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1. Deregulate the health insurance market so you can sell across state lines. 2. Employers start giving their employees the money they pay on their behalf. 3. P

1. Deregulate the health insurance market so you can sell across state lines. 2. Employers start giving their employees the money they pay on their behalf. 3. People shop for the health insurance they want/need. In a year, every other advertisement on TV would be for health insurance, like it is with car insurance now.

fooey 7y ago
It's already legal in several states, but no insurance companies took them up on it. Trump additionally signed an executive order to setup a national way to do it, but it died off as a policy proposal because the insurance companies aren't interested http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx http://www.ncsl.org/research/health/out-of-state-health-insu...
- iamthirsty 7y ago
  Of course they aren’t interested—the default model is working for them right now. Take away the default model, and open pure competition, and the insurance companies will have to compete on that level, and things will relatively quickly get better.
  - fooey 7y ago
    You're acting like every insurance company isn't already a massive multi-state corporation. State Farm Texas competing with State Farm Kansas is surely going to solve all our problems.
    - zip1234 7y ago
      There is probably a serious amount of overhead for those companies caused by making divisions in 50 separate states.
  - prostoalex 7y ago
    The providers still hold the key to pricing. When your choice of hospitals or specialists is limited, you’re going to go with whatever insurance company they accept, or pay some exorbitant price. The problem is that most people don't pre-shop for insurance that way, and only find out that their local provider is out of network when it's urgent that they get help.
    - amanaplanacanal 7y ago
      Even if you plan it all out ahead of time, you end up in emergency surgery in an in-network hospital, with an in-network surgeon, only to find out the anesthesiologist was out-of-network. And you still owe tens of thousands of dollars out of pocket. It's a bad system all around.
  - astrange 7y ago
    Insurance only gets cheaper the larger the company gets, because the risk pool can absorb more risk. Competition doesn't improve it. A giant problem with getting healthcare through insurance companies is that it's not actually insurance. Insurance should only be used to pay out in catastrophic cases; it's always cheaper to pay for something predictable yourself than to make an insurance claim. Of course, most people can't afford any healthcare at all. There's no way to insure that.
    - isostatic 7y ago
      Don’t seem to have the problem in the UK. Everyone has healthcare. Those that can afford to (or their companies) top up with swanky perks, but it’s not needed for most. Total cost is $2800 per person per year. In the US it would cost $950b to provide that for everyone. The US currently spends $1077b on Medicare/Medicaid.
      - vidarh 7y ago
        Just imagine what the US could have if it fixed its pricing issues and regulations and kept spending the insane amounts they do today...
- donarb 7y ago
  The problem with insurance across state lines is that insurance companies would create a policy in a state with lax regulation and rules and sell that policy everywhere else. It's the same sort of crap that allows credit card companies to set up in South Dakota because that state has lax laws over usury rates.
  - TheSpiceIsLife 7y ago
    Regulations should apply where the product is sold, or used, not where it’s manufactured.
    - shalmanese 7y ago
      That's exactly what's meant by insurance not being able to be sold across state lines. The issue isn't whether Kaiser can sell a Californian a Californian health plan and a Texan a Texan health plan, Kaiser can already do that. The issue is whether Kaiser is allowed to sell a Californian a Texan health plan.
    - tfehring 7y ago
      I agree. And that's exactly the status quo for insurance in the US: every policy is subject to the regulatory requirements of the state in which it's sold. "Allowing" policies to be sold across state lines - which, as others have pointed out, is equivalent to preventing states from regulating policies sold within their borders - would reverse this.
whoopdedo 7y ago
You're #1 states two things as if they are the same. Your final statement seems to imply that the affordability of auto insurance derives from the above conditions. Except you make one glaring mistake: auto insurance is not regulated. Rather, the rates that insurers can charge is highly regulated. #3 also doesn't make sense because people don't buy the auto insurance that they want. They buy the insurance that the state requires them to pay, and maybe a little more if they want something better. But the government mandates a minimum level of coverage which the insurance companies need to avoid either going insolvent or charging much higher rates than they do.
- fthssht 7y ago
  "You're #1 states two things as if they are the same." Maybe he was referring to the regulation that prevents health insurance from being sold across state lines? That would have been my guess. And you made one glaring mistake... your spelling of your.
- lsiebert 7y ago
  That's false. California, for example, has regulations on auto insurance rating factors and discounts (banning, for example, discrimination on sexual orientation or discounts not offered to the general public), among other regulations.
objektif 7y ago
