What is the argument AGAINST allowing insurance to be sold across state lines?
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« on: September 30, 2017, 02:12:10 am »

There's not much discussion here. It's kinda boring, so I'm posting a few topics to see if I can't goad you all into some conversation.

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What is the argument AGAINST allowing insurance to be sold across state lines? What is the status of your personal health care plan?

Me, I live in Japan. I pay something like 100USD per month for unlimited coverage. As of today, I've used it like once. (I don't get sick.) I get yearly checkups and go to the dentist for a cleaning annually, all free.
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« Reply #1 on: September 30, 2017, 02:49:59 am »

There's not much discussion here. It's kinda boring, so I'm posting a few topics to see if I can't goad you all into some conversation.

m(_ _)m

What is the argument AGAINST allowing insurance to be sold across state lines? What is the status of your personal health care plan?

Me, I live in Japan. I pay something like 100USD per month for unlimited coverage. As of today, I've used it like once. (I don't get sick.) I get yearly checkups and go to the dentist for a cleaning annually, all free.

Selling across state lines would create competition.  The insurance companies don't want that.
I don't really blame the insurance companies, I blame the healthcare providers that fraudulently gouge the system.  The providers do test that are unnecessary, they do procedures that aren't needed, they bill for procedures they did not do, they over charge, etc.   
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« Reply #2 on: September 30, 2017, 04:09:26 am »

It won't create competition.  It will be a total nightmare for consumers.  The reason it won't work is because of provider networks.  It takes a lot of time and effort to build these networks. 

I live in MA.  If I buy a plan in Idaho then none of my doctors will be contracted with my plan.  I can ask them to contract but that process can take months or even years.  My doctor will need to do that for every patient that comes in with an out of state insurance and I will need to go through this process for all of my doctors.  The amount of administrative overhead  to manage all of this would be enormous (and it's already enormous today).

The doctor will now have to follow the rules of hundreds of insurers and will need to bill them all separately and fight to get paid.  In the end it will be the patient who loses because the insurers won't pay for these non-contracted providers and the patient will get stuck with the bill.  The doctors will never see a dime and will only see patients with certain types of insurance.
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« Reply #3 on: October 01, 2017, 02:22:18 am »

It won't create competition.  It will be a total nightmare for consumers.  The reason it won't work is because of provider networks.  It takes a lot of time and effort to build these networks. 

I live in MA.  If I buy a plan in Idaho then none of my doctors will be contracted with my plan.  I can ask them to contract but that process can take months or even years.  My doctor will need to do that for every patient that comes in with an out of state insurance and I will need to go through this process for all of my doctors.  The amount of administrative overhead  to manage all of this would be enormous (and it's already enormous today).

The doctor will now have to follow the rules of hundreds of insurers and will need to bill them all separately and fight to get paid.  In the end it will be the patient who loses because the insurers won't pay for these non-contracted providers and the patient will get stuck with the bill.  The doctors will never see a dime and will only see patients with certain types of insurance.


That's an interesting point I've never considered or read elsewhere. Is this something you came up with yourself or did you read it someplace?

Ann Coulter reminded me in her article this week that another way to cut healthcare costs is to reform medical malpractice lawsuits/payouts. That would go a long way in simplifying the rules and regulations already in place which might help smooth things out for insurance to be sold across state lines.
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« Reply #4 on: October 01, 2017, 03:01:13 am »

It won't create competition.  It will be a total nightmare for consumers.  The reason it won't work is because of provider networks.  It takes a lot of time and effort to build these networks. 

I live in MA.  If I buy a plan in Idaho then none of my doctors will be contracted with my plan.  I can ask them to contract but that process can take months or even years.  My doctor will need to do that for every patient that comes in with an out of state insurance and I will need to go through this process for all of my doctors.  The amount of administrative overhead  to manage all of this would be enormous (and it's already enormous today).

The doctor will now have to follow the rules of hundreds of insurers and will need to bill them all separately and fight to get paid.  In the end it will be the patient who loses because the insurers won't pay for these non-contracted providers and the patient will get stuck with the bill.  The doctors will never see a dime and will only see patients with certain types of insurance.


