Talk:Health insurance in the United States/Archive 1

Archive 1

Employer/group health insurance is almost always less expensive

The IP 146.145.79.247 has been reverting the edits of my removal of the following: "Average premiums are somewhat lower than those for employer-sponsored coverage, but vary by age." The premiums are not lower for identical coverage, which is what is implied by the statement that was removed. The questionable health insurance industry site that is cited for this quote admits in a disguising manner that the coverage is different. There are many reputable organizations and publications, some within the health insurance industry itself, that will state what is common knowledge, that employer/group health insurance is almost always less expensive than individual insurance. --Historian 1000 (talk) 15:47, 28 January 2008 (UTC)

Historian, I disagree with you on your evaluation of the research. Take a look at the sample size of the AHIP survey - it's larger than anything else out there. They've done this survey several times now, and the results have been consistent. Yes, it's done by a trade association, but they have the contacts with insurance companies to get the data. Beyond that, the KFF has published a very similar, albeit smaller survey. They are hardly in the pocket of the insurance industry.

We've had some back and forth edits on the relationship of average premiums in the individual health insurance market to those in the employer-sponsored market. They are in fact lower on average. There are a number of likely reasons for this. They include the average age and health of people with individual coverage (though if you look at the data, the average age isn't all that much lower), and perhaps most significantly, the benefits tend to be a good bit less generous. In particular, deductibles, co-payments and out-of-pocket limits are higher. In many cases people choose to buy policies that don't cover maternity, which makes a big difference for younger women.

The reasons stated for taking this out of the article include that individual market premiums aren't lower for identical coverage, that it isn't relevant unless you are comparing identical coverage, and it's the net employee contribution that's the real issue anyway. I strongly believe the difference in average premiums is a relevant fact. First, it's a result that's been found by multiple surveys, but is so counter intuitive that people's immediate reaction is say "that's wrong" without even thinking about it. That's exactly the kind of fact that forces us to think through and really understand an issue. Second, it's not true that premiums will always be lower in the group market when the benefits are identical. Look at the age curve in the individual market surveys. It's not unusual to see premium differences of five to one based on age. A healthy young adult may very well be able to find identical coverage at a lower premium than is available to an employer, where the average age may be 40. Third, the benefit differences are relevant in and of themselves - part of the reason group coverage is so expensive is the level of benefits provided. I'm personally agnostic on the whole "consumer driven healthcare" movement, but the possibility that someone can get a lower premium in the individual market - despite all the inefficiencies there - by buying something different is relevant. Fourth, the text already states that the consumer has to pay the entire premium without employer help, so it's not misleading people there (though this is not always true - sometimes small employers will help pay for individual coverage rather than sponsor a group plan). I'd be glad to add some statistics on the average level of employer contributions - that might well help round out the context (though it might make more sense to put it under the section on employer coverage). Fifth, the current policy debate in the U.S. has a number of proponents of moving towards a more individual system, and the relationship between the gross premiums in the two markets is directly relevant to that issue. Sixth, the relationship is directly relevant today for small employers, many of whom have the choice between buying individual coverage for themselves, or establishing a small group plan for their firm. That decision is often made based on price.

If I could find a study that compared premiums for identical benefit packages, I'd include it - but I haven't seen one. I'm not sure how a survey could be done on this, and still have an adequate sample size. It would be extremely hard to match up an adequate number of policies with identical benefit provisions. Researchers have attempted to study differences in benefit levels using actuarial models, but there are limitations there - you have to trust the actuarial equivalence calculations, which can be more art than science (and on a technical level, the results of an actuarial equivalence calculation are dependent on the health cost distribution of the population involved - which will presumably differ between the two markets). If you want to include some of that research, that's fine. I believe that there have been a couple of studies done by ARC that have been published in Health Affairs (I forget who sponsored them - KFF or Commonwealth, perhaps?). I would note, though, that KFF and Commonwealth have their own point of view as well.

