Free American Health Care

Thanks for your comments. My opinion - not legal, ...

2012-05-18T14:38:55.032-07:00

Thanks for your comments. My opinion - not legal, but economic - is that health insurance is not interstate commerce and the Supreme Court's decision in U.S. vs. South-Eastern Underwriters' Assocation was wrong.

Health insurance is not "commerce." It is a contract to pay. Physicians and hosptials are largely not engaged in interstate commerce because once a person shows up in your office or hospital they are in your state. Telemedicine is a different issue.

Medical devices and drugs are interstate commerce, obviously.

But insurance is a contract to pay, not commerce as such.

State mandates have not interfered with CIGNA's or AETNA's or WellPoint's or UnitedHealth Group's ability to offer individual and small-group policies in different states.

As always, I go back to my original example: The pages of federal law governing life insurance or auto insurance amount to zero, and there is no barrier to auto insurers offering policies in every state, although automobiles themselves are clearly interstate commerce.

Just listened to the podcast - agree individual-ow...

2012-05-18T13:51:22.519-07:00

Just listened to the podcast - agree individual-owned policies are key consumer change. I also like the concept of specialty insurers for individuals with chronic conditions (reminds me of predictions back in the 80’s that DRG’s would lead to emergence of specialty hospitals.)

As much as I agree with your thinking, I still believe “cross-state” buying of insurance is an idea whose time has come.

Yes, the much larger, underlying problem is the cost of medical care; yes, the idea of cross-state purchase of insurance does nothing about this underlying cost; and yes, provider reimbursements that an insurer has negotiated in one state wouldn’t apply in another state.

However, it’s also true that current law distorts the insurance markets. States can set their own, independent benefit mandates and states can prohibiting their citizens from buying policies that have fewer mandates and are therefore less expensive; that is, they are prohibited from buying “across state lines.” As a result, some people are obliged to pay more than they need to pay for the insurance they want.

The federal government recently argued before the Supreme Court that insurance is interstate business governed by the Commerce Clause. In fact the Supreme Court reached this very same position in the 1940’s. Why then can the states continue to prohibit their residents from purchasing an insurance policy that has been approved for issue in another state? State prohibitions clearly interfere with the interstate business of insurance. Isn’t it time to modify or repeal McCarran-Ferguson?

You and I can buy thousands of products - even fertilizer – from vendors in states where we don’t live. Why not insurance?

Clearly, it would be far simpler if the states allowed individuals a few simple choices: for example, a policy with all its mandates, or with none. Yeah, that’s gonna happen.

Just to be clear, I don't envision this would reduce the cost of medical care by a nickel. But it could, I think, reduce the cost of insurance for many people - and that's why it's worth thinking about.

John, you make good points regarding the ineffecti...

2012-05-16T20:26:17.417-07:00

John, you make good points regarding the ineffectiveness of the Georgia law. I certainly agree that this is not THE answer to healthcare reform.

At the same time, as someone involved in the healthcare financing business for 40 years, I can tell you that the notion of allowing carriers to do business in all states without compliance with the mandates from each state is certainly part of the solution.

I say that with the belief that any government dictates (mandates) be they federal, state or local regarding the types of benefits that must be offered is counterproductive to effective healthcare reform, and are breeding grounds for corruption and crony capitalism.

This type of legislation is not going to useful if it is done on a state to state basis. It is too "hit and miss" and therefore not surprising that the Georgia law had failed to created a lot of enthusiasm.

You are right that costs vary from state to state for many reasons other than the mandates. That is why the reform must be initiated comprehensively at the federal level.

Hey John,that's really nice! Everybody should ...

2012-04-18T05:33:44.451-07:00

Hey John,that's really nice! Everybody should be aware that it's important to keep a track of their health issues. Nobody can deny the benefits of health insurance but it does mean that you neglecting your health and fitness problems.

Sadly, TN just became the lucky 13th state to adop...

2011-12-15T12:51:40.673-08:00

Sadly, TN just became the lucky 13th state to adopt one

I recently came across your blog and have been rea...

2011-12-02T10:58:42.818-08:00

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

Medical Billing I Free EMR

In fairness, in the 696-page document, the actual ...

2011-10-21T22:20:22.552-07:00

In fairness, in the 696-page document, the actual new rules don't begin until page 623. The first 622 pages are the explanation of how they came up with the new rules.

NOt at all: What I'm stating is that it should...

2011-10-21T14:26:40.689-07:00

NOt at all: What I'm stating is that it should not take almost a thousand new pages of rules to revoke obsolete rules!

Thanks for taking the time to comment.

so you are saying that all those changes designed ...

2011-10-21T06:08:29.129-07:00

so you are saying that all those changes designed to make it easier for hospitals to run their own affairs are wrong?

This is a good common sense Blog. Very helpful to ...

2011-10-07T15:40:31.108-07:00

This is a good common sense Blog. Very helpful to one who is just finding the resources about this part.It will certainly help educate me.

given that Windsor is a pretty well to do city, it...

2011-08-31T22:21:45.645-07:00

given that Windsor is a pretty well to do city, it's shocking they've used Detroit as a safety valve for SO many things - from emergencies to majorly complex disorders.

