September 24, 2009

When Axelrod starts yammering inapt polysyllabic "e" words, you know he's lying.

"That is not endemic to the kind of reforms that we are proposing... We're not into symbolic expedition here."

That really jumped out at me, from an interview with Wolf Blitzer, who asked Axelrod to explain why health care reform can't permit private insurers to sell their policies across state lines:
AXELROD: Because we are trying to do this in a way that advances the interests of consumers without creating such disruption that it makes it difficult to --

BLITZER: Why would that be disruptive if Blue Cross and Blue Shield or United Health Care or all these big insurance companies, they don't have to worry about just working in a state, they could just have the opportunity to compete in all 50 states.

AXELROD: But insurance is regulated at this time --

BLITZER: But you could change that --

AXELROD: State by state.

BLITZER: The president could propose a law changing that.

AXELROD: That is not endemic to the kind of reforms that we are proposing or that --

BLITZER: Why not, why not?

AXELROD: We're proposing a package that we believe will bring that stability and security to people, will help people get insurance, and will lower the cost impact and pass the Congress. And that has to be the test. We're not into symbolic expedition here.
What a strange way to talk. And what a good question from Blitzer.

90 comments:

AllenS said...

I'm left wondering what Eboma thinks.

WV: mutica

Future health care insurer.

Shanna said...

Congrats to Wolf Blitzer for asking good questions.

Hoosier Daddy said...

I always knew Blitzer was a racist.

PatHMV said...

My lord, an actual, intelligent question asked by a CNN reporter. Never thought I'd see the day.

At this point, I'd like to see them just pass a bill which sets some bare-bones minimum requirements for insurance sold across state lines (specifically leaving untouched by the feds insurance sold only within a single state), and a refundable tax credit for people below the poverty line to buy insurance. Plus make insurance tax deductible whether purchased by the employer or the employee, and then call it a day, sit back, and see what happens with those relatively minor changes to the system.

Hoosier Daddy said...

What a strange way to talk. And what a good question from Blitzer.

Yes it was a good question. Actually, a better follow up to Axlerod's We're not into symbolic expedition here. would have been:

What the fuck does that even mean? But then I guess he'd sound like O'Reilly.

rhhardin said...

He probably wanted angelic.

Big Mike said...

Could this possibly mean that even Wolf Blitzer is starting to spit out some of the Kool-Aid?

jayne_cobb said...

Blitzer is just trying to make up for his appearance on Jeopardy.

DADvocate said...

The Obama administration wants eventual take over of all health care insurance. Enabling private health insurance companies operate more effectively and inexpensively defeats that goal.

craig said...

It is probably mis-transcribed and should have said "we're not on a symbolic expedition", but it's still a stupid statement. Axelrod is just trying to pull off a Jedi mind trick to deflect the questioner: "these aren't the reforms you're looking for".

Rich B said...

As they say, the country's in the best of hands. This is ugly and is just going to get uglier. As much as I enjoy the Obama administration's collapse, they sure can do a lot of damage before they're done.

AJ Lynch said...

I saw that clip live. Axelrod was floundering badly.

He and Prez Obama have been unable to craft a few nice, tidy soundbites that justify the govt taking over 15% of our economy.

Balfegor said...

About selling across state lines, I'm wondering what -- concretely -- the issue there is. Is it that states actually prevent insurers registered in other states from offering plans with insured pools crossing state lines? Or is it draconian regulation of pooling and premium pricing (e.g. community rating, or requiring coverage of pre-existing conditions) that simply make it nonsensical for insurers to pool across state lines (e.g. because the premiums would be jacked up uneconomically in the low-cost states)?

When we talk about insurers offering plans across state lines, what's really needed (for cost reductions) is for insurers to be able to offer plans on the same terms across state lines, i.e. that when a man from New York buys a plan from Texas (or wherever), he gets the same terms as any man from Texas, and the insurer is not looped into complying with a thicket of absurd NY regulations. What problems -- concretely -- does that run into?

David said...

The new L word.

He's L . . . ing on behalf of the President, whom we must never accuse of L . . . . ing.


wv=redmiz "Sitting Bull's Wife."

David said...

Blitzer isn't stupid. He is a decent newsman, but even he does not write all the copy or determine what the stories will be.

Roux said...

Alexrod showed that he does know one thing. All these things are regulated at the state level.

How will the Feds in one law override all state laws?

traditionalguy said...

I think Axelrod wants to move on to Cap and Trade. The continual need for more and more lies in the health care take over fight is impairing the credibility they will need to inspire us with 100% BS about evil Carbon Footprints lurking amongst pure people that suddenly requires the Mother of All Taxes.

Pogo said...

Ted Kennedy was able to deregulate the trucking industry, via the Motor Carrier Act of 1980, and remove government control over airfares, plane routes and market entry of new airlines via the Airline Deregulation Act of 1978.

