Home / General / “We’ll Let Them Take Your Money. But Why Should They Provide You With Healthcare?”

“We’ll Let Them Take Your Money. But Why Should They Provide You With Healthcare?”

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Shorter House Republicans:  “It’s outrageous that insurance companies would be expected to provide you with medical care in exchange for your money.   People value the freedom to have their money be used for no useful purpose whatsover.”

Related:  the war on logic.

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  • DrDick

    This is fundamentally the cause of their opposition to health care reform. They are unalterably opposed to requiring corporations to provide the goods and services that they have been paid for. That and they hate helping poor people.

  • Brad Potts

    http://theincidentaleconomist.com/wordpress/medical-loss-ratios/

    Data on MLR shows that the medical loss ratio caps in the ACA are unbinding on our health insurance oligarchs. The MLR requirement carried by the ACA will do nothing to make sure that large companies spend enough of health care, as they are already within the caps. It is their small, heterogeneous competitors that stand to be adversely affected by this.

    So Carter, whatever his motivations may be, is correct that the MLR caps as currently legislated are a constriction on health insurance coverage, and the levels devised by the authors of this plan belie what a corporate handout it is.

  • Scott Lemieux

    It is their small, heterogeneous competitors that stand to be adversely affected by this.

    If “small, heterogeneous[?]” competitors can stay in business only by not spending premium money on health care, what value are they providing?

    • Brad Potts

      If “small, heterogeneous[?]” competitors can stay in business only by not spending premium money on health care, what value are they providing?

      You would have to ask one of their customers for that information. There must be some reason they stay in business.

      All I can tell you is the the smaller the company, the larger the percentage of their business expenditures are made up of administrative overhead.

      • Scott Lemieux

        Again, your point misses me. If companies can only stay in business by not providing value to their customers, who gives a shit if they stay in business?

        Obviously, having state-run health insurance is the best policy, but a regulated-utility model is the second best. Size per se has nothing to do with it.

        • Brad Potts

          Health care provision is not a standardized, homogeneous public good like roads, gas, and police.

          With those public goods, you can standardize them because there is little to no competition on quality of provision. If you made it purely private, no company is going to come out with noticeably better electricity.

          Health care markets at least have the potential to be dynamic, as technology and risk-calculation are constantly shifting patterns in health care.

          There are substantial costs to creating prohibitive costs of entrance within health care markets, and since data seems to suggest that the caps serve no discernible benefit as they do not bind our most notorious offenders, I see absolutely no reason to support them.

          Unless that is, you see a net social benefit in having health insurance prices dictated by health insurance companies ability to lobby the state for price increases.

          • Malaclypse

            as they do not bind our most notorious offenders,

            Just because they do not immediately change the practices of large companies does not mean that the regulations are not binding on them. Look, my mom has not driven above 55 MPH in decades, but speed limits are still binding on her. You, and the article you cite, are using the word wrong.

            Unless that is, you see a net social benefit in having health insurance prices dictated by health insurance companies ability to lobby the state for price increases.

            Two points: 1) with the caps, increased prices must be at least somewhat correlated with increased services provided. This is basic math. If prices go up, and the percentage spent on service cannot change, then the amount spend on service must rise by a similar percentage.

            And 2) at least in MA, price increases are often shot down, or limited, by the state.

            • Brad Potts

              Just because they do not immediately change the practices of large companies does not mean that the regulations are not binding on them. Look, my mom has not driven above 55 MPH in decades, but speed limits are still binding on her. You, and the article you cite, are using the word wrong.

              Ok, you are right. The MLR does stop insurance companies from providing a markedly worse service than they were before the reform.

              Two points: 1) with the caps, increased prices must be at least somewhat correlated with increased services provided. This is basic math. If prices go up, and the percentage spent on service cannot change, then the amount spend on service must rise by a similar percentage.

              That’s my point: the reforms in the ACA basically dictate that MLRs will average around 15%. They average around 10% under market pressure.

              Setting the MLR limit at 15% basically is admitting that the market was actually doing a good job of controlling admin costs. It is self-refuting policy.