It is quiet shocking to see #1 getting posted over and over again. How is that supposed to solve the pricing problem? How do you like pricing of say Comcast, Apple or any other company with pricing power? They offer services accross all states. I think it is way past time that we stop offering cute free market solutions to our disasterous healthcare industry. Medicare for All or gtfo.
- ceejayoz 7y ago
  > It is quiet shocking to see #1 getting posted over and over again. Yup. If anything, it'd make things substantially worse. There's a reason all the credit card companies moved to Delaware - they found the most favorable jurisdiction (and work to ensure it stays that way). Health insurers would love to all move to the most insurer-friendly jurisdiction.
  - User23 7y ago
    Wrong. Everyone incorporates in Delaware because the Court of Chancery[1] has some of the most professional and consistent judges in the country. Both parties know what the judge is going to decide before it ever gets to trial, which makes reaching settlements and thus saving money far easier. A good businessman can work within the constraints of virtually any consistently applied set of rules. It's when court cases become roulette games that massive inefficiencies arise. [1] https://courts.delaware.gov/chancery/ https://courts.delaware.gov/chancery/
    - sbov 7y ago
      While that may be why some companies incorporate there, credit card companies specifically are headquartered in certain states (not just Delware IIRC) because, roughly speaking, the supreme court ruled that usury laws where they are headquartered is the only thing that matters. A while back several states tried to make high interest rates (20% or so) illegal and the supremes smacked them down.
    - ceejayoz 7y ago
      https://en.wikipedia.org/wiki/Marquette_National_Bank_of_Minneapolis_v._First_of_Omaha_Service_Corp https://en.wikipedia.org/wiki/Marquette_National_Bank_of_Min.... > The decision attracted little notice at the time. Two years later, the possibilities it opened up became clearer when Citibank, squeezed by interest rate caps, decided to move its credit-card operations out of New York City. The company persuaded Bill Janklow, then governor of South Dakota, whose agricultural economy was struggling at the time due to high fuel prices, to persuade that state's legislature to formally invite the bank there, as required by federal law before a national bank can do business from a state. He then successfully lobbied the legislators to pass a bill drafted by the bank that repealed the state's cap on interest rates, something a small group of legislators were already trying to do. Citibank quickly moved the 300 white-collar jobs in its credit-card division to Sioux Falls, where it has been ever since. > South Dakota lured a few more large credit operators, such as Wells Fargo, before corporation-friendly Delaware repealed its anti-usury laws as well. Several other states also repealed their interest-rate caps, more lenders entered the credit-card field and introduced newer products and by 1990 the amount of credit cards in use in the U.S. had more than doubled. Credit cards, once a loss leader for the banks that issued them, became a major profit center as banks aggressively marketed them to "revolvers", customers who carried large balances but rarely paid more than the monthly minimum, resulting in large interest payments to the bank.
xur17 7y ago
> 1. Deregulate the health insurance market so you can sell across state lines. Why can't health insurance companies sell across state lines right now?
- gwright 7y ago
  A bit of googling leads to: > Insurance firms in each state are protected from interstate competition by the federal McCarran-Ferguson Act (1945) Basically this is Congress using its interstate commerce power, in this case to prohibit certain types of commerce.
  - js2 7y ago
    No, it's the opposite of that. The act is congress abdicating its power under the commerce clause wrt insurance so that each state can regulate insurance as it sees fit.
    - gwright 7y ago
      I wasn't trying to take a position on what Congress should or shouldn't have done. Just pointing out that it was the Commerce Clause powers that enabled Congress to pass the referenced law. I find your choice of "abdicate" confusing. There is no Constitutional obligation that Congress act in a particular manner on this issue so that word choice just seems out of place to me. It suggests "not doing something" as opposed to "doing the wrong thing". I think you are advocating that Congress take affirmative action to enable interstate insurance transactions and to preempt state regulations in this area. That seems reasonable to me.
      - js2 7y ago
        > it was the Commerce Clause powers that enabled Congress to pass the referenced law No, I don't think so. The Commerce Clause gives Congress the power to regulate insurance. McCarran-Ferguson is Congress explicitly delegating insurance regulation to the states. Delegating regulation to the states is not a power derived from the Congress clause. IANAL and I'm not sure exactly what the legal theory underpinning McCarran-Ferguson is. I believe it's probably an implied power. > that word choice just seems out of place Maybe abdicate isn't the best word choice, but what I was trying to impart is that when the SCOTUS decided that insurance does indeed fall under the purview of Federal law by way of the Commerce Clause, that Congress had to explicitly say that "Federal law does NOT apply to insurance." That's a sort of abdication to me: SCOTUS: Hey Congress, it's your job to regulate insurance per the Commerce Clause. That means things like the Sherman Act apply to insurance too. Congress: Oh, we don't want that. Let's pass McCarran-Ferguson to exempt insurance from Federal law so that the states can regulate it as they see fit.
