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Private insurance in theory and in practice

One of the givens in this debate is that private insurers are awful. And in some ways, they are. But not compared to being uninsured. I've quite a few friends at lefty institutions, and most all of them get private health-care insurance. It is, in fact, a hugely important part of job negotiations. And those who don't get it are rightfully furious about it.

Similarly, I've reported on enough union campaigns to know that they, too, consider securing private insurance a huge win for their employees. And more broadly, I've known enough people who are, well, employed, to know they consider private insurance an important consideration when making job decisions.

Would public insurance be better? It would. I'd be happier arguing for it right now. But that's not the choice before us. The people this bill will affect aren't facing divergent futures with public and private insurance. They're facing divergent futures with private insurance or no insurance. Regulated insurance or unregulated insurance. Exchanges that pool their bargaining power and spreads their risk and a world in which they're on their own. And people are being awfully cavalier in the abstract about a decision that virtually always comes out the same way when people have the good fortune to make it.

This is not a great bill. But the status quo is very, very bad. The cost controls may be insufficient, but in the status quo, they simply don't exist. Private insurance isn't optimal, but it's better than the total absence of coverage.

By Ezra Klein  |  December 17, 2009; 4:37 PM ET
Categories:  Health Reform  
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Comments

I gotta wonder Ezra. Is there some sort of willful ignorance on the part of the left that ignores these things? Were they so fixated on the public option that they were oblivious to the other changes the bill made. Look I can excuse a mistake or two here and there. But the problem is a large portion of those who are "bill killers" simply don't understand what's in the bill. Even Howard Dean screwed up on stuff that are actually in the bill.

They're looking for excuses and frankly, are starting to look a lot like Lieberman in their quest to kill the bill.

Posted by: calchala | December 17, 2009 4:56 PM | Report abuse

You're lying again, Klein. There is no "unregulated insurance". And, truth be told, when the government forces businesses to conducted business in certain ways, as the government has been forcing the insurance companies for half a century or longer, it's even somewhat silly to refer to insurance as "private", at all. It's ownership in name only.

Posted by: msoja | December 17, 2009 5:06 PM | Report abuse

There is a world of difference though between the INDIVIDUAL MARKET and GROUP plans.

This is part of the disconnect between pundits and policy-makers and those opposing these reforms.

How many pundits and policy-makers have actually experienced the INDIVIDUAL private insurance market? I'm not talking about this as experience as some kind of academic exercise, but rather as first hand experience.

Now, you might say that the exchanges change the game based on some theoretical belief about how the regulatory mechanism might work in theory.

Based on experience though, there are those of us who are skeptical of those kind of promises.

Rather than trusting that future Dem and GOP administrations will fight for the interests of consumers subject to the pool; it makes sense to have an option which can provide some consistency without regard to how one set of political appointees decides to enforce, or not enforce the law.

Posted by: JPRS | December 17, 2009 5:09 PM | Report abuse

JPRS, banning pre-existing conditions and banning price differention except for a few broad categories like age will greatly help the individual market. What you seem to be saying is that no amount of regulation is acceptable without a public option because insurers will just figure a way out of it. That seems awfully dogmatic.

Posted by: Chris_O | December 17, 2009 5:12 PM | Report abuse

msoja,

The private insurance market is largely unregulated -- it's the wild west.

1. Most consumers in the private, individual insurance market don't have law degrees, so they are at the mercy of those who draft the agreements to ensure that they are clearly written.

2. When problems in interpretation of the contract come to the surface, insurers in most cases have the leverage because they have the resources and means to fight.

In terms of group plans, the story is somewhat different, because groups have leverage both in terms of their size -- if one member of the group is screwed, the entire group can walk taking a lot of money and revenue for the insurer with it; those insured by group plans also tend to have excess capital which allows them to fight against abusive industry practices.

It's worth noting too that smaller groups have less leverage than the bigger ones.

Health insurance isn't like auto insurance or any other form of insurance (higher stakes, more money is usually involved in the front-end for the purchaser).

Posted by: JPRS | December 17, 2009 5:17 PM | Report abuse

The whole thrust of the exchanges is to make individual insurance more like group insurance (and to make that product available to more people).

OPM is supposed to act like your HR department in keeping out crappy plans. The regs on rescission, anti-discrimination, etc... are there to mimic the effect that principles of workplace civil rights law currently have on group plans.