Axelrod and Obama are lying if they say it's not possible with insurance.

Meade said...

Obama lies but he can't be blamed. Lying is endemic to his Senior Advisors' expeditions.

Rich said...

Balfegor said:

When we talk about insurers offering plans across state lines, what's really needed (for cost reductions) is for insurers to be able to offer plans on the same terms across state lines, i.e. that when a man from New York buys a plan from Texas (or wherever), he gets the same terms as any man from Texas, and the insurer is not looped into complying with a thicket of absurd NY regulations. What problems -- concretely -- does that run into?

Those of us concerned about this worry about the credit card effect. Credit card regulation now is much like what you are talking about: the only regulation that counts is that of the state where the issuer is located, and the state where the card is actually issued has nothing to say about it. There's a reason credit card issuers locate themselves in either Delaware or South Dakota. That's because those two states have the most lax regulation in re credit cards.

So if we let insurance companies be regulated only by the state where they locate, and then just swoop in and start selling policies in the other 49 states without any oversight there, then whatever state becomes the South Dakota (i.e. the most lax regulator) of the insurance industry becomes the de facto regulator for the entire country. That's the "race to the bottom" scenario you hear about from time to time.

The concern here is a function of the fact that many, and I include myself, think the insurance industry cannot be trusted to behave even close to ethically absent significant regulation. For an example of how they act when the tethers are removed take a look at what they do to people when the insurance is employment based and ERISA applies.

AJ Lynch said...

Insurance companies are licensed at the state level. New York and California have historically been the biggest ballbusters with the most regulations. Some insurance companies elect to avoid doing business in those two states. So they don't even apply to get licensed in those states.

A vanilla, catastrophic type health insurance policy can not be offered for sale in all the states because each state has varying policy requirements.

Addressing this drawback by persuading states to allow companies to sell a bare-bones, basic policy could go a long way to reducing premiums. For some reason, Axelrod does not want to try that.

Jason (the commenter) said...

There is a reason and obviously it is politically unpalatable for Axelrod to say what it is.

I assume it must have something to do with who gives certain politicians campaign contributions.

Joan said...

My lord, an actual, intelligent question asked by a CNN reporter. Never thought I'd see the day.

LOL, PatHMV. I had exactly the same reaction.

Pogo: thanks for the brief, instructive history. I was too young to be paying to attention to politics then, but those two instances make that case that deregulation should be possible.

Bob said...

What an erudite post.

Triangle Man said...

Exceptionally elegant elocution there Bob.

Balfegor said...

For an example of how they act when the tethers are removed take a look at what they do to people when the insurance is employment based and ERISA applies.

Yeah, see, you keep saying that, but I look at what you're writing and it all seems to flow from a byzantine series of regulations (ERISA), not from the ordinary action of the market.

I don't think anyone denies that when government regulations are put in, insurers will be able to rig the game in their favour. That's sort of the basic public choice theory insight -- that when you have a concentrated, organised interest group (e.g. insurers), and the opposition is diffuse and poorly organised (i.e. the rest of us), the interest group will be able to pressure political actors more effectively into implementing regulation that is favourable to them (like ERISA. Or the current health care reform proposals). The diffuse opposition is lucky if it can even get its voice heard.

How this turns into an argument for more and more draconian regulation, creating new and horrible opportunities for insurance companies to screw us over through the government, I do not understand.

garage mahal said...

Obama lies but he can't be blamed. Lying is endemic to his Senior Advisors' expeditions..

Insurance companies already can sell across state lines, they just have to be accountable to the laws of the state where they sell it. Who's lying again?

miller said...

I agree with your point that insurance companies will be like credit card companies in racing to the bottom - but that is the way of capitalism. Propping up coverage by mandating things means higher prices for everyone.

I would be perfectly happy to buy an insurance policy that doesn't cover pregnancy, for example, because the chances of us getting pregnant are close to nil. (I hesitate to say "none" because I might laugh at a stranger and then find out -- oops -- "Theo Fanny" wasn't really his name.)

Bissage said...

Actually, Mr. Axelrod’s new “tell” is much better than the old one, which was weeping blood from his deranged tear duct.

Triangle Man said...

How this turns into an argument for more and more draconian regulation, creating new and horrible opportunities for insurance companies to screw us over through the government, I do not understand.

Can you think of a hypothetical. It seems that there are relatively few ways that a health insurance company can screw you (the insured) over. They can charge more money for their coverage or deny coverage or deny payment for claims.

knox said...

I heard this exchange on the radio the other day.

That's the best Axelrod can do? He's obviously not stupid. He just doesn't even care enough to bother to make a decent argument. Or, I suppose, he could know that there isn't one. His goal, after all, is a government takeover.