scroot 7y ago
You choose to have a car. Your body is a given.
- kortilla 7y ago
  Fascinating. Is there anywhere that illustrates this distinction in a form simple enough for us illiterate people to understand? /s Your comment has nothing to do with state boundaries.
_tb1_ 7y ago
Suggestion 1 has been looked at. They've found it doesn't work.
- cheez 7y ago
  It's not so much "doesn't work" as "people in the insurance business have reasons why they would take advantage to the detriment of consumers"
  - mrguyorama 7y ago
    That's a pretty good definition of "doesn't work" in the context of lifesaving medical care
    - cheez 7y ago
      The solution then isn't to keep them in gold coins...
- _tb1_ 7y ago
  Other sources: https://www.google.com/search?q=insurance+%22across+state+lines%22+lower+costs https://www.google.com/search?q=insurance+%22across+state+li...
- buzzerbetrayed 7y ago
  Who are “they”? And why should we trust them?
  - objektif 7y ago
    Who is Aetna, BCBS and why should I trust them?
  - _tb1_ 7y ago
    Well, it's a common talking point. Have you looked into it? It's an honest question, who has the onus of responsibility for research? OP or me?
deleted 7y ago
[deleted]
wwweston 7y ago
Why do state lines make a difference? Is there some geographic location where health insurers have a competitive advantage that major metro areas (certainly where most rideshare drivers are) don't have access to? If there is, which states are already reaping the benefits of market based high access to health insurance? Also, you do realize that this proposed solution essentially disempowers state governments from being responsive to citizen concerns about insurance policy/practice -- if a state can't control who sells in their state, then the only government shaping insurance policy is national. Bonus points if you can address how these locales address the issue that health insurance is a weird good from a market perspective -- the more an individual needs it, the less an insurer probably wants to sell it to them, certainly for an averaged risk pool premium. I totally want to see insurance decoupled from employment, but as far as I can tell, the state line thing isn't an analysis, it's just a mantra that was/is frequently dropped into the discussion without explanation or support.
mwfunk 7y ago
You left out step 4, without which 1-3 would just make everything worse for everyone: just like with car insurance, everyone would be legally required to purchase health insurance up to some minimal level of coverage. Not for their own sakes, but for everyone else’s, otherwise you end up with even more uninsured people seeking treatment, which is how we got into this mess to begin with. Any plan which doesn’t minimize or zero out the pool of uninsured Americans does nothing but drive up the cost of health care, and in turn the cost of insurance for everyone else, in a vicious circle. That’s the whole point of the last 30+ years of never ending ideas about what to do about health care in America. The whole point is to break that cycle, not even getting in to second order effects like exploding Medicare costs or actual public health issues.
- nybble41 7y ago
  > You left out step 4, without which 1-3 would just make everything worse for everyone: just like with car insurance, everyone would be legally required to purchase health insurance up to some minimal level of coverage. So just like with car insurance, that minimal level of coverage would only include health care costs incurred by others as a result of your actions? The minimal required car insurance isn't there for you, it's there to ensure that others can recover their costs from you in the event of an accident. Unless you're paying extra for comprehensive coverage, the insurance company won't pay out for your own treatment or the repair of your own vehicle. The only thing that might come close in the domain of healthcare would be mandatory coverage against the possibility of accidentally transmitting a contagious disease. It wouldn't cover the cost of your treatment, but rather the cost of treating others whom you accidentally infect. The premiums would be minimal (so long as one is vaccinated) and it wouldn't look anything like traditional health insurance. Of course, even the "minimum" level of car insurance is only mandatory in connection with driving on public roads. Putting aside the minor issues of a power imbalance sufficient to imply duress at the best of times and the fact that you'll be paying taxes for those roads whether or not you're allowed to use them, this is somewhat analogous to terms and conditions for use of someone else's property. What you're proposing amounts to mandatory insurance just for being alive—essentially on the basis that denying you healthcare you can't or won't pay for might make others feel bad—which is a rather different proposition. Really, though, a better question is what penalty you propose for not buying whatever "minimal level of coverage" you think people should have. My suggestion is simple and doesn't require any special intervention: If you're not insured, can't pay for it yourself, and can't convince anyone else to pay for it for you as a voluntary act of charity, you don't receive treatment. That is the natural punishment for not buying health insurance. There is no need for any other.
timoth3y 7y ago
