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Wednesday, February 3. 2010

A regional health care plan for New England?

Thinking creatively about medical insurance. He says:



It was pretty crazy for Congress to decide under McCarran-Ferguson that the insurance business should be balkanized into 50 state markets.


Nowhere is the craziness more severe than in New England, where state insurance pools are tiny and health-insurance and health-care costs are the highest in the nation. Even a medium-sized state, say North Carolina (population 9.2 million), would largely escape this problem.


Posted by Bird Dog in Hot News & Misc. Short Subjects at 14:12 | Comments (5) | Trackbacks (0)

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Consolidation among carriers is not a significant cause of health care cost or premium increases. See this recent NBER study: http://www.nber.org/digest/feb10/w15434.html

Higher costs and premiums in the Northeast and New England than elsewhere are primarily due to more state mandates than elsewhere and due to guarantee issue and community rating. The Northeast and New England having higher proportions of elders in their populations further exacerbate community rating pushing costs on to others.

Alabama's Blue Cross has lower rates than competitors because it has more restrictions in its coverage and grinds down provider reimbursements further.
Interesting that Pres. Obama didn't mention Hawaii, where Blue Cross also has a virtual monopoly, although better coverage provisions.
ObamaCare would end up more resembling Alabama than Hawaii.

No where in the US Constitution is insurance regulation a federal matter. McCarran-Ferguson simply made that clear.
On the other hand, if some state themselves chose to band together in their regulation, that's up to them, and still not a matter for the feds.
President Obama is just going about his usual threat and demonize route toward all domestic political issues. He should, instead, try that where more called for, abroad.
#1 Bruce Kesler on 2010-02-03 15:06 (Reply)
Having worked briefly for The Blues as a consultant, I fully support Bruce Kesler's analysis.

If the feds want to do something worthwhile, they could gather data from throughout the marketplace to better inform the consumer what the average cost of a proceedure in a given area is. They might have sufficient info already given their role in Medicaid/Medicare/VA, etc.

I cannot remember where I saw it, but some physician took time off to compare costs for MRIs in two Texas mid-sized cities that were reasonably close to one another (McAllen vs. Corpus Christi?). The notable difference would suggest that a consumer could save greatly by driving an hour or so to the less expensive location even considering the price of gas. Only in healthcare do we undergo treatment without the foggiest idea of the cost prior to getting such services/devices/phara. Big mistake!
#2 jma on 2010-02-03 16:01 (Reply)
When I was unemployed, I got a plan with a $5,000 deductible. I called around to get the price for my annual female exam. I could get the price for the exam, but forgot to ask how much the lab work would be. Or which tests they would do.

I thought I had a urinary tract infection. My internist would have charged $90 to see me to diagnose; my gyn $50. I went to the gyn. The really useful information would have been that I could have gotten a kit at Walgreen's for $13 and peed on a stick at home. I sure wish someone at the doc's office had tole me that, especially as I was very clear that the reason I was asking for the price was that I was paying for this out of my unemployed pocket.

People do make decisions based on price. But only when we are the ones paying.
#2.1 the gold digger (Link) on 2010-02-03 20:23 (Reply)
The states can try this now. IMO no change in law is required. But that is never a sure bet.

States can make pacts with other states. See Article I, Section 10. But they cannot do so without the consent of Congress.

So the states of New England should design a regional plan if that is what they want. Then ask Congress to vote yea or nay.

Unfortunately Article I, Section 10 is not very clear. i.e. exactly what does the Consent of Congress mean? How is it to be expressed? Can it be revoked? etc.
#3 KTWO on 2010-02-03 16:15 (Reply)
Article I Section 10 does not prohibit nor require an act of Congress fior states to organize a regional insurance pool:

No State shall enter into any Treaty, Alliance, or Confederation; grant Letters of Marque and Reprisal; coin Money; emit Bills of Credit; make any Thing but gold and silver Coin a Tender in Payment of Debts; pass any Bill of Attainder, ex post facto Law, or Law impairing the Obligation of Contracts, or grant any Title of Nobility.

No State shall, without the Consent of the Congress, lay any Imposts or Duties on Imports or Exports, except what may be absolutely necessary for executing it's inspection Laws: and the net Produce of all Duties and Imposts, laid by any State on Imports or Exports, shall be for the Use of the Treasury of the United States; and all such Laws shall be subject to the Revision and Controul of the Congress.

No State shall, without the Consent of Congress, lay any duty of Tonnage, keep Troops, or Ships of War in time of Peace, enter into any Agreement or Compact with another State, or with a foreign Power, or engage in War, unless actually invaded, or in such imminent Danger as will not admit of delay.
#3.1 Bruce Kesler on 2010-02-03 20:01 (Reply)

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