Should all insurances be mandated to offer the same coverages or would "menu" system be better?

[Nuclear Unicorn]

Local kerfuffle has the state mandating coverages for things like acupuncture.

I don't want acupuncture. I'll never use acupuncture. If you want acupuncture go for it (and please spare me the appeals for alternative medicine; I'm honestly not interested) but I don't see why I have to have my premiums rise to cover a procedure I'm never going to employ. If I ever do decide to utilize acupuncture (never a lifesaving procedure, BTW) I'd be happy with a 1 year, or some such, period to pay into the premium before utilizing it.

In fact, the more I think about it: I would like to pare-down my insurance as much as possible. My husband and I are the proverbial "young couple just starting out" but the insurance costs are taking a mighty chunk out of our ability to establish a sound financial footing. Just as we are non-smokers and have a lower life insurance premium so too would we like to enjoy benefits from our lifestyle WRT our health insurance. There's a reason we drive fuel-efficient cars or work trucks and not sports cars, SUVs or luxury cars. We don't even have cable or satellite (except for interwebz).

The way health insurance regulations are filtering down through our state our choices are turning into the exact same product being sold under different labels. Needless to say competition in pricing is non-existent. Personally, I'd like to be able to pick and choose my coverages.

[rurallib]

1. personally think their needs to be some broad mandated coverages

otherwise insurance companies will use loopholes to avoid paying and gut the system.

[Nuclear Unicorn]

2. Mandates and loopholes can be two separate issues though.

I don't need acupuncture coverage to make sure my insurance honors its contract to provide my husband long-term orthopedic rehab care if -- God forbid -- he's ever hurt on the job.

EDITED TO ADD: And mandated coverages don't cure your concern as the insurance company collects additional premiums for coverages I know I will never collect on but it does nothing to resolve the concern they may NOT honor their rehab care committments. So they would be getting free money with the loopholes intact.

[zipplewrath]

3. spreading the risk

The reason for a more uniform plan, is roughly for the same reason as "group" policies to begin with. It is to spread the risk around more evenly, and over the years as well. As you suggest, if we allow folks to reduce their coverage as you describe, we'll be back to a similar situation where those most at risk, or with pre-existing conditions pay the most, by far. The young will tend to have simple, almost catastrophic health care plans with no or little coverage for screenings (most of which they do not qualify for anyway) and as one gets older the costs rise dramatically.

Health insurance really isn't insurance at all, since we'll all seek medical treatment at one time or another, and we'll all die. It's more of an extended payment plan. By agreeing to pay over the entire frame of our lives, we cost average over our lives. We also get a small break because since some of us will die before ever reaching our truly expensive years, we all have lower overall rates.

It's about being in this together, vs. "going it alone". We do better when we band together. It's kinda what the whole "halftime in America" commercial was trying to say.

[Nuclear Unicorn]

5. Risk-spreading I understand

But there is no risk in my seeking acupuncture or dying from the lack thereof.

And I think I'm a big girl now. There's no risk of me needing a lot of the coverages like drug rehab. I'm not part of the risk pool on that score and if I could select my coverages the company would be released from all liailities to pay claims by me for drug rehab.

[zipplewrath]

11. Life changes

Truth is, the acupuncture probably isn't a big enough issue to discriminate the policy costs, especially when one considers that many of the "alternatives" are probably more expensive. I wouldn't be surprised if they WANTED you to go to an acupuncturist, instead of say a orthopedic surgeon.

As for releasing you from liability, that's pretty much where we are right now, with folks "going it alone" and then ending up with bills they can't pay.

To the collective, there isn't much to be gained by individualizing the coverage and risks since we are all exposed to some, and not others. The only advantage is differentiating between low and high risk individuals, and again to a collective (such as an insurance company that has to take all comers, and not make more than 15% profit) there is little interest in sorting it all out. Everyone pays, everyone's covered, the costs are spread. The only interest is to the individual consumer who can benefit from either making themselves lower risk, or being born into it. They can potentially keep their costs and risks down, even over a lifetime.

That's the gamblers approach and unfortnuately to some extent you're betting with the house money. Because if you are wrong, in the end it is the collective that will end up covering the costs that you can't afford. Kinda like Freddie Mac.