              • Malaclypse

                Setting the MLR limit at 15% basically is admitting that the market was actually doing a good job of controlling admin costs.

                Except for those companies that you are busy defending, the poor mom-and-pop companies with regretabble high overheads.

          • DocAmazing

            Health care provision is far more standardized than roads, gas, or police. There are not state or federal licensing agencies for police officers; there are for physicians, nurses, respiratory therapists, etc. Hospitals are more closely monitored on the state and federal level than power companies are; look up JCAHO, DEA, FDA, and the relevant agencies in your state and see what their requirements are.

            Ah, but you’re talking about insurers, nicht wahr? That’s different. In California, we have some regulation; many states have much less. let us not, however, mistake health insurers with health care provision. They do not drive the technology, nor do they regulate quality of care. They just hold patient care costs down–while creating administrative costs all down the line.

            Which small operators did you have in mind as being innovative and good for patients? I’d love to know.

      • joe from Lowell

        You would have to ask one of their customers for that information. There must be some reason they stay in business.

        The problem with this argument is that the concept of “customers” doesn’t work. The people who choose health insurance providers and pay for them (employers) aren’t the people receiving the services (employees).

        • Malaclypse

          We’ve pointed that out to Brad many times now. He pointedly ignores that issue. I said 6 hours ago that he would continue to ignore it no matter how often he is asked, while elm said he will try and go off on a tangent about HSAs. Thus far, elm’s prediction has yet to come to pass. Frankly, I’m kind of surprised.

          • joe from Lowell

            I noticed that downthread.

          • Murc

            Dammit, I go to work and miss a perfectly serviceable Brad thread!

            And man, I am SO over that lame flex account. When does the HSA start?

          • elm

            Re-reading my comment, it does seem that I’m predicted a defense of HSA’s (which kind of does eventually emerge downthread.) What I meant to claim was just that if he did address the topic, it would be to defend HSA’s. I actually agree with you that he is likely to ignore it completely.

            • Malaclypse

              I actually agree with you that he is likely to ignore it completely.

              Then I’d say we are both right.

    • Brad Potts

      If “small, heterogeneous[?]” competitors can stay in business only by not spending premium money on health care, what value are they providing?

      I am also assuming you do all of your shopping at Wal-Mart.

      If Wal-Mart’s smaller competitors can only operate by charging higher prices, what value are they providing? We should obviously do everything we can to send retail customers to Wal-Mart, thereby stabilizing their market and making sure they can maintain their low prices.

      • Scott Lemieux

        If Wal-Mart’s smaller competitors can only operate by charging higher prices, what value are they providing?

        Better products? Better service? Anyway, retail and health insurance are not a good comparison anyway…

        • Brad Potts

          Better products? Better service? Anyway, retail and health insurance are not a good comparison anyway…

          The last sentence is true, but why would we automatically assume that smaller companies offer better products and service to its customers than the larger cheaper established insurance companies?

          • Malaclypse

            why would we automatically assume that smaller companies offer better products and service to its customers than the larger cheaper established insurance companies?

            We don’t. You were the one complaining that this would force the mythical mom and pop insurance providers out of business.

            There must be some reason they stay in business.

            It is their small, heterogeneous competitors that stand to be adversely affected by this.

          • Scott Lemieux

            I don’t. You asked me specifically about Wal-Mart.

          • Brad Potts

            I’m sorry, that should have read:

            but why wouldn’t we automatically assume that smaller companies offer better products and service to its customers than the larger cheaper established insurance companies?

            So the question is why you wouldn’t think that smaller insurance companies could exist with higher premiums because they offer some sort of beneficial service their larger competitors don’t?

            • Malaclypse

              Because of a basic concept called economies of scale, which we see demonstrated by the fact that larger companies spend less on overheads?

              I also assume that mom-and-pop nuclear plants would cut some unfortunate corners.

              • hv

                But I loved the nice little hand-knit cozies they always had during meltdowns.

              • DocAmazing

                You really should try the plutonium cobbler.