> 1. Deregulate the health insurance market so you can sell across state lines. I've always found this suggestion a bit disingenuous. First, there is no federal law that bans insurance from being sold across state lines. What they really mean (but can't say because it is not politically appealing) is "Don't allow states to regulate insurance sold in their state." State boards regulate insurance. They seem to do it well. No insurance companies failed during the 2009 financial crisis and the ones that came close (looking at you AIG) did so because of their activities and investments that fell outside of the state regulations. Not allowing states to regulate insurance would reduce costs, but not for the reason you think. The cost of getting a product approved in a given market is predictable and a very small part of the cost of doing business. By taking this right away from the individual states, we could see a race to the bottom where all insurance companies would incorporate in whatever state offered the lowest reserve requirements and loosest oversight. This would decrease the cost of policies and increase the profitability of the insurance companies. It would be great until there was a hard year and the insurance companies would have the be bailed out by the taxpayers. State regulation of insurance companies is a great thing. The states keep each other in line and they keep the industry solvent. Edit: BTW, auto insurance is also regulated on the state-level.
- roenxi 7y ago
  I don't live in America, but having strong opinions is fun so I'll wade in anyway :D The things you are talking about are regulatory standards. I've not seen anyone really suggesting that regulatory standards are a problem in the Americas (on the contrary, everything I've read suggests if you have in insurance the whole process can be pretty comfortable). gp's post is, in my eyes, clearly going towards the point that people should be choosing their own insurers, rather than their employers choosing insurers (on employees behalf). It seems like common sense to me that an individual will be better at choosing a healthcare provider than their employer. The idea that healthcare benefits are a factor to consider when choosing an employer is bizarre. The only reason to link the two is because Americans enjoy being different. And strangely anti-individual-choice in this instance. That dynamic is an obvious perversion of the market to deregulate.
  - 7y ago
dd36 7y ago
The big insurance companies already are multi-state. Transparent provider pricing and reference-based pricing are a regulatory solution that allows free markets to do their magic.
make3 7y ago
single payer health insurance would be much cheaper if you just have the equivalent of what you pay now to the government. Single insurer=massive negotiation power. The US has the most expensive health care per person in the world
- sokoloff 7y ago
  Many people do not trust that the government would achieve as good an outcome as their current private insurance. Probably a greater number fear that healthcare would become more inconvenient for them. (I’m 100% sure of the latter and maybe 50/50 on the former.)
  - make3 7y ago
    The government can literally force healthcare providers to accept prices if it's the only payer. It can even write laws forcing them to accept those prices. It would take some time to adjust, but eventually you would ask win. Right now you both have the most expensive in total, expensive in median and the most unfair. http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/?fbclid=IwAR3WSO7xo8kK9cUjQKMf1kQi6u45owqin7aIxUTr_Fxq9kAvrN03cGevjW http://time.com/2888403/u-s-health-care-ranked-worst-in-the-...
    - sokoloff 7y ago
      I don’t have any doubt they could do such things, just as they’ve done for driver and vehicle licensing. When I or a family member needs medical care, I don’t look forward to a DMV-like experience.
      - mrguyorama 7y ago
        I routinely have spent less than half an hour at the DMV doing anything I need to, with productive and helpful staff who seemed educated about rules, requirements, and best practices. I didn't even get a bill in the mail for it! It's almost like some states/municipalities actually fund things and care about it, and they have good results.
JKCalhoun 7y ago
Also, deregulate the cable/satellite TV market so you can sell across state lines … we'll see costs to the consumer plummet. /s Not convinced the free market will work for health insurance.
ihm 7y ago
> In a year, every other advertisement on TV would be for health insurance, like it is with car insurance now. It's strange to see someone say this like it's a good thing. Almost no one wants to "shop for the health insurance they need". They want to show up when they need care and receive it, and not have to think about it.
- LoSboccacc 7y ago
  dunno, since the car insurance market was deregulated in italy (or better: regulated for transparent competition, which is different in some ways) my premium went from 1200/yr to 250/yr and I'm not receiving a worse service for it. it's all about in how the regulation is carried out. paperless data transfer between company, ban on exit and transfer fees, standardized risk assessment that's binding for all companies allowed a healthy competition.
  - C1sc0cat 7y ago
    id take a look at the small print if I where you based on what happens in the UK
    - LoSboccacc 7y ago
      of course, most insurers are basically running a scam operation. that was happening before irregardless of changes that were introduced to protect customers.
- TheRealDunkirk 7y ago
  > It's strange to see someone say this like it's a good thing. I'm saying that, because the situation would imply a price war for health insurance, which -- crazy me! -- I think would be good for everyone.