[Nuclear Unicorn]

16. Yes, but risks can be apportioned.

That's why smokers pay more for life insurance. As a non-smoker I can contract lung cancer but my risk is substantially reduced. Should not my costs correspond to that?

[zipplewrath]

36. To what extent?

We could do comprehensive risk assessments of each person and figure out what the high and low risk populations are. And we could do some "discrimination" in terms of risk behavior and other "life factors" including pre-existing conditions and genetic tendencies. A guess would be that it would be a guassian distribution with roughly 60% of the population being within one standard deviation of the norm. All of them would get roughly the same rates. Another 37% would be 2 standard deviations out. Their rates might be on some sliding scale. The 3 sigma crowd would be very small. Their rates would be astronomical.

Or, everyone pays the same rates.

In scenario #1, some folks are going to have a real hard time paying their premiums. Others won't have that problem until pre-existing conditions arise. Others will age into them naturally. But everyone, sooner or later, will be paying astronomical rates for their insurance.

In the second case, it is one fixed, life long, rate in which we all share. We tend to "over pay" when we are young, and "under pay" when we are old. For those that are subsidized by the public, the public doesn't really care about these differentiations because in the end it's one large bill to the public. Individual differentiation doesn't accomplish anything. Similarly, saving the individual money when they are young, and then having to subsidize them when they get old isn't really in the general public's interest. They'd rather we keep the rates at one, affordable, level for "life". Then they never have to subsidize, or at least it is minimized by getting people to pay more when they are younger. Furthermore, the public is collecting premiums from some young people that will never get old (accident victims, early fatalities for any reason). And when I say "public", I really mean ANY method of collecivizing, whether it is an insurance company that has to "take all comers" or the government, state or federal.

[Nuclear Unicorn]

41. Why shouldn't someone who has a family history of diabetes and who its crap food

and doesn't exercise NOT pay a higher premium?

We make high-risk industry pay higher taxes for regulatory oversight, bonding, insurance etc. but a home-based web designer is spared those expenses.

[zipplewrath]

42. We can

What I'm getting at is that we ALL will become "high risk" at some point in our lives. And if we do, our insurance could become unaffordable over that period of time. "saving" money when you're young, or in good shape, could then all disappear when you become old, or out of shape. In the end it's not in anyone's particular interest to do that. It is especially not in the interest of the "public" who will be the backstop to your ability to pay when you become high risk. It's better for all concerned that you pay over a long period of time, like your whole life. And that's true whether it is you personally, your company, or your government.

[Nuclear Unicorn]

43. If you'll indulge a strictly hypothetical, round numbers scenario --

Suppose at my ripe old age of 23 my by-age share of costs is $100. For every 10 years (30, 40, 50, etc.) We have to add $50 for my by-age ONLY share of the risks/costs. By the time I'm 60 it's $300, three times my starting cost. This is an exaggeration -- I think -- I doubt lifetime cost inflate threefold.

Granted, my salary could be increasing as I gain experience, promotions and whatnot but one can never tell.

Then let's add each decade and divide by the number of decades and pay that base rate over the duration. Instead of paying $100 at 20 and $300 at 60, I end-up paying an average of $140 ($100 base, plus $200 divided by 5 decades).

Thus my youth and vigor helps pay for my aged decriptness. If I stay healthy and employed my relative wealth increases as my costs are flat compared to take home pay. The plus 40-percent increase today is the 55% savings later in life. in fact, I pretty much break even by the time I'm 35 to 40 so the last 20 years of my working life I'm ahead on cost, the insurance pool is flush with cash and I have choices.

Then modify according to my lifestyle, i.e. tobacco use, family history, family planning, etc. along with whatever additional coverages I elect.

[zipplewrath]

44. sorry, your numbers aren't right

You'd start somewhere around about $2400/year as a youngster. By age 60, it'd be around $20,000 a year. Don't know how you're thinking about the post 60 year old range. It's gonna go up steep after that.

The typical stat is that you spend 90% of your life long health care expenditures in the last 2.5 years of life.

One way or another it's an exponetial curve you're dealing with, maybe parabolic. It sure ain't linear.

