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Monday, August 06, 2007
Chuck Muth :: Townhall.com Columnist
Health Insurance Blues: Give Choice a Chance
by Chuck Muth
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Will the Dems' health care Christmas Present to America be an improvement or detriment to our health care system?


The nation’s largest health insurer, UnitedHealth Group, wants to buy up Sierra Health Services in Nevada. The merger would give the new company a virtual monopoly over health insurance in the Silver State, reducing competition, which usually means increasing costs. Supporters, however, say the merger will actually reduce costs and improve service due to the efficiencies of scale the giant conglomerate will enjoy.

Nevertheless, being a free-market kinda guy I haven’t yet heard any compelling reason for the government to block this merger of two private companies. And the fact that the self-serving Culinary Union is now in open opposition to the takeover tends to weather-vane me in the opposite direction.

No, the answer to legitimate concerns about giving UnitedHealth a virtual monopoly over the health insurance market in Nevada isn’t to block the takeover of Sierra Health Services, but to open Nevada’s market to interstate competition. In this age of Amazon and eBay, it makes no sense whatsoever that Nevadans are prohibited from buying health insurance from a company located in another state.

And yet, thanks to an anachronistic law passed in 1945, the McCarran-Ferguson Act, combined with the lobbying power of Big Insurance, there is no competitive interstate insurance market similar to the highly competitive interstate banking market. For example, Nevadans can deal with a relatively small local bank or choose to deal with a big interstate bank such as Bank of America or Wells Fargo. Both entities thrive in Nevada and consumers, armed with market choice, benefit greatly.

Not so when it comes to health insurance companies. Why not?

Because state legislators want to retain the ability to force insurance companies to foot the bill and cover expensive benefits which they don’t have the guts to sock directly to taxpayers. These are called “mandates” - as in, the legislature makes it mandatory that the insurance company cover them or the insurance company doesn’t get to operate in Nevada. Yes, legal extortion.

Around the country, many states force insurance companies to cover benefits ranging from acupuncture to marriage counseling; from contraceptives to hearing aids to hairpieces; from podiatry to osteopathy; from chiropractors to even massage therapy. All in all, there are over 1,800 such mandates found across the country. And these mandates jack up the cost of insurance, creating a huge difference in premium costs between some states.

For example, a recent e-HealthInsurance.com study showed that a healthy 25-year-old male could pick up a basic health insurance policy in Kentucky for $960 a year. That same policy in New Jersey, however, would set the lad back a staggering $5,880 a year.

And the Wall Street Journal noted that the same study “found that a typical insurance policy - $2,000 deductible, 20% co-insurance – for a family of four could be had for as little as $172 per month in a reasonably regulated locality like Kansas City, Missouri. But in New York that family’s only option – managed care – would run $840 per month, and in New Jersey family policies run a whopping $1,200-plus.”

Why shouldn’t a family in New York be able to purchase that far less expensive policy from the Missouri company?

If you want to shrink the ranks of the uninsured, perhaps it’s time to open the market and reduce the cost so that average people can afford basic coverage without all the government mandated frills. Instead of blocking the mergers of health insurance companies in one state, perhaps it’s time to open up the competition among all 50 states?

Rep. John Shadegg, Arizona Republican, has proposed just such legislation in Congress; however, Congress in the hands of pro-union/anti-free market Democrats and is unlikely to act favorably on such a common-sense, cost-free solution to the health care insurance problem. Which is why state legislatures should take the lead and open up their own markets without waiting for the feds.

Let’s give choice a chance.

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About The Author

Chuck Muth is President and CEO of Citizen Outreach and a professional political consultant.

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0ne simple problem with health insurance

Benicar (a blood pressure med) goes for about $46 and most insurance plans kick in $11 so that you pay $35.

However, if you don't have insurance, the price jumps to $70. The same pharmacies that are more than happy to sell it for $46 when there is an insurance copay have no trouble charging damn near twice for those uninsured.

The same thing is true if you go into the hospital. There is one cost if you have insurance but if you don't it will be about double and they will sue you to get it. I am not a fan of price controls but health care needs to be treated like other industries - concepts such as "price fixing" and "restraint of trade" need to be dealt with.

