Silly People Looking for a Too-Good-To-Be-True Bargain Get Just What They Deserve Ah, the silly citizens. When they need non-group health insurance, and have been completely healthy, they buy this cheap health insurance that is cheap based on keeping all the unhealthy people away. It's really cheap, maybe $900. a year. It's a wasteful product, being that it only pays out 55%-75% in claims of the premiums paid in. But they've got really cheap rates. They see "Harry and Louise" (ad 2), and they feel really good about their really cheap insurance. But then, if they do get sick (which is what they had insurance for), they wind up with much higher rates, or no insurance at all, just like Elizabeth Edwards Says. So, collectively, we are morons looking for a bargain buy getting insurance that keeps away unhealthy people. And when we get sick, that insurance, that keeps away sick people, says "good luck, buddy", and we get what we deserve.

To: By-State Sources and DANGERS Directly to State In That Table: AL AR AK AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA ME MD MI MN MS MO MT NE NV NH NJ NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY General Information on Health Insurance and Pre-Existing Conditions Is Employer Coverage Secure? See The Walmart Memo Life Expectany vs GDP on Healtcare--Comparing Countries Notes On Policy: This Page

Frontline with Full Video on 5 Country's Systems

American Prospect Special Report on Universal Health Care--May, 2008 . The following articles strike me as particularly lucid: Ezra Klein on two of the major proposals and their variants, Marcia Angell on the Massachusetts reform, and Anthony Wright on the California attempt.

