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I’m a former health insurance CEO and this is what Obamacare repeal will do

Scorpio

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#1
Opinion: I’m a former health insurance CEO and this is what Obamacare repeal will do
By J.B. Silvers
Published: Jan 3, 2017 10:35 a.m. ET



It’s easy to predict what induced uncertainty from Congress will do even if the implementation of Obamacare repeal is delayed, says J.B. Silvers




KAREN BLEIER/AFP/Getty Images
Obamacare premiums are jumping. What will change if the program is repealed?
There’s a joke among insurers that there are two things that health insurance companies hate to do — take risks and pay claims. But, of course, these are the essence of their business!

Yet, if they do too much of either, they will go broke, and if they do too little, their customers will find a better policy. This balancing act isn’t too hard if they have a pool sufficient to average out the highs and lows. I speak with some experience as the former CEO of one of these firms.

Employee-sponsored insurance has fit this model fairly well, providing good stability and reasonable predictability. Unfortunately, the market for individuals has never worked well.

Generally, this model forces insurers to take fewer risks so that they can still make money. They do this by excluding pre-existing conditions and paying fewer claims. In such a market, fewer people are helped, and when they are able to get insurance, they pay a lot more for it than if they were part of an employee-sponsored plan.

The Affordable Care Act changed all of this. Companies were required to stop doing these bad things. In exchange for taking on substantially more risk of less healthy patients, they were promised more business by getting access to more potential customers.

The federal government offers subsidies to help pay the premiums for consumers whose income falls below a certain level. The law also stipulates that all people must be covered, or they face a penalty. This so-called individual mandate also guaranteed business for the insurance companies, because it led healthy people into the risk pool.

To entice insurers into the market, the ACA also offered well-established methods to reduce risk. For example, it built in protections for insurers who enrolled especially sick people. It also provided backup payments for very high-cost cases and protected against big losses and limited big gains in the first three years.

The initial exit of some latecomers and undercapitalized minor entrants is almost certain to become a flood of firms leaving the exchanges.

These steps worked well in establishing a stable market for Medicare drug plans when this program started under President Bush in 2006. Competition there is vigorous, rates are lower than estimated and enrollees are satisfied. In other words, the market works well.

But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12% of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the startup years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.

It is no wonder that this year they have dramatically increased premiums, averaging 20%, to compensate for the extra risk they didn’t factor into the original lower rates. In contrast, underlying health costs are rising at about 5%.

Repeal and delay is naive
And now comes the reality of the “repeal and replace” initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules.

Some in Congress seem to think that passing the “repeal” part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naive notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense.

Even if a company reaches break-even in the “delay” years, it will lose when the repeal is effective. If the premium subsidies now available to lower-income enrollees go away immediately and the mandate to sign up for an insurance plan disappears, then the number of people purchasing individual policies on the exchanges will drop like a rock. In fact, it is clear that even debating this scenario is likely to be self-fulfilling, since insurers must decide on their participation for 2018 by the late spring of 2017. Look for many to leave then.

When the risks are too high, just exit
It is easy to leave a market when things look bad. The health plan I oversaw, although top-rated by JD Powers, was losing huge amounts when I took over. Part of the turnaround we put into place was to withdraw from a number of counties where most of the losses were occurring. The same will be the case in the ACA exchanges.

It is easy to predict that this induced uncertainty from Congress will effectively kill the exchanges even if it delays the implementation of repeal. As a result, all of the individuals who have benefited from coverage and subsidies will lose out. They will either not be able to gain insurance because of a pre-existing condition, or they won't be able to afford the higher premiums.

When they leave the market, it is also easy to guess that the political and economic price will be substantial in terms of patient access, provider uncompensated care costs and employment in the health sector — a major job creator. It is hard to predict these costs, but they could be into the billions of dollars. And, the health of millions could be jeopardized.

Pacific Research Institute President and CEO Sally Pipes on how Congress can repeal ObamaCare without stranding insured patients. Photo: iStock

Is there any way out of this dilemma for those who don’t like Obamacare? Clearly the first principle, since all of the solutions suggested rely on private insurers, is to reduce the level of risk for them — the opposite of what we are doing now. Even House Speaker Paul Ryan’s proposals rely on private firms which will be loath to trust the game they are asked to play because of the dramatic changes to the rules.

