Just like Mike says, any number of opportunistic grandstanding bigmouths will make a showy stink. But there isn’t a state politician alive who is stupid enough to ask for a vote while telling that voter that they won’t be getting benefits that the folks in the neighboring state are stampeding to line up for.

Principle, shminciple. You can count on Americans to demand at least as good a deal as the next guy got.

Nick, great points. The employer-based system is generally thought to have come about because of the wage controls after WWII, and it is an odd system. Until the 1970′s, it was mostly a reimbursement plan, where consumers paid the medical bills and got reimbursed at some percentage by the insurer. The consumer was still the customer, and medical bills were kept in check.

I think your idea that health insurance be treated more like life insurance, where the younger you start to buy it the smaller your premiums, is a sound idea from an actuarial basis. In this way its more like a “prepaid” health plan, and probably a suitable idea for the middle class. The poor will always need something like Medicaid.

And you might be right that the “young invincibles” will pony up and pay $2000 for a policy they don’t need to avoid a $1,500 penalty. We’ll have to wait and see.

But none of this is healthcare reform; it is healthcare payment reform. No matter how we pay for it, it is still too expensive, and it should be much cheaper BECAUSE of the medical innovation. A great article pointing out some of this is at http://www.theatlantic.com/doc/200909/health-care (“How American Health Care Killed My Father”).

I agree with a lot of them. Pricing of health products is simply bizarre.

I agree the $750 penalties won’t be enough. That’s why I much prefer the House plan, where the penalty is higher.

I do think you put the penalties too high. They aren’t supposed to encourage more employer-based insurance, they’re supposed to finance our first step in getting away from the employer-based health system. As long as they balance the books we’re good.

They are supposed to encourage young people to buy insurance. Over time an average person’s insurance premium payments must add up to the total benefits they receive. But many “young invincible” refuse to buy insurance because they don’t need it, and then act surprised at gigantic premiums when they hit 45.

Many of those folks could buy a $2,000 policy right out of college, or even High School. And they probably would if it was a choice between spending $2,000 on insurance and paying a $1,500 penalty for nothing.

I still disagree, my point is that companies could drop their coverage right now if they wanted. They keep it because it’s a “benefit” to the employee. People would leave their jobs at a higher rate if not for those benefits.

Health insurance costs are not “real” in the sense that doctors and hospitals charge much more than they expect to collect. Its more akin to a rug bazaar than any other financial transaction you make. We’ve had some pretty large health expenses this year, with one hospital bill over $50,000. But that’s a phony number; the insurance company’s negotiated rate with the hospital was just short of $13,000. That’s the “real cost” of the service provided by the hospital. Office visits at the doctor are much the same way. And Nexium …. Prilosec OTC is available at Costco (and a generic OTC version of it that’s even cheaper), and it is often just as effective. Doctors often prescribe Nexium because it doesn’t have an OTC version so patients can bill their insurance for it.

One more note, we get our prescriptions from two places. One has our insurance, and every generic drug is ours for a co-pay of $10 with name brands at $20. We fill one drug there. The rest we fill at another pharmacy without our insurance … for $2 to $3 per prescription.

But you are right about the first part, our system is so screwed up we’re dependant on insurance to be able to even see a doctor. Maybe if a normal appointment was 15 dollars instead of 200, or a prescription of nexium was 10 dollars instead of 180 per month, then we wouldn’t need insurance.

Insurance is used to cover rare events; only in health care do we think that an insurance policy can cover every cost, every time. It is unsustainable to have the type of first-dollar coverage that the original Finance Committee’s bill had, with no deductibles and no co-pays.

Whatever final form this legislation takes, it will fail unless it includes a mandate that every man, woman and child have insurance. A company penalty of $500 or $750 per employee not covered will ensure that many companies bail out of providing health insurance, as the typical family policy is thousands of dollars more (and companies pay, on average, 80% of the insurance cost). The penalty for a company will have to be on the order of $6 to $7,000. The penalties for individuals will have to be closer to that amount to force people to buy insurance (even if they don’t need it).

The real test will be if the Constitution allows the feds to compel individuals to buy health insurance. The Congress may have to pass an amendment to facilitate it.

Also you’re absolutely right on the most important part of said bill. Pre-existing conditions and dropping needs to go away. I have a few “uninsurable” friends who’ll be happy to hear this.