CLINTON, OBAMA, McCAIN: Which of Them Propose To Get Rid of the Pre-Existing-Conditions Mess? The Clinton web-site issue statement says "The insurance company can't deny you coverage if you have a pre-existing condition", which is technically a little vague, since, since based on the wording alone, they could give you coverage for everything but the pre-existing condition, or they could also charge you more. Indeed, that kind of tricky wording pervades the current crazy system. Nonetheless, based on the fact that everyone would have an option of "the same health care plan that members of Congress have", and most especially since participation in some health care plan is mandatory, I am pretty confident that pre-existing conditions would be covered for all in her plan, even for people who do not now have coverage (that is, will not have "continuous prior coverage" at the time the plan goes into effect). On the Obama Plan, it says "Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions". This has pretty much the exact same meaning as the quoted Clinton text, but here, because of the fact that coverage is not mandatory, I can see that there is an issue of freeloading -- people not picking up coverage until they get sick -- unless they require something like a year or two of "continuous prior coverage" to ignore pre-existing conditions. Thus, pretty certainly people who have and hold full medical insurance now would be covered for pre-existing conditions, and not be charged more, but if there is an insurance lapse, then as I see it, they may have to have the pre-existing condition ignored. Based on the health plans as currently proposed, I have to endorse the Clinton version, because the mandatory coverage avoids the freeloading problem. Further, in the Obama plan, without mandatory coverage, and with lower income people highly or completely subsidized on the premium, I can see a potential for the freeloading to be mostly by people with relatively higher incomes. Mrs. Clinton has lots of exposure to the issue, as she spent time designing a plan, and perhaps that explains why her policy looks sounder. (These mechanisms are kind of complicated--I have a Ph.D. in a math discipline, so frankly I can see them a little more easily than a typical lawyer. Though, really, Obama should have some experts on hand pointing out the freeloading risk, and he should be able to see that when it is pointed out. I see Princeton economist Paul Krugman has weighed in against the Obama plan, for the exact same reason as me, in this column (a) and more recently this column (b). Each of these has a clear and simple explanation of the problem with the Obama plan. Good job Prof. Krugman! That's what public intellectuals are supposed to do in a democracy -- stand up and help us find the light. For this particular issue, you absolutely have to have a quantitative-analytical intellectual, and Prof. Krugman is exactly that.) 2/26/08: The endorsement of Obama by Connecticut Senator Dodd amplifies my suspicion of the Obama plan. Though I have shaken Senator Dodd's hand twice while living in CT, when he came to the pharmaceutical companies where I was doing work, I am also aware that CT is the center of the insurance industry. The success of the insurance industry is, unfortunately, tied to the high cost and inefficiency of the health care delivery system, and this may mean that the health insurance industry believes Obama is much more certain to maintain that high cost and inefficiency. What about McCain? From his link: McCain on Health Care. (NOTE: 5/3/08 The McCain health care page has changed in the last month. Previously, it did not mention pre-existing conditions. As the public has become more aware of this, according to one analyst because of a recent TV interview about her cancer treatment by John Edwards' wife Elizabeth [click for Elizabeth Edwards Interview on Youtube] , he has started to speak of the issue somewhat, and the web-page has had the issue added. Anyway, let's not fault him for changes in platform--it is reasonable to reconsider, correct mistakes, and add details. Unfortunately for him, fortunately for at least the more informed of us, the new page makes clear the defects of his plan, including the fact that he leaves the pre-existing-screened system in place, despite the inefficiencies of that system, and the fact that it does not serve us well -- exposing us to all kinds of ridiculous financial and health risks, that, since Switzerland in 1994 became the last industrialized country to abandon our system, exist only in the U.S. Surely McCain is afraid to take on the health insurance industry. Or perhaps his analytical skills are poor enough that he can't get his mind around the problem. (Inadequately intelligent presidents seem to be a problem lately. I want my president to be one of the best and the brightest.) So that you can check my assertions about his plan, I've copied the 2 sections of the current (5/4/08) McCain Page on Health Care that address pre-existing conditions after the end of this box, after the line across the box.: One thing to note is that he does not have anthing like a Universal Health Care plan. (Further, as far as I can tell, there are a lot of people in the working poor class and middle class who will not be able to afford health insurance under his plan And if you read his words carefully, people with pre-existing conditions will still use a high-risk-pool, which costs much more -- currently up to $25,000 a year per person.). McCain's plan does nothing at all to stop the pre-existing-condition screened system that allows insurer cherry picking, keeps risk from being pooled, wastes resources as healthy people keep switching policies in response to cherry picking in their current pool, and forces people with pre-existing conditions to pay much more or have no health insurance at all. Where it says McCain will work with states to establish a "guaranteed access plan" or "GAP", guaranteed access plan is the exact same as high risk pool. The use of "guaranteed access plan or GAP" is undoubtedly designed to deceive and make it seem like this is something new. It's just the same old high risk pools that have been around in many states for decades. In fact, they've been around so long, that the insurance industry has already tried renaming them to make them seem new, to "CHIPs", or "comprehensive health insurance plans". (Some states do not have a high-risk-pool, and most that have one have some sort of humongous gap, that has caused me to put the big red "DANGER" in my by-state table for 36 of the states+DC.) Thus, if we assume McCain and his analytically adept and persuasive advisors will be able to somehow convince each of the 36 states to wipe the DANGERs out of its system (against the opposition of vast special interests in each and every state), we still have the fact that the high risk pools cost up to $25,000 a year per person. McCain does have a $2500. per individual $5000 per person tax credit for health insurance. The problem is, with the pre-existing-condition screened system, the 46 states+DC that are not community rated and will remain non-community-rated under McCain, even if McCain gets all 36 states to create or patch their risk pools, you have high-risk-pool-premiums plus stop loss currently up to $25,000 a year per person. That is, the credit covers only 10% of the actual cost for people with pre-existing conditions. And you still have to fear getting a pre-existing condition, and you still have to fear huge claims being denied because you honestly forget one of umpteen hundred things that a doctor has at sometime told you might be wrong with you. The McCain page has this curious statement Nothing In John McCain's Plan Changes The Fact That If You Are Employed And Insured You Will Build Protection Against The Cost Of Any Pre-Existing Condition which makes no sense at all to me, except possibly in the most deceptive sense. I don't see that people who are employed and insured build protection against the cost of a pre-existing condition. When they lose their jobs, after the COBRA, they are quite out there in the individual insurance market, unprotected except by the legislation that already exists in some states only.?!? (He might possibly mean that by working, if your income is high enough, you can save up lots of money for when you later can't get insurance for pre-existing conditions, or for when you are in a state where there is a really really expensive high risk pool without a humongous gap. But you really have to save up a lot of money -- perhaps 450,000 dollars per person of rainy-day money -- to cover health insurance in high risk pools for many years. And this assumes each of the 36 DANGER states patch each and every gap. (That is, I did not place "DANGER" in the table when you could always get high-risk-pool insurance even at a high rate like $25,000 a year per person every year. I placed it only when there was a gap where you couldn't get any reasonably complete insurance at all.) So, with McCain, we get the status quo. He's keeping the inefficient, wasteful cherry picking system because his business friends want it. He's keeping the horribly inefficient individual insurance system (paying out only 55%-75% of dollars taken in) because his business friends want it. He's pushing the difficult decisions onto the states, and keeping a system of 51 different sets of state rules, causing opportunities for freeloading on each state by moving to the right state, and causing people to be more concerned about what state they live in than what work they do, for health insurance reasons. He's leaving us open to just about as many medical bankruptcies as before, and he's leaving working poor people actually untreated. Boo McCain. If you are really a nice guy, you don't have the courage or skills to act and fix this problem. Oh, by the way, I'm really having trouble with this from McCain's page, which is clearly designed to deceive: MYTH: Some Claim That Under John McCain's Plan, Those With Pre-Existing Conditions Would Be Denied Insurance. McCain is hoping the average voter will be deceived and take this to mean, "you apply for any insurance policy, and they have to cover you, unlike now where I heard my friend who had a heart attack got denied and went broke". Well, under McCain the system remains exactly the same -- in the 46 non-community-rated states, they will be denied just like before. The only possible way the McCain statement could be is that you won't be denied insurance because you will be able to get some insurance. But, just like now, the insurance you get may cost $25,000 a year per person (when the out-of-pocket limit is added in). So, you won't be actually "denied" insurance: you'll get approved, but you just won't be able to pay for it!! But, even worse, this state of being approved for insurance when you have a pre-existing condition, but unable to pay, depends on the rather ridiculous assumption that 36 states will remove all of the DANGERs in my by-state table. McCain speaks softly like a nice old guy, but he seems out to deceive. And the thing is, when the newer generation of Republicans deceive, they do it in ways that will make the non-rich suffer. I believe the Democrats, though they also deceive quite a bit, do it for reasons that are frankly much more benign. They have the interests of the non-rich at heart, actually. I believe this. McCain Page Full Extract on Pre-Existing Conditions Follows (blue): A Specific Plan of Action: Ensuring Health Care for Higher Risk Patients John McCain's Plan Cares For The Traditionally Uninsurable. John McCain understands that those without prior group coverage and those with pre-existing conditions have the most difficulty on the individual market, and we need to make sure they get the high-quality coverage they need. John McCain Will Work With States To Establish A Guaranteed Access Plan. As President, John McCain will work with governors to develop a best practice model that states can follow - a Guaranteed Access Plan or GAP - that would reflect the best experience of the states to ensure these patients have access to health coverage. One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level. John McCain Will Promote Proper Incentives. John McCain will work with Congress, the governors, and industry to make sure this approach is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs. SETTING THE RECORD STRAIGHT: COVERING THOSE WITH PRE-EXISTING CONDITIONS: MYTH: Some Claim That Under John McCain's Plan, Those With Pre-Existing Conditions Would Be Denied Insurance. FACT: John McCain Supported The Health Insurance Portability And Accountability Act In 1996 That Took The Important Step Of Providing Some Protection Against Exclusion Of Pre-Existing Conditions. FACT: Nothing In John McCain's Plan Changes The Fact That If You Are Employed And Insured You Will Build Protection Against The Cost Of Any Pre-Existing Condition. FACT: As President, John McCain Would Work With Governors To Find The Solutions Necessary To Ensure Those With Pre-Existing Conditions Are Able To Easily Access Care.