Posted by: NS12345 | December 17, 2009 5:26 PM | Report abuse

At least if you're uninsured, you know that you're screwed and broke if you get hit by a bus when crossing the street, as opposed to being gulled into the tissue-paper-thin sense of security that a plan on the individual market offers you.

A couple of things that Ezra is dodging: the period before the exchanges kick in, and the presumption that insurers will be good faith participants during that period and in the exchange's early years. I still don't see how we get from here to there without the political equivalent of nuclear meltdown.

Posted by: pseudonymousinnc | December 17, 2009 5:33 PM | Report abuse

JPRS, you are woefully uninformed, and msoja has it absolutely right.

Private market health insurance (whether individual or group or blanket or HMO or whatever) is, right at this very minute, subject to innumerable number of laws and regulations at both the state and federal levels, and has been so regulated for decades.

Ever hear of HIPAA? ERISA? Mental health parity? Women's Health and Cancer Rights Act? COBRA? Ever look at your state's department of insurance website? Ever look at your or any state's department of insurance's requirements on policy form and rate filing and approval, consumer complaint and consumer appeal process, consumer right to external review? How about the NAIC -- ever heard of them or looked at their website? Didn't think so.

"Unregulated insurance" is prohibited by federal and state law, and is aggressively prosecuted by the feds and the states.

Those that talk about health insurance being "largely unregulated" have no idea what they're talking about.

Posted by: Policywonk14 | December 17, 2009 5:52 PM | Report abuse

@JPRS: "The private insurance market is largely unregulated -- it's the wild west."

I guess the thousands upon thousands of hours both me personally and countless other actuaries I know have spent preparing rate filings, responding to DOI requests based on those filings, redoing rate filings after we are denied, preparing yet more responses to the new DOI requests, performing additional analysis and modeling to even further justify the rates needed, meeting with legal repeatedly to affirm compliance with all state regulations from the 50 completely different DOIs, dropping all of your other work to cooperate in market conduct exams, scrambling to find other ways to reduce costs when the DOI denies the necessary rates needed to merely break even, all of that never happened I guess. I must have dreamt it one night after a long day spent denying care for kids with leukemia in the "wild west" health insurance market. I guess that one credentialed actuary we have to employ full time for the sole purpose of dealing with just ONE particular state DOI and their continued refusal to allow anywhere near reasonable rates, she doesn't really exist either, just a figment of my imagination. But what would I know about the level of regulation of the health insurance market? I should just ask JPRS about it.

Posted by: ab13 | December 17, 2009 6:02 PM | Report abuse

Well PW14,

When was the last time a big insurer was prosecuted for denying coverage, recission, or any other violation? What are the fines? Chances are they are so low it is cheaper for the insurers to pay the fine and continue screwing policy holders precicely when they are sick and have no leverage or chance to go to another company.

msoja, insurance companies are some of the most profitable corporations in the US. That does make them different from an arm of some government agency.

Posted by: srw3 | December 17, 2009 6:04 PM | Report abuse

@srw3: "insurance companies are some of the most profitable corporations in the US."

Did you have a straight face when you typed that? Because you do know it's completely untrue, right?

Posted by: ab13 | December 17, 2009 6:08 PM | Report abuse

This is not a great bill. But the status quo is very, very bad. The cost controls may be insufficient, but in the status quo, they simply don't exist. Private insurance isn't optimal, but it's better than the total absence of coverage.

Gee Ezra, just a bit ago you were saying that this was the biggest expansion of the social safety net since medicare and medicaid. Now, its not a great bill. What gives?
Private insurance premiums take a significant chunk out of my income and when I file a claim, some actuary like ab13 is there to play the 3D game with me (Discuss, Delay, Deny). The fact is insurance companies make more money by denying coverage, so that is their first, best, and most used strategy when a policy holder files a claim. As a child, I worked in my dad's (he was an MD) office and got a first hand look at how insurance companies routinely deny claims for procedures theoretically covered by the patient's insurance. Often we had to refile 3 times and then they would reluctantly pay. Insurance companies are parasites on the body of society.

Posted by: srw3 | December 17, 2009 6:12 PM | Report abuse

"when I file a claim, some actuary like ab13 is there to play the 3D game with me (Discuss, Delay, Deny). The fact is insurance companies make more money by denying coverage, so that is their first, best, and most used strategy when a policy holder files a claim."

Actuaries do not deny claims. But in my capacity in the company I am routinely though peripherally involved in those types of decisions, and your view is ridiculously simplistic. It's just so easy to try and find a villain, isn't it? Facts be damned, let's just blame the insurers.

