Obama appears to be entertaining the idea of mandated healthcare for normal families, but only if those who are quoted high prices for insurance (usually the sick or their family members) are exempted from having to purchase insurance, "because it is too expensive".

This will address his goal of making healthcare more efficient, but it will leave the basic problems unaddressed, keeping the insurance industry profitable.

Ideas being floated are requiring businesses to foot the bill, (making older employees more expensive to hire and replacing employees with investments in technology-driven solutions more attractive) and increasing capital gains taxes on investment income.

The Obama administration has been holding a series of forums with hospital and insurance company executives and handpicked community members to guide the process of healthcare reform.

Q: What is Obama doing to address the problem of adverse selection?

A: This is why Obama is considering a mandate that requires healthy people to buy insurance. The original idea of a public option is a good one, but there is a huge risk that only the sickest 20% of people, people who need prescription drugs or care for ongoing chronic health conditions like hypertension, cancer or diabetes, would seek out the government alternative, given their difficulty in obtaining private insurance. This would make the government program much more expensive. By requiring everybody who was quoted a price under some line to buy insurance, or face a fine, Obama would slightly increase the size of the pool of healthy people buying insurance, the theory is that at least some of them, perhaps those with spouses or children with chronic illness, would purchase the government plan, enlarging the pool of healthy enrollees somewhat. This might lower the rate signficantly without forcing the government to pay more than a few billion dollars more to insure them because their premiums might exceed expenditures, especially if their chronically ill family members were not that sick.

Ultimately, though, the problem of cost is a significant one. How Obama will avoid the issue is a big question. He seems to be adamant against the government negotiating prices down as a bloc, and wedded to the idea of jobs being connected to healthcare access (perhaps to keep wages down)

Stay tuned as reality sets in for the Obama administration.

There's more...

This looks interesting. The Calif. Nurses Assn

"Nurses Blast "Cruel Ruse" by Insurance Giants to Cover Patients As Deal for Forcing Americans to Buy Insurance"

Basically, they are repeating the criticisms that many other healthcare providers have been bringing up about the private insurance mandates and private insurance based health proposals from Obama and the health insurance industry.

They are true. For example, access to care and affordability has worsened in Massachusetts.

Additionally, the devil is in the details. Read this closely:
"On Tuesday, the insurance trade lobby America's Health Insurance Plans and Blue Cross and Blue Shield offered to stop denying coverage to those with pre-existing conditions – but only if the healthcare reform plan under consideration in Congress contains a requirement forcing all Americans to buy private insurance – and if Congress rejects a proposal to include a public plan alternative for people not wanting private insurance."

But at what price? Its not at all useful if insurers offer to turn away nobody ONLY IF THAT PERSON PAYS WHAT THEY CONSIDER TO BE A "FAIR PRICE". Or if they offer, like the drug companies, to cover "people who can't afford it" but those subsidies are limited, like they are in many states, to people with arbitrarily low incomes. Excluding the middle class and even, most of the working poor.

And all others are asked to pay a price based on risk plus profit. or simply, "what they can get away with".

For example,three times the Federal poverty level works out to something like $35,000 a year FOR A FAMILY WITH SEVERAL CHILDREN.

We don't see millionaires without health insurance, even people who have had cancer. They pay huge amounts of money for it.

There's more...

Well, its looking as if it will be 2012 or 2016 at the very least before Americans have a political candidate or progressive party on a national level who makes universal healthcare that also makes healthcare affordable for those who really need it a priority enough to actually make it happen.

To his credit Obama has committed to make US healthcare more efficient by 2019, by embracing the troubled Massachusetts model which dodges the question of affordability and leaves many sick either "insured" but still unable to afford actual care or needed drugs, or uninsured and facing either a fine, or needing an exemption from the law because they could not find a plan- and still uninsured.

That's a problem. Here is another real world example of another major problem with the risk pricing model. It scares people away from preventative and diagnostic care. What about the person who may be healthy on paper now, say they have insurance now, but who is presented with a symptom which may be of a new condition? One that would increase an insurance company's exposure to risk. (Making them not a desirable customer. Insurance companies would prefer not to cover them or perhaps cover them, take their money, but later dump them if they make claims.)

So, (this being the United States, home of the barbaric healthcare system) should they test for it, with the knowledge that some test results may make them "uninsurable", if they lose their job with its group plan that spreads the risk around, OR should they "wait and pray" for real "change" and hope that they do not die before it comes? (Meanwhile, avoiding contact with the medical system.)

The reason I ask is that I have a friend who lives in another state. He has symptoms that he thinks could be cancer.

He is a blue collar employee, almost 40, and could easily end up out of work for a year or so if his company folds.