Upcoming Non-Genetic Discrimination Federal Law Should Help Destabilize the Current Pre-Existing-Condition Screened System and Worsen the Crisis. Hooray! -- an even worse crisis may finally convince everyone that Universal Coverage is needed -- anything less seems to be a little too subtle. The The bill referenced here is expected to pass the House and the President has said he will sign it. What the bill says health-insurance wise is that "genetic" information about medical risk can not be treated like a pre-existing condition. Already in many (but not all) states this is the law. However, with the extension to all states, and mainly, with genetic testing destined to become much more commonplace, the pre-existing-condition-screened insurance system should eventually have its failure to serve the needs of the populace become even more obvious. The reason for this is that in the near future, a person will routinely have a lot of genetic tests done, and if they determine they are very likely to get a serious and expensive disease, they can elect to purchase insurance. However, otherwise, they may decide the health insurance is a bad deal, and chance it. (Not all people will do this, but those with only moderate savings, and also the less financially responsible, may choose to do this. This is the situation called "adverse selection", where higher risk people are more likely to get insurance, and this drives up everyone's cost, especially those who just want to be responsible non-freeloading citizens and have the insurance whether they have especially high genetic risk or not.) This adverse selection problem is precisely the reason that, without regulation, insurers have to screen for pre-existing conditions, or else go bankrupt. Now there will be partial regulation at the national level, allowing genetic risk factors not to be treated as other risk factors. Since it is by-regulation, affecting all insurers equally, it will not cause insurers to go bankrupt. What it will do, along with the increase in genetic testing, is make pre-existing-condition-screened insurance a worse deal for us all. Frankly, since the people seem to need an even worse crisis to realize the problem, we can only hope the further crisis will get the needed legislation. (If you think about it, there is no economic or moral reason that genetic risk factors should be any different than risk factors due to actual disease. Economically they are the same: they both increase the expected cost of a person's medical treatment, and morally they are the same: it's not a person's fault. Further, allowing genetic information to affect getting health insurance would discourage people from getting genetic test information that may help their health, exactly as allowing pre-existing-condition screening causes people to not get medical evaluations and testing that may help their health. The only difference is that the issue of genetic risk is relatively new, and it is easier for the vested interests to prevent change than to affect the new genetic issue in a way (genetic-insurance-screening-allowed) that is obviously morally repulsive and economically and healthwise deleterious. NOTE: I initially became aware of effect of genetic-discrimination-prohibition to undermine the pre-existing-condition-screened system from an on-line article from someone at Johns Hopkins. Unfortunately, this was some years ago, and I am unable to find link you to the article based an internet search today.