fooey 7y ago

It's already legal in several states, but no insurance companies took them up on it. Trump additionally signed an executive order to setup a national way to do it, but it died off as a policy proposal because the insurance companies aren't interested http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx http://www.ncsl.org/research/health/out-of-state-health-insu...

iamthirsty 7y ago
Of course they aren’t interested—the default model is working for them right now. Take away the default model, and open pure competition, and the insurance companies will have to compete on that level, and things will relatively quickly get better.
- fooey 7y ago
  You're acting like every insurance company isn't already a massive multi-state corporation. State Farm Texas competing with State Farm Kansas is surely going to solve all our problems.
  - zip1234 7y ago
    There is probably a serious amount of overhead for those companies caused by making divisions in 50 separate states.
- prostoalex 7y ago
  The providers still hold the key to pricing. When your choice of hospitals or specialists is limited, you’re going to go with whatever insurance company they accept, or pay some exorbitant price. The problem is that most people don't pre-shop for insurance that way, and only find out that their local provider is out of network when it's urgent that they get help.
  - amanaplanacanal 7y ago
    Even if you plan it all out ahead of time, you end up in emergency surgery in an in-network hospital, with an in-network surgeon, only to find out the anesthesiologist was out-of-network. And you still owe tens of thousands of dollars out of pocket. It's a bad system all around.
- astrange 7y ago
  Insurance only gets cheaper the larger the company gets, because the risk pool can absorb more risk. Competition doesn't improve it. A giant problem with getting healthcare through insurance companies is that it's not actually insurance. Insurance should only be used to pay out in catastrophic cases; it's always cheaper to pay for something predictable yourself than to make an insurance claim. Of course, most people can't afford any healthcare at all. There's no way to insure that.
  - isostatic 7y ago
    Don’t seem to have the problem in the UK. Everyone has healthcare. Those that can afford to (or their companies) top up with swanky perks, but it’s not needed for most. Total cost is $2800 per person per year. In the US it would cost $950b to provide that for everyone. The US currently spends $1077b on Medicare/Medicaid.
    - vidarh 7y ago
      Just imagine what the US could have if it fixed its pricing issues and regulations and kept spending the insane amounts they do today...
donarb 7y ago
The problem with insurance across state lines is that insurance companies would create a policy in a state with lax regulation and rules and sell that policy everywhere else. It's the same sort of crap that allows credit card companies to set up in South Dakota because that state has lax laws over usury rates.
- TheSpiceIsLife 7y ago
  Regulations should apply where the product is sold, or used, not where it’s manufactured.
  - shalmanese 7y ago
    That's exactly what's meant by insurance not being able to be sold across state lines. The issue isn't whether Kaiser can sell a Californian a Californian health plan and a Texan a Texan health plan, Kaiser can already do that. The issue is whether Kaiser is allowed to sell a Californian a Texan health plan.
  - tfehring 7y ago
    I agree. And that's exactly the status quo for insurance in the US: every policy is subject to the regulatory requirements of the state in which it's sold. "Allowing" policies to be sold across state lines - which, as others have pointed out, is equivalent to preventing states from regulating policies sold within their borders - would reverse this.

whoopdedo 7y ago

You're #1 states two things as if they are the same. Your final statement seems to imply that the affordability of auto insurance derives from the above conditions. Except you make one glaring mistake: auto insurance is not regulated. Rather, the rates that insurers can charge is highly regulated. #3 also doesn't make sense because people don't buy the auto insurance that they want. They buy the insurance that the state requires them to pay, and maybe a little more if they want something better. But the government mandates a minimum level of coverage which the insurance companies need to avoid either going insolvent or charging much higher rates than they do.

fthssht 7y ago
"You're #1 states two things as if they are the same." Maybe he was referring to the regulation that prevents health insurance from being sold across state lines? That would have been my guess. And you made one glaring mistake... your spelling of your.
lsiebert 7y ago
That's false. California, for example, has regulations on auto insurance rating factors and discounts (banning, for example, discrimination on sexual orientation or discounts not offered to the general public), among other regulations.

objektif 7y ago

It is quiet shocking to see #1 getting posted over and over again. How is that supposed to solve the pricing problem? How do you like pricing of say Comcast, Apple or any other company with pricing power? They offer services accross all states. I think it is way past time that we stop offering cute free market solutions to our disasterous healthcare industry. Medicare for All or gtfo.

