Talk:Health insurance
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[edit] Request for more input
This article needs some more input from economists. It sounds like it's written by an arts student :)—The preceding unsigned comment was added by Psychobabble (talk • contribs) 10:09, 1 October 2004 (UTC).
[edit] Recent added material
Hi, some of the added material by 67.150.9.250 had some merit, but other parts of it were so patently bad that I reverted. Please discuss some of that material here before re-adding it and try to have a factual basis and some references to back up the material you add. - Taxman 03:43, Nov 5, 2004 (UTC)
While this is a very difficult subject, the acticle does seem to be in need of a rewrite. I have begun this rewrite. After you (that is, anyone) reads it, a would welcome comments. Johnwhunt 19:15, 7 Mar 2005 (UTC)
Okay, so I chickened out and made no changes. I still think the entire thing needs a rewrite. In fact, I suggest redcing the material under the subject heading "health insurance" and moving the bulk of this material to "health care costs". That latter topic could then include the pros and cons of private v. public and related issues. Johnwhunt 21:45, 7 Mar 2005 (UTC)
- Well I agree it does need a lot of changes. It just hasn't made it high on my priority list. I only know a lot about health care in the US, so it would be difficult for me to properly fix the article. Its obviously one that attracts a strong POV. Private v public is a key part of the health insurnce issue, so it shouldn't be moved entirely out. In any case, feel free to make what changes will obviously help, try to discuss contentious ones here, and do as much research as you can and cite good sources. - Taxman 13:13, Mar 8, 2005 (UTC)
Hi. It seems to me that much of this health insurance article is pro public health insurance bias. Look how much there is written in Common complaints of private insurance (alot) versus Common complaints of publicly funded medicine (a little).—The preceding unsigned comment was added by 67.150.43.158 (talk • contribs) 08:29, 11 April 2005 (UTC).
Hi, I would like to make some changes to the first part of the health insurance article. I corrected some syntax, mispellings and created a more balanced viewpoint with additional material. The rewritten article is below. Please comment. Jmcmeans—The preceding unsigned comment was added by 69.55.161.153 (talk • contribs) 19:32, 26 April 2005 (UTC).
- I don't know about anybody else, but I can't easily parse the changes just from what is below. Why not just make the changes and let the software show us the diffs. Then we can discuss and change or keep what is agreed on. Also, why not create and account so it is easier to respond to you and track your edits. Then you can sign your comments by typing ~~~~ to add your username and the time of the edit. - Taxman 02:33, Apr 28, 2005 (UTC)
[edit] Private health insurance
Health insurance is one of the most controversial forms of insurance because of the conflict between the need for the insurance company to remain solvent versus the need of its customers to remain healthy, which many view as a basic human right. This conflict of interest is why state and federal regulation of health insurance companies is so important. Some say this conflict exists in a liberal healthcare system because of the unpredictability of how patients respond to medical treatment. But too many health insurance companies put the need for high profits before the lives of their customers.
Here is a hypothetical example of a situation that might confront an insurance company:
Suppose a large number of customers of a particular insurance company contracted a rare disease and the hospital charged 10 million dollars a patient. The insurance company would be faced with the choice of either charging all its future customers astronomical contributions (thus losing customers and going out of business), paying all claims without complaint (thus going out of business) or fighting the customers in an attempt to deny the costly treatment (thus outraging patients and their families and forcing them into bankruptcy, and becoming a target for lawsuits and legislation).
Of course, the insurance company has voluntarily signed a valid, legal and binding contract, the insurance policy, and thus should pay all valid customer claims without question.
Because health insurance companies are in the money business, not the health care business, they tend to be paranoid that their customers are out to take advantage of them. The companies fear that the customers will unfairly get some benefits they are not entitled to or engage in risky behavior that an otherwise sane person without health insurance would not engage in. For example, health insurance companies say there are faced with several unique economic problems with private health insurance. Asymmetry of information about a persons health and behaviour is likely to lead to adverse selection and moral hazard. Health insurance companies say that, in essence, those seeking health insurance are likely to be those with existing medical problems or high likelihood of future medical problems and those who take out insurance may engage in risky behaviour, such as smoking and excessive alcohol consumption, which they otherwise would not. If true, these problems may lead to 'good' insurance risks being priced out of the market or even insurance being uneconomical to provide.
However, most individuals who buy health insurance do so in order to ensure that their family will be able to afford medical care if they need it, knowing that without insurance, they probably will not be able to pay for expensive hospital care or life saving prescription drugs, which could threaten their financial or physical health.
Insurance companies say that with publicly funded health insurance the good and the bad risks are all included in the coverage and the same moral hazard applies.
Health insurance companies in the United States have steered their business model away from the concept of "risk sharing," (offering policies to as many people as possible) to the concept of "risk avoidance." (refusing to offer policies to the sick, the elderly and those who might get sick) These companies emphasize that every risk must subsidize the unhealthy, and those that take care of their health have no opportunity to avoid this subsidization. But disease is no respecter of persons. Even a healthy individual who exercises and eats a perfect diet can fall victim to a life threatening microbe, an environmentally induced cancer, or suffer serious injury in an accident. That's why everyone, including healthy people, needs health insurance, and why individuals need a comprehensive health insurance plan that covers all contingencies.
