Why must the insurance companies be involved at all. Get these leaches out of the picture. Let the hospitals provide the care and the government pay for it with our tax dollars. Without the insurance companies as middlemen tons of money would be saved.

This is a wonderful dynamic.

Forcing insurance companies to sell healthcare to anyone who asks strongly incentivizes them to demand that all people be required to purchase helathcare.

That would lower their costs by preventing adverse selection.

It's also great for society as a whole, because it leads to an honest debate about the role. limits and nature of healthcare coverage in our society. Healthcare becomes a right, not a consumer decision.

"Why must the insurance companies be involved at all. Get these leaches out of the picture. Let the hospitals provide the care and the government pay for it with our tax dollars. Without the insurance companies as middlemen tons of money would be saved."

God yes! Hopefully Daschle, Obama and Kennedy have the chess game plotted farther out than the evil insurers. As far as I'm concerned the health insurance companies are the most dangerous and well-organized terrorists in the world.

If the inusrance companies are involved, it should be only as accountants, not as gatekeepers to care. Get rid of all those deniers of service, and overheads will fall. And their profits cannot exceed the Medicare overhead rate.

The last thing we need is the government mandating that everyone send piles to money to the insurance companies so they can (1) pay their executives outrageous salaries, (2) hire clerks to play doctor and deny care, and (3) reward their stockholders. What's missing from this scheme is health care.

This is horrible news...you just don't get it. The ins has millions invested in full time lobbyists that outnumber congress people. They will do nothing from here on but figure ways and write policies that will increase their profits. What they fear the most is a national healthcare ins like Medicare mandated for all with a 1% overhead operating cost for the same benefits as compared to the 10% private ins companies get now.

They could have made any of these changes themselves without government if they really gave a damn about anything except their profit margins.

This is nothing but a desperate attemot to keep the profiteers in business till they get more bought and sold congressmen willing to vote their way. As long as the private ins profiteers are allowed to dominate the field nothing will ever permanently change.
Single payer not for profit health care ins like the proven effective Medicare and Medicaid programs should be mandated to cover all. If the wealthy want extra ins then there will be the profitable private companies out there for additional ins. . Any other way is just stalling for time and mandating private ins for all keeps the profiteers in the game till they can figure a way to increase their profits. Don't be fooled by this bullshit from the private ins lobby.

It's all a matter of the implementation.

This system is being used in Switzerland, and works well, with the additions that the government regulates which procedures must be covered by the basic procedures, and that the insurers may only consider age, sex and state when computing the premium.

(Also, in Switzerland, if you don't choose an insurer yourself, one will be randomly selected by the govt and the premiums deducted from your paycheck.)

With those additions, the US could go from worst to best in class in medical insurance in one stroke of the pen...

It might end up being a little closer to the French model, which still has private insurance.

Deep breath. The INSURANCE COMPANIES are ARGUING for MANDATES? I think I fell into an alternate universe here.

Whether we like it or not, our politicians have embraced the notion that the health insurance companies will survive to administer expanded health care. It is a political necessity.

It is interesting that the insurance companies are adopting a universal health insurance model closer to Hillary Clinton's proposal than Barack Obama's plan.

Requiring that insurers "sell to anyone" without regulating what they can charge an individual with a given health history is meaningless.

Totally agree with the first poster. Why have insurance companies involved at all?

Get rid of them so that healthcare collars go to drs. and patients-- no middlemen siphoning off dollars.

And abolish Medicare Part D, the worst piece of legislation ever written and jammed thru by insurance companies (AARP-- they are out for themselves, not seniors) and Big Pharma.

Don't know *anyone* who likes the coverage, or being FORCED to have it. People on disability under 65 are forced to have it, too.

Get the insurance industry OUT of healthcare.

We, the Insurance Industry of the United States of America, in order to garner more Rapacious Profits for Ourselves, do hereby lend our Absolutely Greedy Support to the Idea of the Government forcing You, the Huddled Masses, to pay Our Criminally Exorbitant, Feloniously Userous, and Nothing-Says-F***-You-Like-A- Monthly-Premium-Statement-That's-Bigger-Than-Your-Paycheck "fair" rates....

Ummm...Wouldn't it be better to just nationalize one or two of the providers, and let the rest of them die an ignominious-like death?

What's next?

A mandate that I have cell phone service?

This should be about HEALTH CARE, not HEALTH INSURANCE!

