POTUS releases 8 principles of health insurance reform

[GaryC 7]

I joined the Navy at 18 so I was out at an early age. If this is the complete scope of the reform then I could support it. It fixes the worst part of medical insurance. Just as long as there is no public option then let them do this.

How about 50 public options, run by individual states with some federal funding - the so-called "co-ops"?

Sure, I would go for that. This should be addressed at the state level.

Would you be supportive of allowign states to voluntarily group up and form larger co-ops with larger pools?

The problem with the state-co-op idea is that while it will work like gangbusters for states with large populations (say, California), it won't work well at all for Alaska or North Dakota. Those pools will just be too small and won't have the leverage the California co-op will.

To that end, one of the 'solutions' proposed has been to allow states to group together and form larger co-ops. For example, 1 co-op for all the Great Plains states (of course, the states have to agree to group together - I don't see why they wouldn't).

When you consider the entire population of even the smallest state I would think the pool is still big enough to be effective if managed right. That being said, if several states want to band together I don't see a problem with it. Just as long as the federal government isn't the big bully that is forcing the issue. This needs to be a state solution rather than a federal one.

[w¡n9Nµ7 §£@¥€r 123]

When you consider the entire population of even the smallest state I would think the pool is still big enough to be effective if managed right. That being said, if several states want to band together I don't see a problem with it. Just as long as the federal government isn't the big bully that is forcing the issue. This needs to be a state solution rather than a federal one.

I don't disagree.

That said, larger pools will always have more leverage. North Dakota by itself will have better leverage than any of its small businesses alone, but it will still do much better with a number of other states.

[one...two...tree 2,762]

I joined the Navy at 18 so I was out at an early age. If this is the complete scope of the reform then I could support it. It fixes the worst part of medical insurance. Just as long as there is no public option then let them do this.

How about 50 public options, run by individual states with some federal funding - the so-called "co-ops"?

Sure, I would go for that. This should be addressed at the state level.

Would you be supportive of allowign states to voluntarily group up and form larger co-ops with larger pools?

The problem with the state-co-op idea is that while it will work like gangbusters for states with large populations (say, California), it won't work well at all for Alaska or North Dakota. Those pools will just be too small and won't have the leverage the California co-op will.

To that end, one of the 'solutions' proposed has been to allow states to group together and form larger co-ops. For example, 1 co-op for all the Great Plains states (of course, the states have to agree to group together - I don't see why they wouldn't).

When you consider the entire population of even the smallest state I would think the pool is still big enough to be effective if managed right. That being said, if several states want to band together I don't see a problem with it. Just as long as the federal government isn't the big bully that is forcing the issue. This needs to be a state solution rather than a federal one.

Gary, the less populated states survive by the larger donor states. That's just how it works.

[GaryC 7]

I joined the Navy at 18 so I was out at an early age. If this is the complete scope of the reform then I could support it. It fixes the worst part of medical insurance. Just as long as there is no public option then let them do this.

How about 50 public options, run by individual states with some federal funding - the so-called "co-ops"?

Sure, I would go for that. This should be addressed at the state level.

Would you be supportive of allowign states to voluntarily group up and form larger co-ops with larger pools?

The problem with the state-co-op idea is that while it will work like gangbusters for states with large populations (say, California), it won't work well at all for Alaska or North Dakota. Those pools will just be too small and won't have the leverage the California co-op will.

To that end, one of the 'solutions' proposed has been to allow states to group together and form larger co-ops. For example, 1 co-op for all the Great Plains states (of course, the states have to agree to group together - I don't see why they wouldn't).

When you consider the entire population of even the smallest state I would think the pool is still big enough to be effective if managed right. That being said, if several states want to band together I don't see a problem with it. Just as long as the federal government isn't the big bully that is forcing the issue. This needs to be a state solution rather than a federal one.

Gary, the less populated states survive by the larger donor states. That's just how it works.

Why? The lowest population state of Wyoming has 500,000 people in it. That is a lot of people. There is no need for donor states if the program is administered correctly.

[w¡n9Nµ7 §£@¥€r 123]

The entire population of WY won't be in the co-op though. People who have private insurance through their jobs and like it (that's 80% of those currently with insurance) won't be joining the co-op. So the actual pool will be much smaller.

But.. if WY is happy with the rates it negotiates in its go-it-alone co-op... so be it.

[GaryC 7]

The entire population of WY won't be in the co-op though. People who have private insurance through their jobs and like it (that's 80% of those currently with insurance) won't be joining the co-op. So the actual pool will be much smaller.

But.. if WY is happy with the rates it negotiates in its go-it-alone co-op... so be it.

Sure, but that would still be 100000 people in the pool. I have worked for companies that self insure with a lot fewer people than that. With a pool like that I would think they would have some clout to negotiate good rates.

[w¡n9Nµ7 §£@¥€r 123]

The entire population of WY won't be in the co-op though. People who have private insurance through their jobs and like it (that's 80% of those currently with insurance) won't be joining the co-op. So the actual pool will be much smaller.

But.. if WY is happy with the rates it negotiates in its go-it-alone co-op... so be it.

Sure, but that would still be 100000 people in the pool. I have worked for companies that self insure with a lot fewer people than that. With a pool like that I would think they would have some clout to negotiate good rates.

Yes. Generally speaking, the larger you get the higher your admin costs get and the larger your size discount gets as well. Up to a certain size, the savings offsets the increase in admin costs. After that point, it reverses itself and bigger ceases to be better. Point of diminishing returns, and all that.

Any system they come up with should give states the freedom to identify their own point of diminishing returns.

IMHO - I realize no one's asked me.

[GaryC 7]

The entire population of WY won't be in the co-op though. People who have private insurance through their jobs and like it (that's 80% of those currently with insurance) won't be joining the co-op. So the actual pool will be much smaller.

But.. if WY is happy with the rates it negotiates in its go-it-alone co-op... so be it.

Sure, but that would still be 100000 people in the pool. I have worked for companies that self insure with a lot fewer people than that. With a pool like that I would think they would have some clout to negotiate good rates.

Yes. Generally speaking, the larger you get the higher your admin costs get and the larger your size discount gets as well. Up to a certain size, the savings offsets the increase in admin costs. After that point, it reverses itself and bigger ceases to be better. Point of diminishing returns, and all that.

Any system they come up with should give states the freedom to identify their own point of diminishing returns.

IMHO - I realize no one's asked me.

Then we seem to agree. To extend that point wouldn't you agree that a federal solution would have such large admin costs it would negate any cost savings?

[w¡n9Nµ7 §£@¥€r 123]

Perhaps.

It's never been tried so who knows?

That said, if we start at the state level and begin expanding until we hit the point where we no longer see additional savings, we'll avoid the pitfalls of starting too big (it's easier to expand than contract).

If a federal structure does save money, then I am sure we'll get there even if we start at the state level. No state is going to say 'no' to saving money.

[GaryC 7]

Perhaps.

It's never been tried so who knows?

That said, if we start at the state level and begin expanding until we hit the point where we no longer see additional savings, we'll avoid the pitfalls of starting too big (it's easier to expand than contract).

If a federal structure does save money, then I am sure we'll get there even if we start at the state level. No state is going to say 'no' to saving money.

The problem with that is once the federal government gets involved the states lose control. As you well know any federal program only expands once started. For that reason I want the federal government barred from any involvement other than oversight and let this be a state only program. If individual states want to collaborate that is fine but at no time should the federal government exercise control.