Bottom line, I'm convinced that this is a relevant (albeit perhaps inconvenient) research result. It's a result that's well known and understood among researchers studying the individual health insurance market, but is almost completely unknown by anyone else (and, in fact, the opposite is almost universally assumed to be true). That's exactly the kind of thing we should be helping people find. If we exclude it, we're biasing the article by omission. If we think more context and explanation is necessary to help the reader properly understand what it means, I'll be glad to help round out the discussion (look at my last set of edits - I made a good faith effort to bring in the considerations that had been raised, modeled on the discussion in the KFF report). But I strongly object to deleting it simply because we don't like the result, think the fact is somehow misleading, or are afraid the average reader isn't sophisticated enough to draw the correct conclusion (whatever we think that conclusion may be). Let's be as careful as we can to characterize the research correctly, let's add all of the relevant considerations and other factors that bear on the question, but let's not censor stuff out because we don't like it.

What I would like to suggest is that we include this research, along with all the caveats and commentary - and that you add whatever additional research findings you believe are relevant to set the appropriate context and help people understand what it all means. But what I've added is well cited, is not inflammatory, and given our last round of edits is surrounded by a good faith attempt to highlight the concerns and considerations you've been talking about. I'm not trying to POV push, but I don't think it's either correct or reasonable to implicitly say that "we all know that individual health insurance is more expensive" and leave it at that - reality is much more complicated and nuanced. 146.145.79.247 (talk) 16:15, 28 January 2008 (UTC)146.145.79.247 (talk) 17:39, 28 January 2008 (UTC)

Bot report : Found duplicate references !

In the last revision I edited, I found duplicate named references, i.e. references sharing the same name, but not having the same content. Please check them, as I am not able to fix them automatically :)

• "Census 2006" :
  • [http://www.census.gov/prod/2007pubs/p60-233.pdf "Income, Poverty, and Health Insurance Coverage in the United States: 2006."] U.S. Census Bureau. Issued August 2007.
  • [http://www.census.gov/prod/2007pubs/p60-233.pdf "Income, Poverty, and Health Insurance Coverage in the United States: 2006."] US Census Bureau. Issued August 2007.

DumZiBoT (talk) 13:09, 13 August 2008 (UTC)

Criticisms - Or rather the complete lack of them. The article is unbalanced.

In my time reading about health insurance in the United States I have read numerous criticsms of health insurance. For instance

1. Health insurance companies tend not to pay for long term preventative care programs for a patient because they tend to bear the costs only for the savings to be had by a different insurer (because comanies periodically change their insurer)

2. Losing your job (which often happend through ill health) causes you to have to give up your health insurance (COBRA provisions are time limited and can be very expensive as the individual cannot pay the same rate as the employer paid)

3. Insurance companies are happy to take monthly premiums but when it comes to paying out, especially on highly expensive treatments, they will even employ special investigators to find a reason for not paying out, een on the flimsiest grounds.

4. Deductibles and co-pays actually pass most costs on the the insured in many cases, especially for simple consultations. This leads many people to delay getting seeing a doctor in the early stages of illness because nearly all costs fall to the insured at this point. This causes people to see a doctor only when a problem has become serious.

5. Because of the problem in 4. above, the United States has fewer primary care physicians than it ought to and rather too many higher paid specialists.

6. Health insurance companies sometimes do deals with certain hospitals which means that if a patient goes to an out-of-scheme hospital for emergency treatment, the insurance company does not pay. I read a story recently where a small child ended up with permanent brain damage because the ambulance had to make an excessively long journey to an in-scheme facility, when a shorter journey to an out-of-scheme facility would most likely have prevented this. Tragic. It would not happen in any other country I know of.

7. Many doctors are sickened by being unable to treat patients that need health care but are denied it by the insurance company which must pre-approve treatment. This means that health insurance clerks (who it seems are rewarded financially for denying claims) are rationing health care in the United States and decisions are being taken on health care access by people who are not medically trained and overriding the decisions of people that are. This would be a scandal if it happened in Europe. Even people taken to hospital in an ambulance in the U.S following an auto accident have sometimes had the ambulance costs refused by an insurance comåany because the ride was not pre-approved.

8. People sometimes have to fight legal battles with their insurers to get them to pay their contractual obligations. When the battle is won, the company pays but because it comes too late a condition has become fatal.