We can blame the insurance companies and we can blame the corrupt and incompetent government, but the concepts such as "price fixing" and "restraint of trade" remain....

georgiagal/doctork
If all government mandates, coverage demands, and other non-economic factors were removed from the mix, the"invisible hand" of the market would deliver competing policies and coverages folks could purchase just like they now order pizza. Furthermore, if end users of care were the ones paying its' costs, there would be significant price shopping and demand for simple, non-life-at-risk usage would drop. Basically, I believe forcing doctors, nurses, etc. to deliver care to anyone, regardless of ability to pay, and only at rates of payment determined by government, to be slavery. Perhaps if people knew in advance they and they alone would bear the costs of their healthcare, many foolish behaviours would be bred out of the species, through personal choice or death by attrition. Why should responsible, hardworking people be forced to pay (in higher premiums due to cost-shifting) for the care of a premature crack baby whose mother is broke, uninsured, and unable to pay even a fraction of the cost? Survival of the fittest combined with personal responsibility would lead to a healthier and wiser population, something of long range benefit to mankind as a whole in an age of finite, diminishing resources.Also, why complain about high medical costs for procedures or medecines? No-one is forcing you to use them, you can always ask your next door neighbour to perform your bypass surgery, or substitute castor oil or scotch whisky for nembutal or cardizem.Of course, the success rate of surgeries performed by an elementary school teacher or truck driver might not be as high as those performed by a Harvard Med. trained cardiologist, but you get what you pay for. Where in the constituition does it state unlimited cost-free healthcare is a right for even citizens, let alone illegals who sneak into our home ?

Arby, those are good points
that your brought up. From reading the article I did not come away thinking the people in another state would necessarily get the same premium as those in another state, especially if health care costs more in that area. It could go two ways. The people in Kansas City could end up paying more to balance out the people in New Jersey OR the people in New Jersey would pay a higher premium based on where they live (which is the way it should be.) Either way, the people in both states would be given a choice. If insurance companies knew that people could pick and choose from hundreds of other companies (in or across state lines)it would force them to offer more competitive rates. Then just think if state mandates were completely taken out of the equation what would happen. I know when my husband and I were searching for HSA policies we only had 2 or 3 companies to choose from in our state.

Reply
"if there were no insurances and everyone had to pay for the treatments that they received, would the costs continue to rise or would they stabilize and fall?"

What would happen is that the high-tech methods of keeping people alive would be phased out, as only the millionaires could afford to use them. Cancer would return to being an automatic death sentence for all but the wealthy. New medications would no longer be developed, since the thousands of dollars necessary to recoup the cost would no longer be available to the drug manufacturers.

The Libertarian tract "Common Sense Economics" would applaud that outcome ... after all, a person's worth is defined as their income (making Paris Hilton and Lindsay Lohan more worthy than the 9/11 firemen, since their annual income is greater).



does insurance and lawsuits raise costs?
if there were no insurances and everyone had to pay for the treatments that they received, would the costs continue to rise or would they stabilize and fall?

is there an incentive for medical costs to rise since there is a floor set by the insurance companies? do medical businesses know this and set prices accordingly? that seems to be the case for the university costs.

in addition, would people go to the doctor when they needed to instead of everytime they sneeze since the co-pay is only $15?

if there were tort reform that would eliminate the frivolous lawsuits would costs drop?


It's not about "fault" hank
It's about cost.

If someone has a high-risk condition is not incumbent upon those with low-risk conditions to pay for his health care.

That is a communist notion.

If you want to lower the cost of health care, deregulate the industry.

Let providers decide what they will charge for each applicant based on that applicant's own medical history. Make each applicant understand what it will cost HIM each time he chooses to visit a doctor to get a prescription pain reliever instead of buying aspirin or ibupofrin over the counter. Let each applicant understand what it will cost HIM each time he decides to use the local ER as his family physician.

I am a unique human being with a unique health profile and history. There is no logical reason anyone else should be paying the exact same amount for health insurance as I do.

All of the reasons advanced for everyone paying the same rate are political. They have to do with attempting to create equal outcomes, which is the basis of communist economics.

And if you examine the health care in communist countries you will find it is universally AWFUL. It is so bad that Michael Moore felt compelled to do one of his fraudulent documentaries to promote it.

The Health Care Industry
To Mr. Muth.

If your claim is that market forces will eventually resolve the health care crisis, where is the demonstrable empirical proof substantiating that claim?

Doctor K
http://www.equalhealthcareforall.com

One has to understand economics first
One has to understand economics and the free market. I recomend the book "Common Sense Economics" for GeorgiaGal. Somehow I don't think she will pick that book up.

Chuck's failure
Chuck and other writers like him have failed to either fully understate the complex concept of interstate insurance that they allude to, or they understand it but have decided to misrepesent it.

A family of 4 -- or for that matter, an insured person of just 1 -- living in New York City could not possibly buy insurance from, for example, an insurance company in Kansas City, Missouri, AND expect to pay the rates that families in Kansas City pay. That's because families who live in Kansas City go to providers in and around that area. The Kansas City insurer has rated the family of 4, in part, on a geographic model based on what it costs to deliver health care to people within 5, 8 or 12 different Zip codes in and around Kansas City -- by health care providers in this area.