Part of the deal you're cutting with the old folks is that you're paying for their health care now. Since not all young folks will make it to being old, the ratio is greater than 1 to 1. So there is a savings.

Same way for potential chronic diseases. We all pay for them now, only a few will actually contract them. Some won't because they'll die before they contract them. But you're spreading the cost over time and population.

[WillowTree]

48. And what happens if you get diagnosed with breast or ovarian cancer at age 27?

Or what if your husband suddenly has to deal with a previously-undetected congenital heart condition?

Think it never happens to fit young people who take good care of themselves?

Think again.

[Nuclear Unicorn]

49. Those things are figured into actuarials upon which premiums are based. n/t

[Yupster]

19. I was thinking the same thing

If I am an employer in a specialized industry and all of my employees and myself are over 60 years old (let's say I run a buying and transportation service for assisted living centers and employ people at the centers), then must I pay fopr an insurance policy that mandates free birth control? COuldn't I save a little money by leaving that out of my package?

[Nuclear Unicorn]

21. What do you mean you don't want to fund octogenarian contraceptives!

[SlimJimmy]

22. Yes, That would be a good example of opting out of unecessary coverage. (nt)

[Nikia]

31. Employers could run into discrimination lawsuits

Even if no one sued, it isn't very ethical to discriminate against potential childbearing women. Don't think that it hasn't been done or that this would make a major come back if employers could leave out birth control and any pregnancy related services out of their health care plan.

[bemildred]

4. We need health care, not health insurance.

Single payer for all, the rich can still pay extra if they like.

[CAPHAVOC]

6. Medicare for all.

I want Medicare for all. Original Medicare. Not the mess it has become. Get the Insurance Companies and Lawyers out of it.

[Nuclear Unicorn]

7. "Get the Insurance Companies and Lawyers out of it."

Careful. They'll sue you and cancel your legal insurance for saying stuff like that.

[Yupster]

27. And employers too

Really, why should your health insurance have anything to do with where you work?

[area51]

9. +1

[br]Each day, http://www.pnhp.org/facts/singlepayer_faq.php 273 people die due to lack of health care in the U.S.; that's 100,000 deaths per year. This is not only a moral issue, but a national security issue that we're so vulnerable given that our health care delivery system is so fragmented and dysfunctional.

We need http://www.pnhp.org/facts/singlepayer_faq.php single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

We don't need the GingrichCare of mandated, unregulated, for-profit insurance that is still too expensive, only pays parts of medical bills, denies claims, bankrupts and kills people.

http://www.kaiserhealthnews.org/Stories/2010/February/23/GOP-1993-health-reform-bill.aspx
Republican '93 plan:

[font face="courier"]"Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."[/font]

"We will never have real reform until people's health stops being treated as a financial opportunity for corporations."

"Employer-based health insurance has always been a bad idea. Your life should not depend on who you work for." -- T. McKeon

[font face="times"]"Any proposal that sticks with our current dependence on for-profit private insurers ... will not be sustainable. And the new law will not get us to universal coverage ...." -- T.R. Reid, The Healing of America[/font]

"Despite the present hyperbole by its supporters, this latest effort will end up as just another failed reform effort littering the landscape of the last century." --John Geyman, M.D., Hijacked! The Road to Single Payer in the Aftermath of Stolen Health Care Reform

[Nuclear Unicorn]

15. Until that actually happens in another generation --- eom

[Nikia]

34. I agree

Health care should be a basic right just like education. No one should have to go bankrupt because they got unlucky with their health.

[HopeHoops]

8. Same coverage. Same rate. No pre-existing condition clauses - just non-profit insurance.

It's the only thing that makes sense. They spend so much on rejecting claims that they could just pay them and save money. Insurance should not be for profit - for anything. It should be a simple pool of group coverage based on rather simple actuarial tables so that the amount coming in is sufficient to cover the amount going out. I don't mind if business and government cover part of the cost, but the insurance companies are scamming us for way too much money to think about - all in the name of profits.