If we want them to continue to do the good things required by the ACA, we can’t make it so uncertain. What this means is that the mechanisms designed to reduce risk and a stable set of operating arrangements must be reaffirmed as core principles of all reform and replace efforts. This shouldn’t be hard for market-oriented Republicans, if they can leave behind their political baggage. Blind talk of repeal with no clear way to build confidence among the private insurers, which will be needed in the replace phase, leads to market failure.

Like the dog that finally caught the car it had been chasing and doesn’t know what to do, what comes next for the administration and Congress isn't clear. But we shouldn’t fool ourselves to think it will be easy or painless. Otherwise, it may be that the great experiment trying to establish a viable market for individual insurance — ironically long a conservative objective — will end in the chaos of what came before.

J.B. Silvers is a professor of health finance at Case Western Reserve University. This was first published on The Conversation and is republished with permission.

http://www.marketwatch.com/story/im...are-repeal-will-do-2017-01-02?link=MW_popular
 

anywoundedduck

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#2
Basically, the OCA gave free medical care to those with little or no income.
Basically, the OCA gave free medical care to people who have never had the inclination to go to work.
NO MORE FRIGGIN HANDOUTS TO THE PHYSICALLY ABLE.

There, that fixed it.
 

gliddenralston

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#3
Gop plan is to repeal & replace with nothing! I got a feeling its going to get a lot worse and may never get better.
 

D-FENZ

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#4
Gop plan is to repeal & replace with nothing! I got a feeling its going to get a lot worse and may never get better.
It may get worse but "worse" would only depend on your interpretation. If you are currently getting something for nothing then your concern may well be valid. But for those of us paying for other's health care it will most likely improve- however marginally.

The damage has already been done. With the passage of the ACA, health care has morphed into a right. Pulling the eaters off of the tit will not be easy and may be impossible. It was the plan all along.
 

Uglytruth

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#5
Basically, the OCA gave free medical care to those with little or no income.
Basically, the OCA gave free medical care to people who have never had the inclination to go to work.
NO MORE FRIGGIN HANDOUTS TO THE PHYSICALLY ABLE.
Your talking about rapeugees & illegals also right? Healthcare not just for welfare people anymore.
 

Irons

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#6

But we shouldn’t fool ourselves to think it will be easy or painless.
I hope it is truly painful for you, oh mighty insurance company. Your industry is the source of the problem and jumping in bed with a communist community organizer for some quick bucks and bonuses was short sighted. Even for you.

I hope you go under, I hope you die and I hope you rot. Whatever comes around to replace you could hardly be worse.

.
 

anywoundedduck

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#7
Gop plan is to repeal & replace with nothing! I got a feeling its going to get a lot worse and may never get better.
I hope you are right! Why do hard working Americans have to pay for lay abouts and illegal A-Holes medical needs?
They are already being fed, clothed and sheltered by us. That needs to change, as well!
Perhaps if Trump concentrates on deportation of illegals, in addition to cutting them off of all Federal assistance might get this country moving in the right direction. Cutting off foreign aid to all countries ruled by despot dictators is also needed.
 

Usury

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#8
Notice the article is written by a "professor"....with an obvious liberal-leaning slant. I'll interpret: O-Care is/woulda/coulda been wonderful if not for those pesky Republicans in Congress that are too stingy to pay-up. Nevermind that this travesty is on track to bankrupt the entire industry (individuals, providers and insurers) and perhaps the country with all the BS subsidies.
 

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#9
With double and triple premiums, and deductables which are unreachable, most of us who have had to suffer through this abomination known as Obamacare would see a repeal and replacement with nothing as a huge improvement. As the law stands right now, it is pretty much useless to the average working class American, and a huge burden on all businesses.
 

TAEZZAR

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#10
As long as we are dependent on a 3rd party to pay our bills, we will continue to be F^^^^D
Think what would happen to food costs if we had insurance to regulate & pay our food costs !!!
Back in the 1950's (prior to the insurance scam) an office visit was $5 & other costs were affordable, including surgery. Today, with the insurance scam, an office visit is $400 ++ & surgery in the $100,000 ++++ !!!!!! WTF, over.
 

Irons

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#12
Not that long ago if you worked full time you had employer provided health insurance. If you wanted better insurance you got off your ass and got a better job.
NAFTA destroying manufacturing jobs destroyed the insurance pool. Now the companies are chasing millions of fewer customers and offering garbage coverage for ridiculous prices and wondering why nobody is buying.