If he gets diagnosed with something serious, whenever, he can't have a period of noninsurance, because he may never be able to purchase nongroup insurance. If he lived in MA. he would be one of those who could not afford a policy within his income, so he would be exempt or perhaps less likely, fined for not having insurance.

He wants purchasing affordable insurance on the private market to be an option for his family as he has three children and a wife who currently get their insurance through his threatened job. (His wife works in a coffee shop and does not get insurance.)

Obama's risk pricing model would price insurance "fairly for both insurer and insuree", based on cost times some calculated risk plus profit, I would guess, but for a formerly middle class person with a medical condition, that fair price could be so far out of reach that it might as well be millions of dollars a year. Many people are just getting by. (The devil is in the details.)

(Moving to Canada, Europe or Australia isn't an option for them. They are Americans, and this is their home.)

What should he do? Wait and pray? Or test and pray?

Another consideration. Drugs to treat cancer can cost as much as $1000 a month or more, but his current insurance policy has a $1000 YEARLY cap on prescription costs.

Obama seems to like the Massachusetts model. It elimiantes the "free riders" who were being subsidized by the providers as writeoffs. Its also hurt many free clinics in urban areas. Money that used to go to them is now going to the insurance companies and drug companies, who charge more in MA. now. (more demand)

Massachusetts's basic minimal healthcare policies for the healthy, as well as for the ill, often don't include prescription drugs at all. They seem perhaps designed to insure the government more than the people.

The consumer driven healthcare model ("choice") saves money by making the patient pay more out of pocket through exemptions and cost shifting.

Earth to Obama, we have a problem here. People can't afford this path you have placed us on.

There's more...

Adding insult to their injuries, the Obama administration has proposed a new policy of asking health insurers to foot the bill for war injuries of veterans, despite blanket policy exemptions that have for decades, exempted acts of war from almost all kinds of private insurance coverage.

The LA Times has more here: "Plan to bill insurance for combat injuries criticized"

This new cost-shifting in billing policy seems to have already been implemented by the VA, and it is apparently already resulted in the US-based offices of many businesses becoming unwilling to hire veterans of any war, because they are afraid their insurance bills will rise.

Veterans groups are up in arms.

There's more...

STUDY SHOWS MASSACHUSETTS' PLAN IS A FAILED MODEL FOR HEALTH CARE "REFORM":

A recent study shows that Massachusetts program forcing all citizens to buy for-profit health insurance is failing the poor, middle class and especially the chronically ill because they cannot afford the allegedly "fair" prices inevitably demanded by for-profit insurers. (The health insurance industry takes 33 cents out of every dollar spent in the United States on healthcare, trillions of dollars a year.) Plus, those who can't also afford prescription drug insurance are being price-gouged on prescription drugs.

BEGGING FOR REAL, NOT SIMPLY COSMETIC, "CHANGE":

A group of 500 Massachusetts doctors has sent a letter to the Obama administration begging that they stop holding up Massachusetts as a model of healthcare success, because the system is failing the middle class and all of the chronically poor whose incomes are more than three times the federal poverty line (which works out to around $66,000 for a family with four CHILDREN (my edit))

""Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all," the letter said.

The Massachusetts healthcare law essentially builds on the existing health insurance system, where most people obtain coverage through their employers. It requires virtually all people to buy insurance and provides limited assistance to those who cannot afford it. President Obama and Senate Finance Committee Chairman Max Baucus have endorsed aspects of the plan, making it likely to influence any effort to overhaul the national system.

The doctors' analysis -- written by Rachel Nardin, a neurologist and an assistant professor at Harvard Medical School, and Steffie Woolhandler and David Himmelstein, both primary care doctors and associate professors at Harvard Medical School -- questions the quality of data showing that all but 2.6 percent of Massachusetts residents have insurance, arguing the number is probably 5 percent or more.

The doctors also say that the new insurance available to lower middle class people imposes unaffordale out-of-pocket costs, particularly on the chronically ill. And they argue that because the new law is more expensive than anticipated, the state has prematurely cut funding for "safety net" providers who help the poor free of charge, leaving them without a last resort.

"Despite having health insurance, many Massachusetts residents cannot afford care," Nardin said at a press conference in Washington earlier today. She cited the example of a young diabetic from the Boston area whose costs went from nothing under the old "free care" system to $340 per month under the new law, consuming one-quarter of her take-home pay.

Asked how Congress and the White House might avoid Massachusetts' mistakes to create a better national system, Woolhandler and Nardin said the main lesson was that a Medicare-for-all style system is the only way to achieve universal health reform."

Thought that mandated health insurance in Massachusetts would include drug coverage? You were wrong.

There's more...