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	<title>Comments on: Discriminating Our Way to Universal Health Care</title>
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	<description>The Law, the Universe, and Everything</description>
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		<title>By: Daniel S. Goldberg</title>
		<link>http://www.concurringopinions.com/archives/2008/02/discriminating.html/comment-page-1#comment-50182</link>
		<dc:creator>Daniel S. Goldberg</dc:creator>
		<pubDate>Tue, 26 Feb 2008 23:11:59 +0000</pubDate>
		<guid isPermaLink="false">http://www.solove.org/archives/2008/02/discriminating-our-way-to-universal-health-care.html#comment-50182</guid>
		<description>Roger,

I am unsure I understand your point.  Please explain to me how, in a completely free and unfettered market, there exist incentives for insurers to cover seriously ill persons?

Of course, this could easily be done by simply correlating premiums to the risk level, but that kind of begs the question b/c, as you admit, so many sick persons would be priced out of coverage and thereby excluded from the pool.  So I&#039;m having difficulty seeing how this current case is a product of &quot;regulation&quot; rather than the array of incentives in the health insurance industry.  Removing all regulation would hardly ameliorate these incentives, nor would it make it likelier that sick persons obtain insurance coverage, if we care about that at all.

Indeed, premiums are more closely calibrated to individual risk in the individual health insurance market, which is partly why the cost of individual health insurance is exorbitant.

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		<content:encoded><![CDATA[<p>Roger,</p>
<p>I am unsure I understand your point.  Please explain to me how, in a completely free and unfettered market, there exist incentives for insurers to cover seriously ill persons?</p>
<p>Of course, this could easily be done by simply correlating premiums to the risk level, but that kind of begs the question b/c, as you admit, so many sick persons would be priced out of coverage and thereby excluded from the pool.  So I&#8217;m having difficulty seeing how this current case is a product of &#8220;regulation&#8221; rather than the array of incentives in the health insurance industry.  Removing all regulation would hardly ameliorate these incentives, nor would it make it likelier that sick persons obtain insurance coverage, if we care about that at all.</p>
<p>Indeed, premiums are more closely calibrated to individual risk in the individual health insurance market, which is partly why the cost of individual health insurance is exorbitant.</p>
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		<title>By: Frank</title>
		<link>http://www.concurringopinions.com/archives/2008/02/discriminating.html/comment-page-1#comment-50181</link>
		<dc:creator>Frank</dc:creator>
		<pubDate>Tue, 26 Feb 2008 16:05:52 +0000</pubDate>
		<guid isPermaLink="false">http://www.solove.org/archives/2008/02/discriminating-our-way-to-universal-health-care.html#comment-50181</guid>
		<description>To Roger Zimmerman: is there any serious politician or policy expert pushing a nationalization model in the U.S.?  France, Germany, the Netherlands all provide models for us more compelling than the British NHS...which has itself become more open to private insurance and innovation.

Taiwan provides yet another model:

http://dissentmagazine.org/article/?article=985

&quot;The provision of health care is not nationalized, despite a degree of information and coordination that, for example, the British system cannot match after spending billions on computerization. Rather, [Taiwan&#039;s National Health Insurance Program, introduced in 1995] is a classic single payer scheme—the government runs a compulsory, mostly premium-financed insurance system, which negotiates a single payment schedule with the private and municipal or government-owned providers.&quot;

&quot;Health care is provided by a competitive mixture of municipal and public (about one-third of the beds) and privately owned hospitals that also offer comprehensive primary care. Between them they employ almost two-thirds of doctors.&quot;

</description>
		<content:encoded><![CDATA[<p>To Roger Zimmerman: is there any serious politician or policy expert pushing a nationalization model in the U.S.?  France, Germany, the Netherlands all provide models for us more compelling than the British NHS&#8230;which has itself become more open to private insurance and innovation.</p>
<p>Taiwan provides yet another model:</p>
<p><a href="http://dissentmagazine.org/article/?article=985" rel="nofollow">http://dissentmagazine.org/article/?article=985</a></p>
<p>&#8220;The provision of health care is not nationalized, despite a degree of information and coordination that, for example, the British system cannot match after spending billions on computerization. Rather, [Taiwan's National Health Insurance Program, introduced in 1995] is a classic single payer scheme—the government runs a compulsory, mostly premium-financed insurance system, which negotiates a single payment schedule with the private and municipal or government-owned providers.&#8221;</p>
<p>&#8220;Health care is provided by a competitive mixture of municipal and public (about one-third of the beds) and privately owned hospitals that also offer comprehensive primary care. Between them they employ almost two-thirds of doctors.&#8221;</p>
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		<title>By: Roger Zimmerman</title>
		<link>http://www.concurringopinions.com/archives/2008/02/discriminating.html/comment-page-1#comment-50180</link>
		<dc:creator>Roger Zimmerman</dc:creator>
		<pubDate>Tue, 26 Feb 2008 15:57:52 +0000</pubDate>
		<guid isPermaLink="false">http://www.solove.org/archives/2008/02/discriminating-our-way-to-universal-health-care.html#comment-50180</guid>
		<description>To claim that Health Net&#039;s (and the other California insurers) behavior is that of an actor in a free-market system is ludicrous.  This is just another example of regulation begetting more regulation.  The insurers were using cancellations as a cost control measure in a rigged system - one that forces them to cover a prescribed menu of conditions and prescribed rates if they want to do business.  Now they can no longer use that cost control measure, so they will try to find others, such as discriminating as best they can with initial sign ups (though I&#039;m sure this is heavily regulated as well).