WHY IS HEALTH INSURANCE DIFFERENT FROM OTHER INSURANCE LIKE FIRE AND AUTO?, (that don't need pre-existing condition regulation or subsidies). This is a perceptive question with a compelling answer. A)Pre-Existing Condition Regulations are Needed because the larger part of the cost of a medical event (heart attack, coming down with cancer, etc.) is not the immediate cost of treatment, but rather the future cost of treatment due to conditions which will pre-existing after the event. (Compare: If your house burns, it gets rebuilt and the insurer pays for that, but you can still get insurance on the new house because it is not more likely to burn again. Auto is actually similar -- yes, there is a detail that after an accident the insurer may presume you are a less good driver and raise your rate even 50% for a few years, but this is nothing like the event of a heart attack or cancer, where if you lose your current insurance, or you need to change insurers because your insurance pool gets cherry picked (see box below), your unregulated insurance premium (i.e. expected medical cost) may rise to 10 or 30 times what is was. Another way of looking at the paragraph above is that any truly rational consumer (with assets to lose) will only buy health insurance that covers, for a medical event, not only the cost of treatment now, but the elevated expected cost of future treatment which becomes apparent due to the current medical event. Of course, one reason no individual or job insurance offers this is that only about 2% of people are economics-quantitative analytical enough to see this even when pointed out, and the other 98% are oblivious to this. (Thus, for the health insurance product, consumers are not informed consumers -- rather they are terribly, terribly ignorant consumers for this product.) Another reason the rational-consumer insurance is unavailable is that such truly sound insurance is impossible to offer, based on the unpredictability of future medical advances and costs. Thus, the only available solution for a rational consumer would be to join a non-revocable agreement to pool medical costs with a large number of other individuals. Well, if you make that large group of individuals everyone, this is one form of universal care. B)Subsidies are Needed (even after regulation for pre-existing conditions) because many people simply can't earn enough to pay for the average cost of treating disease. This has much to do with the free-market spirit of U.S. regulations, where those with limited labor market power to garner a high wage (which arises largely because there is not a shortage of people doing the particular work that they do in the absence of unions of much higher minimum wages). C)Regulation Reducing Redundancy and Increasing Administrative Efficiency are not essential, but desirable, because of the extreme waste, partly in the insurance-marketing area. For example, because of so many insurers existing with all kinds of different rules, perhaps 20%-25% of doctor and hospital costs are due to assistants dealing with all the forms and different pre-approval rules for the different insurers. Further, on non-employer insurance, beyond that administrative loss on all health insurance, the insurance company only typically pays out 60%-72% in bills of the premium dollars it takes in. (I actually saw 55% for one individual insurance policy one time.) Thus, we spend 16% of GNP on medical care whereas the other industrialized countries spend 6%-11% or GNP, and many have longer life expectancies than us.

