How to make the public beg for Single Payer= regulate the insurance companies into non-existence

[andym]

I realized quite some time ago, that they key to getting some kind of single-payer system (or at least a universal multipayer system like France or Switzerland) is to tightly regulate the insurance companies. That's what's done in some of these European countries (although I do not believe any for-profit insurers remain there). In fact, new regulations constitute much of the new proposed health reform already: insurers can't discriminate on pre-existing conditions, etc.

SO, the key is just to define comprehensive basic insurance by law that includes a regulation capping premiums on the basic plan:

1) Premiums (including co-pays) for basic insurance can not exceed some reasonable percentage (eg 5 %) over the cost (as determined by Medicare rates) as averaged per person over all users of health care. This would limit profits to a maximum of 5% for insurers, saving a fortune. Essentially there would be a maximum reasonable price for basic insurance. Many for-profit providers would leave the business. (This would serve as a strong CAP)


2) No one can be denied basic insurance. (already included in proposed reform)
3) Premiums subsidized on an income basis. (already included in proposed reform),
4) All tests/treatments requested by Doctors must be covered.
5) Preventive care, and Drug benefits included with reasonable maximum cost to patient built-in.

There are other useful aspects that could be included, especially:

6) Maximum charge for prescription drugs to be negotiated by govt with big Pharma.


Outside of the subsidies for the poor and the new regulators needed, these regulations would cost the government almost nothing.

If premiums are tightly capped for extensive basic insurance, it is essentially the end of the private insurance for profit. Insurers will drop out of the market, leaving a huge vacuum The public will beg the government to come in and extend Medicare or create a new Medicare-like program for those under 65. In fact public health care would be needed to prevent collapse.

Would republicans vote for this? NO
Would conservative Democrats? Maybe some

My proposal is to just insist on tacking on the tight CAP for premiums.

[phantom power]

1. As I understand it, the Dutch do well with a highly-regulated private system...

I'm not sure that approach would work as well here, given the ease with which corporations can lobby to change (i.e. dismantle) regulatory structure in this country.

Maybe the Netherlands doesn't allow private industries to lobby govt directly. Or maybe their govt is less dysfunctional for some other reason. I don't know.

[andym]

2. Limiting the effects of lobbyists means

preventing the government official/representative from working with or being compensated by companies represented by lobbyists for several years after leaving office.

[ipaint]

3. Info on the netherlands and regulation

The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.<6>

Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductables, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees' premiums as an employment benefit). All insurance companies receive additional funding from the regulator's fund.

The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders. Thus insurers with high payouts will receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than might be expected. Insurance companies compete with each other on price for the 45% direct premium part of the funding and try to negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medicially disadvantaged by his or her choice of insurer.

Hospitals in the Netherlands are also regulated and inspected but are mostly privately run and for profit, as are many of the insurance companies. Patients can choose where they want to be treated and have access to information on the internet about the performance and wait times at each hospital. Patients dissatisfied with their insurer and choice of hospital can cancel at any time but must make a new agreement with another insurer.

http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands

[bkkyosemite]

4. Dental and Vision...that's is very much a part of our health.

[andym]

8. American Dental Association made sure to prevent this years ago.

American Dental Association made sure to prevent this years ago. It's their fault more than the insurers. We do need to include dental insurance!

[bkkyosemite]

9. HR 676 has dental coverage in Medicare for All and Kucinich is still pushing it.

[andym]

10. If they put in the premium limiting rule, they would NEED to pass HR676 ASAP n/t

[Phoebe Loosinhouse]

5. Some of the worst practices of the insurance companies should have been regulated out of existence

long ago. There is no excuse that federal and/or state regulators did not ban long ago the practices of rescission and rejection due to prior conditions. We wouldn't be in the pickle we're in had that been done.

One very simple reason is that the insurance companies would not have been able to essentially mint money by avoiding their basic function. Those oceans of dollars are what went to the predator CEOs and their henchmen and what also provides the funds that corrupt our very own Congress.

A failure of regulation once again. Gee, what a surprise.

[andym]

6. Agree, completely

But it's time to roll back the excesses of deregulation from the Reagan/Bush years (or absence of regulation) with smart regulations that actually do some good.

[andym]

7. repied to wrong post n/t

[andym]

11. The most politically viable aspect of this solution is that new taxes would =< than current plans

The prospect of tax increases have put most of the more progressive proposals off the table, so it's useful to have one path to single-payer that is cost-effective and could actually pass.