ceejayoz 7y ago
> It is quiet shocking to see #1 getting posted over and over again. Yup. If anything, it'd make things substantially worse. There's a reason all the credit card companies moved to Delaware - they found the most favorable jurisdiction (and work to ensure it stays that way). Health insurers would love to all move to the most insurer-friendly jurisdiction.
- User23 7y ago
  Wrong. Everyone incorporates in Delaware because the Court of Chancery[1] has some of the most professional and consistent judges in the country. Both parties know what the judge is going to decide before it ever gets to trial, which makes reaching settlements and thus saving money far easier. A good businessman can work within the constraints of virtually any consistently applied set of rules. It's when court cases become roulette games that massive inefficiencies arise. [1] https://courts.delaware.gov/chancery/ https://courts.delaware.gov/chancery/
  - sbov 7y ago
    While that may be why some companies incorporate there, credit card companies specifically are headquartered in certain states (not just Delware IIRC) because, roughly speaking, the supreme court ruled that usury laws where they are headquartered is the only thing that matters. A while back several states tried to make high interest rates (20% or so) illegal and the supremes smacked them down.
  - ceejayoz 7y ago
    https://en.wikipedia.org/wiki/Marquette_National_Bank_of_Minneapolis_v._First_of_Omaha_Service_Corp https://en.wikipedia.org/wiki/Marquette_National_Bank_of_Min.... > The decision attracted little notice at the time. Two years later, the possibilities it opened up became clearer when Citibank, squeezed by interest rate caps, decided to move its credit-card operations out of New York City. The company persuaded Bill Janklow, then governor of South Dakota, whose agricultural economy was struggling at the time due to high fuel prices, to persuade that state's legislature to formally invite the bank there, as required by federal law before a national bank can do business from a state. He then successfully lobbied the legislators to pass a bill drafted by the bank that repealed the state's cap on interest rates, something a small group of legislators were already trying to do. Citibank quickly moved the 300 white-collar jobs in its credit-card division to Sioux Falls, where it has been ever since. > South Dakota lured a few more large credit operators, such as Wells Fargo, before corporation-friendly Delaware repealed its anti-usury laws as well. Several other states also repealed their interest-rate caps, more lenders entered the credit-card field and introduced newer products and by 1990 the amount of credit cards in use in the U.S. had more than doubled. Credit cards, once a loss leader for the banks that issued them, became a major profit center as banks aggressively marketed them to "revolvers", customers who carried large balances but rarely paid more than the monthly minimum, resulting in large interest payments to the bank.

xur17 7y ago

> 1. Deregulate the health insurance market so you can sell across state lines. Why can't health insurance companies sell across state lines right now?

gwright 7y ago
A bit of googling leads to: > Insurance firms in each state are protected from interstate competition by the federal McCarran-Ferguson Act (1945) Basically this is Congress using its interstate commerce power, in this case to prohibit certain types of commerce.
- js2 7y ago
  No, it's the opposite of that. The act is congress abdicating its power under the commerce clause wrt insurance so that each state can regulate insurance as it sees fit.
  - gwright 7y ago
    I wasn't trying to take a position on what Congress should or shouldn't have done. Just pointing out that it was the Commerce Clause powers that enabled Congress to pass the referenced law. I find your choice of "abdicate" confusing. There is no Constitutional obligation that Congress act in a particular manner on this issue so that word choice just seems out of place to me. It suggests "not doing something" as opposed to "doing the wrong thing". I think you are advocating that Congress take affirmative action to enable interstate insurance transactions and to preempt state regulations in this area. That seems reasonable to me.
    - js2 7y ago
      > it was the Commerce Clause powers that enabled Congress to pass the referenced law No, I don't think so. The Commerce Clause gives Congress the power to regulate insurance. McCarran-Ferguson is Congress explicitly delegating insurance regulation to the states. Delegating regulation to the states is not a power derived from the Congress clause. IANAL and I'm not sure exactly what the legal theory underpinning McCarran-Ferguson is. I believe it's probably an implied power. > that word choice just seems out of place Maybe abdicate isn't the best word choice, but what I was trying to impart is that when the SCOTUS decided that insurance does indeed fall under the purview of Federal law by way of the Commerce Clause, that Congress had to explicitly say that "Federal law does NOT apply to insurance." That's a sort of abdication to me: SCOTUS: Hey Congress, it's your job to regulate insurance per the Commerce Clause. That means things like the Sherman Act apply to insurance too. Congress: Oh, we don't want that. Let's pass McCarran-Ferguson to exempt insurance from Federal law so that the states can regulate it as they see fit.

scroot 7y ago

You choose to have a car. Your body is a given.

kortilla 7y ago
Fascinating. Is there anywhere that illustrates this distinction in a form simple enough for us illiterate people to understand? /s Your comment has nothing to do with state boundaries.