            • Scott Lemieux

              But “higher premiums” isn’t the issue. Under this regulation, firms are able to charge higher premiums if they offer more services. What they can’t do is charge higher prices without providing more services. (All leaving aside the fact that health care provider generally isn’t “chosen” in a meaningful way.)

            • joe from Lowell

              Because the people who provide the demand for health insurance – mainly employers – aren’t the ones receiving the service of getting their doctor’s bills paid for, and hence, are insulated from market pressure coming from those receiving crappy benefits.

    • Warren Terra

      Cards on the table: I’d prefer single-payer, and I’m open to single-provider. And I have now problem with regulating the “medical loss ratio” (and how creepy is that term “medical loss”?)

      That said, I can see one way for big insurers to cheat on this that smaller insurers can’t: they can get the hospitals to do adminstrative work for them, to spend time and money coding the data into their systems and the like. Smaller insurers wouldn’t be able to extract the same level of cooperation. All that’s in theory of course; I know hospitals spend a lot of money in processing paperwork to send to Medicare, Medicaid, and big insurers, but I dont know how small the insurer has to be before the hospitals won’t do so, nor what standardized reporting options are available to the small insurers.

      One other possible way a regulated MLS would harm smaller insurers might be that the big insurers wouldn’t have to spend money denying claims because the health care providers know them well enough not to try to seek reimbursement; potentially, bigger insurers might also have the clout to be more able to make denial of reimbursement stick than smaller insurers. Again, I don’t know if this scenario is real.

  • Malaclypse

    You would have to ask one of their customers for that information. There must be some reason they stay in business.

    And would you consider “their customers” to be the employers who typically pay the premiums, who may or may not care about quality of coverage, or their subscribers, who usually have no choice about what plans are offered?

    • Scott Lemieux

      You seem to be confused. What makes you think that shopping for health insurance is any different than shopping for dishwasher detergent? It’s exactly the same kind of market in every respect!

      • NonyNony

        And both are amazingly exactly like the market for wheat c.a. 1770.

      • Brad Potts

        You seem to be confused. What makes you think that shopping for health insurance is any different than shopping for dishwasher detergent? It’s exactly the same kind of market in every respect!

        That isn’t my argument.

        I am saying that health care provision is a dynamic part of our society, and a policy like the MLR and the mandate standardizes the suppliers and method of health care provision.

        I would reword your question: Why do you think our current market for health care provision would reflect the best form of market for health care provision in 20 years?

        • Malaclypse

          Why do you think our current market for health care provision would reflect the best form of market for health care provision in 20 years?

          Nice strawman. I’m willing to best most of us favor some form of single-payer or nationalization. Can you name one person who called this the best reform? Please note that this is not the same as the best politically possible reform.

          • Scott Lemieux

            For me, see above. I would prefer single-payer to a regulated utility model, but certainly regulated utility is better than a market in which insurance companies make money by denying care.

          • Brad Potts

            Nice strawman. I’m willing to best most of us favor some form of single-payer or nationalization. Can you name one person who called this the best reform? Please note that this is not the same as the best politically possible reform.

            I support nationalization and single payer to this, and have admitted as much on several occasions.

            That is besides the point.

            This argument is about whether health care reform is made better by the MLR limit. I have seen no argument that it is. I say that, under the current plan, the MLR is a barrier to improved service in the future and does nothing to cut costs or lower prices.

            Why am I wrong?

            • Malaclypse

              I say that, under the current plan, the MLR is a barrier to improved service in the future and does nothing to cut costs or lower prices.

              It does, however, establish minimum levels of service. If you ever get cancer (I know, I know – libertarians never get seriously ill, and when they do, they pull themselves up by their Galtstraps, but indulge me) – if you ever get cancer, you might find yourself happy that lifetime and annual limits went away last September, for example.

              There were goals of both cost containment and expanded coverage. Looking at a feature designed to expand coverage, and complaining it does not also contain costs, misses the point.

              • Brad P.

                Looking at a feature designed to expand coverage, and complaining it does not also contain costs, misses the point.

                The MLR was designed as a cost cutter, not a coverage expander.