Posted by: ab13 | December 17, 2009 6:15 PM | Report abuse

Chris_O,

I'd says it's more realistic than dogmatic.

Given that an industry representing less than 1 percent of the electorate won out in a dispute involving the preference of the majority of Americans (e.g. on a strong national public option) -- what does that signal to you in terms of how future disputes will play out?

(e.g. let's say that people within the exchange start complaining about abusive practices by the insurers; why would those incidents play out any differently than this one involving a negotiation of a public option?)

As a side note: my position has never been that just ONE kind of bill is acceptable; nor has it been that there is only one way to fix our health care system.

My position has been that there are many ways that we can improve our health care system, and there are only a few ways short of the status quo that we could actually make things worse.

I don't think it's especially unrealistic either to expect that a provision that enjoys fairly substantial popular support should be included in a piece of legislation (so long as the measure is Constitutional).

If that expectation somehow makes me a "dogmatic" thinker, so be it.

Posted by: JPRS | December 17, 2009 6:17 PM | Report abuse

ab13,

Wow that sounds like a really inefficient system.

We could simply eliminate the problem and save you all that trouble by adopting a Single-Payer system.

Maybe some lives would even be saved in the process. Certainly it would give taxpayers at large and consumers a much better ROI.

Posted by: JPRS | December 17, 2009 6:22 PM | Report abuse

@srw3:

The bill being the biggest expansion of the social safety net since medicare/medicaid and the bill being not so great are not mutually exclusive concepts.

How is that so hard to grasp?

The insurance reforms in the bill will eliminate rescission, perhaps the most pernicious practice of insurance companies, and use risk adjustment to shift practices away from the current cherrypicking.

I'm currently uninsured and would love to have a public option choice - but I would certainly take subsidies to buy private insurance if that was available.

Of course, due to inane budgetary window scheming, it will be four years until these kick in, but...

The calls by progressives to join conservative obstructionists in calls to kill the bill are so damn foolish.

Posted by: jeffro20 | December 17, 2009 6:22 PM | Report abuse

jeffro20,

The issue isn't "killing the bill" -- its negotiating a deal that a majority of the population will actually benefit from and support.

In the case of a Medicare Buy-In, it could be rolled out within a year of its enactment (this is what was said during the discussions on this issue last week).

Given that reality, we could just as well enact the measure in 2010 or 2013 and it would come on line no later than the exchanges. Granted there is risk of failure, but it's a risk that's probably worthwhile in light of the Sh-t Sandwich that's currently on the table.

Posted by: JPRS | December 17, 2009 6:30 PM | Report abuse

Policywonk14,

LOL. Well, I can think of some households where that news has yet to reach the people.

In a strictly literal sense, yes, the insurance market is regulated. In the experience of a typical person with a dispute -- it's the wild west.

Without question the greatest abuses in the insurance market happen in the individual market. There's a reason for this.

Posted by: JPRS | December 17, 2009 6:35 PM | Report abuse

So let me be clear. We propose some regulations on the insurance industry that will help consumers. But we can't trust the companies to actually implement those regs. And we can't trust the regulators to do their job. So i guess we can't do anything? Where have you all been, under a rock? This stuff in the bill has been there for months and now you are upset about individual mandates and regulation? Of course this is a bit of a gamble, but it's better to try than not try at all. Your alternative -- to kill it and start again is the REPUBLICAN strategy. Please tell me how that helps!

Posted by: LindaB1 | December 17, 2009 6:44 PM | Report abuse

ab13 there is a reason that many of the big buildings in major cities in the US were named for insurance companies, like the Prudential building in chicago. Its because they had the money to build them. If insurance companies were not profitable, they would be out of business like GM or Chrysler. They must be making some money to afford mulitmillion dollar salaries for their executives, right? So insurance companies must be making money right. Give me a break.

Posted by: srw3 | December 17, 2009 6:47 PM | Report abuse

--"Without question the greatest abuses in the insurance market happen in the individual market. There's a reason for this."--

Yeah, it's the result of the horsetrading between people trying to run their businesses and meddling government bureaucrats and legislators. All that stuff in health care contracts is the rancid fat that comes out of the legislative bureaucratic sausage making machine.

The only good thing about the current dismal situation versus the impending dismal situation is that consumers now have recourse to the courts. After health care is more completely swallowed by the government, recourse will involve handing out campaign literature on behalf of congressional candidates.