Balfegor said...

Insurance companies already can sell across state lines, they just have to be accountable to the laws of the state where they sell it. Who's lying again?

If Axelrod & Co. actually thought that was a good idea, they'd probably have said exactly that, without all that weaselly hemming and hawing. They understand that such an answer sidesteps the issue.

That aside, could a dormant commerce clause argument be made that such state regulation on insurance sold across state lines violates the dormant commerce clause? Congress clearly has the power to regulate sale of insurance across state lines. And the extant state regulations do pretty significantly burden interstate sale of insurance policies.

PatHMV said...

One could, in fact, draft Congressional legislation which would create the "basic" policies which include all the things the President says he wants insurance to have to cover, and then declare that any insurance meeting those federal requirements could be sold across state lines, subject to enforcement (as with any other contract) in state or federal court... without preempting existing state laws and regulations.

This would allow all existing insurance to remain unchanged. Then, if the basic requirements were sufficiently tolerable that the insurance company could profitably offer the policy, the policy could be offered across the country, while the company also continued to market state-specific policies where it found it most advantageous to do so. In a sense, the federal regulations and the state regulations would be competing with each other.

Balfegor said...

Can you think of a hypothetical. It seems that there are relatively few ways that a health insurance company can screw you (the insured) over. They can charge more money for their coverage or deny coverage or deny payment for claims.

Yes. The new and horrible thing is that under the current health care bill, the you're faced with a choice. Either you can buy the insurance companies' product, or the government will impose a penalty tax on you and give your money to the insurance companies anyway. Heads they win, tails you lose. That sounds like a new and horrible screwing-over to me.

Rich said...

Balfegor said...
Yeah, see, you keep saying that, but I look at what you're writing and it all seems to flow from a byzantine series of regulations (ERISA), not from the ordinary action of the market.

***

How this turns into an argument for more and more draconian regulation, creating new and horrible opportunities for insurance companies to screw us over through the government, I do not understand.


miller said...
I agree with your point that insurance companies will be like credit card companies in racing to the bottom - but that is the way of capitalism. Propping up coverage by mandating things means higher prices for everyone.

I would be perfectly happy to buy an insurance policy that doesn't cover pregnancy, for example, because the chances of us getting pregnant are close to nil. ...


Balfegor, the fact ERISA is a federal law does not mean it is “regulation,” not in the sense you are using it. In this arena its primary effect is to cancel out regulation. So ERISA brings us closer to, not further away from, the zero-regulation utopia you envision.

You simply can’t go around telling an industry like this one they can commit fraud with no meaningful consequence and then expect them to behave themselves. The ERISA experience has proven that if you ask me. Since 1987 at least (that’s when the Supreme Court decision interpreting ERISA this way came down) they’ve been told do what you want and you won’t get in any trouble for it (i.e. there’s no regulation), leaving the market place as the only check on their conduct. Notable federal judges have said more or less the same thing you do: Judge Posner of the Seventh Circuit has said he thinks market forces will ameliorate the absence of regulation because who wants to buy coverage from a fraudulent insurer? It hasn’t worked. They’ve behaved disgracefully.

Miller, I agree with you that many many state mandates are ridiculous. But just as you would not want to take the worst state in that regard and make it apply to the whole country, neither would you want to take the state which is 50th out of 50 in terms of consumer protections and do the same thing. I would not mind enacting one overriding federal set of rules which provides meaningful consumer protection. I am just not prepared to leave it up to whatever state thinks it can lure the most insurers to relocate there with its extremely lax regulation.

peter hoh said...

A half-dozen GOP senators on board with a concerted effort to make cross-border health insurance part of this reform bill might make it happen. If all of them sit on their hands, it won't.

Michael McNeil said...

As I recall, it was formerlawstudent here who offered what I regard as just about the dumbest defense of all the locally state-wise restricted health insurance markets: that Congress's opening up of those markets nationwide would be a “violation of states' rights.”

Dumbest because one of the actual Constitutionally mandated powers of Congress — and where it's clearly not one of those situations where the power has been shoehorned into an area (such as growing food on one's own land for one's own consumption) which lies far beyond that mandate — is control of interstate commerce.

Balfegor said...

So ERISA brings us closer to, not further away from, the zero-regulation utopia you envision.

The things you point out about ERISA -- ways that it restricts the availability of evidence to the insured, etc. These are not aspects of a deregulated market. Those are restrictions that would be insupportable without specific government regulation stacking the deck -- otherwise, if these restrictions are as draconian as you claim, courts would probably be able to exclude them as unconscionable, under the ordinary law of contract, as courts have occasionally done in arbitration cases.

Hoosier Daddy said...

Could this possibly mean that even Wolf Blitzer is starting to spit out some of the Kool-Aid?

I don't think its Kool-Aid some of these talking heads need to be spitting out.