[Nuclear Unicorn]

10. But I don't want or need the same coverages as some other people.

It's like going to a restaurant and having to pay for food you don't want and won't eat. My husband and I don't use tobacco products and we're both well within our weight standards. I'd like to see a benefit/incentive for that. Sure you can get lung cancer or diabetes without smoking or being obese but as our risk is markedly reduced we ought to have a corresponding risk-share as far as costs are concerned. I certainly shouldn't have to pay for someone else's deliberately unhealthy lifestyle choices if they smoke, eat unhealthy food and don't exercise. I'm not going to dictate how they live, they should be kind of enough to return the favor and not demand I cover their self-inflicted costs.

[HopeHoops]

35. Think of it more as an all-you-can-eat buffet.

A large part of the reasons healthcare is so expensive is because of the hoops the insurance companies jump through to tailor premiums and the for-profit motivation. Ideally it should be universal, but what you are saying is along the lines of "I shouldn't have to pay as much for the roads because I don't drive much", or "I shouldn't have to pay for public schools because my kids are in private schools."

And I doubt you are paying much if anything less, but if someone needs healthcare, it should be provided. Period. The presumed savings of having a company evaluate "lifestyle choices" easily outweigh the level playing field. Universal is still the best approach, and a successful one in many countries, but there's too much money tied up in the for-profit insurance industry and they know the GOP is going to support them.

[subterranean]

12. I think there should be standardized basic coverage for everyone...

but people should also have the option of buying supplemental plans to cover things like acupuncture if they want to. That's what they do in France and some other countries.

[renie408]

20. +1

[Nuclear Unicorn]

23. What about incentiving healthy lifestyle choices?

Honest questions. If poor life choices are costing us as much money as some suggest then there ought to be a reward for those that exercise good judgement. It makes no sense -- to me anyway -- for some to rail about tobacco but then it costs me just as much money to NOT use tobacco. And tobacco taxes for health coverage is a farce. That money goes straight into the general fund. Asking politicians to NOT spend a pile of money is so naive as to disqualify any who might suggest it.

[subterranean]

45. I'm not opposed to such incentives in principle.

And I understand your point of view. The problem is how would the incentives work in a system of guaranteed coverage? Offering lower premiums for non-smokers, for example, would give people an incentive to lie about their smoking habits if their insurance can't be cancelled for lying.

I could see giving overweight people financial incentives to reach certain weight goals and keeping the weight off for an extended length of time, because that would ultimately reduce the future burden on the system. Maybe discounts could be offered if your vital statistics at checkups stay within a healthy range for a given period of time, sort of like the "good driver discounts" in car insurance.

But I don't think it's feasible, or desirable, to have insurance companies (or the government) monitoring what people eat, or how much they exercise, or whether they practice safe sex, for the purpose of adjusting their insurance premiums. Besides, there are other costs associated with unhealthy behavior (cigarettes aren't cheap), and good health is its own reward.

[hughee99]

47. Ah, the slippery slope of "incentivising" life style choices,

particularly for those who get their health coverage from the government, where the government isn't telling you how to live your life, just making it expensive if you don't make the "right" life style choices.

Who will a "healthy-lifestyle" policy hurt the most? Those least able to afford health care and probably most in need of it.

[Yo_Mama]

30. Yes, that is a better way to handle it.

It is more important to get the major medical stuff covered.

[DisgustipatedinCA]

13. The same coverages should be mandated

Spread the risk, etc.

[Nuclear Unicorn]

14. I'm at zero risk for illnesses related to

obesity, hard drug use or tobacco. Nor will I seek alternative medicine therapies.

[Lurks Often]

17. Talk to your employer

Likely, they are the ones who added the acupuncture coverage and some of the other things you don't expect to use.

Other services may be required by the government, especially the behavioral health stuff.

[Nuclear Unicorn]

18. Actually, we're a small office and the boss is fuming over it more than I am. n/t

[Lurks Often]

25. Still might be a requirement under state law that it be offered,

you'd have to check your state law.

I strongly doubt it was the insurance company's idea to mandate acupuncture coverage.

[Nuclear Unicorn]

40. That's my point, it is a state law and one I don't like. n/t

[Matariki]

26. Well I find acupuncture is effective for my allergies

and probably don't and won't ever use things you or your husband does - things which I have to pay for even though I'll never need or want to use them. See how that works?

[kestrel91316]

28. Medical insurance SHOULD be outlawed altogether in favor

of SINGLE PAYER.