That's an interesting point I've never considered or read elsewhere. Is this something you came up with yourself or did you read it someplace?

Ann Coulter reminded me in her article this week that another way to cut healthcare costs is to reform medical malpractice lawsuits/payouts. That would go a long way in simplifying the rules and regulations already in place which might help smooth things out for insurance to be sold across state lines.

Malpractice suits are way out of control, and the awards are excessive.   

------

Aadam works in the healthcare insurance industry - no wonder it is so screwed up.   He also lives in Taxachussetts. 
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« Reply #5 on: October 01, 2017, 04:14:24 am »

It won't create competition.  It will be a total nightmare for consumers.  The reason it won't work is because of provider networks.  It takes a lot of time and effort to build these networks. 

I live in MA.  If I buy a plan in Idaho then none of my doctors will be contracted with my plan.  I can ask them to contract but that process can take months or even years.  My doctor will need to do that for every patient that comes in with an out of state insurance and I will need to go through this process for all of my doctors.  The amount of administrative overhead  to manage all of this would be enormous (and it's already enormous today).

The doctor will now have to follow the rules of hundreds of insurers and will need to bill them all separately and fight to get paid.  In the end it will be the patient who loses because the insurers won't pay for these non-contracted providers and the patient will get stuck with the bill.  The doctors will never see a dime and will only see patients with certain types of insurance.


That's an interesting point I've never considered or read elsewhere. Is this something you came up with yourself or did you read it someplace?

Ann Coulter reminded me in her article this week that another way to cut healthcare costs is to reform medical malpractice lawsuits/payouts. That would go a long way in simplifying the rules and regulations already in place which might help smooth things out for insurance to be sold across state lines.

I work in healthcare.  A single payer system would likely put me out of a job.  I will find something else to do.

A few years ago a few states decided  to allow plans to be sold across state lines.  Not a single insurer was interested.  The  only way it would work is if the thousands of insurers across the country consolidated into a small number of companies.  That is the opposite of what the GOP is trying to accomplish.

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« Reply #6 on: October 01, 2017, 05:40:19 am »


I work in healthcare.  A single payer system would likely put me out of a job.  I will find something else to do.

A few years ago a few states decided  to allow plans to be sold across state lines.  Not a single insurer was interested.  The  only way it would work is if the thousands of insurers across the country consolidated into a small number of companies.  That is the opposite of what the GOP is trying to accomplish.


This is really interesting. Working in healthcare you have insight that most of us don't.

From your perspective 1) I The Affordable Healthcare Act working as it should and 2) how do you think it should be amended (or should it be repealed and replaced with something else)?

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« Reply #7 on: October 01, 2017, 07:24:32 pm »


I work in healthcare.  A single payer system would likely put me out of a job.  I will find something else to do.

A few years ago a few states decided  to allow plans to be sold across state lines.  Not a single insurer was interested.  The  only way it would work is if the thousands of insurers across the country consolidated into a small number of companies.  That is the opposite of what the GOP is trying to accomplish.


This is really interesting. Working in healthcare you have insight that most of us don't.

From your perspective 1) I The Affordable Healthcare Act working as it should and 2) how do you think it should be amended (or should it be repealed and replaced with something else)?

The ACA is actually working better.  Every county will have a plan next year despite Trump telling us that it's a total disaster.  The places with only one plan option are mostly rural areas so maybe something needs to be done in those areas.  Any business is tough for rural areas.  The FCC just allowed Verizon to cut off a bunch of rural customers (some of them fireman and police officers) because they were too expensive.

ObamaCare can be fixed very easily.  We need to have a public option.  A state run health plan would force costs down because most people are going to choose the public option.  This isn't unheard of. This is exactly how Medicare operates.  85% of people on Medicare choose the public option.  Medicaid operates the same way in my state (and a few others).  Most people choose the public option there too but I do believe there are benefits to the private plans.
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« Reply #8 on: October 01, 2017, 07:59:22 pm »


I work in healthcare.  A single payer system would likely put me out of a job.  I will find something else to do.