Posted by: msoja | December 17, 2009 7:02 PM | Report abuse

You just noticed it's a bad bill, Ezra? I have a pre-existing condition. Sure the insurance companies will have to cover me--if I can afford the premiums. No public option, no big pool, means I won't be able to. And your precious exchanges won't work.
The insurance companies will play dodge'em
through the states.
Glad you've got yours, Ezra. I'll have to wait for medicare--if Obama doesn't kill that.

Posted by: kmblue | December 17, 2009 7:05 PM | Report abuse

jeffro20, Ezra kept saying that there are some great things in the bill without the PO and medicare buy in. Now it sounds like he is changing his tune a bit. That's all.

@LindaB1 "But we can't trust the companies to actually implement those regs. And we can't trust the regulators to do their job." Well that is about the size of it. I haven't heard about the robust regulation and swift and effective enforcement provisions in the bill. If you find them let me know. The NLRB regulates how workers form unions, but trivial penalties and lax inforcement, along with big corporations throwing the weight of their legal departments at struggling workers has meant that union busting goes on unabated. Why should we believe that getting insurers to toe the line will be any more effective?

Posted by: srw3 | December 17, 2009 7:08 PM | Report abuse

@LindaB

"This stuff in the bill has been there for months and now you are upset about individual mandates and regulation? Of course this is a bit of a gamble, but it's better to try than not try at all."

But there were provisions that would ameliorate these failings which have been taken out in the interim or haven't you been paying attention

Posted by: williamcross1 | December 17, 2009 7:40 PM | Report abuse

LindaB1,

The advantage of a strong national public option or a Medicare buy-in is that is that it reduces the reliance on regulation or regulators on the part of consumers.

The public option also protects consumer regulations within the exchange -- unlike the private insurers it won't be pumping money back into the political system after the fact to loosen regulations.

Finally, the public option provides a bench-mark to measure the other products in the exchange. It is a kind of public insurance against the insurers.

Posted by: JPRS | December 17, 2009 7:52 PM | Report abuse

msoja,

I'd say the reason is that unchecked private actors tend to act with impunity; whereas they tend to avoid fights with larger fish, because, like a lot of bullies, they are risk averse.

This view of human nature is pretty consistent with the Framers on view on the need for political institutions and checks and balances.

But who knows, maybe we've evolved beyond those limitations. That's not my view, but perhaps that's where you're coming from.

Posted by: JPRS | December 17, 2009 7:58 PM | Report abuse

@srw3: "there is a reason that many of the big buildings in major cities in the US were named for insurance companies, like the Prudential building in chicago. Its because they had the money to build them. If insurance companies were not profitable, they would be out of business like GM or Chrysler. They must be making some money to afford mulitmillion dollar salaries for their executives, right? So insurance companies must be making money right. Give me a break."

Really? That's how you measure profitability, by the name on big buildings? Here in the reality-based community we use these crazy things called profit margins, which for health insurers are pretty low compared to other industries. As for the rest of your nonsense, yes they do make profits. They're not going out of business. But you said they are "some of the most profitable corporations in the US," which is totally false. How about you try to back that up rather than wasting all of our time talking about the Prudential building.

Posted by: ab13 | December 17, 2009 8:16 PM | Report abuse

@JPRS: "Wow that sounds like a really inefficient system."

It sure is. Maybe we ought to get rid of the 50 different state DOIs and have a more efficient system of regulations. It's pretty hilarious that you think the answer to inefficient gov't intervention in the market is a complete gov't takeover of the market.

And how about you try to back up your initial claim of the individual insurance market being unregulated, rather then trying to change the subject to single-payer once you are confronted with some actual facts that prove your claim to be laughably untrue.

Posted by: ab13 | December 17, 2009 8:19 PM | Report abuse

ab13,

Of course, a government takeover of one part of the health care sector -- the insurance market -- would streamline the regulatory structure.

From the consumer and taxpayer perspective it would also reduces costs substantially; it would probably even improve the quality of life for many.

Of course there are other ways to attack the problem. On the other side of the equation -- which I suspect is your position -- we could model the insurance market on what the credit card market has become: One single-standard defined by a state with a state house that can be purchased for pennies on the dollar.

In reference to the initial claim about the individual insurance market being """LARGELY""" unregulated:

1. Compared to Europe this is absolutely true.

2. Compared to the group insurance market this is also true.

Just in practical terms too, you can't get redress without leverage. And you don't have leverage unless you have substantial resources -- or numbers.