As long as health insurance is a for profit industry, a mandate puts the consumer in the weaker position of the relationship, and that, we don't need.

Even with a subsidy, how is the level of need decided? Do I get help once my premiums reach 15% of my income? 20%? 30%?

It is the insurers who are saying "don't throw me in that briar patch" here.

Don't be so gullible.

From AmericaBlog: Sen. Jeff Sessions, R- Ala., told reporters Wednesday, “I can not imagine a real justification for a worker in Alabama who does not have any health insurance at his company to be taxed to maintain a Cadillac health care plan for somebody in Detroit.�

I think this says everything you need to know about how big business (including health insurance companies) and Republicans think both about the middle class and health care. It's not "Let's fix Alabama", it's "Let's all be like Zimbabwe." Mandated health insurance with minimal regulation is a tax paid directly to Wall Street. That's why the insurance companies (and Lieberman &Dodd are their biggest allies) are taking the position for mandates.

This is highly inegalitarian. Largest single portion of uninsured comprises people who are young, healthy and relatively low income.

If the expected value of your annual health care costs is a few hundred dollars (if that, for men), annual health insurance premiums can be thousands of dollars and you don't have a ton of dollars to throw around, then you'd be insane to buy health insurance.

Mandatory health insurance is a regressive tax forcing the young and low income to subsidize the older and higher income.

Mandatory health insurance is a regressive tax forcing the young and low income to subsidize the older and higher income.

Voluntary health insurance is a de-facto tax forcing the older and higher income to subsidize the treatment of the uninsured young who rolled the dice -- 'I'm young. I'm healthy. I'll do fine without insurance' and lost, both through higher taxes and higher premiums.

You want equity? Put everyone into the risk pool.

No ox left un-gored.

A basic contradiction that is in debate right now with the Republicans and the Evangelist right is the right to life from embryo through living your life till death, here; many Americans can not afford basic health insurance out of the embryo phase. So, fend for your self after you’re pulled into a system that is dysfunctional, corrupt, and driven by pharmaceuticals, wacked out medical dysfunctional professionals, and basic Homeland Security that have little over sight or obviously doesn’t give shit about a real America.

That’s like we talk about, “We the People� can write our own destiny, but only if a few politicians and drug companies can say what will happen and when. Here, we have Obama enter the scene with huge support from the electorate to remedy the situation. But, Joe in morning always throwing in the political money wrench. On the side of confusion based Mainstream Media especially the mad money man crammer of MSNBC says it looks impossible to breach that six thousand point level on the stock market.

But grimly exposes the possibility it might happen where finally a huge , huge significant portion of the stock holders, the fat cats will get out with what ever they can get, here really making the market tumble. For me, that is what all this bail out mad money is for, going to support the stock market till as many as possible can sell off.

Oh, incidentally there is no mess with Obama’s appointments, it is just that MSNBC and a host of other jag offs don’t like the Democratic win, and they never liked Obama or Democrats or what Obama is going to do. Here, Mr. Blow hard Pat Buchannan who can not muster 1% of the favored vote of the electorate is blasting daily with what is wrong with Obama. The Irony is Obama is not the president. Obama can not make the “decider decisions� Bush is supposed to make. Worse here we have the Snare and Snarky of Joe Scar, plus the smooth and best back up of Mika Brzezinski loaded with her dad’s revolutionary goobledy gook in government direction.

This is funny, they vent about Ayers in his anti patriot stuff and here we have Mika Brzezinski with her father in his theory Americas modern revolutionary change, between two ages. It’s a long read.

Key in Brzezinski into http://www.scribd.com/ to get her father thesis on the American direction, it span to spectrum of interesting to wild realism like Pat Buchanan’s new book on World War II. America started it? The reading is sort of like listening to Arnold Schwarzenegger giving a lecture on unified theory of gravity starting with string theory. I’LL be back after you get it.

That coupled with Andrea Mitchell being the wife of former Chairman of the Federal Reserve, Allen Greenspan begs the question on wheeling and dealing that the Clintons are doing. This MSNBC gang shoots from the hip with convoluted goobledy gook every day like the Sundance kid. To me its so funny Allen Greenspan probably was stupid about the whole thing of collapse likely Andrea and a pool of others dealing with her have been the perpetrators in the market crash. Hard to believe huh.

The whole scenario of the of the decades of Allen Greenspan now likely looks like a storm of corruption that was following the Greenspans for years. This media knew all about it and covered it up, now all of a sudden nothing works right. Sheesh. What happened to the resilient economy? Well folks it never was there.