Huh, kinda just like GM putting tens of thousands of their most loyal customers in the unemployment line and then standing there with their thumbs up their high management asses wonder why nobody is buying their cars anymore.

You must need a 4 year degree in fucking idiot to come up with this stuff.

.
 

TAEZZAR

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#13

ToBeSelfEvident

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#14
The damage is already done. The 30-hour work week is already the standard. Every health provider has already paid tens of thousands for ACA-compliant EMR (electronic medical record) software. The govt now has access to your complete medical history. We will not be returning to (private) paper medical charts.

I would be happy if they just got rid of the mandate/penalty.
 

Aurumag

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#15
I always liked the idea of paying cash for a competent MD, with house-calls and all that quaint, archaic service, while paying insurance to cover traumatic injuries only.

I alone am responsible for the condition of my immune system, heart, liver and kidneys.

Aside from my own family members, I am NOT responsible for paying the medical bills of others who lack the responsibility to care for themselves.

The Communist planks are rotting beneath our feet.
 

Goldhedge

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#17
I can hear the left already...

But the insurance CEO's make MILLIONS of dollars in salary! That's unfair!!


But the OP has a point. Before you kill it, either fix it, or have something viable to replace it before the SHTF!
 

anywoundedduck

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#18
I can hear the left already...

But the insurance CEO's make MILLIONS of dollars in salary! That's unfair!!


But the OP has a point. Before you kill it, either fix it, or have something viable to replace it before the SHTF!
Reverse the clock to before this bill passed. That is what reality will be. Illegals and layabouts will no longer have a free plan. They will go to the emergency room for a stumped toe, instead of their own doctor. It was paid for before, the indigent got healthcare as needed, and the state and the hospital worked fees out through state run Medicaid. At least we weren't paying premiums 10 times as much, or more. This fucking ACA is nothing but a scam to quickly eleminate the middle-class.
Well, fuck the Democrats, and anyone else wanting a free ride. There is a new Sherrif in town.

Yahoooo!!!! Giddy up!!!
 

Joseph

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Reverse the clock to before this bill passed. That is what reality will be. Illegals and layabouts will no longer have a free plan. They will go to the emergency room for a stumped toe, instead of their own doctor. It was paid for before, the indigent got healthcare as needed, and the state and the hospital worked fees out through state run Medicaid. At least we weren't paying premiums 10 times as much, or more. This fucking ACA is nothing but a scam to quickly eleminate the middle-class.
Well, fuck the Democrats, and anyone else wanting a free ride. There is a new Sherrif in town.

Yahoooo!!!! Giddy up!!!
There you go. how hard could this be ? we had insurance before "the AFFORDABLE health care act". nuke obamacare and go back to what we had prior.
Then if someone deems to improve, start from there. I had to let my long term care policy lapse after they said there will be a 76% increase in 2017.


fuck.off.jpg
 

Uglytruth

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#20
Before you kill it, either fix it, or have something viable to replace it before the SHTF!
Remember their idea is to ALWAYS GROW GOVT! They think it's job security. Little do they know they won't be needing health care as the people have bought the rope & are ready and gaining confidence by the day at any given moment.
I expect them to crash it & piss everyone off. You are already stuck stuck with 8 years of 25% YOY increases & higher deductibles...... your wages are stagnate, zero interest rates and then they bitch cuz you ain't going out to eat enough, buying new cars, try to find the best deals online to bypass taxes, etc................ f'em!

I ordered something online yesterday for $369 delivered. Prices for same item, brand, pn, ranged from $369 to $469 with most in the $420 area.
 

Usury

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#21
I can hear the left already...

But the insurance CEO's make MILLIONS of dollars in salary! That's unfair!!


But the OP has a point. Before you kill it, either fix it, or have something viable to replace it before the SHTF!
Why do we need .gov to "save" us or "fix it". IMO, that's faulty thinking....we can do it better w/o them.

duck is right...they will just go to the ER and continue to clog them up for minor stuff so they don't have to pay up front. The heck of it is that ACA was supposed to fix that problem but it's actually made it worse. Even though these people have insurance, they still don't want to pay the co-pays and deductibles, so they are even MORE likely to go to the ER now because they think they at least have some insurance and know they won't have to pay anything up front. So let's see: ER--worse for everyone, bills--worse for everyone, total cost of scenarios--worse for everyone. Everyone's a loser with the ACA. E-V-E-R-Y-O-N-E. Even those few feeling good b/c they're getting a free ride for the moment will be losers when the insurance morphs into something completely useless and unaffordable for even them. Got math?
 