"YOU JUST GO TO AN EMERGENCY ROOM." --G.W.B. (yes--he said it--see below) From researching the (often simply incompetent) provisions at the state level to keep the middle class from going into medical-related poverty, I am afraid I believe now that only Universal Coverage at the National Level would substantially solve the problem. (There are just too many ways for people to freeload on the rest of us otherwise. Often, the freeloading is involuntary -- good people not freeloading pay extra for health insurance to support the freeloaders, then they find that the insurance system that they thought protected them has left them without assets, and they have to start freeloading themselves.) Universal coverage seems possible in a few years, but the country may blow it again -- and it may continue that only the very poor, the exceptionally well off, and the imprisoned can count on stable, reliable, continuous health insurance. The recent George W. Bush advice, "I mean, people have access to health care in America. After all, YOU JUST GO TO AN EMERGENCY ROOM."* is not so hot if you are trying to have something left to lose. If you go to the emergency room, and/or the the hospital, they will track you down and make you pay. Until and unless you have nothing left to lose. That's the problem, the cluelessness, with the Medicaid- or Emergency-Room-Only safety-net system he is touting in the speech. (And let's not forget that those emergency room costs get cost-shifted to everyone with insurance, making their insurance unaffordable.) *Yes, he really said that. Here at this transcript at the White House Site, paragraph 16, the one that starts with "The immediate goal...". The video of available on the top right of that page, and within the video, you can find the President saying that remark at timing 7:05 (i.e. seven minutes and five seconds in).

The Cherry Picking Dynamic (in States Without Community Rating / Modified Community Rating): Suppose you live in a state without community rating or modified community rating. (Community rating and modified community rating prevent what is called "cherry picking".) Say you already have an individual health insurance policy in that state, and your state even has laws say that it can't be cancelled on you, or at least that it can't be cancelled on you unless the insurer stops offering insurance in the state. You might feel pretty secure. There's a way you might get stuck, which you might not expect. Say you do develop a medical condition: a heart problem, cancer, etc., and at the time you currently have private insurance. You might feel secure: you have a policy, you keep paying the premium, and under the laws of your state your company can not cancel your policy unless they decide to cancel all policies in the state. But that sense of security is false. What will happen is this: all of the people who are in your insurance policy's "pool" of people were pretty healthy when they got issued their policy. But over time, a few have gotten sick, but most are still pretty healthy. The small number of sick people in the pool will start to make rates rise a bit. Then other insurance companies, and possibly your own insurance company, will seek out the people in the pool who are still healthy, and sell them insurance that is a bit cheaper, since there are no sick people in that new pool. As they keep doing this, only pretty sick people will be left in your pool, and your insurance rates will get very high. You won't be able to get new insurance from a private company, though, unless they exclude your expensive condition. So, just like people who had an explicit loss of an old insurer, you're stuck, and you really need reasonably priced insurance or you may go broke. (This continuous increase in price due to other insurance companies cherry-picking out healthy people from the pool actually happened to me about 5 or 10 years ago in CT. I had a policy that started at about $1000 a year, and in less than 5 years it went to about $5000 a year, which was more than the cost of the high risk pool for my young age at the time. When I called the insurance company that had issued the policy to ask how high the rate might go, they told me they couldn't say, but then they connected me immediately to their Connecticut agent, who tried to sell me a new pre-existing-screened policy. (That is, they tried to cherry-pick me from their own pool.) At that point, I just took the high-risk pool even though I was healthy, in order to avoid any part in the insane system, and also resolved to leave the state I was in -- CT -- for a community-rated state at the nearest economically opportune time.) (Aside: that insurance company probably had cherry picked other people out of its own pool prior, and that was probably, in part, responsible for my rate rising so high. Whether that is illegal or not -- I haven't checked -- is irrelevant. If they hadn't cherry picked healthy people out, other insurance companies would have. The pre-existing-screened system has that fundamental cherry-picking mechanism for rates on current policy holders to rise, and force them to get a new policy if they are still healthy. Moreover, folks of an economics or mathematical bent will easily see that this product being billed as "insurance", which is supposed to pool risk, actually pools only the risk of costs for a period of time after disease onset, that period of time getting shorter and shorter as the technology for cherry-picking gets better and better. Only restraint on the part of cherry pickers, motivated not by any morality, but rather by not making too obvious the uselessness of the consequent product, prevents them from using computer and internet technology to bring that period of time of being insured down to say 1 hour from disease onset.) Another thing I wanted to point out about cherry-picking is that, although agents and insurers routinely actively pursue this strategy (the agent for a commission that they get from this wasteful churning), without regulations, even if agents and insurers tried to be very, very moral and absolutely stopped trying to do it, the same thing would happen by itself automatically. To see why this happens, say I and 99 oother very healthy pass a pre-existing condition screen and get put in an insurance pool by an insurance company. The rates are low, maybe $1,000 a year because we are all so healthy. Well, in a few years, maybe I and someone else in the pool have a heart attack. The rates for the 100 people in the pool go up to say $1900. a year for everyone, because of the medical bills and likely future medical bills of the two of us. But then 20 of the 98 people who didn't get sick and are still really healthy realize that they can pick up new health insurance for just $1150. (they're a little older than when they got the policy), and they do so. Then just 80 people are paying for 2 sick people in the original pool, so the rates are $2400. a year, and all but the non-asleep of the remaining healthy people in the pool get new insurance. So in just a few years, there might be 5 people in the pool, 2 of them have heart conditions, and so the 5 of us pay $80,000. a year.

