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23 March 2010

Just running it up the flagpole, to see if anyone salutes....

There can be no doubt that with passage of Obamacare, this may be a moot point, but I started thinking about how a truly deregulated health services market might look. For whatever reason, people seem to believe that health insurance, one of the most comprehensively regulated industries in the US, suffered from a lack of regulation that was driving up costs in the health industry. I started considering how a broad health services market, employing everything from deregulated plans which people could buy across state lines, to decoupling of employment and insurance, to the inclusion and promotion (through advantageous, or at least fair, tax treatment) of health savings accounts, might look like. One possibility that I haven't heard about but seems like it could be interesting would be the possibility of "a la carte" health insurance. We already have it, in a way, with Medicare Advantage, and the fact that we buy glasses and go to the dentist's with separate insurance (or even out-of-pocket). Why couldn't there be a larger insurance market for selected services? For example, say you have a pre-existing condition, or maybe a family history of heart disease. Is there any reason that you couldn't be put into a high-risk pool exclusively for treatment dealing with your pre-existing condition, but, say, if you fell down skiing and blew your ACL, your "regular" insurance policy would cover it like normal?

It's true that pre-existing conditions lead actuaries to understand that some people are at higher risks for, say, lung cancer. That's why smokers pay more for health insurance. (Strangely, I didn't hear anybody talk about this unjust treatment of a lifestyle choice during President Obama's year-long push for health care nationalization.) And it's undoubtedly true that sometimes a pre-existing condition can lead to multiple health problems, and identifying the pre-existing condition as *the* cause would be difficult. But considering the situation we find ourselves in now, could it really be worse?

If anybody has any clever comments on this, or if I'm overlooking some common-sense reason (or a very complicated and highfalutin' reason) why I'm completely off-base, I'd appreciate it.

1 Comments:

Blogger Mr. Bross said...

I would speculate (and I confess that I have no expertise here at all) that the whole system is too dependent on people who pay for insurance that they wouldn’t be bothered with under an ala carte system. Consider that right now, a portion of my insurance premiums is going towards coverage against the possibility that I’ll break a leg. This coverage isn’t worth all that much to me—I’m in my thirties, I work at a desk, and somewhere ein the closet I’ve got an old cub scout book that’ll tell me how to work things out with a bandana and some sticks—so I’d probably forgoe it. I would, however, pay a lot for whatever part of my insurance covers stomach pumping and alcohol poisoning. Meanwhile, there’s a 70 year old Mormon out there that actually is concerned that’ll he’ll snap a femur if he stands up too fast. I’m going to overpay for the broken leg insurance, and he’s going to overpay for the stomach pumping insurance, but it’s all going to round out for the insurer. Apply that logic over the full spectrum of potential health problems, and it only makes sense to bundle everything.

00:37

 

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