On both sides of the border, health care needs to be reformed!

I hear you, but I think I've been too tough on...

2011-07-20T10:11:24.072-07:00

I hear you, but I think I've been too tough on the carriers. That is, I think they'll be able to pivot when the time to repeal and replace comes.

If their investments in Health Benefits Exchanges mean that they are more prepared for the individual market to be the market of first resort, rather than a residual market, they may weaken their resistance to tax reform that gives individuals, not employers, the tax benefit for owning health insurance.

I'm just an optimist by nature.

John, no doubt UHC is keeping quiet about its lobb...

2011-07-20T07:26:22.803-07:00

John, no doubt UHC is keeping quiet about its lobbying efforts "post" PPACA, probably because it hopes there to not be a "post" PPACA.

I'm not sure about Wall Street in general but you can be sure That UHC is not addressing a world without PPACA because they have so much invested in it already. Besides, whatever replaces PPACA is sure to be less profitable for the BUCAs.

Sam E - Your work has inspired me to be an excellent source. I pass on your blog to many of my friends as well.

John, thank you for this post. Don't forget...

2011-07-01T18:52:30.363-07:00

John, thank you for this post.

Don't forget that PPACA requires the federal government to step in with a federal solution for those states who are not ready. HHS decision time on which states will be ready is supposed to be before year-end 2012.

A "failure to launch" state-based exchanges in a timely fashion, given the significant taxpayer subsidies they promise, is probably not an option for the Obama Administration - just as failure to deliver Medicare Part D Rx in a timely fashion to 44MM Medicare beneficiaries was not an option for Leavitt and others in the Bush Administration.

Jack Towarnicky

it would be a great Health care resolution for Ame...

2011-06-27T02:08:27.231-07:00

it would be a great Health care resolution for America.

John, the "Clinton" model for cleaning u...

2011-06-23T12:13:19.649-07:00

John, the "Clinton" model for cleaning up Medicaid would certainly be an improvement. I assume Coburn's "capped allotment" puts a ceiling on the Fed's contribution to the obligations of the states. It is a step in the right direction.

I would hope at some point a voucher program directly to the recipient would be the ultimate answer. In fact, IMO, a tax credit/voucher program should not only replace Medicaid, but Medicare and healthcare reform for the rest of the population as well.

This is what I was really looking for. Thanks very...

2011-06-23T00:00:15.771-07:00

This is what I was really looking for. Thanks very much. Keep up this good work.

Health Insurance

free speech rights of pharma? This government is t...

2011-06-09T02:15:31.138-07:00

free speech rights of pharma? This government is the sole country that has allowed drug manufactures to push there products over the air waves,print media,and this practice
has never been allowed in country's that have health care for all!
It is considered UN-ethical,UN-professional by the medical world!~
it a line drawn in the sand by most all entity's its absence meant that a drug manufacturer of whom has spent all of its resources on supplying a product that was first off,had a high degree of efficacy,secondly its application was only used by doctors after a true practitioner had themselves studied it use
today we have HMOs that cover the cost of drugs that cure erectile
dysfunction,more sexual pleasure but yet a growing number us citizens have no heath care!

Cool Post.... Smith Alan kamagra

Well, John--there are concrete reasons why the CER...

2011-06-02T17:35:45.977-07:00

Well, John--there are concrete reasons why the CER idea will be bad for the public. Think about the makeup of the committee--some 15 people. No matter how many staff they have, most of them will have to read something. How many different diseases and procedures are there? Let
's just say between 10,000 and 25,000.
If they try to be rigorous, they'll ask for the kind of professional research that is contracted out, and reported back in an academically pure fashion. How much time will that take? Add on the obligatory comments from the affected professional societies, so that another year goes by. At best 3 years per diagnosis or procedure. (It will cost real money to do this, too.) In the meantime, the science isn't standing still. What will happen is a kind of mudpie. People will be slogging through for an answer, all the while knowing that it will be obsolete when it comes out. But the most terrible thing is that it will stand as an answer until the next funding cycle, so that gradually the knowledge capital of healthcare will be eroded. Politicians believe that the best methods will be identified and will prevail. No, the methods considered standard by the current publishers of standards and protocols will prevail.

We are in the hot bed of genetics research; I dare the CER people to do an honest comparative of cancer treatments against honest to God genetic cures. Imagine protecting future patients from chemo--a true debilitating set of drugs.

I have read in many newspapers and other articles ...

2011-05-28T10:49:02.962-07:00

I have read in many newspapers and other articles that Obama is really concentration on the many things like the health of the family. And his wife al also taking initiative for this. And t his is really wonderful.

Thanks for the valuable information. It's grea...

2011-05-24T04:46:18.651-07:00

Thanks for the valuable information. It's great to read interesting and informative post like your blog. Keep it up, keep informing people. thanks again.

Fabulous. This should be required viewing at ever...

2011-05-20T15:03:40.311-07:00

Fabulous. This should be required viewing at every insurance company, state and federal insurance office, and the White House.

Kirby V. Nielsen

hmmm very nice ,you have a very nice blog ,You sho...

2011-05-04T04:32:02.784-07:00

hmmm very nice ,you have a very nice blog ,You should have some health and safety training it will make you fit and healthy....