vundercind
The ACA’s loss ratio rules don’t apply to self-funded plans (many large employers use these) even if they’re administered (and possibly re-insured) by a health insurance company, which is usually the case. Just doesn’t apply at all.
Certain plans also allow much lower loss ratios, like 60/40 for expat plans.
A provider that manages to have a lot of new plans in a given state in a given year is immune from loss ratios rules in that state, for that year. I don’t know how gameable this is but my WAG would be it’s only state insurance commissions preventing this from being the case in every state, every year, for every provider, and keeping it to only some states in some years for some providers (I bet the biggies manage to rotate their state[s] and have at least one most years)
So a company the only business of which is health insurance can easily spend far less than 80 or 85% of income on payouts, and only need maintain that ratio on some subset—possibly small—of the premiums it’s collecting.
I don’t know how the game of this affects decisions for insurers that also own providers, but I bet there’s something beneficial there and that’s why they’ve been snapping up provider offices for the last several years.
Similar reaction for the other examples. I’m baffled that they look similar to anybody at all.
[edit] hold on, ok, another angle that may clear up why I’m confused: if my health insurer denies my legit claim, should I be more, less, or equally angry with the leadership of that company, or with every single person in the country who fails to donate to my resulting gofundme? I’m immediately inclined to wish horrible things on one of these groups, and to find the idea of wishing horrible things on the other confusing and repulsive.
I’d maybe vote against state level single payer, let alone taking over healthcare entirely, because I think it’d be a ton less efficient than doing it at the federal level—enormous amounts of money already go to various federal healthcare programs and it’d be better to pool that, and also lack of state level control over their markets is likely to cause problems. I dunno, it might depend on the law, but my gut reaction is a “no” vote on that, too.
Anyway, as for the other question, I believe that the rise of the postwar think-tank industry (a mash up of k-street and Madison Avenue, but for white papers, as it quickly became) and deliberate party and industry efforts to shift public sentiment in pro-market directions, tied up with lots of government spending on anti-Soviet messaging (were they bad? Oh, yeah. Were all the things the government tried to lump in with them and decry as un-American bad? Ehhhh… I mean atheism is among those, see the change to the pledge and to our money at the time, among other things, and I think atheism’s fine) is probably why healthcare can be this incredibly messed-up and nationalization remains not just not-popular-enough-to-pass, but entirely outside the Overton window, yes.
“GitHub with a worse UI except GitHub’s has been getting worse for years so now they’re both similarly bad so never mind”
“Worse gitea but with more features so sometimes it’s better”
I think if you poll the people taking this as a good thing, you will get an overwhelming answer of “probably not”, and the implications are exactly what you suppose.
This is top of my list for conversation topics to steer things toward when I’m around Republican relatives, so we’ll have something we can agree on.
Law-abiding doesn’t mean much when you can kill lots of people for money and remain within the bounds of the law. Killing one such person is definitely far less bad than killing a bunch of people arbitrarily. Yet only one of these cases is illegal, and it’s the better of the two.
But also the trading reputation of a country is kinda a common good that individuals can profit by tarnishing, which makes it a prime target for very-valid and probably-a-good-idea regulation of that sort.
What norm?
I think the Nation’s quote of him on the topic points out something that may be true, which is that he might have balked at doing it given how many people would be laid off (hundreds of thousands, surely) and what the optics of that would be, though I kinda doubt the quote itself.
But yeah, even if he’d been gung-ho behind it, it wasn’t happening.
Once you actually tally up how many people are having their healthcare paid for by public dollars—local, state, and federal workers plus retired; the military, active and retired; Medicare (old people); Medicaid (poor and disabled); CHIP (poor kids); the families of some of those categories; et c—it’s really not the case that moving to entirely public-funded would even be as big a leap as one might suppose. A whole lot of people already have government-funded healthcare.
What we really lack, that every single other OECD state I’ve looked at has as a feature of their healthcare systems, is more-aggressive price controls, either set directly or via partial or complete monopsony. We’ve sniffed around at it, but never taken a full bite.
What’s this norm you mention?
I dunno. This is the most publicly-united I’ve seen people against the industry maybe ever. Usually they’re separately-angry at the industry in their partisan silos (everyone hates it, more or less—hence the amazingly consistent and widespread reaction) but this has been the closest thing to a bipartisan healing moment since, like, the week after 9/11. Not particularly close to that, sure, but I can’t think of anything closer.
If this were part of a theory of change, it strikes me as no less serious than any other I’ve seen. At least.
It’s a regressive-tax-funded white collar makework jobs program. JFC.
Live by the sword…
> If he had done wrong to people, he should be brought to justice via the court of law (in a democratic nation at least..)
Even the Sacklers are free and still rich. This is like wishing for a unicorn for Christmas. You want something that flat out isn’t real.
My conclusion is everything does. This conveniently makes it easy to dismiss criticism of any one part (all of which are responsible) because “well they’re just increasing it a little—go look at these other things, they’re bad too, and if you add up all of that, they’re worse!”
Right, but if you keep not addressing the one in front of you because of that kind of misdirection, you never fix any of it, because all of it is taking too much money.
I will say that our private insurance system in particular seems to be responsible for most of the insanely-high indirect costs of our system.
Dozens of hours for patients and their families lost per major incident, playing middleman between insurance and provider billing departments, trying to make insurance do what they’re supposed to. Stupid billing systems where the prices are all kinda fake, which wastes time in a few ways. Tons of time shopping for and managing healthcare plans by folks in HR. Government social safety net people having to dick around with private insurance nonsense to sort out who’s getting what from where. Employees losing time poring over plans to figure out which one they should get (is it just me, or if you’re offered three is there always one that doesn’t make any sense compared to the other two, no matter what kind of usage pattern or expectations you can think up?) Tons and tons of overhead staff at providers.
I’m aware of multiple companies that would love to know about these, because they’re currently flailing around trying to replace writers with editors + LLMs and it’s not going great. The closest to success are the ones that are only aiming to turn out stuff one step better than outright book-spam, and even they aren’t quite where they want to be, hardly a productivity bump at all from the LLM use and increased demand on their few talented humans.
The remains true even if the entire and only cause of the shortage is people stocking up for fear of a shortage, and even if you know that.