/ducks

grandrants said...

Huh. Blitzer is trying desperately to regain a shred of the credibility he lost in the great Celebertiy Jeopardy debacle of last week.

Dude, it's gonna take a heckuva lot more than that...

Quayle said...

Maybe Axelrod has been memorizing the dictionary to try to move up in society.

Rich said...

Balfegor said:

The things you point out about ERISA -- ways that it restricts the availability of evidence to the insured, etc. These are not aspects of a deregulated market. Those are restrictions that would be insupportable without specific government regulation stacking the deck -- otherwise, if these restrictions are as draconian as you claim, courts would probably be able to exclude them as unconscionable, under the ordinary law of contract, as courts have occasionally done in arbitration cases.

See, you believe in some regulation after all. You think the common law of contracts should apply to insurance companies.

The bad rules of evidence you point out are actually themselves a function of a lack of meaningful regulation. I will say up front that what I am about to say would not get a very good grade on a law school exam, 'cause I am trying to be brief and I readily admit I am biased against the industry and against the way the law is. But here goes:

The reason evidence is limited is that evidence tending to show an insurance company committed fraud is irrelevant because they can't be liable for fraud anyway, due to the absence of regulation. Irrelevant evidence is inadmissible.

Rich said...

I should add to my last comment that nothing in ERISA itself addresses evidence. Judges in ERISA cases have said ERISA provides no remedy so what is the point of admitting evidence of bad behavior. The evidence thing is judge-made law based on relevance given what remedies ERISA provides.

Rich said...

One last thing and I gotta walk the dogs.

It may be helpful on this across-state-lines thing to distinguish what types of regulation you're talking about. If you are talking about policy design -- what benefits the policy provides, what is the deductible and such -- then lots of my objections go away and indeed the marketplace, IMO, can very well function properly. But when it comes to enforcement -- making sure that what the policy says it provides is actually provided -- then we need some teeth, and there I don't want South Dakota being the national insurance regulator.

miller said...

But the point is, I could *choose* to pick a weak policy *or* a strong policy. I would not be limited to what the state requires me to buy.

I would prefer not to buy a policy that covers pregnancy. I can't. My state won't let me because my state thinks for me.

Hoosier Daddy said...

So if we let insurance companies be regulated only by the state where they locate, and then just swoop in and start selling policies in the other 49 states without any oversight there, then whatever state becomes the South Dakota (i.e. the most lax regulator) of the insurance industry becomes the de facto regulator for the entire country. That's the "race to the bottom" scenario you hear about from time to time.

Well there has been a big push recently, particularly with the AIG debacle, for federal regulation of the insurance industry, and that, ironically, made not be such a bad thing. As it stands now, insurance companies licensed in multiple states are subject to the laws of each state they do business in.

Naturally the various state insurance laws are not identical despite efforts by the NAIC to enact model regulations. This results in huge costs that require companies to develop products that meet the regulations of each state they do business in. For example, you may have a basic annuity or life insurance product you want to sell yet you may have 10-12 different versions of said product because of variations in state regulations over that type of product.

Same thing goes for health insurance. Let’s say that ACME Insurance has a product called Basic Health Plan A+ that they want to sell in every state. Every state has mandated coverages yet not every state has the same mandates which means ACME has to create multiple versions of the same plan, have multiple underwriting standards for the same plan and also obtain approval from each state for each plan. This costs money, quite a bit of money actually.

The idea of selling across state lines is actually a call for federal regulation in which ACME can develop ONE type product which can then be sold anywhere in the country. As a Hoosier, say I want to buy a bare bones type of policy that doesn’t contain X, Y and Z. Well I can’t because Indiana requires a health insurance policy to provide X, Y and Z thus I have to end up paying for benefits I don’t want or need.

Balfegor said...

See, you believe in some regulation after all. You think the common law of contracts should apply to insurance companies.

Well, yes. I also think common law prohibitions against fraud and so on should also be applicable to insurance companies. These ancient "regulations" -- if you want to call them that -- are essential for the operation of a free market.

That said, it's not at all clear to me that -- regardless of what the originating state does with its contract law (e.g. if it choses to permit exclusion of certain contract claims against insurers) -- courts in other states will choose to apply those provisions of the contract law. Credit card companies have already, as I understand it, run into trouble with unconscionability and choice of law and choice of forum provisions in cardholder agreements, and not all courts have been willing to enforce those agreements.

knox said...

I don't think its Kool-Aid some of these talking heads need to be spitting out.

Now, that was uncalled for. LOL

downtownlad said...

I believe that there was talk of creating a national exchange for insurance as part of the new bill.

If I recall correctly, it was the Republicans and Blue Dogs who were opposing it. But not positive on that. Haven't studied it much.

