No. of Recommendations: 5
Time Magazine has a good story on so called "surprise bills" that could total tens of thousands of dollars over and above your Obamacare maximum out-of-pocket limit. Even if you choose an in-network hospital and in-network doctor, you could still be left with a big stick up your behind. Consumer Reports estimates that 1 out of 3 Americans with private health plans have suffered financial rape during the past two years. [Note: If you have fee-for-service Medicare, this doesn't appear to be a problem.] There is no limit to what an ethically-challenged doctor or hospital administrator can charge you for an out-of-network medical procedure - five times the in-network charge is common, 20 or 100 times not unheard of.

http://time.com/4246845/health-care-insurance-suprise-medica...

At one point in that nightmare, the medical bills started rolling in. A few thousand here. Ten thousand there. Twenty-two thousand more. By end of the year, Elfrank-Dana was staring down roughly $106,000 in medical bills. And none of it was covered by his insurance.

“My insurance had made payments to the hospital and anesthesiologist but it was a fraction of what they were asking,” Elfrank-Dana told TIME recently. “So they started going after me for the balance.”

The second issue has to do with the total amount that patients can be charged out-of-pocket. Under Obamacare, insurers are required to cap out-of-pocket payments at $6,850 (and $13,700 for families). Again, that’s progress. But those caps only include in-network care. If a patient like Elfrank-Dana reaches the $6,850 cap, but then receives $80,000 in surprise, out-of-network bills, after leaving the hospital, then, well, he’s out of luck.

The big question on most people’s mind is who’s to blame. And the answer is a political hot potato: if you pass a law that prohibits saddling patients with “surprise bills,” then someone else is going to be on the hook. And that someone else will be one of the three most powerful players in the American medical industry: insurance companies, hospitals and the physicians lobby. None of them want to be left holding the bag.

</snip>


intercst
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If Time wanted to do some homework, instead of using a wet behind the ears unpaid intern to do the research they would have discovered that private insurance works exactly the same way.

Even with the subsidies policies under Obamacare aren't free. If you want good coverage you gotta pay more. The lowest cost policies are really for young healthy people.

Blue Cross/Blue Shield Silver plan covers just about everything. There maybe a doctor in Maryland that won't take BS/BC but I haven't found him yet. The Silver level is virtually identical to my shop policy. BTW: if a network physician recommends a particular specialist out of network, BS/BC will typically pay.

There is NO EXCUSE for not knowing. If you can't read the information on the website, they've got a million people to tell you the deal. What stupid people do is buy the cheapest plan available and then whine when they unexpectedly need to use it. These cheapo plans were included because of all the whining by people who had these plans before Obamacare, and complained that they got canceled.

I didn't know Time was still in business. If this is the quality of their reporting they shouldn't be. My wife who has serious spinal problems just had surgery for a hernia repair. Her normal surgeon said because of her spinal problems he didn't want to deal with it and sent to a surgeon who is one of the top specialists in the country on abdominal surgery. He's written text books on the subject. Even he told me after the surgery which took twice as long as he thought it was a real job. Cost me $25 in copays. Parking downtown when I visied cost me about $60. Think I'll write to Time and tell them how Obamacare screwed me on those parking fees.

Cr@p like that sorry a$$ed phony hit piece really pisses me off.
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goofnoff complains,

If Time wanted to do some homework, instead of using a wet behind the ears unpaid intern to do the research they would have discovered that private insurance works exactly the same way.

</snip>


That's exactly the point of the article. Obamacare leaves private insurers in charge of your healthcare. O'care was sold as a program that would prevent people from going bankrupt when they get sick (i.e., the $6,850 max annual out-of-pocket cost for singles, $13,700 for married.) But insurers, hospitals, and doctors are finding loopholes in the system and continuing to screw people.

I think Time Magazine did a great service in exposing this activity.

I noticed that the Administrator of Medicare & Medicaid Services (the Gov't bureaucrat that writes the Obamacare rules) has told the health care industry to clean up their act, or he'll write regulations that do it for them.

http://www.huffingtonpost.com/entry/surprise-medical-bills-i...