_tb1_ 7y ago

Suggestion 1 has been looked at. They've found it doesn't work.

cheez 7y ago
It's not so much "doesn't work" as "people in the insurance business have reasons why they would take advantage to the detriment of consumers"
- mrguyorama 7y ago
  That's a pretty good definition of "doesn't work" in the context of lifesaving medical care
  - cheez 7y ago
    The solution then isn't to keep them in gold coins...
_tb1_ 7y ago
Other sources: https://www.google.com/search?q=insurance+%22across+state+lines%22+lower+costs https://www.google.com/search?q=insurance+%22across+state+li...
buzzerbetrayed 7y ago
Who are “they”? And why should we trust them?
- objektif 7y ago
  Who is Aetna, BCBS and why should I trust them?
- _tb1_ 7y ago
  Well, it's a common talking point. Have you looked into it? It's an honest question, who has the onus of responsibility for research? OP or me?

deleted 7y ago

[deleted]

wwweston 7y ago

Why do state lines make a difference? Is there some geographic location where health insurers have a competitive advantage that major metro areas (certainly where most rideshare drivers are) don't have access to? If there is, which states are already reaping the benefits of market based high access to health insurance? Also, you do realize that this proposed solution essentially disempowers state governments from being responsive to citizen concerns about insurance policy/practice -- if a state can't control who sells in their state, then the only government shaping insurance policy is national. Bonus points if you can address how these locales address the issue that health insurance is a weird good from a market perspective -- the more an individual needs it, the less an insurer probably wants to sell it to them, certainly for an averaged risk pool premium. I totally want to see insurance decoupled from employment, but as far as I can tell, the state line thing isn't an analysis, it's just a mantra that was/is frequently dropped into the discussion without explanation or support.

mwfunk 7y ago

You left out step 4, without which 1-3 would just make everything worse for everyone: just like with car insurance, everyone would be legally required to purchase health insurance up to some minimal level of coverage. Not for their own sakes, but for everyone else’s, otherwise you end up with even more uninsured people seeking treatment, which is how we got into this mess to begin with. Any plan which doesn’t minimize or zero out the pool of uninsured Americans does nothing but drive up the cost of health care, and in turn the cost of insurance for everyone else, in a vicious circle. That’s the whole point of the last 30+ years of never ending ideas about what to do about health care in America. The whole point is to break that cycle, not even getting in to second order effects like exploding Medicare costs or actual public health issues.

nybble41 7y ago
> You left out step 4, without which 1-3 would just make everything worse for everyone: just like with car insurance, everyone would be legally required to purchase health insurance up to some minimal level of coverage. So just like with car insurance, that minimal level of coverage would only include health care costs incurred by others as a result of your actions? The minimal required car insurance isn't there for you, it's there to ensure that others can recover their costs from you in the event of an accident. Unless you're paying extra for comprehensive coverage, the insurance company won't pay out for your own treatment or the repair of your own vehicle. The only thing that might come close in the domain of healthcare would be mandatory coverage against the possibility of accidentally transmitting a contagious disease. It wouldn't cover the cost of your treatment, but rather the cost of treating others whom you accidentally infect. The premiums would be minimal (so long as one is vaccinated) and it wouldn't look anything like traditional health insurance. Of course, even the "minimum" level of car insurance is only mandatory in connection with driving on public roads. Putting aside the minor issues of a power imbalance sufficient to imply duress at the best of times and the fact that you'll be paying taxes for those roads whether or not you're allowed to use them, this is somewhat analogous to terms and conditions for use of someone else's property. What you're proposing amounts to mandatory insurance just for being alive—essentially on the basis that denying you healthcare you can't or won't pay for might make others feel bad—which is a rather different proposition. Really, though, a better question is what penalty you propose for not buying whatever "minimal level of coverage" you think people should have. My suggestion is simple and doesn't require any special intervention: If you're not insured, can't pay for it yourself, and can't convince anyone else to pay for it for you as a voluntary act of charity, you don't receive treatment. That is the natural punishment for not buying health insurance. There is no need for any other.