Posted by: JPRS | December 17, 2009 8:51 PM | Report abuse

Oh please. Now you're adding qualifiers and trying to back away from your initial claim. Grow a pair and either defend your claim or retract it.

There is a pretty wide chasm between "European regulations" and "the wild west," and you used the latter to describe the individual market. And your 2nd qualifier is also false, the individual market is just as regulated as the group market, in some aspects even more regulated.

As for this bit: "From the consumer and taxpayer perspective it would also reduces costs substantially"

No it wouldn't. It would merely eliminate some administrative expenses of dealing with multiple regulatory schemes, but that is a drop in the bucket compared to the bigger problem: the rate of growth in medical costs.

"On the other side of the equation -- which I suspect is your position"

How typical, you've just created a caricature in your head of my position, with complete disregard for anything I've actually said. You don't care to address my points, you want to argue with a strawman, so you present a false choice of gov't takeover or the credit card market.

Posted by: ab13 | December 17, 2009 9:14 PM | Report abuse

ab13,

I'm not adding qualifiers -- you're dropping them. Read my original comment at 5:17 PM.

Sure though, in practical terms it's an unregulated market for individuals.

Any market where a customer can have coverage rescinded after paying premiums for years is in every practical sense one where the deck is stacked against the consumer.

In reference to single payer -- yes, it would absolutely provide savings to consumers.

1. Single payer would produce savings at the administrative level;
2. it would eliminate several parts of the organizational structure that have nothing to do with health care delivery (e.g. marketing costs, lobbying fees, adjusters, in-house lawyers, shareholder kickbacks, or rather dividends).
3. It would provide uniform standards in processing claims (saving providers time and money);
4. It would likely enjoy the kinds of price discounts from providers that large purchasers tend to get in other single-payer systems.

We should be able to provide universal coverage for hundreds of billions less a year than we're currently paying. This is true even if we opt for something other than single-payer (personally, I'm not tied to it, because I see the value of some of the other alternatives. There is something fundamentally amiss though when we're pouring 18 percent of GDP into the health care sector when other industrialized nations are spending 30 to 50 percent less for universal coverage).

As far as who you are and aren't, the questions and answers you're dishing out speak pretty well for themselves. I'm answering you, but you keep saying that it isn't an answer that's acceptable to you.

So be it.

Posted by: JPRS | December 17, 2009 9:51 PM | Report abuse

JPRS,

you do realize that in most states I'd expect (I know mine does) that the regulations and regulators in the individual market are the EXACT SAME ONES as in the small group market (normally 2-50 lives). You do get that right? I can't believe the number of people on here that really have no clue on this. I saw on MSNBC tonight where Ed said that with new reform we'd need state insurance commissioners in every state. UH, we already have them DUH. Olbermann makes the same stupid blunders of fact all the time. The fact that these "experts" on that channel are funneling info to their masses on the left with such misinformation is mind-numbing. Its like the blind leading the blind.

Oh and JPRS,

in your single payer model that saves in admin cost where do you put fraud? Is that an admin cost?

Oh and that lovely speeding up of processing time is what is costing medicare and medicaid tens of billions of dollars per year. the requirement to pay claims in 15 days forces auto ajudication which in turns tells fraudulent providers to hear: "Lookey here, come and submit fraudulent claims here, we'll pay WHATEVER and by the time we figure it out you'll have bilked us for tens of millions of dollars and you'll move on to the next shell company and site."

Oh and you believe that "Of course, a government takeover of one part of the health care sector -- the insurance market -- would streamline the regulatory structure."

Have you ever LOOKED at the IRS CODE? Its (at last count I could find) 67204 pages long. It makes this bill look like a book my 5 year old would read in kindergarten. You honestly should place "government" and "streamlined" EVER in the same sentence without the word NOT or NEVER.

Posted by: visionbrkr | December 17, 2009 10:08 PM | Report abuse

--"I'd say the reason is that unchecked private actors tend to act with impunity"--

Circular. In the free market, consumers are the ever forceful check on private actors. No one, except the government, can force you to buy insurance you don't want or need. Right now, if you want insurance, though, it comes with things you don't want or need in it, also thanks to the government, which is just one of the reasons it is so expensive.

And the more the government gets involved, the worse it is going to get. There is no other way it can go. Until it collapses or there is widespread revolt.

Posted by: msoja | December 17, 2009 10:12 PM | Report abuse

msoja,

In competitive markets that may be the case; however, not all private insurers operate in competitive markets.