Health insurance rules are arcane and filled with exceptions. The networks of providers covered by plans are constantly changing, and the directories of covered hospitals, doctors and the like that insurers offer are often inaccurate. The prices charged by physicians, hospitals, labs and others are all over the map and difficult to discern in advance. Medical providers themselves don't understand how insurance works, and usually no one is responsible for keeping track of who is doing what when a patient gets care.

The problem is especially acute nowadays, because insurance policies that don't cover any out-of-network care have become more common.

"Everybody in the chain is culpable, but they also -- in this wonderful system we have -- have the ability to point to each other and say, 'See? It's not my fault because it's the way the system works,'" said Andy Slavitt, the acting administrator of the federal Centers for Medicare and Medicaid Services. Slavitt's agency also oversees the Affordable Care Act's health insurance exchanges.

At the federal level, the Centers for Medicare and Medicaid Services is pressuring the health care industry to find a way to free patients from these billing disputes -- and warning that government action may come if they don't, Slavitt said.

"The industry can solve this problem without our help, but with a lot of strong encouragement, and I think they would be wise to do that," Slavitt said. "I refuse to believe that this is as difficult as people say it is."

"You're going to be seeing me playing a very visible, public role trying to bring people to make progress on this issue on their own, and if they don't, we have regulatory tools," Slavitt said. "This is a personal passion of mine."


</snip>


intercst
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Here's what MMS Administrator Slavitt told the hospital lobbyists.

https://blog.cms.gov/2016/02/29/cms-acting-administrator-and...

But retail won’t stop there. Consumers will want better service and fairer service, and will likely be less tolerant of things that don’t work well for them. When the auto mechanic tells you that your $3000 estimate turned out to be $10,000, you probably won’t go back. Hidden charges, for things that happen in the ER or when the anesthesiologist is out of network and has separate charges, won’t be tolerated. The promising news is that leaders always emerge– and I am beginning to have conversations with hospitals and physicians who want to lead the charge so there are no more consumer surprises in their hospitals. Those that make that promise can expect to be rewarded by consumers. The retail world is emerging and with it, there is new opportunity.

</snip>


intercst
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I'll only comment from the anesthesiologists point of view since part of the article wants to throw us under the bus.

At various times in my career, insurance companies have wanted to renegotiate our contracts, usually to something that makes Medicare/Medicaid look great. Hey, its their job, they are in it to make a living just like everyone else.

In an emergency situation, my group usually works with the patient and say, if we were in network, this would be your bill. Pay us $100/mon till its gone. Not everyone works that way, obviously.

Non-emergency situations, they should have checked. Their problem, they should never have assumed.

"Fixing" the healthcare problem is loaded with many questions, each deserving its own thread. Unfortunately, almost all politicians are too afraid to ask about much less deal with those problems. And equally unfortunate, most of the population.

JLC, who has to make a living too.
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In an emergency situation, my group usually works with the patient and say, if we were in network, this would be your bill. Pay us $100/mon till its gone. Not everyone works that way, obviously.

Right. Consumers have absolutely no choice in this. It is not like the typical emergency room visit involves a discussion of who will be doing billing and what their unofficial practices are.

Non-emergency situations, they should have checked. Their problem, they should never have assumed.

Check with who??? Try calling your insurance company as a consumer to find out who you can use for anything other than routine visits. After waiting on hold for 30 minutes to an hour, you will get to talk to someone who looks it up on the web site you tried to use before you called. The cryptic lists on the web site didn't make sense to you and it doesn't make sense to them. Then they either make something up or just lie to you . . . but they won't write it down, so there's no record. Or try calling a specialist who you know does the kind of procedure you are interested in and ask if they will be covered under your insurance. They are clueless. The honest ones will tell you they don't know and you should call your insurance company (see above). The lazy ones will see that you have a XY/XZ policy and say, "sure, your're covered," because they know they saw a XY/XZ patient last week. But not all XY/XZ policies cover the same networks. And if yours isn't one of the policies that covers this provider, you will be treated like the criminal trying to renege on your bill.

Of course even if you get it all right, then they still might misfile the claim. Once that happens, you are totally screwed. The billing people don't listen to anyone. They send bills. Good luck getting them to file correctly. They don't care. Pay this ridiculous bill that exists because we were too stupid to file correctly or we will send you to a collection agency.