                It also does nothing to expand coverage.

              • Malaclypse

                It also does nothing to expand coverage.

                Except for mandating that insurers spend money on, you know, coverage.

        • IM

          Health care and health insurance are two different thinks. That will be somewhat more regulated is the health insurance market. And that market is right now not really dynamic, if insurance should be dynamic at all.

    • Brad Potts

      Again, I don’t know what motivates their customers to choose them.

      Basic economics would dictate that their customers prefer them to the alternative absent the presence of market failures or exogenous factors.

      • Malaclypse

        And who are “their customers”? You failed to address this basic question. Are the customers employers, or subscribers?

      • Scott Lemieux

        And you completely miss the point, which is that many people have little to no practical “choice” about insurers.

        • Malaclypse

          He did not miss the point – he’s avoiding it, as it does not fit his model of free exchange.

          If he ever does address it, I expect some tangent about how employers will be forced to offer only quality plans by the Magic Market, so there are no divergent interests.

          • elm

            No, no, he’ll claim that he supports HSA’s since they correct this problem, though he’ll never acknowledge that his arguments about the current reform fall apart with (or are, at least, complicated by) consideration of who the consumers are in the actually existing insurance market.

            • Malaclypse

              You are right – he would go off on an HSA tangent, if he answered the question. I still say he will continue to ignore it though. But yes, if he does answer, then HSAs will fix everything.

        • DrDick

          The existing studies show near monopoly share or worse in virtually every state. Here in Montana, BCBS controls 75% of the market and New West controls 10%, leaving a grand total of 15% for all those moms and pops.

  • Stitch

    You are all giving Brad way too much credit. Referring to small business is just another anti-regulation knee-jerk cliche that does nothing to help actual small businesses.
    I remember hearing the same thing decades ago and thinking, “So where are these street-corner, Mom’n’Pop insurance companies?”

    • Brad Potts

      This has nothing to do with small businesses and everything to do with the stringent limitations this puts on market entrance.

      I don’t care if its Bank of America, if they find a new way to organize their their administrative activities to provide better more cost-effective health insurance in a way that simultaneously increases their administrative costs, they should be allowed to do so.

    • DocAmazing

      “So where are these street-corner, Mom’n’Pop insurance companies?”

      Eaten, digested, and defecated by the large ones.

  • Brad Potts

    Can anyone on here actually explain to me why we should have medical loss ratio limits of 15% and 20%, anyways?

    I did provide an argument with data from a reputable source that opposed the MLR limits, but not a sole has actually proposed a supporting argument for MLR’s.

    Is this one of those “I know why I hate conservatives, but I don’t know why I’m a liberal” moments?

    • DocAmazing

      http://en.wikipedia.org/wiki/Medical_care_ratio
      Medical care ratio (MCR), also known as medical cost ratio, medical loss ratio, and medical benefit ratio, is a metric used in managed health care and health insurance to measure medical costs as a percentage of premium revenues.[1] It is a type of loss ratio, which is a common metric in insurance measuring the percentage of premiums paid out in claims rather than expenses and profit provision.

      Just so we all know what we’re talking about.

      So your question is: why do we demand that the providers of a necessary good not gouge their clientele by providing services at a level far below what the consumers of that service are paying for it?

      For a guy who believe strongly in the idea of contractarianism, that’s an odd question.

      • Brad Potts

        So your question is: why do we demand that the providers of a necessary good not gouge their clientele by providing services at a level far below what the consumers of that service are paying for it?

        No, the question is why we should have a market wide limit of 15% when the market average is around 10-11%.

        In other words, why do you impose penalties on small and marginal insurance providers, when doing so provides no effect on the vast majority of insurance plans.

        • IM

          See? The regulation is very mild and the average market participant is already able to comply.

          That hasn’t anything to do with small or marginal, you just want to protect insurers who short-change their customers.

          • Brad Potts

            See? The regulation is very mild and the average market participant is already able to comply.

            That is the point. It amounts as a subsidy to the largest insurance companies and a penalty to the smaller ones.