Insurance companies say that, in general, if many sick people buy health insurance from a private health insurance company, but few healthy people buy it, the price of the insurance rises. However, in reality, few sick people are able to buy health insurance. Insurance companies also say, that, if many healthy people buy health insurance, but few sick people buy it, the price drops. In other words, the price drops if more money is going into the insurance, and less is being paid out. In reality, only healthy people are allowed to buy health insurance, but the price of insurance still rises by ten percent or more each year.
Some people argue that most healthy people don't buy health insurance because they don't need it, so the price tends to stay high. But, 80-90% of Americans do buy or obtain health insurance, either through their employer or as individuals, because they realize that they cannot afford the high cost of hospital care, which can amount to as much as $10,000 a day. Because of advanced medicine, people are living longer and longer, creating a larger group of senior citizens who require more pay outs than the young (a similar effect is seen in Social Security). This also increases the price of health insurance. Some factors that raise health insurance premium prices are: people who don't exercise, eating junk food, shortage of doctors in proportion to population size, excessive alcohol use, smoking, street drugs, obesity, the modern sedentary lifestyle, and the large number of semi-fraudulent health insurance companies exploiting small businesses and the self employed. The opposites of these (exercise, eating healthy food, less addictions, non-profit community based health insurance providers, etc.) lowers health insurance prices, because healthier lifestyles protect the body from disease, and with fewer diseases, fewer doctor bills must be paid by the health insurance companies. The savings are passed on to the customer, paid out in generous salaries to company executives, or retained as profits by the health insurance company.
A person who buys health insurance must fill out a form that asks about the person's medical history, whether that person is a smoker, how much the person weighs, etc. The applicant can get discounts if he lives a healthy lifestyle. This incentive may encourage some people to live a healthier lifestyle. Unfortunately, this medical history is also used as a tool to deny coverage to many individuals with pre-existing conditions.—The preceding unsigned comment was added by 69.55.161.153 (talk • contribs) 19:32, 26 April 2005 (UTC).
[edit] Changes
Hi,I have made the changes to the article. What I ended up with is slightly different than what I submitted below. I welcome your input. I tried to maintain the core and format of the orginal article. I thought that the original article only gave the insurance industry point of view, so I retained that and added the health insurance reformers or consumers point of view. I didn't want to get too technical or statistically, is that a word?, since this is a general interest encyclopedia. I learned about the wik from an article in the Atlanta Journal Constitution. April 17. I have created an account. Since I'm new, I'm not sure about procedures, so feel free to tell me if I mess up.
Jim—The preceding unsigned comment was added by 69.55.161.151 (talk • contribs) 02:54, 29 April 2005 (UTC).
[edit] Removed from article, etc.
In addition to other changes, I removed the following paragraph from the article:
- Consumer advocates say that health insurance companies have adopted a business model of "risk avoidance" (refusing to offer policies to the sick, the elderly and those who might get sick) rather than the traditional insurance concept of "risk sharing" (offering policies to as many people as possible to mitigate individual risk, i.e., a Universal Pool). Insurance companies say that in Universal Pools, healthy policyholders must subsidize the unhealthy, and that those who take care of their health can pay lower premiums if they are given the opportunity to avoid this subsidization. Consumer advocates say that risk sharing or cross subsidies between classes of people like the sick and healthy and the young and elderly are what constitutes the very definition of health insurance. Consumer advocates say the young and healthy need to remember that one day they could well be older and sicker.
Just who says that "risk sharing" as opposed to "risk avoidance" is the traditional insurance concept? "Risk sharing" doesn't seem like something that people with different levels of risk would do voluntarily.
Generally, this article has way too much of a "point-counterpoint" style of writing. It also relies much too heavily on the term "consumer advocates". "Consumer advocate" is a title that could reasonably be claimed by almost anyone who is not actually in the industry, or their dependents and loved ones; something more precise would be good. Other changes, in addition to what's in my edit summaries:
- I took out "But consumer advocates say that only healthy people are allowed to buy health insurance, but the price of insurance still rises by ten percent or more almost every year." This is actually a different argument that doesn't follow from the preceding paragraph. Industry people and people familiar with economics argue that such-and-such makes the price higher or lower than it otherwise would be.
- I added a couple specifications where we are talking about developed countries specifically; some parts had something of a geographic bias.
- I took out a couple instances "unfortunately" or the like, for NPOV purposes.
- Nat Krause 10:48, 25 Jun 2005 (UTC)
[edit] Consumer advocates
As noted by Nat Krause, the term "consumer advocates" is vague to whom it actually refers. I may also make some similar changes to those sentences in which it appears. AED 9 July 2005 05:40 (UTC)
[edit] Liberal healthcare system
The third sentence in the Private health insurance section states: Some say that this conflict exists in a liberal healthcare system because of the unpredictability of how patients respond to medical treatment. Liberal healthcare system redirects to healthcare system leaving me wondering what the "liberal" adjective is supposed to mean in this context. Can anyone rephrase that sentence to make it make sense? AED 9 July 2005 05:40 (UTC)
[edit] Private healthcare insurance
I'm a bit confused as to what the Private healthcare insurance section is to discuss. A great deal of the information in the section is duplicated in the Common complaints of private insurance section. Should the criticisms in the former be moved to the latter? AED 9 July 2005 06:06 (UTC)
[edit] Statistics
Is there a place in this article to mention that as of 1998, 44.3 million Americans do not have health insurance?—The preceding unsigned comment was added by Adc718 (talk • contribs) 05:21, 17 December 2005 (UTC).