This whole system is broken and can't be fixed. Throw it out. Get rid of the blood-sucking middleman.

[Yo_Mama]

29. Certainly for stuff like this you should be able to opt out.

There is no good argument for making you have this coverage. No one else is ever going to be stiffed or have to pay extra to cover your ER acupuncture bill.

Congrats on the healthy low consumption lifestye, btw.

One of the benefits that healthcare reform was surely going to deliver is that it costs a lot more to lobby the federal government. A lot of state governments had clauses in law mandating coverage for items such as acupuncture, aromatherapy and so forth. It was relatively easy for those providing such services to lobby state governments to mandate such coverage.

While it certainly does not offend me if people use such treatments, and I believe people ought to be able to buy coverage for such treatments if they choose to do so, it is ridiculous IMO to mandate coverage for such treatments, and for the taxpayer to subsidize such treatments.

HHS' recent decision means that states that have such mandated coverages will keep them, and that the federal subsidy to help individuals buy affordable health insurance will cover such treatments. This seems totally irresponsible to me.

We're cutting back on heating subsidies, looking to restrict effing food stamps!!!! and we're paying for stuff like this? I don't think so. We'd get far more health benefits from not freezing and starving our low-income population.

I think the mandated coverages ought to be pretty bare-bones, and exclude more discretionary items such as even most fertility treatments. I realize that sounds harsh, but we really are picking and choosing who gets to live and die in other places on the ledger, and I'd rather make sure people get to eat and older people, especially, don't die of hypothermia, than pay for someone's artificial insemination.

However when you look at having to make choices such as that, it does make you goggle at things like aromatherapy.

I think one good way to start would be to review the services that Canada covers and does not cover. They do have reasoning in place behind those choices, and to some extent we are doing a new thing - but we can profit from the experience of countries for whom it is not new.

[lumberjack_jeff]

32. mandated to offer the same coverages

At a macro level, the government and the ama know what things are likely to happen to people and what treatments are ordinarily prescribed for them. Consumers don't, nor are they psychic; they don't know what they'll get sick from.

It's like being asked to order from a menu, but in different cities and different restaurants, 5 years in advance. You have no way of knowing that you'll be in that city on that date to make use of the meal you paid for, and if you pick wrong, you'll go hungry.

[eShirl]

33. Medicare For All: problem solved. n/t

[baldguy]

37. You don't like accupuncture

But would you refuse to accept an insurance package that offered it? And campaign for the insurance company to drop it altogether, even if you didn't want it & sign up for it?

The trouble with offering insurance a la carte with regard to reproductive services, is that the anti-choice and anti-contraception nutcases would want any any list of offered services to NOT have them available - even if the insurance funds for such services can separated from the general fund.

In addition, the whole concept of insurance is that the cost of expensive medical services is distributed among policyholders. If a portion of the funds collected are prohibited from being used for some services, those services are going to be that much more expensive.

[Nuclear Unicorn]

39. So?

Let the Duggars pay no extra premium for contraceptives but let them pay their fair share for pre-natal and delivery.

[kctim]

38. No mandates and a menu system would be great

[Warren DeMontague]

46. I think there should be a basic baseline coverage- and YES it should include birth control.

that said, in my ideal situation we'd have single payer and this would be moot.

[TheKentuckian]

50. Just down this very path a little ways is a fucking mess of exclusions on needed treatments

and/or the complete destruction of risk sharing in favor of some guessing game based on individual risk.

No thanks. Pay for the acupuncture and the person that gets it will pay for whatever you need that they don't. I will pay for my neighbor's inhaler that I don't use they will pay for the burn I got that they didn't.

[Nuclear Unicorn]

51. Except acupuncture is voodoo quackery. I might as well be asked to subsidize Benny Hinn.

[TheKentuckian]

52. Then what you want is a process to discern what treatments are effective

so that your group isn't throwing money away.

That seems a horse of a different color to me but a reasonable thought.

[Nuclear Unicorn]

53. The efficacy of treatment might lead to greater ills

Some people want acupuncture, I'm not going to tell them no, I want the right to not join them. Some people think chemotherapy is legalized slow murder; I however would prefer to have that option.