Good post. A+++. Would read again.
I still don't think universal coverage is feasible in the US, but that doesn't mean that I'm satisfied with the way things are, and that doesn't mean I don't think there are some things we could do to greatly
expand coverage.
Jenner wrote:So, instead I know that no one is immune to accidents and that, if an accident happens and you do not have health insurance, you are -Fatal Hopper- for the rest of your life. Inversely, if an accident happens and you do have health insurance they still may not cover it, and they will go to amazing lengths NOT to cover it.
Yes. The incentive system is completely screwy for insurance. I'm going to give an economist's answer a little later on that. For now, I'll note that the number-one problem with the health insurance setup is that profitability is directly related to providing an inferior service (through denying claims).
And now that the market is down and they cannot rely on brokerage it is the way they've chosen to make the bulk of their profits now. Stacking fees are applied retroactively, you find yourself making a payment on your debt, not on your account, and still getting billed a late fee. Less ethical banks and credit companies actually change your billing date on you every billing cycle with the intent of invoking missed payments.
Fees in and of themselves aren't bad--as long as they're clear and up-front, and you know what you're paying, why you're paying it, and how much it is. Minimum account balances (which is the setup I have, because it's easier than worrying about monthly deposits) isn't unusual. The problem is with hidden fees and stacking fees (negative/minimum balances can be the worst, actually, since they can take you below the minimum and incur another fine in a weird vicious cycle). Most banks you can negotiate with to actually get all those fees taken off, but, well, it requires you going out of your way to do it. I've known this happening to a lot of folks, and all of them were able to get it taken off (after some negotiation); several of them switched banks thereafter.
Changing billing dates on the billing cycle... Yeah, that -Dragon Diamond- does happen. "Hidden" fees also happen because most people don't closely monitor their account activity. Variable interest, same deal, but that's more due to the bank doing what it needs to to remain profitable. Banks are in a better situation, though, since they still rely on individual customers. If enough people are irritated with a particular bank (BoA is often a target) then you'll find rival companies getting better business on the premise of little or no fees (Wachovia, PNC). There's still an incentive structure to provide good service there. That's not the case for HMOs, though (reasons later).
Even if you are insured, your insurer will do everything they can to weasel out of paying as much as they can weasel out of. Also, let us not forget that if you have a "pre-existing condition" you cannot get health care. (My Costochondritis prevents me from getting health care without ridiculous premiums, co pays, and monthly payments.)
Yeah, I couldn't get my own insurance either due to a pre-existing condition. Funny thing is, what's "pre-existing" isn't determined by doctors, but by an HMO who doesn't know -Dragon Diamond- about medicine. Given the methods they use to determine individual premiums, well, they'd charge higher rates to Blacks and women if there weren't legal means blocking them (and even then, there are some ways of getting around it).
That relates to the number-two problem with health insurance's setup, that they get business from employers rather than individual customers (unlike banks).
This is also why they want you to have babies, so they can roll your debt onto them and their debt onto you. And by the way, they won't pay for you to have that baby unless you jump through hoops and follow their rules about how/when to get pregnant stated in your insurance policy.
There's a point there about generally trying to deny coverage by any means necessary, but, "they want you to have babies" gets clear into conspiracy theory territory. It's the same deal as any other claim: their incentive is not to provide you coverage. The only unique aspect about pregnancy is that it's something that normally happens (as opposed to appendicities, e.g., which is not a condition anyone
wants to get).
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Anyway, recall that I already pointed out the two fundamental problems with how healthcare is set up in this country, that is:
1) Profitability is based on denying coverage to your customers. A customer is anyone who is already paying the company for coverage; the extent to which an insurance company can deny claims to existing customers determines how profitable they are. In other words, they're rewarded for providing you a product, but providing a very poor product.
2) The choice of which insurer you go to is rarely made by an individual. It's usually made by your employer, meaning that an individual dissatisfied with the service of his/her insurer has very limited options for switching to a competitor.
There's also a third, related to item 1:
3) The final decision of accepting a claim, or providing coverage in the first place, is often
not made by someone with a background in medicine. (This is the only part that gets personal to me, since I get really irritated at people playing doctor when they're uneducated.)
That means that the healthcare insurance industry is
not a competitive one. It functions more like a series of separate monopolies in which poor service is rewarded. There is still some competition (to mitigate poor service) since employers can still choose to go with another insurer, if their present one isn't providing good enough coverage to their employers (remember, an employer has an incentive to make sure his/her employees are healthy)--but this functions much more slowly than if individuals had complete free range. And there still is some regulation of the industry, which helps to keep it from being a complete mess--but regulation can't accomplish everything, and it's highly vulnerable to political pressure.
Even given all that, government-provided universal health care as an option still poses some risks for making the entire situation worse, and it could be impossible to implement, depending on the form it takes.
As a preview of the next post, my main two issues are:
1) Any hybrid system could (
could, not would) be untenable since the government would be an unfair competitor. This could (
could, not would) draw enough people away from existing insurers to where private insurance is no longer possible to maintain.
2) Americans have a stronger aversion to higher taxes than most other places--it'd be easier to convince the average person to sacrifice 20% of their paycheck for healthcare than it would be to convince him/her to pay 10% more in taxes to fund universal health care. So, it'd be really difficult to get publicly-funded healthcare to be well-funded healthcare.
I'll get more to this in a later post. KF