Obama probably doesn't see it as essential to reform. Which it isn't.

Anyway - here are the opposing arguments, since I'm pretty certain you spent no time studying the other side of the argument . . .

https://www.highmark.com/hmk2/pdf/hm_connector.pdf

The link is from a health insurance company, so I would say that insurance lobbying (probably of both parties) is what is driving this issue.

Pogo said...

"If I recall correctly, it was the Republicans and Blue Dogs who were opposing it. But not positive on that. Haven't studied it much."

"I have no idea about the actual facts, but the GOP is bad."

Shanna said...

See, you believe in some regulation after all. You think the common law of contracts should apply to insurance companies.

This is a common argument against people who think some particular bit of regulation is onerous. Nobody but anarchists think there should be no regulation, or no laws.

Simply saying that does not mean that any particular regulation is a good idea. Nor is hypocrisy.

downtownlad said...

I didn't say it was bad Pogo.

I really don't have an opinion on this issue. I haven't studied it.

A national plan sounds right, but who knows, it might be a complete logistical nightmare.

The biggest opposition is coming from the insurance industry - you know - private businesses. They usually support Republicans.

Pogo said...

"I don't know the subject at hand, but Republicans are bad, and so are insurance companies."

downtownlad said...

Looks like I'm right and Pogo is wrong.

SHOCKER.

I favor exchanges at the state level, not at the national level as Mr. Emanuel and Barack Obama prefer. Why? One big reason is that getting the details of the design right is no easy task and state-level experimentation would be an ideal way to do that.
Stuart Butler, the vice president of domestic policy at the Heritage Foundation (conservative think tank.

http://campaignstops.blogs.nytimes.com/2008/10/07/insurance-exchange-is-a-good-idea-but-not-at-the-national-level/

The article was written a year ago.

So it looks like Obama is not pressing this issue, in order to satisfy the blue dogs and not piss off the Republicans. Exactly as I presumed.

downtownlad said...

Now let's see Pogo twist himself in knots as he now realizes that the wingnut commandment is to support state exchanges and not oppose them.

downtownlad said...

My own opinion is that states should have the option of merging their exchanges with other states, getting economies of scale if they so choose.

You know - kind of like that lottery thing.

Pogo said...

No twisting required.
Whatever it is, the GOP is bad.
Bad, bad, bad.

John Lynch said...

Insurance regulation seems to be as good an example of commerce clause regulation as anything. I wonder why it's not?

Joan said...

I really don't have an opinion on this issue. I haven't studied it.


DTL, I appreciate you putting your disclaimers near the top of your replies so I know which ones to skip.

downtownlad said...

As opposed to Joan, who makes an opinion on an issue WITHOUT having studied it.

Rich said...

Shanna said:

This is a common argument against people who think some particular bit of regulation is onerous. Nobody but anarchists think there should be no regulation, or no laws.

Point taken. Understand this came up originally in the context of an anti-ERISA screed by me, and ERISA in fact does gut the common law of contracts when it comes to insurance. That and I was being a bit snarky to Balfegor. So I was making an obscure reference to that; not surprised it was not clear to others.

As so we go on to debate not whether regulation is proper but how much and what type.

FWIW I am not one who attributes to conservatives the belief that all regulation of any type is bad.

Sofa King said...

So it looks like Obama is not pressing this issue, in order to satisfy the blue dogs and not piss off the Republicans. Exactly as I presumed.


Please see, e.g.: http://www.govtrack.us/congress/bill.xpd?bill=h111-109

Note: Republican bill
Note: Inaction by Democratic House

Do you care to revise your blanket assertions?

Hoosier Daddy said...

I don't think its Kool-Aid some of these talking heads need to be spitting out.

Now, that was uncalled for. LOL


I'm sorry knox. My inner cretin just couldn't pass that one up.

I'll do penance later.

Balfegor said...

The biggest opposition is coming from the insurance industry - you know - private businesses.

Um, no, I don't think so. Remember this? The pharmaceutical industry signed a secret deal with the White House to get their perks written in, in exchange for $150 million in advertising for health care reform. The insurance companies have been slightly less enthusiastic, but other than the public option, they're pretty much on board with the Democrats' wacky plan. Here Blue Cross, back in 2008 pushing for a mandate and guaranteed coverage. And here's them just a few weeks ago making the same point. Other insurers (e.g. Wellpoint) have gone along with some of the Democrats' proposals, but have been careful to leave some daylight between them and the Democrats' proposals.

The people most pissed off about this aren't the insurers -- they clearly see a fantastic opportunity to gain a captive market (all of them seem to support the mandate, one of the most objectionable features of the bills under consideration) -- but ordinary people who are going to get screwed by whatever "grand bargain" gets put together in the smokey backrooms of the Capitol.

They usually support Republicans.