In a free market, insurers could discriminate based on price and coverage, and reach an equilibrium which would offer the widest possible insurance options with the greatest efficiency.  Since DNA does not guarantee future health (one way or the other), there would still be some degree of risk which could be shared among those that were not currently sick.

Would some people be priced out of health insurance?  Of course.  But at least they would have a viable health care industry to serve their needs as charity cases, in contrast to the slowly decaying monstrosity that would result from the complete nationalization of health care funding.

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		<content:encoded><![CDATA[<p>To claim that Health Net&#8217;s (and the other California insurers) behavior is that of an actor in a free-market system is ludicrous.  This is just another example of regulation begetting more regulation.  The insurers were using cancellations as a cost control measure in a rigged system &#8211; one that forces them to cover a prescribed menu of conditions and prescribed rates if they want to do business.  Now they can no longer use that cost control measure, so they will try to find others, such as discriminating as best they can with initial sign ups (though I&#8217;m sure this is heavily regulated as well).</p>
<p>In a free market, insurers could discriminate based on price and coverage, and reach an equilibrium which would offer the widest possible insurance options with the greatest efficiency.  Since DNA does not guarantee future health (one way or the other), there would still be some degree of risk which could be shared among those that were not currently sick.</p>
<p>Would some people be priced out of health insurance?  Of course.  But at least they would have a viable health care industry to serve their needs as charity cases, in contrast to the slowly decaying monstrosity that would result from the complete nationalization of health care funding.</p>
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		<title>By: KipEsquire</title>
		<link>http://www.concurringopinions.com/archives/2008/02/discriminating.html/comment-page-1#comment-50179</link>
		<dc:creator>KipEsquire</dc:creator>
		<pubDate>Sun, 24 Feb 2008 08:15:45 +0000</pubDate>
		<guid isPermaLink="false">http://www.solove.org/archives/2008/02/discriminating-our-way-to-universal-health-care.html#comment-50179</guid>
		<description>Isn&#039;t it interesting that redistributionists once legitimized their views with a &quot;veil of ignorance&quot; and are now legitimizing it with an &quot;anti-veil of knowledge&quot;?

Whatever it takes, I guess.

</description>
		<content:encoded><![CDATA[<p>Isn&#8217;t it interesting that redistributionists once legitimized their views with a &#8220;veil of ignorance&#8221; and are now legitimizing it with an &#8220;anti-veil of knowledge&#8221;?</p>
<p>Whatever it takes, I guess.</p>
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		<title>By: Daniel S. Goldberg</title>
		<link>http://www.concurringopinions.com/archives/2008/02/discriminating.html/comment-page-1#comment-50178</link>
		<dc:creator>Daniel S. Goldberg</dc:creator>
		<pubDate>Sun, 24 Feb 2008 07:43:07 +0000</pubDate>
		<guid isPermaLink="false">http://www.solove.org/archives/2008/02/discriminating-our-way-to-universal-health-care.html#comment-50178</guid>
		<description>Note that this award was ordered by an arbitration judge, the importance of which ought not be understated.  Nor is it irrelevant that the $9 million in damages were punitive in nature, and that the arbitrator found the insurer breached its duty of good faith and fair dealing (I&#039;m not sure how it is in California, but I practiced insurance law in Texas, and in Texas it&#039;s difficult to satisfy the BOP on this particular duty, meaning that the conduct would have to be quite egregious to prove up this count).

Perhaps the tort reform proponents urging that consumers are not necessarily worse off in arbitration would endorse this decision?

The language in the &lt;a href=&quot;http://www.calendarlive.com/media/acrobat/2008-02/35955051.pdf&quot; rel=&quot;nofollow&quot;&gt;opinion&lt;/a&gt; is actually worth quoting here, as its among the most acerbic I&#039;ve seen from an arbitrator, though, admittedly, most arbitration resolutions are not reduced to writing:

&quot;It&#039;s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive.&quot;

Reprehensible, surely.  But it just shows the power the possibility of rents exerts on our behavior.  It&#039;s why, again, I &lt;a href=&quot;http://www.medhumanities.org/2007/03/insurance_justi.html&quot; rel=&quot;nofollow&quot;&gt;query&lt;/a&gt;, along with Allen Buchanan, why anyone ever imagined for one solitary second that health insurers are &lt;i&gt;likely&lt;/i&gt; to act in ways that allocate resources justly.

</description>
		<content:encoded><![CDATA[<p>Note that this award was ordered by an arbitration judge, the importance of which ought not be understated.  Nor is it irrelevant that the $9 million in damages were punitive in nature, and that the arbitrator found the insurer breached its duty of good faith and fair dealing (I&#8217;m not sure how it is in California, but I practiced insurance law in Texas, and in Texas it&#8217;s difficult to satisfy the BOP on this particular duty, meaning that the conduct would have to be quite egregious to prove up this count).</p>
<p>Perhaps the tort reform proponents urging that consumers are not necessarily worse off in arbitration would endorse this decision?</p>
<p>The language in the <a href="http://www.calendarlive.com/media/acrobat/2008-02/35955051.pdf" rel="nofollow">opinion</a> is actually worth quoting here, as its among the most acerbic I&#8217;ve seen from an arbitrator, though, admittedly, most arbitration resolutions are not reduced to writing:</p>
<p>&#8220;It&#8217;s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive.&#8221;</p>
<p>Reprehensible, surely.  But it just shows the power the possibility of rents exerts on our behavior.  It&#8217;s why, again, I <a href="http://www.medhumanities.org/2007/03/insurance_justi.html" rel="nofollow">query</a>, along with Allen Buchanan, why anyone ever imagined for one solitary second that health insurers are <i>likely</i> to act in ways that allocate resources justly.</p>
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