9. As most seniors migrate to Medicare, the insurance industry is only interested to make sure that ill health does not affect them financially before the person reaches 60. Because of this, costs that really should be borne by insurers are effectively passed on to the government.

10. The insurance industry is geared to managing two perfect circles that should not overlap. The circle of people that are healthy and will make only very small claims as policy holders (which it will seek to attract) and the circle of people who will make above average claims (which the company will do all it can to avoid paying out for -- by exclusions, higher co-pay rates etc). The latter activity is antithetical to the whole concept of insurance (which is that the fortunate healthy should meet the health care costs of the unfortunately ill.healthy)

11. Insurance companies have high administrative costs associated with pre-screening applicants and the screening of claims. None of these costs represents value for money to the American people - they just reduce the amount of money available for health care delivery.

12. The multiplicity of rules in each companies scheme and different types of claims procedures adds a high administrative load on the medical supply sector (doctors and hospitals) as well as onto patients themselves.

13. Hospitals and individual physiscians must account for their costs at the patient level, adding to the level of adminsitrative complexity in the system. Simple things like band-aids and bandages end up being charged out to the patient or their insurer at exhoribitant prices.

These are just some examples that come immediately to mind. There must be many more. I searched the article for the string "critic" expecting to find "criticisms" and the only word that came back was "critical care insurance" or something like it. I scanned looking for examples of the above criticisms and found none.

Conclusion: This article is seriously lacking any serious reflection of the very high level of criticisms directed at the health insurance industry in the United States.--Hauskalainen (talk) 23:35, 17 March 2009 (UTC)

Economics section

Two (or perhaps it is just one) editor has been making edits in a mew section entitled "economics" which seems to be describing some economic issues with regard to Health Insurance. Whilst sympathising with much of what has been written, the content as it stands is just the opinion of one editor and it really needs to be backed up with more substantial argument by WP:RS references to prevent it from being perceived as WP:OR. I therefore reluctantly deleted the section. If the content was smaller in size I would have just asked for WP:Citations at the appropriate points but the content is so extensive that I feel compelled to ask the editor to provide more references for these arguments before adding the material back.--Hauskalainen (talk) 23:04, 13 April 2009 (UTC)

the cause of more uninsured people

Since the inception of the NAFTA agreement many company's moved jobs to other country's. This caused much unemployment in the united states and lead to home foreclosures and yes the inability to stay with company health insurance programs. This trend will continue until the NAFTA agreement is revoked by the senate,congress and president of the united states of north america. —Preceding unsigned comment added by 173.67.227.147 (talk) 17:07, 22 March 2010 (UTC)

Death

Yesterday I added this subsection to the section about the Uninsured. It was removed without explanation. Please provide objection based WP rules before removing text. Removal of a relevant, well sourced contribution without explanation or discussion here smacks of vandalism.--NYCJosh (talk) 15:21, 29 September 2010 (UTC)

Since people who lack health insurance are unable to obtain timely medical care, they have a 40 percent higher risk of death in any given year than those with health insurance, according to a study published in the American Journal of Public Health. The study estimated that in 2005 in the United States, there were 45,000 deaths associated with lack of health insurance.

Please stop removing this text until you explain why it's irrelevant and the source is unreliable. Please comply with WP rules. Stop accusing CNN and the American Journal of Public Health of being "political." They are perfectly good RS sources. You are entitled to your political views but not to making up WP rules. This behavior is unacceptable on WP! --NYCJosh (talk) 19:50, 30 September 2010 (UTC)

References

Short term health insurance

Should this article have a subsection on Short term health insurance? (Currently a red-link, planning on starting an article in the near future.) A couple sources explaining what this is are: [1], [2] ~Adjwilley (talk) 19:44, 15 March 2014 (UTC)

MFN status

The section on MFN status seems to be saying the polar opposite of what its cited source is saying. MFN status meant that a provider would get the same rate that a comparable provider was offered, and that such agreements were pro-competitive. The wiki article claims that MFN status meant that all competitors would get a higher rate, which was anti-competitive.

http://www.insurance.ohio.gov/Documents/MFN6.PDF

--Ryan W (talk) 05:55, 14 April 2014 (UTC)