            And I have been given no reason to believe that for some reason smaller insurers are exploiting customers where their bigger more established rivals aren’t.

            • Malaclypse

              And I have been given no reason to believe that for some reason smaller insurers are exploiting customers where their bigger more established rivals aren’t except for the fact, cited by me and undisputed, that smaller providers spend a smaller portion of their revenue on actual health care than their larger rivals.

              Completed that sentence for you.

              Also, multiple people have asked you multiple times: who, exactly, is the customer in your scenario? Is it the employer who pays the bills, who cares about price and may or may not care about coverage, or the subscriber, who may or may not care about price, but almost certainly cares about coverage?

              Do you think the fact that there is a good deal about who the customer actually is might be a wee argument in favor of regulation, given that there are (at least) three concerned parties, with divergent interests, and the people receiving the actual coverage have the least bargaining power in this triad?

              • Malaclypse

                a good deal of ambiguity about who

                Oops.

              • Brad P.

                Do you think the fact that there is a good deal about who the customer actually is might be a wee argument in favor of regulation, given that there are (at least) three concerned parties, with divergent interests, and the people receiving the actual coverage have the least bargaining power in this triad?

                This is true. There is a disconnect between user of health care and the negotiating parties that can cause health care prices to diverge from quality and costs.

                However, per the link before large group plans are fairly stable averaging about an 90% MLR. The individual, small group, and other less common insurance plans are the ones whose ratios drop below 80%.

              • Malaclypse

                The individual, small group, and other less common insurance plans are the ones whose ratios drop below 80%.

                Yes, we know. That is a good reason to regulate the activities of insurers, so that insurers need to spend money on, again, covering sick people. If some companies cannot comply with that radical requirement, I can think of worse fates than their going out of business. Companies that don’t spend money on coverage going away is a feature, not a bug.

            • IM

              A subsidy? How is that supposed to work? A company able to comply with a regulation because of better business practice is hardly getting a subsidy.

              And only you are talking about small business. The rule is the same regardless of size.

              And I have been given no reason to believe that for some reason smaller insurers are exploiting customers where their bigger more established rivals aren’t.

              I don’t see any reason either, so small insurers should have no problem to keep non-medical cost below 15% or 20%.

        • Malaclypse

          No, the question is why we should have a market wide limit of 15% when the market average is around 10-11%.

          In other words, why do you impose penalties on small and marginal insurance providers, when doing so provides no effect on the vast majority of insurance plans.

          Okay, I must admit to being bemused by a libertarian argument that regulations are not onerous enough.

          Also, “marginal” insurance companies are a Bad Thing. What do you think happens to the insured when that marginal company goes away without warning?

          • Brad P.

            Okay, I must admit to being bemused by a libertarian argument that regulations are not onerous enough.

            It has nothing to do with the stringency of the regulation, it has to do with the inconsistency of the regulation. MLRs have more to do with the type of services offered than the greed of the companies offering them.

            For example, HRAs and HSAs inherently run low MLRs, but will be discouraged as if they are an exploitative instrument.

            • Malaclypse

              It has nothing to do with the stringency of the regulation, it has to do with the inconsistency of the regulation.

              Well, consistent regulation would cap everybody at 15%. You are the one who is complaining that a 20% cap for those “marginal” insurance companies that you inexplicably want to keep afloat is too difficult.

              For example, HRAs and HSAs inherently run low MLRs, but will be discouraged as if they are an exploitative instrument.

              Sadly, No!

              The health care bill may make High Deductible Health Plans paired with HSAs more attractive than ever to the self-employed and small businesses.

        • joe from Lowell

          No, the question is why we should have a market wide limit of 15% when the market average is around 10-11%.

          Why do we want to curtail the practices of the worst actors, but not curtail the practices of others, who already operate in a more responsible manner?

          Is this a serious question?

    • Malaclypse

      Can anyone on here actually explain to me why we should have medical loss ratio limits of 15% and 20%, anyways?

      That’s right, we should let the market be free. It worked well for California’s energy market ten years ago, amirite?

      • Brad Potts

        I have provided data showing that, as it currently exists, the market is already operating with MLRs averaging much lower than the limit.