CALIFORNIA INSURER WRITES DOCTORS ASKING THEM TO FINK ON PATIENTS (So They Don't Have to Pay Claims on Pre-existing Conditions) See story here.

WHY ULTIMATELY, EMPLOYER-SELF-INSURED EMPLOYEE HEALTH INSURANCE WILL NEED TO BE DONE AWAY WITH As the famous Walmart Memo reifies for us, large corporations that "self insure" their employees are under increasing pressure (due to globalization competitive pressures, rising stockholder nastiness, and rising health care costs as a percent of GDP) to minimize health insurance costs by selecting healthier and younger employees. Meanwhile, smaller companies can't handle the risk of self insuring, and, to cover their employees, must purchase small group insurance from an insurance company. These typically follow community rating and modified community rating rules (in far more states than the 5 states that community-rate and modified-community-rate individual insurance). Further, universal coverage being inevitible (though perhaps 40 years away--since you indeed can fool most of the people all of the time), premiums will no doubt be based on community rating or modified community rating. I presume here that there is not a single payer, but rather independent insurance companies under community rating or modified community rating rules, with some possible risk-adjustment between insurers. With modest math skill and a single economics course, it is easy to see that what happens if large employers can self-insure and thus form their own pools, is that they save lots of money by organizing their own pools of just healthy and/or younger employees. It is also not hard to see that they gain a competitive advantage for a strategy of hiring just healthy, young employees. This competitive advantage has nothing to do with their economic efficiency -- it just has to do with freeloading on the rest of society by not pooling everyone's risk in their own pool. Thus, they are getting around community rating or modified community rating by having the legal right to form their own pools not subject to such community rating. Obviously, the economically sound solution is that we make Walmart, Target, etc., if they do provide insurance for its employees, buy it from a community rated private or non-profit company. (Obviously, they will likely react by paying for less of the proportion of the cost than they do now, and the difference will be borne by the taxpayer, but this honest accounting removes economic misincentives leading to misallocation of resources, and actually it's zero net lost for the taxpayer when costs are summed up over society. That is, there is an economic net gain, being that the loss from misallocation of resources is cleaned up, and the net other costs: through taxes and cost-shifing adds to 0.)

DOES THE CURRENT INSURANCE SYSTEM MAKE IT HARDER FOR OLDER PEOPLE, AND LESS HEALTHY PEOPLE, TO GET JOBS? See Walmart Memo.

TWO GENERAL SOURCES OF SOME BY-STATE AND CROSS-STATE INFORMATION: is the Georgetown University All-States Health Insurance Site. There is, for individual insurance, a by-state comparison table on the site: Georgetown By-State Table) THERE IS EVEN BETTER STATE-COMPARISION INFORMATION (ABOUT INDIVIDUAL AND STATE SMALL GROUP RULES) AT: kaiser statehealthfacts.org "Managed Care and Health Insurance" subpage.,