I want to know exactly how the US is going to enforce "every citizen has to have health insurence". Are there going to be random stops by cops to make sure I am carrying a valid insurence card? Forcibly enroll me in a plan and send me a bill? And if I refuse, do I go to jail? I have to pay insurence for my car and I'm cool with that because I can choose to ditch the car and not pay for the insurence. But - short of suicide - I cannot avoid the US govt forcing me to give money to a private company. The last time the US let private business demand compensation from individuals without restraint we referred to it as chattel slavery - Do I now have to address the CEO of Blue Cross as "Massa"?

I have no problem with the government acting as a basic insurerer of all and paying some more in taxes to do so, as I see the improvement of public health as a function of government. But I'll be damned if I will have the government force me to give money to companies that actively seek to deny people access to health care so that their boards can buy yet another private plane.

No- it's a bad idea.

The insurance companies want a legally enforcable profit, much like the automatic profit they get from auto insurance (also required in many states).

If you are on the free-market side this is bad because it removes the freedom for the customer to go elsewhere or even to do without; if you are on the socialist side this is bad because it is throwing something we all agree is important yet (obviously) cannot be provided by the 'free market' to the people who won't provide it now!

How about - yes, everyone is required to have insurance, but the insurance companies are required to provide that insurance with zero profit - if they can sell you more, then they can make a profit, but the minimum legal required insurance must be provided in such a way that they make no money on it.

ex animo

As you say, the devil is in the details -- and current proposals from any side in the debate may represent only a step in a longer term strategy.

The agreement of insurance companies to cover everyone is relatively meaningless without some controls on costs. Setting the price of coverage is an essential part of insurance companies' business model and any 'free market' system in the current business model.
The path to a rational single payer system in the current political environment likely goes through the 'public pool' included in Obama's plan, but the insurance company strategy may be to undercut that public model by their offer to insure everyone directly. If the public plan provides better care, greater equity, and more efficiency, the argument for private insurance withers away.
The key to that evolution is regulation -- negotiation of drug prices in common, price controls, etc.
But the concern with proposals like McCain's for national insurance freed from state regulation is that while seemingly rational from a free market perspective, it is also a serious threat to some safety nets that some states have been able to put in place. In Minnesota for example, the MN Care program -- despite cuts from Governor Pawlenty -- provides a public insurance program for otherwise uninsured people. We shouldn't take that program away until a real national program and regulation are in place.

You can't have mandated coverage without mandated participation. Why do so many fail to understand that fundamental principle?

Whether single payer or a private system, the principle remains.

If we want reform, then those of us who don't have and don't want (until they get sick or have an accident) health insurance are going to have to participate. What an irony that so many who are screaming for health insurance reform don't want to participate, and are now calling "foul!"

It is only rational and fair that smokers, obese people, pay more for insurance,

All you people who think insurance companies are leeches, just wait until you have to deal with federal employees who have jobs for life and no incentive to do anything for you. Have you been to the DMV? At least insurance companies have to compete for your business. Obamacare has no competition, so your corpse will be found in the line waiting for treatment. There will be no other option. Careful what you wish for.

Yeah, and the people at the DMV have always been very helpful to me. Whenever I go and there is a line, those people are all working to process people faster.

And don't even get me started on the USPS. USPS is awesome in my experience. I love USPS.

@ BeaverCleaver: Single payer is not government run. Payer simply means the agency processing claims against eligibility requirements and then paying those claims. It does not mean that healthcare infrastructure and providers are owned and controlled by that payer.

But the US does have a govt. run system - two, in fact: military healthcare and the VA healthcare systems. And by all measures, they outperform their private, civilian counterparts in patient quality, performance measures and administrative overhead costs.

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Simple plan: universal catastrophic layer funded by taxes and administered by the Federal National Health Insurance Corporation created by Congress, with FNHIC also selling non-profit coverage underneath. FNHIC must fund the plan underneath with revenue from sales, no tax money (or limited). Private industry can compete underneath the catastrophic layer to its heart's content, through employers, associations, individual policies, whatever. Without the unlimited exposure, policies underneath the umbrella can be far less expensive. Rules to encourage competition on merits of policies and cost: mandated deductible and co-pay steps that all insurers including FNHIC must offer -- e.g. annual $300, $500, $1000, etc., or percentage of income if that is manageable -- to make comparison easier.

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