The insurance companies are the primary source of evil in this system. They are nothing but leeches that do not serve any good purpose. They are the death squads the right was so concerned about. Their slow to non-existent response to consumers only creates worse health care issues. They are a primary driver in the costs of health care. But the providers don't do anything to help the consumer either.

First, kill all the insurance companies. . .
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There is no limit to what an ethically-challenged doctor or hospital administrator can charge you for an out-of-network medical procedure - five times the in-network charge is common, 20 or 100 times not unheard of.


I look forward to when either Clinton or Sanders assumes the presidency and democrats retake the senate, maybe we can get some fairness and truth in medical billing legislation. Hopefully if the house of representatives is still republican they will have had enough fear put into them to quietly play along.

It is absolute bull feces that hospitals and other providers can pretty much charge any price they want just because the poor sap failed to have a pre-negotiated deal with the right insurance plan. This has to stop.

A fairness in medical billing law would be a nice half-way point on the road to a single payer national health system.
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A fairness in medical billing law would be a nice half-way point on the road to a single payer national health system.


Beridian

You guys still fighting over this stuff, thought that was all going away?

I don't think there is any way the insurance guys are going to let single payer happen in USia? We got ours back in the days when the health insurance companies barely existed and there is no politician wanting to continue his career who would dare touch it now. The insurance guys get to play in the supplemental healthcare insurance market.


Tim <watching a hockey game, somewhat bored and checking out the best of>
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Beridian,

You wrote, I look forward to when either Clinton or Sanders assumes the presidency and democrats retake the senate, maybe we can get some fairness and truth in medical billing legislation. ...

Right. Like that will happen. Reps and Dems are two sides to the same corrupt coin.

- Joel
Libertarian.
And an odd one that admits emergency services are a captive market.
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Check with who???

Not sure who or how your insurance works, but every year I get a little package that lists what is covered by my insurance*. As far as what physicians are covered, there is this thing called the telephone. I've had a few patients actually call me to see if I participated in their plan (currently there is only one my group doesn't participate in). For more detailed questions and/or estimates of cost, I let them talk to my billing agent.

JLC

* thanks to Obamacare rules, my individually bought HSA plan is grandfathered in. However, I can not change one single thing about my plan. I couldn't even INCREASE my deductible or out of pocket expense limits if I wanted to to be able to decrease my premiums. FYI, if I were to drop my existing policy and get a fairly equivocal one via Obamacare, my premiums would double.
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JLC

* thanks to Obamacare rules, my individually bought HSA plan is grandfathered in. However, I can not change one single thing about my plan. I couldn't even INCREASE my deductible or out of pocket expense limits if I wanted to to be able to decrease my premiums. FYI, if I were to drop my existing policy and get a fairly equivocal one via Obamacare, my premiums would double.



Since I'm here and looking around for a board that isn't focused on ...
https://days.to/election-day-in-us/2016

... heard an interesting story on Canuck business news this morning. A guy bought a tube of prescription cream for C$35 in Canada. A few months later he bought one in California for US$95 (copay), his insurance company was charged over US$2000 by the drug company. How could this possibly be justified and it is no wonder the insurance rates are so high?


Tim <this may not be the one>
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A guy bought a tube of prescription cream for C$35 in Canada. A few months later he bought one in California for US$95 (copay), his insurance company was charged over US$2000 by the drug company. How could this possibly be justified and it is no wonder the insurance rates are so high?

I've never understood why that happens either. Everyone talks about bringing down healthcare costs but misses some obvious/easy solutions. One, let people buy insurance across state lines (more competition is always good). Two, ditto with prescription drugs. Except it would have to be at the international level*.

IMHO, the biggest change, put patient responsibility into the equation. Right now, no matter the system, there is none. I would do that via HSA accounts. Does it solve all the problems? No.

JLC

* I wouldn't have problems buying drugs made in Canada but would be a little leery of drugs made in China or India.
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IMHO, the biggest change, put patient responsibility into the equation. Right now, no matter the system, there is none. I would do that via HSA accounts. Does it solve all the problems? No.

I live in Illinois, I'm retired, have had HSA plans since retirement, first directly through the insurance company, and when ACA became available, through Blue Cross/Blue Shield under ACA.