DO YOU MISS HARRY AND LOUISE? Well, they are available on YouTube "Harry and Louise" ads here. For the record, lets dissect these 2 ads. The first one points out the minor problem of individuals possibly winding up changing specific health plans, and getting ones "government designed" (rather than insurance-company designed to maximize profits by whatever sneaky means). (Poor stressed Harry and Louise must have a bill for something that the new plan won't cover and they clearly are living paycheck to paycheck and can't swing that extra expense.) They make it sound scary. Somehow the really scary thing, that thanks to the influence of the ad still prevails: the reasonable possibility of having no health insurance at a time when $400,000 in medical bills roll in is out of the picture. (Let's see how Harry and Louise handle that.) Of course, let's not forget that Harry and Louise, by being such scaredy cats, are keeping millions and millions of people who work at jobs without health insurance from getting care for really serious things that will kill or cripple them. [As a concession to the significant minority of Americans who are, like Harry and Louise, pathetic, current reformers like Clinton and Obama are careful to specify in their plans things like "if you are happy with your current plan, nothing will change".] The second ad in the video is an attack on community rating. The large cost increase that an individual who gets individual health insurance while very healthy is, in fact, realistic in community rated states and modified community rated states vs. the unregulated system. But what Harry and Louise don't say is that the health insurance in unregulated states is just lousy, short term insurance. If the folks in the unregulated state with the cheap insurance do get and stay sick, they will have a pre-existing condition, and their rates will go really high, as insurers cherry pick only the people without pre-existing conditions out of the pool of people with the cheap policy. In community rated and modified community rated states, this doesn't happen. Rates are higher, but the coverage is real long term coverage that doesn't have cost increase on you in the long term if you do get sick. If you have a a serious pre-existing condition in the non-community-rates states that Harry and Louise want to live in, health insurance can be really expensive if available--e.g. now $25,000 a year in CT counting stop-loss in high age groups. And CT is not one of the states where I have put DANGER in my By-State Comparitive Table, for which states there is a real risk of having no coverage at all, or no coverage for the bulk of the expenses of pre-existing conditions. Of course, in ad 2, the image of responsible non-smokers paying for irresponsible smokers in community rating is misleading. Yes, that does happen with community rating. It may raise rates by a few percent for non-smokers. That could easily be addressed by Harry and Louise demanding that community rating states just allow the companies charge more for smokers and prior smokers -- the jump to no community rating at all only follows if you are -- well -- very dumb. Apparently Harry and Louise are not only pathetically unable to cope with any change, but very dumb. By the way, the reason the insurance companies behind Harry and Louise don't like community rating is that it takes away the profitable (society-destructive) business model of many health insurance companies, which is to sell insurance only to very healthy people. Shame on these particular American businessmen. (From Walter Lippmann: But when the chaff of silliness, baseness, and deception is so voluminous that it submerges the kernels of truth, freedom of speech may produce such frivolity, or such mischief, that it cannot be preserved against the demand for a restoration of order or of decency. If there is a dividing line between liberty and license, it is where freedom of speech is no longer respected as a procedure of the truth and becomes the unrestricted right to exploit the ignorance, and to incite the passions, of the people. Then freedom is such a hullabaloo of sophistry, propaganda, special pleading, lobbying, and salesmanship that it is difficult to remember why freedom of speech is worth the pain and trouble of defending it. from Essays in the Public Philosophy)

More From Walter Lippmann: We must assume that the members of a public will not anticipate a problem much before its crisis has become obvious, nor stay with the problem long after its crisis has past. They will not know the antecedent events, will not have seen the issue as it developed, will not have thought out or willed a program, and will not be able to predict the consequences of acting on that program. We must assume as a theoretically fixed premise of popular government that normally men as members of a public will not be well informed, continuously interested, nonpartisan, creative, or executive. We must assume that a public is inexpert in its curiosity, intermittent, and that it discerns only gross distinctions, is slow to be aroused, and quickly diverted; that, since it acts by aligning itself, it personalizes whatever it considers, and is interested only when events have been melodramatized as a conflict. The public will arrive in the middle of the third act, and will leave before the last curtain, having stayed just long enough to decide who is the hero and who the villain of the piece. Yet usually that judgement will necessarily be made apart from the intrinsic merits, on the basis of some sample of behavior, an aspect of a situation, by very rough external evidence. Actually, Lippmann wrote that in the 1920s. Since then, the U.S. has had the GI bill and quite a bit of higher educational expansion. Many have been pulled up, including myself. (Thank you, Nelson Rockefeller.) Let's not forget the Flynn Effect. Thus, I think things are overall better, at least there are a lot more non-ignorant people around, despite counter-forces, such as video when used at the wrong development stages, and possibly a new load of immigrants from the uneducated class. Unfortunately, Lippmann's words remain pretty accurate. As an aside, note that just about every sufficiently educated and able person comes to realize the truth of Lippmann's view by a certain age. Certainly most people in positions of public office or power realize this, and many of them have been brought up and told at an early age to expect ignorance from the common man. Further, it has apparently been demonstrated many times that any sort of attack on the ignorance of the ignorant (folks not used to discourse), no matter how indirect, alienates them and their votes in a democracy, so virtually all in power are careful to keep quiet about this ignorance. Before any of us gets too despondent about this, though the ignorance is very, very costly, we should at least be happy that the country has made progress since the period of extreme slaveholding and segregationist ignorance of the American South, and further we know well that around the world today there are many places where the ignorance of the people leads to murders on a massive scale. Counterpoint: In the 1920s, there was a public debate on how democracy could be run best, between Lippmann on the public-is-big-dodohead side, vs John Dewey, believing we can expect more from them under proper circumstances. The Dewey book below was his reply to Lippmann's book above. If the situation of voter ignorance and/or lack of analytical skills bothers you, you may find a kindred spirit in: , which book though I do admit I have many quibbles with. More of this kind of stuff Social Science Books for Science People