A few years ago a few states decided  to allow plans to be sold across state lines.  Not a single insurer was interested.  The  only way it would work is if the thousands of insurers across the country consolidated into a small number of companies.  That is the opposite of what the GOP is trying to accomplish.


This is really interesting. Working in healthcare you have insight that most of us don't.

From your perspective 1) I The Affordable Healthcare Act working as it should and 2) how do you think it should be amended (or should it be repealed and replaced with something else)?

The ACA is actually working better.  Every county will have a plan next year despite Trump telling us that it's a total disaster.  The places with only one plan option are mostly rural areas so maybe something needs to be done in those areas.  Any business is tough for rural areas.  The FCC just allowed Verizon to cut off a bunch of rural customers (some of them fireman and police officers) because they were too expensive.

ObamaCare can be fixed very easily.  We need to have a public option.  A state run health plan would force costs down because most people are going to choose the public option.  This isn't unheard of. This is exactly how Medicare operates.  85% of people on Medicare choose the public option.  Medicaid operates the same way in my state (and a few others).  Most people choose the public option there too but I do believe there are benefits to the private plans.

If Obamacare can be fixed easily, then why don't the democrats come up with a fixed plan to promote? They have done nothing but sit on their hands.   When it comes to congressmen, there is not that much difference between a republican and a democrat.  It's like choosing whether to have your left leg amputated or your right leg amputated.
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« Reply #9 on: October 01, 2017, 09:03:43 pm »

The Democrats don't have any power.  Any plan they come up with will be rejected by Republicans.  The GOP promised to save healthcare.  They lied.
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« Reply #10 on: October 02, 2017, 02:19:31 am »


      are can be fixed very easily.  We need to have a public option.  A state run health plan would force costs down because most people are going to choose the public option.  This isn't unheard of. This is exactly how Medicare operates.  85% of people on Medicare choose the public option.  Medicaid operates the same way in my state (and a few others).  Most people choose the public option there too but I do believe there are benefits to the private plans.

      Let me make sure I understand your overall opinion across threads.

      • 1. Private businesses/companies shouldn't be allowed to give their employees healthcare as a perk.


      • 2. The state should have its own health plan (I'm guessing this is how Medicaid/Medicare work)


      • 3. The federal government should operate a public option that individual businesses can pay into rather than pay for their employee's healthcare themselves.
      [/list][/list]
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      « Reply #11 on: October 02, 2017, 03:01:22 am »


          are can be fixed very easily.  We need to have a public option.  A state run health plan would force costs down because most people are going to choose the public option.  This isn't unheard of. This is exactly how Medicare operates.  85% of people on Medicare choose the public option.  Medicaid operates the same way in my state (and a few others).  Most people choose the public option there too but I do believe there are benefits to the private plans.

          Let me make sure I understand your overall opinion across threads.

          • 1. Private businesses/companies shouldn't be allowed to give their employees healthcare as a perk.


          • 2. The state should have its own health plan (I'm guessing this is how Medicaid/Medicare work)


          • 3. The federal government should operate a public option that individual businesses can pay into rather than pay for their employee's healthcare themselves.
          [/list][/list]

          I don't know if the federal government necessarily needs to offer the public plan.  It could be administered at the state level provided that it  is portable and a person can freely move from state to state.  This has risks as states like Alabama and Mississippi will happily create the worst plans in the country.  They seem to like to be at the bottom.
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          « Reply #12 on: October 02, 2017, 03:25:46 am »


              are can be fixed very easily.  We need to have a public option.  A state run health plan would force costs down because most people are going to choose the public option.  This isn't unheard of. This is exactly how Medicare operates.  85% of people on Medicare choose the public option.  Medicaid operates the same way in my state (and a few others).  Most people choose the public option there too but I do believe there are benefits to the private plans.

              Let me make sure I understand your overall opinion across threads.

              • 1. Private businesses/companies shouldn't be allowed to give their employees healthcare as a perk.


