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Comment by zrail | Hacker News Reader

Or, and I’m just saying maybe, we could use this crisis as an opportunity to create a Federal-level reinsurance program. This isn’t quite Medicare for all but it would guarantee costs higher than some reasonable number are spread across the entire population.

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So, keep the idiotic bargaining wars between insurance companies and hospitals that don't reduce costs but do increase administrative overhead, keep the profit pipeline, keep the cherry picking / lemon dropping, but get rid of the ability of insurance companies to lose money?

That's so cynically "privatize the gains, socialize the losses" that I'm sure the lizards will love it!

Wouldn't that proposal get rid of the incentive of cherry-picking/lemon-dropping?

Actually you're right, it would get rid of the worst of the lemon dropping, which is when they find excuses to dump cancer patients with the least ability to retaliate (least family, least social media, whatever).

The example that was at the top of my mind when I made that claim was the cherry picking, because at this point in my life I'm a cherry, so that's what I have experience with. It's the situation where insurance companies all provide first year discounts, encouraging companies to switch every year, and then make getting set up a hassle so that relatively healthy people forego interaction with the medical system entirely.

Reinsurance wouldn't fix that problem, but that problem is much less pressing than the "dump cancer patients" problem.

> This isn’t quite Medicare for all

Why not have "Medicare for all"?

Like every other Western country.

My impression is that medicare for all covers people, and reinsurance covers insurance companies. A huge danger would be that the premiums would be insufficient, and it would become a taxpayer bailout program. Spreading a cost over the population doesn't necessarily mean it's a reasonable cost.

Perhaps a middle ground is to have it like the FDIC, which covers depositors not banks. As I understand it, if a bank goes under, the FDIC takes it over and runs it until a suitable buyer can be found.

That isn’t true though. Switzerland has a much better predecessor version of the ACA: everyone is required to buy insurance (with subsidies for those that can’t). They got rid of the group market so everyone is in the same risk pool, which is an improvement over our system. However, Switzerland has the second highest healthcare costs when comparing developed countries in a per capita basis.

AFAIK every other rich country regulates some or all medical costs per procedure or what have you (that is, they have price controls). Some do it directly and others by establishing a monopsony on buying healthcare, but that and a good fall-back insurance provider (or a system set up such that one isn’t needed as everyone’s basically already on it) seem to be the common necessary ingredients in keeping costs sane and everyone covered, as far as I can tell.

Sure, I can agree with that. But many countries have hybrid systems that mix public and private insurance (Netherlands?) and then add it in a bunch of regulation and control to keep things sane.

I’m not really sure what health insurer roles are in Switzerland, since the cantons heavily regulate premiums and care. Maybe a Swiss could make light of the situation.

When you actually look at any of these systems, you find there is such great government control of these nominally "private" insurers that it's effectively Medicare-for-All.

All insurance offered at a standard price, subsidized by government, that covers the exact same things by law for every single person and can't be cancelled... who cares whether you're nominally dealing with the government or a private entity?

"Quality Federal Health Insurance for all" = yes "Medicare for all" = Terrible idea

Medicare is insufficient coverage. Almost all folks on Medicare need supplemental insurance, or a state plan to actually get the care they need. Medicare under pays on claims, typically under the costs of providing care. Every industry group, union, medical association, who has looked at all the various plans has said it would lead to more hospital bankruptcies, particularly in rural areas.

Now, if you want to break the current system and force a government take over of the whole system it's not a bad idea, but selling it as something that would give folks the care they need is very disingenuous.

Medicare for All isn’t an extension of existing Medicare benefits to everyone, it’s an expansion of those benefits, for everyone, under a single-payer system.

https://www.vox.com/2019/4/10/18304448/bernie-sanders-medica...

You didn't understand what the person you replied to said, and he's right.

Medicare is NOT good insurance. Its reimbursement rates for hospitals is lower than their costs, and it doesn't fully cover people, it only covers 80%.

Like the person you replied to said: Most people on Medicare need to buy supplemental private insurance - it's called Medicare Advantage, and it may be government funded.

We need good insurance, and Medicare is NOT good insurance.

They clearly did understand what they said. The "Medicare for All" proposals do not simply extend existing Medicare benefits to everyone, they also expand what Medicare covers for the people it covers.

I understood perfectly and they and you are both incorrect. Medicare for All is not Medicare, it expands and closes the gaps in coverage under the current regime using a single payer system (which is not even really a form of “insurance” to begin with).

Because such a system would require years of refinement and I don't want to sacrifice my health while the government figures it out.

Public option is a fine transition.

Because the problem isn't on the payment side of health insurance, it's on the cost side.

So Medicare for all will solve nothing.

This doesn't sound hard to achieve in a bipartisan manner. Why didn't this get created with the Affordable Care Act? This also seems much more in line with traditional insurance (big, occasional claims) and would probably be easier to audit due to the lower volume of cases.

It did, but it was temporary:

> The goal of the ACA’s temporary reinsurance program was to stabilize individual market premiums during the early years of new market reforms (e.g. guaranteed issue). The temporary program is in place from 2014 through 2016. The program transfers funds to individual market insurance plans with higher-cost enrollees in order to reduce the incentive for insurers to charge higher premiums due to new market reforms that guarantee the availability of coverage regardless of health status.

https://www.kff.org/health-reform/issue-brief/explaining-hea...

I believe it also ended up tragically underfunded. I believe the co-op started in Illinois was still in a lawsuit over underpayments when it became insolvent and was shut down.

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