U.S. Health Insurance System Broken? To Me It Seems Very Broken, Indeed I've noted that policies in my area will go up 14% this year, that being 11% over inflation. It is an easy calculation that at this rate of increase, 60% (rather than the current 16%) of the average salary will be health insurance cost in 16 years. Further, it would seem cost-shifting to cover the uninsured, taxes to cover the insured, it seems, will have to increase. I can't imagine this is good for the economy. A free-market economy works on the principle of incentives, that is, that producing more will usually yield more money and security. But now people who make very little money get full insurance (Medicaid), but if they produce more and make a bit more money they can't afford insurance. And then if they produce even more and make even more money, they pay even more, plus their hospital bills include costs for all those people without insurance. And if they commit crimes and harm society, they get free and secure health insurance in prison. It would seem many of us are going to have to think a little less of our own maximum benefit, and let a little progress be made. Every other industrialized country has universal health care, pays 2/3 or 1/2 of what we pay, and many have longer life expectancies. Physicians, this includes you. Health insurance underwriters and sales-people: get a useful job. As for myself, I'm eschewing work in the pharmaceutical industry of late, and thus I've removed the burden of my own salary from the national health load.

From Whence Came the Crisis? Back in, say the 60's, (a)medical costs were only about 4% of the GNP and (b)by virtue of America's economic dominance and consensus of the people running the country, jobs could be stable. In the interim, medical technology has evolved, making us live longer, but also quadrupling its cost (there went (a)), and much of the world has recovered economically or started to develop, plus greed has gotten a bit more in fashion, and there went (b). What this has done, is made the formerly manageable inefficiency of the US system get to affect us and our economic incentives much more (due to the price quadrupling and further now cost must be shifted to cover the uninsured). To see the inefficiency: if you wind up with an individual policy, typically only about 75% is paid out in claims (an old policy of mine stated on the application that only 60% is paid out in claims). The inefficiency on individual policies is due to advertising, paying sales-people, the statisticians at the company working on ways to find healthy people to take away from other plans to sell them cheaper insurance, the insurance underwriter reviewing each application and perhaps ordering medical tests to make sure the person doesn't have too many pre-existing conditions, and then paying the lawyers to defend not paying claims if they suspect a pre-existing condition existed. But that was only the added inefficiency of individual policies, which are what policies you get if you don't have insurance through a job. Group policies pay out bills more like 90% of premiums. On these and all policies we still have 20% or 30% of the bills being to deal with all of the insurance companies to get payment. Also, collection agencies, and lawyers for big cases. Further, hospitals and doctors need to be able to attract customers, and so they advertise, and each hospital and medical office gets the latest expensive medical machines, so they can attract customers, even though the machines are most of the time not being used, and could be shared if there were some coordinating force. As well, our system is mostly fee-for-service, and thus there is an incentive for not-really-essential services, especially so the docs can pay back the humongo loans for medical school. Undoubtedly, medical malpractice is some of the cost, and that should be fixed, but it is the smaller part of the costs. If we could muster the political initiative to fix this waste, it would seem we could get to be like the other industrialized countries, where life expectancy is often better than ours, costs are 1/2 to 2/3 of ours, and middle-class people don't live in fear of losing all their money, and don't have their lives revolve around that fear. And in many of those countries are fully democratic, and people are free to read what they like and say what they like. I suspect they may feel freer in that they can move from place to place and job to job without worrying about getting bankrupt over health insurance issues. In all honesty, I can only see that the problem may be somewhat solved only if, in the 2008 election, we get one of the Democrats currently running as a president, and further a strong Democratic majority in both houses. Even so, the special interests may drag out a new version of the "Harry and Louise" commercials, and I can see that it may fail. In any case, the country has so many aggressive special interests, that we certainly won't get something like the highly efficient systems that they have in some other countries. We'll still be paying 16% of the GNP for healthcare, rather than 8% or 10%. But that will have to be O.K.

Who am I? I am Norm Spier, a mathematical statistician who lives in New York State.

If you have any comments, or want to point out an error or oversight, please email me at norm@nastechservices.com

SAY I AM PERMANENTLY HARMED IN A CRIME? Can they count that as a pre-existing condition? Yes. Even in a terrorist attack? Yes. (Patriot Act has no provisions for pre-existing conditions.)

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