This year BC/BS removed the hospital closest to my home from ALL of its ACA plans. I had been paying an extra $4k per year for a plan that included that hospital.

I hope only that nothing serious happens before my wife and I start Medicare.

So yes, I take responsibility for my coverage, as much as I can. But you cannot buy something that is not sold!

Bob
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JLC

* I wouldn't have problems buying drugs made in Canada but would be a little leery of drugs made in China or India.



Oh I failed to mention, the drug was from a US company.

I'll see if I can find the clip later.


Tim
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The insurance companies are the primary source of evil in this system. They are nothing but leeches that do not serve any good purpose.

Health insurance companies are like war profiteers, making their money on the misery of others precisely when they are least able to make good decisions.

Insurance companies in other sectors provide a valuable economic service (when properly regulated), smoothing out economic busts and preventing catastrophic failure. Health insurance companies are another breed entirely.
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I'll see if I can find the clip later.

Tim



I couldn't find the clip but saw mention of it and found this. Gotta love this free market stuff ... that isn't really free at all. I suppose it would be silly to ask why all y'all's insurance companies don't just buy the stuff from the Brits like we do?


Tim


https://groups.google.com/forum/#!topic/rec.sport.pro-wrestl...

Cold-sore cream: $34 in Canada, $2,532 in U.S.


Source: Los Angeles Times

Jim Makichuk bought a 5-gram tube of Zovirax, a prescription cold-sore cream, a few years ago in Canada for $34.65. That was the over-the-counter price; no insurance involved. He recently purchased a fresh 5-gram tube from a Kaiser Permanente pharmacy in Los Angeles. It cost him $95, or nearly three times as much as the Canadian price -- with insurance.

But that's not what raised Makichuk's eyebrows. What surprised him was a report Kaiser sent him on prescriptions he filled in January. There was the tube of Zovirax, and there was the $95 payment Makichuk made. And beside that was a listing for what Kaiser paid for the cream: $2,532.80.

... Laurie Little, a Valeant spokeswoman, said the cost of the cream "takes into account many factors, the cost of the active and inactive ingredients, the manufacturing process, the packaging and its related process, as well as the distribution and a myriad of other expenses."

... As for why the Zovirax cream available in Canada is so cheap, that's simple: It's manufactured in Britain, not the U.S., and British law requires that drug prices be reasonable. So does Canadian law.
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One, let people buy insurance across state lines (more competition is always good).

But health insurance coverage - via a provider network - is local.
What use is it to have cheap health insurance if the doctors you can go to are in a different state?
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Go back to paying the doctors cash. Health insurance (if it should exist) should be more like car insurance, it covers accidents and not routine maintenance.

Life is not fair,if you don't have a bazillion dollars to cover some expensive procedure that might save your life, you die.
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AdvocatusDiaboli writes,

One, let people buy insurance across state lines (more competition is always good).

But health insurance coverage - via a provider network - is local.
What use is it to have cheap health insurance if the doctors you can go to are in a different state?

</snip>


No foolin' From what I can see, the US health plan with the most robust interstate provider network is Medicare. You don't have to worry about "Financial Rape" from an out-of-network provider if you're on Medicare.

intercst
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let people buy insurance across state lines (more competition is always good)
......................

You're a doctor--could you really be that obtuse?

I have BCBS of SC. When I lived in NYC to babysit for my grandson, I couldn't find any medical care in NYC that would accept the low negotiated rates of my South Carolina insurance. Can you figure out why?!
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Can you figure out why?!

Oh me, me, take me teacher!

No idea. If I'm in Ontario I just hand my Nova Scotia healthcare card to the doc's receptionist and they bill Nova Scotia for the service.

You know guys after years of many of all y'all telling me how terrible our system is and after a few experiences over the past 5 years of actually having it to use it ... I like ours far better.

OK on that note I shall wander off into the sunset and stop bugging y'all.

Tim
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...a few years ago in Canada for $34.65. That was the over-the-counter price; no insurance involved...

Ding, ding, ding, we have a winner!!!

The cynic in me askes, what would an oil change cost if we had our auto insurance cover it.

...and a myriad of other expenses...