              • 2. The state should have its own health plan (I'm guessing this is how Medicaid/Medicare work)


              • 3. The federal government should operate a public option that individual businesses can pay into rather than pay for their employee's healthcare themselves.
              [/list][/list]

              I don't know if the federal government necessarily needs to offer the public plan.  It could be administered at the state level provided that it  is portable and a person can freely move from state to state.  This has risks as states like Alabama and Mississippi will happily create the worst plans in the country.  They seem to like to be at the bottom.

              You hit on something that I noticed when driving several times from Florida, Georgia, Alabama, Mississippi, Lousiana, and Texas... and that is.. Alabama and Mississippi are toilets compared to other states.

              You hit on something else too.. if someone lives in one state, and purchases their health insurance in that state.. What happens when that person moves to another state?  Or even if they are just on vacation in another state?  Or overseas? 

              Healthcare is a cesspool of abuse.  Other than a broken arm, my father never went to a doctor his entire life other than for his stent at 81 years old which only took 1 hour.    I have never needed a doctor other than a $50 out of pocket visit to get a pain killer and antibiotic for one bout of gastroenteritis.   

              Another thing about health insurance that is insane.. is that it nearly always excludes medical issues that all people face, such as vision, hearing, and dental.
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              « Reply #13 on: October 02, 2017, 03:32:19 am »


              You hit on something else too.. if someone lives in one state, and purchases their health insurance in that state.. What happens when that person moves to another state?  Or even if they are just on vacation in another state?  Or overseas? 


              That all depends.  For most people healthcare is tied to employment so if they move to another state they probably have a new job or they have an insurer that operates in multiple states. 

              ObamaCare plans are actually sold at the COUNTY level.  If you don't live in a county where that plan is sold you need to change plans.  You are allowed to change plans.

              Generally, all plans offer emergency coverage out of state.  Most plans do not offer ANY type of coverage out of the country.  Medicare has some limited circumstances in which it can be used in Canada but no other country.
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              « Reply #14 on: October 02, 2017, 05:37:23 am »


              You hit on something else too.. if someone lives in one state, and purchases their health insurance in that state.. What happens when that person moves to another state?  Or even if they are just on vacation in another state?  Or overseas? 


              That all depends.  For most people healthcare is tied to employment so if they move to another state they probably have a new job or they have an insurer that operates in multiple states. 

              ObamaCare plans are actually sold at the COUNTY level.  If you don't live in a county where that plan is sold you need to change plans.  You are allowed to change plans.

              Generally, all plans offer emergency coverage out of state.  Most plans do not offer ANY type of coverage out of the country.  Medicare has some limited circumstances in which it can be used in Canada but no other country.


              hmm..  if someone moves to another country.. I am sure they still get their social security checks / benefits,  but I bet they lose their medicare benefits.  They take money out of mt dad's ss before he ever sees it.  If he moved to another country, I wonder if they would continue to talke $$ from his ss to pay for medicare that he isn't getting.

              Here's a wild idea..   put a tax on tobacco that is used to fund cancer treatments. 
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              « Reply #15 on: October 02, 2017, 09:38:43 am »

              As for benefits, if you move to a country that is part of the "partnership" then your SSI counts toward that countries state pension.   

              If I stay in the UK, my US SSI credits go toward my UK state pension.  If I return to the US, my UK pension credits go toward social security.

              As far as Medicare, that ends once you leave the US. 
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              « Reply #16 on: October 02, 2017, 09:53:39 am »

              It's my understanding, from living in TX, that the issue is regulations on insurance.     Texas is the most protectionist against interstate stuff. 

              If we have interstate insurance sales, then we end up with the same situation we have with credit cards, where a couple states make their laws so lax to draw the insurance companies in.    Delaware and South Dakota control (at least they did 16 years ago) the entire credit card industry because they made their laws benefit the companies and not the customers.   

              Also, it's a huge loss in tax revenue for the states that don't pander to the insurance industry.
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              « Reply #17 on: October 03, 2017, 02:21:22 am »


              You hit on something else too.. if someone lives in one state, and purchases their health insurance in that state.. What happens when that person moves to another state?  Or even if they are just on vacation in another state?  Or overseas?  