anywoundedduck

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#22
Why do we need .gov to "save" us or "fix it". IMO, that's faulty thinking....we can do it better w/o them.

duck is right...they will just go to the ER and continue to clog them up for minor stuff so they don't have to pay up front. The heck of it is that ACA was supposed to fix that problem but it's actually made it worse. Even though these people have insurance, they still don't want to pay the co-pays and deductibles, so they are even MORE likely to go to the ER now because they think they at least have some insurance and know they won't have to pay anything up front. So let's see: ER--worse for everyone, bills--worse for everyone, total cost of scenarios--worse for everyone. Everyone's a loser with the ACA. E-V-E-R-Y-O-N-E. Even those few feeling good b/c they're getting a free ride for the moment will be losers when the insurance morphs into something completely useless and unaffordable for even them. Got math?
These friggin politicians must think we are brain dead when they tried to pull this shit on us. A lot of us have finally woke up to recognize Obamacare as the scam it truly is! This alone may have been the deciding issue. People don't like getting their pockets picked.
 

TAEZZAR

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Government should NOT be in business, ANY business. They fuck up everything they touch !!!
 

itsamess

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#26
From Trumps twitter (read from bottom up)


  1. Donald J. Trump ‏@realDonaldTrump 15h15 hours ago
    massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight - be careful!

    11,068 replies 11,494 retweets 42,762 likes








  2. Donald J. Trump ‏@realDonaldTrump
    15h15 hours ago
    like the 116% hike in Arizona. Also, deductibles are so high that it is practically useless. Don't let the Schumer clowns out of this web...

    5,400 replies 9,295 retweets 35,957 likes









  3. Donald J. Trump ‏@realDonaldTrump
    15h15 hours ago
    Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases......
 

Usury

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#27
Exactly Don...Exactly.
 

Joe King

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#28
Government should NOT be in business, ANY business. They fuck up everything they touch !!!
Well that would certainly explains things.

Our gov has been secretly touching itself for many decades now, and has obviously gotten itself caught in an endless feedback loop.

That's the only thing it could be.
 

andial

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#29
From Trumps twitter (read from bottom up)


  1. Donald J. Trump ‏@realDonaldTrump 15h15 hours ago
    massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight - be careful!

    11,068 replies 11,494 retweets 42,762 likes








  2. Donald J. Trump ‏@realDonaldTrump
    15h15 hours ago
    like the 116% hike in Arizona. Also, deductibles are so high that it is practically useless. Don't let the Schumer clowns out of this web...

    5,400 replies 9,295 retweets 35,957 likes









  3. Donald J. Trump ‏@realDonaldTrump
    15h15 hours ago
    Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases......
Trump is right on target here the demscum own this mess we have to be careful of Ryanscum turning this into our problem.
 

917601

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#30
We.are.doomed.either.way......the problem is the price doctors, hospitals, nurses, drug companies are allowed to charge! I have been all around God's green earth....Russia, doctors make top end middle class wages and still do house calls,....South America, a tube of medicine for a nasty fungus infection there was $6, here, by prescription only, $80!...lasik, in Bogota, $600 both eyes, here, $4000 plus,....one day hospital stay here, $10,000, there, couple hundred bucks all inclusive.....there, the druggists give shots at the counter, here, a doctors office visit, $250 plus......how to cut their way out of line wages?.. No idea...
 

Joe King

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#32
The problem is control and insurance companies are just as bad as the government. I would like to see both of them get out of health care.
That's the only real solution I can see.

Today, just to be able to go see a doctor, not only are you paying for the doctor and his/her staff, you are paying the wages of the insurance company's employees and their investors as well as many gov employees.

All that cost has to somehow be added into the overall cost of healthcare. Which is why we have such crazy prices for healthcare. Too many fingers in the bowl.
 

CrimsonGuardJay

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#33
As long as we are dependent on a 3rd party to pay our bills, we will continue to be F^^^^D
Think what would happen to food costs if we had insurance to regulate & pay our food costs !!!
Back in the 1950's (prior to the insurance scam) an office visit was $5 & other costs were affordable, including surgery. Today, with the insurance scam, an office visit is $400 ++ & surgery in the $100,000 ++++ !!!!!! WTF, over.
12 year health insurance agent, those figures are exaggerated. Even in the northeast, a doctor visit, self pay is more like 80-120. Trust me, that isn't the problem.
 