I'm sure the knee jerk reaction involves tort reform. I did work one summer during medical school in the R&D department of a pharmaceutical company. Mostly helping write protocols and double checking data. I found in interesting the amount of time and testing involved. Literally millions with no guarantee that the drug will make it to market much less turn a profit. Kind of like Edison and his thousands of failed lightbulbs.

British law requires that drug prices be reasonable. So does Canadian law.

So I wonder what would happen if the US require drug prices to be reasonable? How quickly would new drugs stop being produced? Who gets to decide what is reasonable?

JLC
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JLC asks,

Who gets to decide what is reasonable?

</snip>


How about we let Medicare use its market power to negotiate lower drug prices for its beneficiaries just like Exxon and IBM does for the employees on its health plan?

If you're buying drugs for the 60 million people on Medicare, you should be getting better prices than they pay in Canada, Denmark, The Netherlands, etc.

intercst
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I have BCBS of SC. When I lived in NYC to babysit for my grandson, I couldn't find any medical care in NYC that would accept the low negotiated rates of my South Carolina insurance. Can you figure out why?!

Because NYC in an insanely expensive place to do anything. Although I seriously doubt who ever took your information really looked into it. I imagine someone just looked down a list, nope, don't participate.

Over the course of my career, I've taken care of patients with BCBS from about 20 states. Just a few months ago had one from Hawaii. And no, not emergency case where they didn't have a choice. For me, most of the time private insurance is good enough. And I have an excellent billing agent who used to work for a health insurance company.

JLC
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How about we let Medicare use its market power to negotiate lower drug prices for its beneficiaries...

Personally, sounds like a good idea. However, it is currently against the law according to Medicare Part D. So you would have to re-write/change the law.

Say they are successful. I wonder, to compensate, when do prices in other countries go up?

JLC
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JLC asks,

<<How about we let Medicare use its market power to negotiate lower drug prices for its beneficiaries...>>

Personally, sounds like a good idea. However, it is currently against the law according to Medicare Part D.</d> So you would have to re-write/change the law.

Say they are successful. I wonder, to compensate, when do prices in other countries go up?

</snip>


Yes, we can thank Dr. Bill Frist and the "Frist Amendment" for the prohibition on Medicare negotiating drug prices. Hard to imagine how many people he killed with that one. (I'm sure he'll be blowing Lucifer after he meets his Maker.)

As to drug pricing, R&D is a sunk cost. The decision to manufacture and sell the one millionth pill to someone in Honduras is based on clearing your marginal production & distribution costs. Since margins are so high in the drug trade, I doubt there'd be much difference in foreign drug prices if Medicare negotiated prices in the US, but margins would be lower for drug company investors.

intercst
(long time pharmaceutical investor)
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As to drug pricing, R&D is a sunk cost. The decision to manufacture and sell the one millionth pill to someone in Honduras is based on clearing your marginal production & distribution costs.

Does that assume that the first 999,999 pills paid for the R&D costs? Or does the drug company have to eat the R&D costs after the first pill is produced?

PSU
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I did work one summer during medical school in the R&D department of a pharmaceutical company. Mostly helping write protocols and double checking data. I found in interesting the amount of time and testing involved. Literally millions with no guarantee that the drug will make it to market much less turn a profit.

Perhaps you should have spent sometime in the Marketing department.

Drug companies justify the high prices they charge by arguing that their research and development (R&D) costs are huge. On average, only three in 10 drugs launched are profitable, with one of those going on to be a blockbuster with $1bn-plus revenues a year. Many more do not even make it to market.
But as the table below shows, drug companies spend far more on marketing drugs - in some cases twice as much - than on developing them. And besides, profit margins take into account R&D costs.


http://www.bbc.com/news/business-28212223

Or looking into their lobbying efforts.

Pharmaceutical and health product companies injected $51 million into the 2012 federal elections and nearly $32 million into the 2014 elections, according to the Center for Responsive Politics (CRP).

http://www.truth-out.org/news/item/33010-how-much-of-big-pha...

Maybe a university or biotech company.

The drug companies, of course, say they have no choice and need to charge outrageous prices to pay for research that enables them to innovate and develop new drugs that save our lives. But that's not true. Half of the scientifically innovative drugs approved in the U.S. from 1998 to 2007 resulted from research at universities and biotech firms, not big drug companies. And despite their rhetoric, drug companies spend 19 times more on marketing than on research and development.

http://www.huffingtonpost.com/ethan-rome/big-pharma-pockets-...
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PSU asks,

Does that assume that the first 999,999 pills paid for the R&D costs?