Well, yes. But they've got a trillion dollars of government subsidies to gain here. You honestly think that wouldn't buy their loyalty?

miller said...

"Do you care to revise your blanket assertions?"

You're kidding, right?

This will happen in a month with two blue moons.

WV: james, I kid you not.

Joan said...

As opposed to Joan, who makes an opinion on an issue WITHOUT having studied it.

I have made extensive study on the issue of which posts I should read and have found that it is generally OK to skip the ones where the author indicates up front that he doesn't have an opinion because he hasn't made a study of the subject under discussion. In most cases, the lack of study and disclaimer do not prevent the author from expounding on the subject anyway, but I get to skip all that because my research has demonstrated that such expositions offer little in the way of enlightenment or entertainment.

Henry said...

I recommend this white paper at the Competitive Enterprise Institute for a discussion of the type of market-oriented reforms that aren't endemic to Obama's symbolic expedition.

One proposed reform (among many -- read the paper) is to allow individuals to purchase across state lines. The point of this isn't to have one common insurance package for everyone -- it is to have more packages that anyone can choose from. I can buy life insurance from a company in Wisconsin and a mortgage from a company in Delaware, but I have to buy my health insurance from one of the few crappy and wildly expensive plans offered in Rhode Island. That's what should change.

Interestingly enough, Mr. Butler (in DTL's link and in other posts at The Times) never expresses a judgment about whether individuals should be able to buy insurance from private carriers across state lines. He is focused on what would constitute a good government approach. But his reasons for supporting health care exchanges at the state level parallel the argument of the CEI White Paper -- that state level initiatives would create a greater variety of programs and make it more likely that we find ideas that actually work.

What is happening now at the Federal level is the embrace of every idea shown to increase health care costs -- community rating, mandatory issue, mandatory purchase, first-dollar coverage.

In every state where these "reforms" are instituted, health care costs go up faster than in unreformed states. Yet Obama pretends that he's making health insurance more affordable.

That, indeed, is a symbolic expedition.

Henry said...

Nuts -- I should have written guaranteed issue, not mandatory issue. That's my lexical stutter at work.

Bruce Hayden said...

The problem with ERISA here is that for a while, the proponents of ObamaCare were claiming that insurance companies routinely made their money (however little they actually make, as a percentage of sales) by denying coverage. But then, that talking point was effectively rebutted by pointing out that insurance companies get hit with punitive damages if they actually do that and get caught at it.

So, the next talking point that was trotted out was that health insurance at big companies is typically exempt from the non-economic damages by ERISA. Federal law that often prevents employees from suing their employer's health insurer for non-economic damages, and thus, these companies routinely made a lot of money by, again, allegedly denying coverage.

But the problem, that was alluded to above, is that this is a federal law that is allegedly causing the alleged problem that is the justification for ObamaCare.

So, no, the problem isn't too few laws, esp. at the federal level, but too many. And, the solution there would be to remove the (federal) prohibition against non-economic damages for ERISA covered employer supplied health insurance. Far, far, cheaper and easier than what is being proposed.

Of course, I always enjoy the argument about insurance companies making money by denying coverage as a justification of ObamaCare. What is humorous is that the proposed solution would be to make it impossible to sue for either economic or non-economic damages if denial of health care harmed the patients, because, of course, the federal government has sovereign immunity.

John said...

I have a question for the "race to the bottom" crowd, i.e. those who believe that allowing free interstate commerce of health insurance will result in the majority of business flowing to the least palatable (lowest regulated, least accountable) states.

Is that what has happened to life insurance, or homeowner's insurance, or mortgages, or extended warranties on large purchases? And if so, has the customer been demonstrably harmed?

I ask this because I am curious, and because I can see some logic to your claims. I just wonder if there is evidence to back up the claim.

I know it seems as if I am asking others to do my homework for me, but several of you write as if you have explored this topic in depth, and can perhaps make the case.

Thanks.

WV: flumecto -- losing an article of clothing on the log ride.

bagoh20 said...

Clearly there are people here who have a better understanding of the law and regulation than I do, but I can offer this:

As someone who has been directly negotiating and purchasing health insurance for decades for hundreds of my employees including myself, and using that insurance big time, I can tell you that the biggest obstacle to lower cost is lack of competition. The plans to pick from are nearly identical in cost and benefits. Often the only difference is how much the broker takes in commission. Half of what you buy is for insurance that most will never want or need.

The other big cost pusher is the uninsured. Nearly a third of our employees do not want the insurance even though the company pays 60% of the premium. They simply would rather keep the $120/ month and just go to the hospital for free when they need to, including for many, a yearly pregnancy.

Just my contribution to the facts.

Rich said...