But, families living in New York go to health care providers in New York who charge more -- and insurance companies easily allow for this charging of more. Even if insurance could be sold across state lines, does anyone not believe that the Kansas City-based insurance company would charge the NYC family pretty much what the NYC insurance company is already charging them? Don't for a minute think that the NYC family will be able to buy insurance for $172 a month, just like the Kansas City family. That is fantasy land.

Open markets are good to a point -- but they are not going to seriously reduce by even 50% what the cost of insurance will be for that NYC family.

The Insurance Companies...

Have bought the Democrat Governor of Michigan. We have little choice, can be dropped in the midst of surgery (really), pay extra to insure crack-heads, and our premiums fund every Democrat candidate in Michigan.

This is plain Bull... These Democrats are in bed with the insurance companies and drug companies. The Democrats are simply using this issue as an election tool, and leverage to extort more money from the Insurance companies.


Paying the Same Rate
elong's comment: "Why should all pay the same rate?" is answered by hank from mass: "a person, through no fault of his own, may not be able to obtain health insurance because of cost, if he has a condition that is higher risk".

To answer hank from mass: Medical science has advanced over the past 50 years so that about 10% of the population (health care industry figure, not sure how they came up with it) can live for years with chronic but treatable conditions. Some people get the conditions by risky behavior; more get the conditions through genetics or age.

The answer is two-part:
1. Pro-life: If Americans wish for that 10% to have the access to the health care they need to stay alive (think: insulin; dialysis; asthma inhalers), at some point Americans have to ask the other 90% to pay more for their health insurance than their individual risk would otherwise pay.
2. Life experience: at any point in their life, an individual may enter that 10%, regardless of their personal habits (think: stroke; surviving a traffic accident; extreme food poisoning that can result in permanent kidney damage). Making sure that 10% today can get the health care they need ensures that if you, yourself enters that 10% the health care will be available and affordable.

Good article
On a related note, Massachusetts mandates the car insurance rates in this state, meaning we do not see the benefits of competition and our insurance rates for auto coverage are some of the highest in the nation.

Elong and GeorgiaGal, I'm a little torn on the issue of how higher risk individuals should be treated for health insurance purposes. It doesn't seem right to me that a person, through no fault of his own, may not be able to obtain health insurance because of cost, if he has a condition that is a higher risk. On the other hand, it seems that risk factors such as smoking and obesity, controllable by the individual, should lead to higher premiums for those who subject themselves to those risks.

GeorgiaGal
Why should everyone pay the same rate? Part of the problem right now with various state mandates is that folks are paying for coverage that they don't need. Some states mandate coverage for fertiility. If you're married and are trying to start a family that would make sense to make that part of your plan. But if you are older with children already why have your insurance costs go up for something you're never going to use.

Take the hand cuffs off of the insurance companies and let the market work.

Senator Kerry's Solution
Senator Kerry in 2004 (and now, Senator Edwards in 2007) have a solution. Allow everyone to buy into the Federal Employees Insurance Program. Federal Employees have a choice of about 200 private sector plans. The plans have some restrictions, namely:

1. Everyone is charged the same rate, so that the young healthy male pays the same rate for a plan as does the young diabetic male, or the young asthmatic male.

2. Companies must be bonded, so that they won't go out of business when someone on their plan gets sick.

3. Mandates which ensure that all plans cover treatment for the chronic ailments and that all plans provide access to specialists. I believe all plans must include a prescription drug benefit.

The advantage is that the Federal Employee Health Plan system has been operational for decades, so that the bugs have all been worked out already; that coverage for those with chronic ailments is guaranteed at reasonable rates; and there is competition between plans.

Both Kerry's and Edward's plans include vouchers for low wage workers to enable them to buy into the plan.

Alot of Chuck Muth's concerns are satisfied by the Kerry/Edwards plan (if he can only get past the fact that a Democrat came up with the plan first).

The People's Republic of New York
I'm one of those people paying through the nose for health insurance in NYS (and this with my wife working in the health insurance industry).

Pull the protectionist walls down, and let us shop around for a better deal.

But of course, government (including my restrictionist Albany government) cares little for better deals. Remember the $1,000 toilet seats on submarines?

Chuck
Good column. Well done.

So wait, it's the gov't that is part of the problem when it comes to insurance costs? Huh?

The gov't? But I thought the gov't could fix EVERYTHING by giving us "Universal Healthcare" and that real competition would do no good.

The gov't stifling the free market? WOW! Who would have guessed that?

I hope your column will set some folks straight.
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