No. The R&D is "paid for" by whatever the drug company sees as the global market for a drug. The decision to sell a drug in a given country is based on whether you can make money on it after absorbing whatever costs you incur in getting it approved for sale in the country.

If a company can make $1 per pill over its incremental cost by selling it in Honduras, they're not going to give up that $1 because it's not covering the R&D cost.

You'll often see the argument made that "if Medicare negotiated drug prices, drug companies won't sell cheap drugs in 3rd world countries". It doesn't work that way.

intercst
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As to drug pricing, R&D is a sunk cost. The decision to manufacture and sell the one millionth pill to someone in Honduras is based on clearing your marginal production & distribution costs.

But you are also forgetting about the patent protection time frame, i.e., when the drug becomes generic. Can the company sell enough during that time frame to make up that "sunk cost"?

It is a calculation and a gamble.

JLC
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Perhaps you should have spent sometime in the Marketing department.
...
Or looking into their lobbying efforts.


Yes, look at how successful the Soviet Union was in keeping drug prices down.
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Everyone talks about bringing down healthcare costs but misses some obvious/easy solutions. One, let people buy insurance across state lines (more competition is always good).

I'm skeptical if that would any savings at all. Most big insurance (Aetna, Unitedhealth, Cigna, etc.) companies already sell insurance in every state or almost every state. Of course, their policies have to be compliant with the rules in that state. Just like auto insurance in that regard.

In theory, Congress could laws saying New Yorkers could buy policies licensed in South Carolina. But as you point out, the costs are different, the doctor networks are different, etc. If no New York doctors that your South Carolina policy, the ability to comparison shop won't save you much because your SC policy is nearly useless. I've never heard anyone suggest that car insurance would be cheaper if it worked like that. Also, good luck getting the SC insurance commissioner to deal with a problem in California if there is a dispute.

Another way it could work in theory, is that Congress could standardize what must be included in insurance, and that way the rules would be the same in every state. I don't see how that is politically possible.
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syke6 writes,

Another way it could work in theory, is that Congress could standardize what must be included in insurance, and that way the rules would be the same in every state. I don't see how that is politically possible.

</snip>


The only insurance we have that's standardized across all 50 states is Medicare. Medicare also has the lowest admin expenses by far.

intercst
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Another way it could work in theory, is that Congress could standardize what must be included in insurance, and that way the rules would be the same in every state. I don't see how that is politically possible.

Pay attention to Obamacare much?

JLC
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Pay attention to Obamacare much?

I do, and that's why I said it wasn't politically possible. Health insurance policies are still not standardized across the states. Each state has its own rules in addition to the federal regulations and each state regulates insurance differently.

As above, Aetna will be happy to sell you a policy in any state you like, and they are domiciled in Connecticut. If that doesn't meet your definition of "across state lines" then the other only solution is to have insurance polices completely standardized and regulated on the federal level.

All of the remaining Republican candidates have said that selling health insurance across state lines is low hanging fruit as far as cost control. But it isn't low hanging fruit, it is actually complex and requires far more re-regulation of the insurance market that Obamacare ever attempted.
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syke6 writes,

As above, Aetna will be happy to sell you a policy in any state you like, and they are domiciled in Connecticut. If that doesn't meet your definition of "across state lines" then the other only solution is to have insurance polices completely standardized and regulated on the federal level.

</snip>


Actually the Republican "sell insurance across state lines" proposal is an effort to force New York & California to accept the Mississippi standard of insurance regulation that has made the state so wealthy and healthy.

intercst
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intercst:

syke6 writes,

As above, Aetna will be happy to sell you a policy in any state you like, and they are domiciled in Connecticut. If that doesn't meet your definition of "across state lines" then the other only solution is to have insurance polices completely standardized and regulated on the federal level.

</snip>

Actually the Republican "sell insurance across state lines" proposal is an effort to force New York & California to accept the Mississippi standard of insurance regulation that has made the state so wealthy and healthy.

Made cynically by people who generally support states' right and bemoan federal interference.

Regards, JAFO
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