Bruce Hayden said:

...So, the next talking point that was trotted out was that health insurance at big companies is typically exempt from the non-economic damages by ERISA. Federal law that often prevents employees from suing their employer's health insurer for non-economic damages, and thus, these companies routinely made a lot of money by, again, allegedly denying coverage.

Would that it were true. This has been a “talking point” for about six people from what I’ve seen, and they are low-level blog trollers like me. I do think this point needs to be made, and forcefully, but so far it has not. It certainly has not entered the public consciousness or been a “talking point” on, say, Sunday morning shows etc.

And, the solution there would be to remove the (federal) prohibition against non-economic damages for ERISA covered employer supplied health insurance.

True that. I am constrained to say this in itself would do nothing about the uninsured, but it would at least make it so people who think they have insurance actually do.

AlphaLiberal said...

What a strange post. I hope she's joking and not really that dumb to think using two words starting in "e" means anything.

Maybe Ann's into Tarot cards, too.

Rich said...

John said:

I have a question for the "race to the bottom" crowd, i.e. those who believe that allowing free interstate commerce of health insurance will result in the majority of business flowing to the least palatable (lowest regulated, least accountable) states.

Is that what has happened to life insurance, or homeowner's insurance, or mortgages, or extended warranties on large purchases? And if so, has the customer been demonstrably harmed?


Can't speak to all those but I can tell you that insurance generally, including life and homeowner's, have to be approved by the state where they want to sell policies. So there hasn't been any opportunity to see if they would act like the credit card issuers have and migrate in mass to the state with the most lax regulations. I don't know anything about mortgages or warranties in this context.

But I will say I find it hard to believe that given the opportunity to migrate to a state where regulation is lax and that lax regulation will apply nationwide, any company would not avail themselves of that, especially including insurance companies. It would certainly be the rational thing for them to do.

AllenS said...

Tarot cards are like so yesterday. The latest thing is Word Verification.

WV: calart

Art from you know where.

Bruce Hayden said...

Tarot cards are like so yesterday. The latest thing is Word Verification.

What we need to do is figure out how to use WV's for lotto and lottery picks. And then sell them. Guaranteed by Google/Blogger to mean something. Almost.

Bruce Hayden said...

True that. I am constrained to say this in itself would do nothing about the uninsured, but it would at least make it so people who think they have insurance actually do.

Then, let's address that issue. About 1/3 have dropped off the 47 million count by eliminating illegal aliens. About another 1/3 could afford coverage and don't. I don't have much sympathy for them - I would suggest that they suffer the consequences if they need medical care. But most won't, since many are 20 something guys who think they are bullet proof and will live forever. Which leaves maybe 15 million or so who are legal and can't afford the insurance, many of whom may qualify for some program, but haven't gotten it for some reason or another (my guess is many need help there). That is somewhere around 5% of our population. That is a very tractable problem to solve, and we don't need to totally restructure the health care system to do it.

Henry said...

Rich, I don't watch Sunday morning talk shows, but just about every health reform supporter I know is convinced that insurance companies make huge profits by denying coverage. It's a common theme. One friend recently took part in a protest against a local insurer for that perceived reason.

According to the Huffington Post, most states don't track claim denials. In California, which does, a nurses group claims that 21% of claims are denied.

Sounds like a big number, but it's still not definitive. That number includes duplicate and fraudulent claims that must be rejected. Claims may be made for services legitimately not covered. Claims may be submitted without sufficient information to even be processed. Some of those denials will be approved on resubmission. Is that a horrible crime? It recently took me several tries to get my doctor and insurance provider in sync on some services that -- for legitimate reason -- were only partly covered. It was a hassle, but not enough of one to make me think the government would do a better job.

Obama promised to pay for his health care reform by squeezing the waste and fraud out of Medicaid. How will he do that? He'll do that by hiring investigators to uncover fraud and gimlet-eyed adjustors who deny claims.

If the plan doesn't do that, the government won't save any money.

If the plan does do that, the government will be acting like an evil insurance company.

Pick your poison.

F15C said...

We keep discussing the health care matter as though it is really all about health care. But is there more to it than that?

Had Obama/Reid/Pelosi/Axelrod, et al, gotten their way the original health-care-bill-understood-by-none would be signed into law by now.

It would seem that duty, honor and integrity would dictate that if they are sincerely trying to improve such a massive, complex part of our economy and lives they would be willing to accord the matter the due diligence it deserves. Obviously, such is not the case.

So the question then is, what is their *real* motive in this matter? What do they fear we will learn about them and most importantly, what are they really trying to accomplish?

Original Mike said...

What this fight is really about is one side trying to make catastrophic health insurance (a.k.a. health insurance) available to everybody and the other side fighting tooth and nail to stop that. Catastrophic health insurance would actually be affordable, and it addresses the real danger facing the uninsured. Thus, it threatens the dreams of the single-payers and must be stopped at all costs.

