Just need to vent...

They appear to have incentivized poverty very effectively.

 

Well that's always necessary when the goal is to turn USA to a socialist country. Has there ever been an extreamly well-to-do country that has switched, otherwise? or is it just when country's finances begin to collapse

 

why do they have to be connected?

 

are you saying the current government couldn't do a great job with it?

 

2 out of 3 ain't bad. In reverse order:

• "tax free HSAs coupled with high deductible policies". Implemented. I've got one.
  
  The part about getting "patients to behave more like consumers" is still a bit of gaslighting at this point, given that the patients' ability to get reliable cost information in advance is still really spotty, and it's still not uncommon for the number (even after the original bill has been paid) to change by hundreds or thousands of dollars, or the provider and the insurer both tell the patient they haven't agreed on something, and it becomes the patient's job to either pay the difference or solve their problem and get them to agree, when the one person who never saw and can't get any of the messages exchanged between the provider and insurer is the patient.
  
  Nothing that couldn't be fixed by suitably strict and enforceable regulation, and if that existed, then the "patients to behave more like consumers" idea could become realistic enough to live up to the hype.
  
  
• "decoupling medical insurance from employment so it could be portable from job to job". Partially implemented, thanks to ACA. Larger employers are still expected to offer an employer plan, but as an employee, you no longer have to shape your career plans around whether you'll be able to afford healthcare during a career shift.
  
  
• "opening the insurance market to interstate competition". So far not implemented, which is fine with me, since that slogan is really a dogwhistle for gutting insurance regulation, using the playbook we already saw before when we all lost usury protection on credit-card interest rates. (Some credit-card issuers formed up in states with lousy or nonexistent usury laws, and then argued to be allowed to operate under the same terms in all states.)

The key thing making insurance regulation important is that insurance is an unusual kind of business. In most businesses, you have a product or service that you sell to customers, and you have the price set so as to expect each transaction and each customer account to be profitable.

The whole nature of insurance is that you have a whole 'book of business', a bunch of customer accounts where most of those accounts will make you positive money any given year but some of them won't. You need to price your premiums so that you make your expected profit on the whole book of business, and that's the reason you hire actuaries, and have your book of business include a variety of people you don't expect to have large expenses at the same time. But you never expect each customer to be profitable each year, because if that was happening, what you're selling wouldn't be insurance.

And it becomes something common to see, any time healthcare reform is being debated, where insurance-company flacks say the quiet part out loud and complain how the mean ugly regulations are making them have some customers in their book of business who don't always make them money. They'd probably stop playing for sympathy like that if enough alert people in the audience said "well, right, you're an insurance company." But as long as audiences include enough people who have forgotten (or never knew) what insurance is, they get enough sympathetic "awww"s to be worth continuing the play.

In effect, insurance companies would basically love to forget about the pooling of risk (which is what makes insurance insurance), and instead be installment-financing companies for each person's own health expenses (whether you are or are not a person a tree falls on or cancer strikes). And the one basic, overarching job of insurance regulators is to keep saying "yes, well, you know what, you're an insurance company."

 

• 
  1st yr they were offered - all money not spent by the end of the year got to be kept by carrier. That's legal stealing! If expenses weren't so over scrutinized, it would have been easier to plan to get all the money spent down out of the account Later on they changed it to at least 2 years but who knows how many folks still get short-sheaded by that kind of nonsense.

 

What might not be great is an insurance federalization passed with bipartisan opposition, but then blaming republicans for what passed.

Not everyone has to be thrilled with the McCain proposal, but it would be odd to maintain that it hadn't been proposed.

Pricing regulation can fix bad pricing in theory, but allocating that authority to some part of government has an unhappy history ranging from poor municipal spending to military procurement.

On the other hand, consumers appear to wield considerable authority where they have an array of options offered but not compelled from multiple providers for hamburgers, clothing and appliances as well as procedures typically not made more opaque by the insurance process like laser eye surgery or liposuction.

Some systems have reduced price opacity somewhat with a quote for a procedure that includes the overall price and the net payable by the patient. I agree that many places don't offer the same kind of price competition as you'd have in buying a dishwasher from one of the dozen Home Depots or Lowes in every urban area, but making consumers insensitive to price is unlikely to help them choose like consumers.

Employer paid medical insurance premiums still aren't taxed as compensation to an employee because labor unions were part of the political process that shaped the ACA. I don't believe the ACA has profoundly changed calculations about the affordability of medical insurance. The result seems to be high deductible/high premium insurance for those in the individual market.

We have interstate competition for 529 plans, and that latitude seems satisfactory for people who use them.

Insurance companies are very easy to hate. My doc friends hate that they hire people whose only job is to follow up with ins companies for payment, and those same docs are gullible enough to believe that "out of control malpractice suits" are why they pay high malpractice insurance premiums. Policy holders may hate ins companies for the outrageous premiums they pay and how hard it can be to deal with ins company people whose whole job it is to be a lying PITA.

As long as there are a number of insurance companies from which to choose, no one of them has the power to ruin one's life the way the government does. People frustrated by insurance companies turning to government for less callous deception and waste haven't spent enough time dealing with government.