Quote from kid.fx.cross:
ah, I was thinking about it last night,
If you think about it, almost all pregnancies go just fine. That is why there are 6 billion people in the world. But if anything goes wrong, the bill can hit 100k very quickly. It's going to take a lot of people just to save those few babies. Buying insurance after you get pregnant just like you buy insurance when you buy a new car isn't going to cut it. You really need a very big pool.
Now you've got it! All universal access plans are predicated on risk sharing within large pools of participants in widely varying states of health within age brackets. These plans can not afford to let people gamble that they won't have a serious health issue when they are young by selecting a high deductible, limited coverage plan and then waiting until they are old to buy into a low deductible comprehensive plan. The idea is to achieve cost averaging of a sort. Some of the successful national plans in other countries place participants in age brackets and do vary the premium by bracket. But the assumption underlying the plans is defeated by people being allowed to gamble by choosing to accept more risk.
The I-want -more-risk-and-lower-premium group is disgruntled with Obamney care. In broad, shared risk pools, on the other hand, the lucky end up subsidizing the unlucky. The Lucky pay a somewhat higher premium than they would had they gambled and gotten away with it. The unlucky pay a significantly lower premium then they would had they chosen not to gamble but had no healthy participants to back them up. The net result is that some pay a little more and some quite a bit less (assuming the pools are properly designed) and the risk of medical bankruptcy is eliminated for all and all get comprehensive coverage. Some think the trade off is good, others want the freedom to gamble on their unknown health future, but once the die is cast in statutory law, the gamblers choice is no longer available as an option.
There are some however who, from their remarks, I can tell haven't a clue what the real tradeoffs are and why they can no longer be allowed to gamble under Obamney care.
Now, of course, we are in the early stages of Obamney care, the insurance exchanges are a helter skelter mix, a total mess occasioned by the McCarran Ferguson Act. Because Medical insurance is not regulated by the Dept of Commerce, there is no guarantee that premiums will make sense in every State. Some States have been willing to cooperate and relinquish sovereignty over medical insurance to the federal government, whereas other States have not. In my own State there was a fight for control between the Attorney General and the Insurance Commissioner. It is a god awful mess. Unless, and until, we get rid of McCarran Ferguson, it will remain a mess.
Ultimately for national health care to work efficiently you must have uniformity among the States and single payer, so that you form very large risk pools. We are doomed as long as we're attempting to make the ACA work piecemeal. It may function after a fashion, but it won't be anywhere near as efficient as it could be.
We should have gone to a single payer, 80/20, medicare-like plan for most plus expanded medicaid for the indigent in all States, accompanied by formation of large, national, risk pools. And then, after ditching McCarran Ferguson, invite the insurance companies to sell supplemental policies to cover the 20% co-pay in national competition with each other. Oh Well.