Bruce Hayden said...

AXELROD: But insurance is regulated at this time --

BLITZER: But you could change that --

AXELROD: State by state.

BLITZER: The president could propose a law changing that.

AXELROD: That is not endemic to the kind of reforms that we are proposing or that
--

This whole interview pointed out what many of us have known for quite awhile. The various problems that have been discussed are entirely pretextual. The Obama people started with their solution, and worked backwards to come up with justifications that might possibly sell it to the American people. They never looked at 47 (or now 30) million uninsured and asked themselves, what is the best solution to this problem. Rather, they started with the goal of federalizing the health care system, and worked backwards coming up with one justification after another.

And, here, Axelrod essentially admitted that that was what they had done. Don't let pesky facts get in the way of grandiose plans to massively increase the federal government, and, as a side effect, possibly install a permanent Democratic majority because of all those who are now even more totally beholden to Uncle Sam for their basic needs.

Bruce Hayden said...

What this fight is really about is one side trying to make catastrophic health insurance (a.k.a. health insurance) available to everybody and the other side fighting tooth and nail to stop that. Catastrophic health insurance would actually be affordable, and it addresses the real danger facing the uninsured. Thus, it threatens the dreams of the single-payers and must be stopped at all costs.

I am not sure who you think is on which side of that debate, since it really hasn't been debated.

bagoh20 said...

We are already paying for and treating the uninsured, so the question really is how to do it better. They are paying nothing for that treatment. In effect they have insurance; they know they will be treated just an insured person does. They need to pull their weight and pay for it; that's the problem.

bagoh20 said...

Bruce Hayden said: "The Obama people started with their solution, and worked backwards to come up with justifications that might possibly sell it to the American people."

Exactly!

F15C said...

Bruce Hayden: "In California, which does, a nurses group claims that 21% of claims are denied.

Sounds like a big number, but it's still not definitive."

You are quite correct and these claims by such organizations are deliberately misleading at best. Further, it is rarely discussed, but not all denied claims are bad for the insured.

Case in point, I am a part of that 21%. But the denied claim by the Insurance company saved me a lot of money.

Under my policy I pay (up to my yearly deductible) for my medical care and the amount I pay for any particular service is based on an agreement between my insurer and the provider.

The denied claim arose from a series of lab tests and office visits that were billed in the amount of $397 to me by the providers.

Healthnet (my insurer) denied the claim on the grounds that the amount was in excess of that allowed by the contract between Healthnet and the provider.

I ended up paying $63 instead of $397.

Original Mike said...

Bruce - Catastrophic insurance can not be purchased by people in many states because it is outlawed in those states. In states with heavy mandates, the only policies available must, by law, provide accupuncture, chiropractic, and whatever else the interests groups in that state have been able to finnagle. I believe that the push by the conservative opposition to allow policies to be purchased across state lines is primarily an attempt to make catastrophic plans available to all. The resistance by the liberals to this change in law is because doing so would provide affordable health care outside of their single-payer schemes.

Dust Bunny Queen said...

Catastrophic insurance can not be purchased by people in many states because it is outlawed in those states.

In addition the Obama plan is to outlaw or forbid insurers from offering new policies that are below a certain level of coverage...aka...catastrophic plans. Obama wants the insurance companies to be forced to offer the more elaborate, bells and whistles plans, to everyone without the ability to scale or charge more for pre existing illnesses.

Most people, and especially young people, do not need this expensive comprehensive coverage and would be better suited to a catastrophic plan that would be affordable.

They don't want this option to be available, because their aim is t drive the insurance companies out of business and force everyone to be on the government/single payer plan.

VW; flabi

LOL

F15C said...

DBQ: "They don't want this option to be available, because their aim is t drive the insurance companies out of business and force everyone to be on the government/single payer plan."

Agreed. But the bigger question is why do they *really* want to drive us to government as single payer health care?


WV = clapyr. Term used in the original health care bill for one who has a bigger case of the clap than someone else.

Bruce Hayden said...

Agreed. But the bigger question is why do they *really* want to drive us to government as single payer health care?

Dependency and power.

You get them hooked and they are in your power.

In this case, it means another permanent dependency. And that is part of how the Democrats have done so well in the 75 or so years since FDR was first elected. The more people dependent upon the government, the more Democratic votes there will presumably be.

As I noted above, the reason that you know that it isn't about the ostensible reasons that they have given us, because they keep changing, while the cure to those presumed ills stays the same.

Health care costs too much? ObamaCare. People denied coverage? ObamaCare. People refusing to pay for insurance because they don't see the need? ObamaCare. Medicare going bust? ObamaCare. Global Warming? ObamaCare (oh, wait, that is GoreCare).

Elmer Stoup said...

When will NPR ask a similar question?? Julie Ravner is ObamaCare's running dog.