TAEZZAR

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#34
We.are.doomed.either.way......the problem is the price doctors, hospitals, nurses, drug companies are allowed to charge! I have been all around God's green earth....Russia, doctors make top end middle class wages and still do house calls,....South America, a tube of medicine for a nasty fungus infection there was $6, here, by prescription only, $80!...lasik, in Bogota, $600 both eyes, here, $4000 plus,....one day hospital stay here, $10,000, there, couple hundred bucks all inclusive.....there, the druggists give shots at the counter, here, a doctors office visit, $250 plus......how to cut their way out of line wages?.. No idea...
Absolutely spot on !!
Back in the 1983, I got an injection in Lima Peru to help with my back pain, it was very effective. It cost me $3. It was Dolo-Neurobion. It is available all around the world EXCEPT here !!
It is made my MERCK !! I found this medication in Tijuana, Mexico, for $6 !!!!!!!!!!!!!!!!! I injected myself every couple of weeks for over 2 years, without any side effects.

BTW, the contents are in 2 vials - Vial 1 - Vit. B1, 100 mg, Vit. B6, 100 mg, Vit. B12, 5000 mcg - Vial 2 - Dipirona, 1 g & Lidocain, 30 mg. Nothing in here is, in any way, a dangerous drug !!

This made it quite clear to me that our medical business is more interested in $$$$ than cure. With costs like this ($6), how can they live so high ?
 
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TAEZZAR

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#35
12 year health insurance agent, those figures are exaggerated. Even in the northeast, a doctor visit, self pay is more like 80-120. Trust me, that isn't the problem.
those figures are exaggerated BULLSHIT !!
I disagree, would you like to see a COPY of my medical bills, I have 2 doctors that CHARGE $400 FOR A FUCKING OFFICE VIST !!!!
I believe this is due to the insurance company's manipulation of the bills & is the only way a doctor can get something when the insurance co's are done.
It is not the fault of the doctors, both doctor & patient are VICTIMS of the 3rd party interference ! Health insurance is a SCAM
 

Irons

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#36
When it comes to the medical racket in the US just remind yourself there is no money in cures.
They want to treat you. They want to treat you often and in person and for the rest of your life.
Eat right, keep in shape and exercise.
Like the court system, your best bet is to stay as clear of it as possible.

.
 
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Howdy

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#37
When it comes to the medical racket in the US just remind yourself there is no money in cures.
They want to treat you. They want to treat you often and in person and for the rest of your life.
Eat right, keep in shape and exercise.
Like the court system, your best bet is to stay as clear of it as possible.

.
So true. This is what makes it easy to avoid insurance companies. Spend a little more on healthy food instead.
 

Uglytruth

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#38
Brother was in hospital for 3 days for an emergency. Bill was 55K They gave him pills I get a 90 day supply for $10 & they were charging $30 3 times a day......... no operation or anything just some testing.
He paid $50 month for a while on the bill then simply quit paying. If it had been a FAIR BILL of say 5K or even $7500 he would still be paying........ 55K = FU.
Yes that is why our rates are to high because they get stiffed for being thief's. Like the govt they think it's their money. I hope every one of them when needing a plumber or mechanic get overcharged. Hey maybe we could start a billing service for tradesmen. You know the first line on the form is "occupation" so we know how much to F you.

There is a LOT of middle man administration costs between the Dr. & the patient.

I would ranter have a 10K or 20K deductible policy in case I'm in an accident and run up a 500K bill & pay for the rest on the spot. 10K I can figure something out....... 500K I'm BK.
 

ErrosionOfAccord

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Coal Country
#40
In the end repealing the law even if it isn't replaced, will cost a ton of money. I watched the companies I work for struggle with the new laws for eight years, that struggle wasn't free. Likewise the whipsawing going on in the insurance companies isn't cheap either. The implementation cost had to be huge. Regulation IS the problem. Drop it and the cost of medicine goes down. More often than not I could do some of my own labs if I had access to a lab, but I don't, and have to go to a doctor to have them done. Same with many prescriptions. There are legitimate fears in letting the populace dose themselves, such as the overuse of antibiotics and resistant strains but, a few competitive well written wiki's could alleviate many, many office visits. The ex used to get UTI's on a regular basis we knew what she needed but had to schedule an appointment, often days out, when a simple trip to the pharmacy would have sufficed. I should have went long on this stuff.