European models may give Obama a way out of US healthcare quagmire

http://www.dw-world.de/dw/article/0,,4621532,00.html

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European models offer compromise solutions

"It was recently written in the New York Times that the best model for the reform of the insurance system was that of Germany, which doesn't have a government-run plan but where there are private health funds," Reinhardt said. "They compete but within a regulatory structure which makes that competition fair and humane.

"You could pick either the German system, the Dutch system - even more so as they allow for profit-orientated insurance companies - or the Swiss system," he continued. "All these systems are fairly similar in having a structured, regulated market for private insurers, either non-profit or profit-making."

"But I think a mixture of the Dutch and German systems would be perfect for the insurance reform in the US," he added. "It's a shame that instead of having a rational discussion on the German system or taking a plane load of senators and congressmen and flying them over there, you have this shouting match over euthanasia, and pictures of Hitler being waved about. It has descended into quite an ugly scene."

Wendt agrees that that the German model is a political hot potato in the US and that the Dutch healthcare system could provide Obama with the compromise model he is looking for.

"I don't think it's a good idea to refer to the German model in the US for political reasons," Wendt said. "In general, I would say that the German model in comparison to the US model is in quite good shape because Germans have competition between different plans and the patients can choose between different plans and healthcare providers.

"But the Dutch model might be a good option for the US," he continued. "This would show that a new healthcare system could be run through private organizations and as a publicly-run concern, which is a fear in some circles in the US. The Swiss model may also work as the insurance business is conducted by private organizations, and this could be implemented in the American healthcare system."

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The insurance comapnies are exempt from anti-trust laws and can price fix under McCarran-Ferguson, so neither model can function under those conditions in the US.

The health care reform bill already modifies a large number of laws, which is why it is so many pages.

They affect the ENTIRE insurance industry, not just the health care sector.

The health care sector alone accounts for over $1 billion spent trying to kill health care reform over the past 18 months.

IF you tried to repeal either the anti-trust exemption of McCarran-Ferguson, you are taking on the ENTIRE insurance industry and the combined resources would spend somewher between $50 and $100 million PER DAY to kill the attempt.

Medical is a separate line of business, and most of it is provided either by specialized health insurance companies, such as United Health Group, or by subsidiaries of larger insurance companies, such as Aetna.

In fact, I'd think that most already have separate corporate subsidiaries set up for health insurance in each state that they operate in. Otherwise the current regulatory requirements would be hard to satisfy.

The law as originally intended was meant to empower Congress to only regulate insurance if it passes such an act explicitly aimed at the business of insurance. Any regulation, therefore, meant to regulate business in general, such as anti-trust law, does not apply to the business of insurance except if Congress explicitly addresses the business of insurance directly.

As it stands, anti-trust law does not currently apply to insurance under the assumption that it is the realm of state regulators to enforce their own anti-trust laws. The act was passed in the aftermath of the US Supreme Court decision in US v. South-Eastern Underwriters Association, a company that had a virtual monopoly in six southern states in the area of fire insurance and other insurance. The Court ruled that "insurance" was not "commerce" and therefore did not fall under federal regulation per the Interstate Commerce Clause of the US Constitution. However, the Court left open the door to regulation by giving Congress the opportunity to address the issue by passing a law directly regulating the industry.

Congress punted on the issue and simply passed the McCarran-Ferguson Act to let individual states regulate the industry rather than let federal statute apply unless specifically enumerated in a future act of Congress (which never came).

The Sherman/Clayton Anti-Trust Acts could conceivably apply if someone quickly, discreetly inserted a small amendment into any bill that will likely pass that explicitly stated federal regulatory law applies to the business of insurance.

The really big ones that nobody knows what they are voting on anyway, but they have to pass?

If Obama wanted another 50 billion dollars on top of the budget already allocated to defense to expand the war in Afghanistan, he probably wouldn't veto the entire bill because somebody in the dark inserted an amendment blowing out McCarran-Ferguson.

The insurance industry would be crying over it, but you can bet the defense industry would be telling them to shove it up their ass so that they can get their money without delay.

:crazy:
rocktivity

But I have an irony deficiency...

:evilgrin:
rocktivity

But I guess she's Brazilian.

The standard monthly premium for health care paid by individual adults is about €100 (143.00 usd) per month. Persons on low incomes can get assistance from the government if they cannot afford these payments. Children under 18 are insured by the system at no additional cost to them or their families because the insurance company receives the cost of this from the regulator's fund.

...Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductables, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary).
The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees' premiums as an employment benefit). All insurance companies receive additional funding from the regulator's fund. The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders. Thus insurers with high payouts will receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than might be expected.
Insurance companies compete with each other on price for the 45% direct premium part of the funding and try to negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medicially disadvantaged by his or her choice of insurer."

http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands



That kind of regulation would never be allowed in our current corporate controlled government.

Health care in Germany

Germany has Europe's oldest universal health care system, with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889. As mandatory health insurance, these bills originally applied only to low-income workers and certain government employees; their coverage, and that of subsequent legislation gradually expanded to cover virtually the entire population.<2>

Currently 85% of the population is covered by a basic health insurance plan provided by statute, which provides a standard level of coverage. The remainder opt for private health insurance, which frequently offers additional benefits. According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.<3>

The government partially reimburses the costs for low-wage workers, whose premiums are capped at a predetermined value. Higher wage workers pay a premium based on their salary. They may also opt for private insurance, which is generally more expensive, but whose price may vary based on the individual's health status.<4>

Reimbursement is on a fee-for-service basis, but the number of physicians allowed to accept Statutory Health Insurance in a given locale is regulated by the government and professional societies.


Public insurance

All salaried employees must have a public health insurance. Only public officers, self-employed people and employees with a gross income above ca. 50000 EU (adjusted yearly) may join the private system.

In the public system the premium

* is set by the Federal Ministry of Health based on a fixed set of covered services as described in the German Social Law (Sozialgesetzbuch - SGB), which limits those services to "economically viable, sufficient, necessary and meaningful services"
* is not dependent on an individual's health condition, but a percentage of salaried income (typically 10-15%, depending on the public health insurance company one is in, where half of that is paid by the employer)
* includes family members of any family members, or "registered member" ( Familienversicherung - i.e. husband/wife and children are free)
* is a "pay as you go" system - there is no saving for an individuals' higher health costs with rising age or existing conditions.

With an aging population, there is an intrinsic risk that, in the long, run the burden to be carried by the young and working generations for the higher share of elderly will run the public system into a huge deficit or result in high premiums.

Private insurance

In the private system the premium

* is based on an individual agreement between the insurance company and the individual defining the set of covered services and the percentage of coverage
* depends on the amount of services chosen and the individual risk and entrance age into the private system
* is used to build up savings for the rising health costs at higher age (required by law)

The private system is said to be more stable to a changing demography, due to the savings accumulated over time. However with life expectancy rising the premium will also eventually rise for individuals.


http://en.wikipedia.org/wiki/Health_care_in_Germany


try to do that Obama, would be very cool, 77% gov funded.