              That all depends.  For most people healthcare is tied to employment so if they move to another state they probably have a new job or they have an insurer that operates in multiple states.  

              ObamaCare plans are actually sold at the COUNTY level.  If you don't live in a county where that plan is sold you need to change plans.  You are allowed to change plans.

              Generally, all plans offer emergency coverage out of state.  Most plans do not offer ANY type of coverage out of the country.  Medicare has some limited circumstances in which it can be used in Canada but no other country.
              ,  

              hmm..  if someone moves to another country.. I am sure they still get their social security checks / benefits,  but I bet they lose their medicare benefits.  They take money out of mt dad's ss before he ever sees it.  If he moved to another country, I wonder if they would continue to talke $$ from his ss to pay for medicare that he isn't getting.

              Here's a wild idea..   put a tax on tobacco that is used to fund cancer treatments.  

              You don't have to be enrolled in Medicare.  You can cancel. You can continue to get SS if you are out of the country.  I've seen people with US Social Security and Social Security from another country.  They worked enough in both countries to get both.
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              « Reply #18 on: October 03, 2017, 07:28:04 am »


              You hit on something else too.. if someone lives in one state, and purchases their health insurance in that state.. What happens when that person moves to another state?  Or even if they are just on vacation in another state?  Or overseas?  


              That all depends.  For most people healthcare is tied to employment so if they move to another state they probably have a new job or they have an insurer that operates in multiple states.  

              ObamaCare plans are actually sold at the COUNTY level.  If you don't live in a county where that plan is sold you need to change plans.  You are allowed to change plans.

              Generally, all plans offer emergency coverage out of state.  Most plans do not offer ANY type of coverage out of the country.  Medicare has some limited circumstances in which it can be used in Canada but no other country.
              ,  

              hmm..  if someone moves to another country.. I am sure they still get their social security checks / benefits,  but I bet they lose their medicare benefits.  They take money out of mt dad's ss before he ever sees it.  If he moved to another country, I wonder if they would continue to talke $$ from his ss to pay for medicare that he isn't getting.

              Here's a wild idea..   put a tax on tobacco that is used to fund cancer treatments.  

              You don't have to be enrolled in Medicare.  You can cancel. You can continue to get SS if you are out of the country.  I've seen people with US Social Security and Social Security from another country.  They worked enough in both countries to get both.

              Hmm.. I wonder if some elderly people, such as those who have a DNR or live in a hospice cancel their medicare? 
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              « Reply #19 on: October 04, 2017, 02:02:40 am »


              You hit on something else too.. if someone lives in one state, and purchases their health insurance in that state.. What happens when that person moves to another state?  Or even if they are just on vacation in another state?  Or overseas? 


              That all depends.  For most people healthcare is tied to employment so if they move to another state they probably have a new job or they have an insurer that operates in multiple states. 

              ObamaCare plans are actually sold at the COUNTY level.  If you don't live in a county where that plan is sold you need to change plans.  You are allowed to change plans.

              Generally, all plans offer emergency coverage out of state.  Most plans do not offer ANY type of coverage out of the country.  Medicare has some limited circumstances in which it can be used in Canada but no other country.


              hmm..  if someone moves to another country.. I am sure they still get their social security checks / benefits,  but I bet they lose their medicare benefits.  They take money out of mt dad's ss before he ever sees it.  If he moved to another country, I wonder if they would continue to talke $$ from his ss to pay for medicare that he isn't getting.

              Here's a wild idea..   put a tax on tobacco that is used to fund cancer treatments. 

              You don't have to be enrolled in Medicare.  You can cancel. You can continue to get SS if you are out of the country.  I've seen people with US Social Security and Social Security from another country.  They worked enough in both countries to get both.

              Hmm.. I wonder if some elderly people, such as those who have a DNR or live in a hospice cancel their medicare? 

              Hospice is a Medicare benefit so that is doubtful.  Very few people actually go to a Hospice center.  Those services are usually provided at home or in a nursing home.  Hospice is short term.  Generally people who need Hospice services will die pretty quickly.
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