timoth3y 7y ago

> 1. Deregulate the health insurance market so you can sell across state lines. I've always found this suggestion a bit disingenuous. First, there is no federal law that bans insurance from being sold across state lines. What they really mean (but can't say because it is not politically appealing) is "Don't allow states to regulate insurance sold in their state." State boards regulate insurance. They seem to do it well. No insurance companies failed during the 2009 financial crisis and the ones that came close (looking at you AIG) did so because of their activities and investments that fell outside of the state regulations. Not allowing states to regulate insurance would reduce costs, but not for the reason you think. The cost of getting a product approved in a given market is predictable and a very small part of the cost of doing business. By taking this right away from the individual states, we could see a race to the bottom where all insurance companies would incorporate in whatever state offered the lowest reserve requirements and loosest oversight. This would decrease the cost of policies and increase the profitability of the insurance companies. It would be great until there was a hard year and the insurance companies would have the be bailed out by the taxpayers. State regulation of insurance companies is a great thing. The states keep each other in line and they keep the industry solvent. Edit: BTW, auto insurance is also regulated on the state-level.

roenxi 7y ago
I don't live in America, but having strong opinions is fun so I'll wade in anyway :D The things you are talking about are regulatory standards. I've not seen anyone really suggesting that regulatory standards are a problem in the Americas (on the contrary, everything I've read suggests if you have in insurance the whole process can be pretty comfortable). gp's post is, in my eyes, clearly going towards the point that people should be choosing their own insurers, rather than their employers choosing insurers (on employees behalf). It seems like common sense to me that an individual will be better at choosing a healthcare provider than their employer. The idea that healthcare benefits are a factor to consider when choosing an employer is bizarre. The only reason to link the two is because Americans enjoy being different. And strangely anti-individual-choice in this instance. That dynamic is an obvious perversion of the market to deregulate.
- 7y ago

dd36 7y ago

The big insurance companies already are multi-state. Transparent provider pricing and reference-based pricing are a regulatory solution that allows free markets to do their magic.

make3 7y ago

single payer health insurance would be much cheaper if you just have the equivalent of what you pay now to the government. Single insurer=massive negotiation power. The US has the most expensive health care per person in the world

sokoloff 7y ago
Many people do not trust that the government would achieve as good an outcome as their current private insurance. Probably a greater number fear that healthcare would become more inconvenient for them. (I’m 100% sure of the latter and maybe 50/50 on the former.)
- make3 7y ago
  The government can literally force healthcare providers to accept prices if it's the only payer. It can even write laws forcing them to accept those prices. It would take some time to adjust, but eventually you would ask win. Right now you both have the most expensive in total, expensive in median and the most unfair. http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/?fbclid=IwAR3WSO7xo8kK9cUjQKMf1kQi6u45owqin7aIxUTr_Fxq9kAvrN03cGevjW http://time.com/2888403/u-s-health-care-ranked-worst-in-the-...
  - sokoloff 7y ago
    I don’t have any doubt they could do such things, just as they’ve done for driver and vehicle licensing. When I or a family member needs medical care, I don’t look forward to a DMV-like experience.
    - mrguyorama 7y ago
      I routinely have spent less than half an hour at the DMV doing anything I need to, with productive and helpful staff who seemed educated about rules, requirements, and best practices. I didn't even get a bill in the mail for it! It's almost like some states/municipalities actually fund things and care about it, and they have good results.

JKCalhoun 7y ago

Also, deregulate the cable/satellite TV market so you can sell across state lines … we'll see costs to the consumer plummet. /s Not convinced the free market will work for health insurance.

ihm 7y ago

> In a year, every other advertisement on TV would be for health insurance, like it is with car insurance now. It's strange to see someone say this like it's a good thing. Almost no one wants to "shop for the health insurance they need". They want to show up when they need care and receive it, and not have to think about it.

LoSboccacc 7y ago
dunno, since the car insurance market was deregulated in italy (or better: regulated for transparent competition, which is different in some ways) my premium went from 1200/yr to 250/yr and I'm not receiving a worse service for it. it's all about in how the regulation is carried out. paperless data transfer between company, ban on exit and transfer fees, standardized risk assessment that's binding for all companies allowed a healthy competition.
- C1sc0cat 7y ago
  id take a look at the small print if I where you based on what happens in the UK
  - LoSboccacc 7y ago
    of course, most insurers are basically running a scam operation. that was happening before irregardless of changes that were introduced to protect customers.
TheRealDunkirk 7y ago
> It's strange to see someone say this like it's a good thing. I'm saying that, because the situation would imply a price war for health insurance, which -- crazy me! -- I think would be good for everyone.