        Most large insurance companies will be allowed to double their medical loss ratios (while relying on the mandate to keep customers rolling in), and most small and niche insurance companies will be forced to cut their MLRs in half.

        • joe from Lowell

          “Averaging” is a not a terribly helpful comment. It simply means that some health insurance companies have terrible practices, with others do not.

          Why am I supposed to be bothered by the observation that the regulation hits those companies that are worse than the industry average, but not those that are about average or better? That sounds like the way regulation should work.

          • Malaclypse

            joe, joe – the regs limit the Freedom of a company to deny coverage in order to maintain their gross margins. You know who else limited Freedom?

            • joe from Lowell

              Fuhrer Smurf?

    • IM

      Because the individual insurance market is now working very well. Group insurers have much lower non-medical cost and so will comply with the regulations. One reason is that the groups they insure are in much stronger negotiation position than individual customers. If group insurers do spend to much on profit and sales or administration, the group (company, union) will do something.

      Individual customers are in no position to do anything. So if a insurer want to earn more it can pressure the providers or try to cut costs. But the provider will fight back and even the employees, at least the well paid, will resist. So the insurer will travel down the path of least resistance and deny insurance to its customers. Medical cost will drop, administrative costs ands profit will rise.

      Everybody who is powerful will be content.

      Now the state tries to step in and give the individual customer a bit of leverage, so that he will get some value for his money.

      Will it work? The ACA sets up a system like ion Switzerland, so it does work, even if it is more expensive then public systems.

      • Brad Potts

        Because the individual insurance market is now working very well.

        Good lord, I hope that is sarcasm.

        • Malaclypse

          Good lord, I hope that is sarcasm.

          The second sentence pretty much proved that the first was, in fact, sarcasm. The second-to-last paragraph removed any reasonable doubt on that point.

        • IM

          Not working very well.

      • Brad Potts

        Why would you say groups have powers of negotiation where individuals don’t. Both negotiate from a position dependent upon suppliers, and what’s more, even insurance companies providing individual plans do so with groups in mind.

        From my personal experience, I had a much, much broader choice of insurance plans available to me on the individual market than my employer does on the group market. I have also never had an insurance company try to offer me a “personal” insurance policy, rather they were offering a particular demographic like me the opportunity to join a group.

        • Hogan

          Why would you say groups have powers of negotiation where individuals don’t.

          Oh good lord.

          If you can bring me approximately 5,000 individual customers, like my employer can, you can bargain for terms and concessions that will improve the deal for you and still make it satisfactory for me. (How do I do it? Volume!) If you’re bringing me one customer, why should I bother with anything other than my initial offer? If you don’t like it, someone else will be along in a minute, and it might be someone with 300 or so individual customers.

          Remember, these aren’t one-off purchases; these are one-year subscriptions that are overwhelmingly likely to be renewed as long as I don’t screw things up that much worse than my competitors.

          (You’ve heard of “collective bargaining,” right? There are reasons why lots of working people think that’s a really good idea.)

        • Malaclypse

          From my personal experience, I had a much, much broader choice of insurance plans available to me on the individual market than my employer does on the group market.

          Ooo – anecdata!

          Tell me, Brad – do you really think your employer openly and honestly tells you what goes on with their benefits decisions?

          • piny

            Legally, as Some Guy who has assumed responsibility for Some Guy’s wellbeing out of the kindness of his heart, you have far fewer constraints on the sort of health insurance you can purchase for Some Guy, which means that the available options are broader.

            For example, you can offer Some Guy a plan that includes no coverage for prescription medication. Or you can offer Some Guy a plan that requires Some Guy never become pregnant. Or you can offer Some Guy a plan that only covers catastrophe.

            Employers have an enormous amount of leeway in deciding how much of their employees’ mortal frailty they will assist with, but there are many constraints on the sort of coverage they have to offer. They have chosen to employ many people in diverse states, and to offer coverage as part of a compensation package. So if their options are more constrained in some ways, it is because their offering is a whole lot more useful to people who actually stand a chance of becoming ill.

