsureds/Illegals/Uninsurables amount to about 70% to 80% of the expenses for Hospitals and Doctors who end up raising rates for the 20% to 30% of patients that have ability to pay. Until these costs are brought under control, there is not a program that can solve problem.
In all reality there is no solution to healthcare cost in America. Insurance companies aren’t making a mass amount of money from healthcare as cost are sky rocketing. Plus, how can you tell a doctor that went to school for so many years they can only charge so much. You can’t band all malpractice suits, especially if you’re asking a doctor to cut his prices when his only recourse is to see more patients per day to make up for it. If you do, then you’ll lose good doctors in the future as college students will pick law instead of med school to make good money (or become politicians). Seeing ball players making millions per year and doctors not, just doesn’t make scense. I understand the entertainment part of it, but people don’t sue a team or a player if they lose, but yet they’ll sue a doctor for missing something in your exam. Too many Americans go to the doctor because they have a cold or the flu, which waste insurance money. Maybe the companies need to stop paying for doctors visits and only for major medical and that will keep people from going to their doctor for everything (and yes I understand the cost is lower if something is found out sooner to treat). Or just provide major medical and allow one wellness check a year and if you need to go to the doctor outside of that, you pay for it. Other than that, there really is no solution! (And no government backed plans for you socialists. I’m sick of paying taxes just for the government to hand out to whomever says, “This happened to poor me…,” as I’m sure we all are.)
Good point! Too bad the liberals are going to have a field day with your comments, but I totally agree.
The solcialist don’t seem to be able to learn from history, or even current solcialized health programs, these are all doomed to fail. Someone needs to look at reducing costs of the medical providers, not just the insurance companies. If doctors and hospitals could only be paid what a free market could bear then they would figure out a way to reduce cost and still make good money. Example: Maybe more nurse practitioners working for doctors could give the preventive care and doctors could make a profit off them like all other employers do off their employees. But as long as we have a “unlimited payer” system there is little incentive to be innovated from the provider side.
What if we used the MRI machine for every patient to detect tumors before they were symtomatic….the machine would cost less per user; preventive care would be cheaper than stage 3 cancer care.
What if everyone went on a diet and quit smoking, and got some exercise, saved some money and took some personal responsiblity for their lives.
Then, we could talk about how much a doctor should earn, or how much profit a company should make. But we just keep pointing the finger to the other guy to make a change in his life.
And yes, McCain’s idea would lead to adverse selection. I just had to shut down an association group health plan because of adverse selection and it is a really sad state of affairs when that happens.
The big cost issues; insuring the un-insured, Deal with the cost shift from Medicare and Medicaid fee schedules, Reduce the cost of defensive medicine with some form of Tort Reform, restrict the unlimited research and development open insurance checkbooks provides, and push managed care/ wellness practices.
Wrap up reform in the Essential Services Benefit by the following.
The un-insured:
Now to get most residents insured, I agree we must change the individual market to a Guaranteed Issue, but to avoid what occurred in Washington, we must implement a system where most are insured. Have all residents prove by certificate of credible coverage they have a benefit package no less than a defined Essential Services Benefit, or they’re automatically enrolled in the States Essential Benefits Package. (This package isn’t a rich package, but is low cost, and when I say low cost plan, I don’t mean high deductibles, I mean a managed care plan that limits or excludes as many lower-value health care services or practices as possible.) This affects no one with current major medical, only those without. Those without, will miss out on a Tax Credit, AND be automatically enrolled in a no frills plan, which includes enrollment with a PCP and some participation in wellness and managed care. Those without coverage from an employer who have not purchase the minimum insurance on their own end up paying their portion by not receiving a tax credit. Now we have substantially increased those participating in an insured environment lowering the cost to the rest who currently are, AND those currently covered will have an option of buying a low-cost plan, not currently an option.
How do we capture those not enrolled? All children registering for school must not only prove immunizations, but also certificate of credible coverage, or they’re enrolled in the Essential Benefits Package. Their parent/s or guardian/s must also prove they’re covered, or they’re enrolled. All receiving public health services must also prove credible coverage, or will be enrolled in the EBP. All those receiving any public service to residents must prove residency with evidence of picture ID or State Photo Driver’s License. Those attending a clinic or ER (or any access point) must prove credible coverage or will be enrolled in EBP on the spot.
Medicare, Medicaid Cost Shift:
Have the EBP pay providers on a fee schedule we do this now with Worker’s Compensation. We also do this on auto insurance, where Personal Injury Protection (PIP) is limited by statute how much it will pay for the insured’s injury claim. Why not have a fee-schedule and adjust up or down in area’s the fee schedule needs to go? (up for PCP’s for example willing to see EBP patients, down for say specialists?)
Tort reform:
Have tort caps for all services provided under the OEBP too, again, same as with Worker’s Comp, where Worker’s Comp is the sole remedy, and for the most part, subject to no more than $250,000. Many States have Tort Caps of $200,000 or more; why not subject EBP to that cap too? We have the Federal Tort Claims Act immunity for community clinics, why not something like that for EBP? If we lack providers, there are community clinics up and running? Support them in some way to deliver EBP, or contract out to TPA’s?
Unlimited funding of research and development:
There is little or no rationing or restricted certificate of need. With 7 MRI’s in a local small town, and no 24/7 access, we have excess in expensive services, equipment and supplies. Have the EBP allow for say only the first three MRI’s to be covered by the Essential Benefits Package, the others may be covered by private pay or any willing insurer covering beyond the OEBP. Have too many specialists? Only certain few are covered by the EBP. This should result over time in a dramatic price difference between EBP and coverage beyond EBP, building up a market force to keep costs down, yet allowing for choice, innovation, etc.
Managed care:
Require the EBP benefits payable be done in a Managed Care environment. Monitor insurers for enrollment in use of wellness programs, see that insurer pay providers more for better outcomes and manage subsidies for those limmited income.
RAD and Whimp Stomper have got it pegged correctly! I’ve been an agent for 29 years now and am getting tired of my long time customers that have not been paying for health insurance come crying to me about how they are now in the 50s, are having health problems and will lose everything they have accumulated unless they can fool some insurance company into giving them coverage. If they had been paying into the system like responsible people then, they wouldn’t be in this mess. It was more important for them to spend their health insurance money on non-esstential ‘toys’ that the average person doesn’t have. I understand that not all non-insured people can afford coverage and just don’t want to spend the money but, far too many do. The ones that can’t are usually already on Medicaid. The pre-existing condition fear factor is the best tool I have to get them to start a health insurance plan and keep it in force. If necessary, I refer them to the state health plan offered here in Texas but, it has high deductibles and premiums – PAY NOW or PAY LATER is my motto.
It will take years to get everybody insured. I say make people that has health problems and can’t qualify for normal plans enroll in either state sponsored plans or Medicaid BUT, make them pay high rates and have high deductibles during a penalty period.
I agree with Whimp Stomper that we must get the kids insured at an early age.
Bottom line – the biggest problem is everybody needs to pay into the health care system one way or another to keep the costs down – it simply gives us a bigger pot of money to pay claims with. Tort reform is also a must. And yes, it concerns me that my doctor drives new and expensive cars – I personnally think he is making too much money regardless of the length of his education.
John McCain – I’m voting for him because he is the best qualified to be our commander-in-chief but, I don’t agree with him on health care. Besides, the senators and house repres have more say so in drafting health insurance laws – not the president.