The ACA’s loss ratio rules don’t apply to self-funded plans (many large employers use these) even if they’re administered (and possibly re-insured) by a health insurance company, which is usually the case. Just doesn’t apply at all.
Certain plans also allow much lower loss ratios, like 60/40 for expat plans.
A provider that manages to have a lot of new plans in a given state in a given year is immune from loss ratios rules in that state, for that year. I don’t know how gameable this is but my WAG would be it’s only state insurance commissions preventing this from being the case in every state, every year, for every provider, and keeping it to only some states in some years for some providers (I bet the biggies manage to rotate their state[s] and have at least one most years)
So a company the only business of which is health insurance can easily spend far less than 80 or 85% of income on payouts, and only need maintain that ratio on some subset—possibly small—of the premiums it’s collecting.
I don’t know how the game of this affects decisions for insurers that also own providers, but I bet there’s something beneficial there and that’s why they’ve been snapping up provider offices for the last several years.
This is one of those things we state as a normative absolute in general society and you usually only see the nuance (or how it’s basically just a polite lie, in some cases) in relevant college classes or spaces dominated by certain kinds of professionals and nerds (the kind who took those college classes, usually).
I can’t begin to relate to seeing someone with a median income failing to donate to some particular go-fund-me as the same as choosing to head an organization that makes more money when people don’t get the health care they need, and overseeing operations that did that even more recklessly than the industry standard. One has taken on a business relationship already and is taking people’s money then screwing them, at a mass scale. The other just didn’t donate to a gofundme that may not even be legit and for someone they have no connection to.
Similar reaction for the other examples. I’m baffled that they look similar to anybody at all.
[edit] hold on, ok, another angle that may clear up why I’m confused: if my health insurer denies my legit claim, should I be more, less, or equally angry with the leadership of that company, or with every single person in the country who fails to donate to my resulting gofundme? I’m immediately inclined to wish horrible things on one of these groups, and to find the idea of wishing horrible things on the other confusing and repulsive.
Interesting, tried Vermont but couldn’t find it (a 2015 single-payer effort, but not that), will look more later, I’d love to see what a state-level law at governments taking over hospitals and such even looks like, gotta be some weird reading and I have no idea how you’d write that such that it’d have a prayer of surviving court challenge—seize poor people’s houses to give to companies (or, on behalf of a company that then backs out, and all you got was wrecking some of your own citizens’ houses, lol) you’re all good according to the courts, but do basically the reverse? No way that’d fly. Those proposals have to be crazy reads.
I’d maybe vote against state level single payer, let alone taking over healthcare entirely, because I think it’d be a ton less efficient than doing it at the federal level—enormous amounts of money already go to various federal healthcare programs and it’d be better to pool that, and also lack of state level control over their markets is likely to cause problems. I dunno, it might depend on the law, but my gut reaction is a “no” vote on that, too.
Anyway, as for the other question, I believe that the rise of the postwar think-tank industry (a mash up of k-street and Madison Avenue, but for white papers, as it quickly became) and deliberate party and industry efforts to shift public sentiment in pro-market directions, tied up with lots of government spending on anti-Soviet messaging (were they bad? Oh, yeah. Were all the things the government tried to lump in with them and decry as un-American bad? Ehhhh… I mean atheism is among those, see the change to the pledge and to our money at the time, among other things, and I think atheism’s fine) is probably why healthcare can be this incredibly messed-up and nationalization remains not just not-popular-enough-to-pass, but entirely outside the Overton window, yes.
> Was this guy uniquely evil, as far as health care executives go?
I think if you poll the people taking this as a good thing, you will get an overwhelming answer of “probably not”, and the implications are exactly what you suppose.
Literally everyone I know IRL was like, “nice. More please.” I was actually surprised and heartened to see the initial HN thread, even, was overwhelmingly supportive.
This is top of my list for conversation topics to steer things toward when I’m around Republican relatives, so we’ll have something we can agree on.
Law-abiding doesn’t mean much when you can kill lots of people for money and remain within the bounds of the law. Killing one such person is definitely far less bad than killing a bunch of people arbitrarily. Yet only one of these cases is illegal, and it’s the better of the two.
This is kinda true, even with a generous take on the CIA: they don’t want rogue freebooters screwing with their plans—why, you might destabilize a democracy they weren’t planning to replace with a dictatorship!
But also the trading reputation of a country is kinda a common good that individuals can profit by tarnishing, which makes it a prime target for very-valid and probably-a-good-idea regulation of that sort.
Yes, I agree that is at least one reason that happened, and possibly the main one.
I think the Nation’s quote of him on the topic points out something that may be true, which is that he might have balked at doing it given how many people would be laid off (hundreds of thousands, surely) and what the optics of that would be, though I kinda doubt the quote itself.
But yeah, even if he’d been gung-ho behind it, it wasn’t happening.
Yes, we pay more per-capita for our public healthcare system than some countries do for universal coverage, but we don’t cover everyone. Just for the public parts.
Once you actually tally up how many people are having their healthcare paid for by public dollars—local, state, and federal workers plus retired; the military, active and retired; Medicare (old people); Medicaid (poor and disabled); CHIP (poor kids); the families of some of those categories; et c—it’s really not the case that moving to entirely public-funded would even be as big a leap as one might suppose. A whole lot of people already have government-funded healthcare.
What we really lack, that every single other OECD state I’ve looked at has as a feature of their healthcare systems, is more-aggressive price controls, either set directly or via partial or complete monopsony. We’ve sniffed around at it, but never taken a full bite.
Sure, the actual universal element of other OECD healthcare systems is price controls, de facto or direct, not necessarily whether private insurance still exists. I don’t think even a majority outlaw private insurance, and it’s a major part of quite a few.
The ACA’s loss ratio rules don’t apply to self-funded plans (many large employers use these) even if they’re administered (and possibly re-insured) by a health insurance company, which is usually the case. Just doesn’t apply at all.
Certain plans also allow much lower loss ratios, like 60/40 for expat plans.
A provider that manages to have a lot of new plans in a given state in a given year is immune from loss ratios rules in that state, for that year. I don’t know how gameable this is but my WAG would be it’s only state insurance commissions preventing this from being the case in every state, every year, for every provider, and keeping it to only some states in some years for some providers (I bet the biggies manage to rotate their state[s] and have at least one most years)
So a company the only business of which is health insurance can easily spend far less than 80 or 85% of income on payouts, and only need maintain that ratio on some subset—possibly small—of the premiums it’s collecting.
I don’t know how the game of this affects decisions for insurers that also own providers, but I bet there’s something beneficial there and that’s why they’ve been snapping up provider offices for the last several years.