The Health Care Overhaul: Who Pays and How Much?

Posted Wednesday, August 19, 2009

The health care overhaul promised by President Obama aims to insure the uninsured, rewrite the insurance industry's rules, prioritize wellness and prevention, and, perhaps most ambitiously, do all of the above without adding to the deficit. Whether the legislation before Congress can actually do that is a subject of much debate. Wednesday morning at 9, we continue our coverage of the health care overhaul with analysis this question: How will this all be paid for?

Guests

Katherine Baicker Professor of Health Economics, Harvard University
Anna Edney Reporter, CongressDaily
Bob Laszewski President of Health Policy and Strategy Associates

Please follow our community discussion rules when composing your comments.

Jason 9:41 AM 8/19/09

Without a public option this healthcare “reform” is a handout to Insurance and Pharmacutical companies. Obama tried to split the the two by giving hand outs to drug companies so they wouldn’t oppose his efforts. Eliminating the public option gives a handout to both and fleeces regular americans.

Susan Blair 9:47 AM 8/19/09

How can we get an efficient system when the big business of the medical,insurance and pharmaceutical companies are lobbying the politicians? I heard that a provison against Doctor owned hospitals was dropped after one Doctor owned hospital donated money to the Democratic Party and that Nancy Pelosi actually visited the hospital and cut the ribbon on their new cancer center.

Lisa 9:48 AM 8/19/09

I am a Registered Dietitian in the NE Ohio area. Listening to the comment about the gentleman who mentioned patient responsibility, I have a few things to mention. First when the doctor tells the patient that they are overweight, most times that is all the doctor will do! Say loose weight. They rarely refer that patient to a dietitian to help that patient. The other problem is that if they are referred their insurance does not always cover our costs. Simply telling the patient they need to loose weight is not the solution.
I understand that there is a patient responsibility, but these patients have gained this weight over time, often times they need guidance to help them loose it.

Ernest J. Schwarz 9:53 AM 8/19/09

1. In all the discussion about costs, nothing has been said about the cost of administrating what seems to be an awkward system of insurance. I have heard various figures comparing our adminisatrative costs with other countries and our costs are always much greater.
2. I also hear no mention of the PROFITS being paid by private insurers. Can we reduce those expenditures?

In other countries, less money is spent per person with much better health results than in the US. Does anyone research this and apply it to our situation?

Scott, Chagrin Falls 7:31 AM 8/20/09

What has always troubled me about health insurance is the way underwriting rules are conducted. I think if they were to adhere to the same underwriting rules as automobile insurers, health insurance might be more affordable for everyone. For example:

(a) In order for an automobile insurer to sell insurance in a state, they need to file their underwriting rules and rates with the state. This means the “group” of insureds is the size of an entire state. Why is it that health insurance companies are allowed to sub-divide a state’s population and claim that smaller groups—individuals and small businesses—should be charged higher rates than the larger groups—e.g., governmentals and corporations? This seems to be a very misleading way to represent their pool of risk.

(b) I believe that automobile insurers take responsibility for high-risk drivers by either contributing to a fund or insuring some percentage of them. I am less certain how this works, but I know that the automobile industry has a way to ensure that everyone is insured.

This system results in some tensions between states and automobile insurance companies. Sometimes, companies choose not to offer insurance products in a state because the underwriting climate is too adverse, in their opinion.
However, market forces inevitably prevail and drivers are insured: we’ve never heard a news article about drivers in New Jersey, as a fictitious example, not being able to buy car insurance. I mention this because I’d hate for a representative of the medical insurance industry to raise this false red flag.

There might be very good reasons why health insurance companies are permitted to conduct their underwriting activities according to a drastically different set of rules than other types of insurance companies.
I hope you have the opportunity to ask someone.