As far as "when government gets involved, bad things always happen" -- take a look at China. The government has no effective regulatory oversight -- or consumer protection laws -- in many areas.

So you have a few hundred kids dying because milk suppliers tampered with the product and put fatal additives into it.

You may be able to punish the malefactors after the fact, but until you find a way to resurrect the dead, you haven't really solved the consumers loss side of the equation.

visionbrkr,

When the Canadian single-payer law was introduced it was 19 pages long. Simplicity and clarity are not really arguments against a single-payer system.

Posted by: JPRS | December 17, 2009 10:30 PM | Report abuse

--"In competitive markets that may be the case; however, not all private insurers operate in competitive markets."--

I don't think you understand the simple things people have been trying to explain to you: There is NO free market in health insurance in this country.

But, if you think competition works, and it does, how about we get the government out of the insurance business. Duh?

--"take a look at China."--

That's what years of communist thugocracy gets ya. At least they *have* milk, now. And a huge amount of enterprise and endeavor and *wealth* that the old command and control system prohibited by its very nature. Sure, there are going to be some tragedies, but we're not living in some fluffy bunny farm. Grow up.

Posted by: msoja | December 17, 2009 11:23 PM | Report abuse

msoja,

Our insurance market has a lot less government interference than most other developed nations.

We even have anti-trust exemptions for insurers. If you believe those anti-trust exemptions should be repealed, well, you're someone who doesn't believe in a certain kind of free-market operation. Maybe you think unregulated monopolies are consistent with representative democracies; I think history shows otherwise.

In reference to a number of public services, we don't look at fire depts, or police depts, or even the military (up until recently) and say -- what's the ROI. We recognize that the profit incentive in those areas usually ends up perverting the purpose of those public services and functions.

Posted by: JPRS | December 17, 2009 11:36 PM | Report abuse

msoja,

It's also worth asking: Why is it that industrialized nations with much more involvement in the operation of their health care markets and systems spend significantly less than we do to provide universal coverage?

Based on your line of reason, less involvement should yield the greatest competition, which in turn should provide the lowest costs. Yet the reality is something completely different.

Even if there are lurking variables that make an apples-to-apples comparison between any two countries hard to draw -- the fact stands that we pay significantly more than every other developed, industrialized, democracy. And yet we give our private markets in the insurance sector a freer-reign than elsewhere.

Posted by: JPRS | December 18, 2009 12:23 AM | Report abuse

Would you pls stop framing the debate as if the only altrnatives are all or jothing, Ezra? It simply isn't true. Capitulating to the Liarman isn't unavoidable. Senators who remain swtadfastly committed to a better reform, like Burris and Sanders, can force Reid to use reconciliation instead. Actually, since Nelson isn't on board either, and the 60 votes simply aren't there, this increasingly looks like the only way to pass a Dem reform at at all!

And in reconciliation, the bill can be improved in important ways, for instance by putting the Medicare extension back in. The GOP has successfully used this method several times, so why shouldnb't the Dems be able to do the same? As I see it, this isn't a matter of means, but a matter of will.

So, there is a third alternative, it is proven and preferrable, and you really should stop ignoring it. You readers deserve to learn about all the possibiliites, not only the ones that you prefer!

Posted by: Gray62 | December 18, 2009 7:14 AM | Report abuse

"When was the last time a big insurer was prosecuted for denying coverage, recission, or any other violation? What are the fines? " - srw3

I can't answer for "the last time" but 3 major insurers in California were assessed millions in fines and required to reinstate hundreds of patients last year.

Insurance regulators are considerably less aggressive in some states -- which is why insurance companies would like to undermine strong departments and sell crappy plans across state lines.

Posted by: Athena_news | December 18, 2009 9:23 AM | Report abuse

"I'm not adding qualifiers -- you're dropping them. Read my original comment at 5:17 PM."

No, you're adding the qualifiers of "well they are less regulated than Europe/the group market". Your original claim at 5:17 was "The private insurance market is largely unregulated -- it's the wild west."

And this next sentence just proves you have no clue what you're talking about:

"Any market where a customer can have coverage rescinded after paying premiums for years is in every practical sense one where the deck is stacked against the consumer."

This is a fantasy. Rescission is limited to 24 months from issue, so no one is having coverage rescinded after paying premiums for "years".

Nothing in your list of single payer benefits does anything to address rising medical costs. Admin costs and profits are a red herring. Take them all away and you've bought us a couple years, nothing more.

Posted by: ab13 | December 18, 2009 11:18 AM | Report abuse

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