            They may also still feel some faint pang of capitalism when they consider slashing benefits down to the eight-thousand-dollar deductible available to Some Guy: employees take benefits into account when choosing to take or keep jobs.

            But aside from all that, if you’re an individual with any sort of health problem or even any special risk, the chances of you purchasing any coverage that doesn’t amount to pre-emptively trading dollars are nil. Most insurance companies will tell you to go fuck yourself, and whyever not?

  • Steve

    You know, I saw that there were 50+ responses to this post, and I said to myself, “I bet Brad Potts is cheerfully jumping in and patiently asking already-answered questions and demanding that people explain things to him over and over again.”

  • dave

    Wow. You know what you guys need? A National Health Service. Then you can argue about which other public services get cut in order to extend ever-more expensive forms of treatment to an ever-older population. Which will at least be a different argument to this one.

    • DocAmazing

      And, given that every country that utilizes a national health system has half the administrative overhead that the US has, and that most have better health outcomes, we’ll be having that argument much later in history.

    • Warren Terra

      Dave, didja know that the US government already spends more of its GDP on healthcare than does the British government, through which the Brits get decent coverage for the whole country? That we’re basically spending twice as much of our GDP on healthcare as our peers?
      Yes, Britain is contemplating difficult spending decisions in its NHS. But in part that’s because they’re trying to keep it as being the cheapest bargain in the wealthy world: they’d have to double the NHS budget before their society was suffering the same healthcare expense burden that ours is. I’ll bet that if they doubled the NHS budget they would make a couple of those decisions a little easier. They won’t, and I’m not saying the should. But you are barely comparing apples to oranges here; it’s closer to comparing apples to orange-flavored soft drink.

    • Malaclypse

      Then you can argue about which other public services get cut in order to extend ever-more expensive forms of treatment to an ever-older population.

      Because raising taxes is always and forevermore unpossible.

      • dave

        You try winning an election by promising to raise taxes. You’ll need them to pay for the back surgery after hauling the Overton Window that far to the left all by yourself.

        • Malaclypse

          “Right now, some employers are irresponsible, and don’t offer health care for their employers. That makes it harder and harder for the good, responsible employers out there to compete. So, to the responsible employers, I promise you a level playing field. We are going to take the ever-rising costs of insurance coverage off of your bottom line. We will do that by taxing all employers, both responsible and irresponsible. We’ve paid for Social Security for decades this way, and that is a fine, actuarially sound program, no matter what the fear-mongers of the right like to say. Every employer will be back on a level playing field, and all Americans will have the health care they need and deserve.”

  • wengler

    The US has a national healthcare system(the VA), and a national healthcare insurance program(for those over 65). What it doesn’t have is the young healthy people to provide the healthcare savings while being covered themselves. This amounts to a massive subsidy for private insurance giants that are tasked with providing basic healthcare for a large population without the sort of responsible regulation that entails.

    This feat is only accomplished with a sort of enforced ignorance instituted among the American populace.

  • Bill Murray

    Given that the ACA law is going to mandate coverage for pre-existing conditions and no limits etc., do the previous MLR numbers have any relevance going forward?

    • Warren Terra

      If anything, this makes the MLS ratio mandates less stringent – because the insurance companies will have less power to limit “medical losses” (i.e. spending on care). Also, one of the ways money is spent other than “medical losses” is on more administrative effort to reduce spending on care – but some of that administrative effort will now be pointless, because there will be less weaseling out of covering necessary medical care.

      • chris

        there will be less weaseling out of covering necessary medical care

        Optimist. In any fragmented system, the incentive to push the cost of necessary spending onto someone else is just too high to expect a corporation to ever pass it up. That’s why single-payer has such huge cost savings — a single payer cannot pass the buck, so it has no reason to try, so conditions that get progressively worse (which is a lot of them) can be identified and treated earlier and cheaper.

  • ploeg

    Apologies for the lateness. This sort of regulation would prevent insurance companies from providing innovative services like, for example, nude ladies. Obviously this cannot be allowed to stand.

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