- According to the article, 85% of Americans have health insurance. So it's already there; 15% of 300 million is 45 million. Kafziel 15:32, 23 January 2006 (UTC)
[edit] "Socialism"??
- Because publicly funded medicine is a form of socialism.
- Give me a break. Just because something is publicly funded doesn't make it socialist. Socialism means the state *OWNS* the means of production, as well as *FUNDS* the production itself. By this reasoning, almost everything in the United States is a form of socialism because it's supported by taxpayer dollars. 198.59.188.232 15:07, 6 April 2006 (UTC)
- The claim that many parts of our economy has socialist elements, i.e. employer provided benefits get tax benefits (pensions and health care premiums) is not necessarily a dirty word. In addition Judge Janice Rogers Brown has called our New Deal consensus as socialistic. It is to some degree. Other parts of the society are more laissez faire.John wesley 15:34, 6 April 2006 (UTC)
- I added a capitalism section to the private health care part. 169.232.94.217
- The claim that many parts of our economy has socialist elements, i.e. employer provided benefits get tax benefits (pensions and health care premiums) is not necessarily a dirty word. In addition Judge Janice Rogers Brown has called our New Deal consensus as socialistic. It is to some degree. Other parts of the society are more laissez faire.John wesley 15:34, 6 April 2006 (UTC)
- Give me a break. Just because something is publicly funded doesn't make it socialist. Socialism means the state *OWNS* the means of production, as well as *FUNDS* the production itself. By this reasoning, almost everything in the United States is a form of socialism because it's supported by taxpayer dollars. 198.59.188.232 15:07, 6 April 2006 (UTC)
[edit] Employer Based Insurance
This whole article treats health isurance as if it is a choice between individually purchased health insurance and government-funded insurance. However, the vast majority of health insurance in this country is employer-funded. This is critical to the debate for several reasons:
1. The bigger the employer, the less underwriting goes into identifying bad risks among the employees.
2. Small business insurers (2-50 employees) are currently highly regulated by all 50 states. These laws restrict how much insurers can charge due to unhealthy members. All policies are guaranteed to be renewable, and the increases are restricted.
3. The ex-post moral hazard costs are higher, since the employee generally only pays 20% of the premiums, while the employer pays 80% of the premium.
Toonces 20:01, 17 April 2006 (UTC)
–Not to mention that it incorrectly states that employees pay taxes on health insurance premiums. Sonria 00:55, 17 September 2006 (UTC)
[edit] History and evolution section
I removed a reference to the industrial revolution. I don't think anyone say that the industrial revolution 'matured' during the late 20th century. I hope no one objects. Also, this sentance: 'This payment model continued until the start of the 21st century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance.' is a little obscure. Are we trying to say that the "disability" payment model still existed in california, or that the law still referenced disability rather than health insurance. I would assume it's the latter, but as I don't live in Cali I don't know. 69.207.22.219 19:11, 15 June 2006 (UTC)
[edit] History and Evolution Question
The linked Pinky Show at the bottom of the article mentions that the real historical reason for the divergence of the American system away from other industrialized countries was the incentive scheme devised by employers during the second world war as a way to attract scarce workers. It's hard to really identify a cohort nation for comparison -- the best example seems to be Canada, since it didn't suffer invasion during the war. Britain might be a close second. Both of these nations' economies must have experienced the same difficulties of a constrained labour force during wartime, but neither evolved a significant private health insurance system. Perhaps this is more of a political question, but I would be interested in references to material that discusses this history, sociology, and political science in more detail. —The preceding unsigned comment was added by 69.119.92.25 (talk) 23:10, 7 January 2007 (UTC).
[edit] Health insurance in the world or health insurance in the USA
Hey, When i looked up this article i was looking up information about health insurance in the united states. Almost all the information there was indeed about united states. Only then, lower in the article i noticed that there is a "main" article for Health care in the United States. As such that means that the article is about USA, USA, and two lines about other countries.
I think in this article should be general information about health insurance, it's origins, and maybe a short comparison of differences between the countries (in Netherlands, where i am from, the basic (mandatory) health insurance covers all the costs of hospitals, GP, and all prescription medication, while in USA that's not the case). Right now the article is not very balanced.
It would be nice if someone could do it.. Otherwise i'll begin moving stuff around :)
Robert 19:24, 24 February 2007 (UTC)
[edit] Resources
I am employed by a United States health insurance company, so I will not be editing the article, but if anyone has any questions I might be able to answer, I would be happy to contribute. Just ask. I do watch this page, so posting here should catch me. Slavlin 19:35, 28 March 2007 (UTC)
