Sunday, December 26, 2010

New laws will allow Calif. to begin health reforms

By DON THOMPSON Associated Press
Posted: 12/26/2010 11:03:05 AM PST
Updated: 12/26/2010 11:07:05 AM PST


SACRAMENTO, Calif.—California will create an Internet-based insurance exchange to let consumers comparison-shop for affordable health insurance coverage under two of the many laws taking effect with the new year. read more

Friday, December 24, 2010

Test of "Accountable Care Organizations" going well

Excerpt of an article By ALLISON BELL
Published 12/20/2010 Subscribe to Life & Health


The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.

An ACO is a vehicle for paying teams of health care providers to care for whole patients, instead of paying for care one service at a time.

The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), is requiring Medicare to use ACOs starting in 2012, and many private health carriers are now testing ACOs.

Elizabeth Mills, a senior counsel in the Chicago officer of Proskauer Rose L.L.P., a law firm, ACO organizers still face regulatory challenges.

The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.

Aetna Inc., Hartford (NYSE:AET), says an ACO it has been testing on 20,000 Medicare Advantage enrollees since 2007 seems to be working well.

This year, the ACO enrollees have been using 43% less acute hospital care than comparable enrollees in unmanaged Medicare have been using, Aetna says.
read more

Tuesday, December 21, 2010

A doctors take on universal heath insurance mandate

The Insurance Mandate: Is It Legal?
Published: December 21, 2010

Re “Can Congress Force You to Be Healthy?,” by Jason Mazzone (Op-Ed, Dec. 17), defending a federal judge’s ruling that the health insurance mandate is unconstitutional:

We need to look at the consequences to patients, interstate commerce and the economics of health care if the mandate provision of the Affordable Care Act is overturned. When an individual with limited income chooses to forgo health insurance and comes down with appendicitis, how should the health system respond?

Mr. Mazzone uses the analogy of someone forgoing auto insurance alternatively taking the bus. What is the alternative to an appendectomy?

The care providers must either (1) explain to the patient that he did not choose wisely, provide him with some pain tablets and push him to the parking lot or (2) treat him appropriately. The former is both illegal and unethical; the latter (current practice) is where the commerce issues arise.

The costs of care for illness must be borne by someone. Currently these costs are paid by the state (taxpayers) and, through cost-shifting, the insurance carriers, many of whom are national companies.

The bus analogy, while clever, is inappropriate and trivializes the dire status of our current system and our public’s health.

Tim Carey
Chapel Hill, N.C., Dec. 17, 2010

Thursday, November 11, 2010

No Social Security until age 65?

November 11,2010
The author of the recently released report, Andrew Biggs, a scholar in residence at the American Enterprise Institute, a conservative think tank , outlines these advantages:

•Prolong the life of the Social Security trust fund by five years, a modest but significant increase.
•Raise median income of older Americans by $7,500 a year, including both increased Social Security benefits and savings and other pension income.
•Boost gross domestic product by about 5 percent through increased productivity, adding billions to the economy and tax revenues.
Biggs says keeping people working until 66 or 67 isn't a physical problem for most these days. Biggs would offer one big concession. He suggests reducing significantly or eliminating Social Security payroll taxes for people who work and contribute to Social Security longer than 35 years, Eliminating payroll taxes would "sweeten the pot" for those asked to work longer, he says.

for full textclick here

Monday, October 25, 2010

New health law is a prescription for distortion
By: JO CIAVAGLIA
Bucks County Courier Times


The onslaught of misinformation and distortions about the Patient Protection and Affordable Care Act this political season isn't helping the many Americans who are confused about the law.

Who hasn't seen political ads claiming that under the health law, Medicare will be cut $500 billion.

But are any of these claims true?

Yes and no. Mostly it depends on what health coverage you have, who pays for it, how much you earn and how you earn it, according to health care policy and reform experts.


Next year employers will be required to list the value of employee health benefits on W2 forms. No, you won't be taxed on it.

But combine a take-no-prisoners political season with a law as voluminous and complex as the Patient Protection and Affordable Care Act, and confusion explodes. Experts who've studied the new reforms say the truth is out there, but it can be hard to find.

Four out of 10 surveyed believed the health care law would require Americans to provide a government ID card to get hospital care. (It doesn't.)

Almost as many believed that committees would review medical histories of some people and decide whether they can get medical care paid for by the government. (That's also untrue).

Six in 10 think the law increases the federal deficit. (The nonpartisan Congressional Budget Office projects the law will shrink the deficit.)

"The great irony is the law was designed to avoid a government takeover," said Timothy Jost, a law professor at Washington and Lee University who specializes in health care reform and policy. "It's a law that is intended to make private insurance work and it's troubling that it's being attacked as a (government) takeover of the markets

Sunday, October 24, 2010

New Healtrh reform drives cost acutting

SAN DIEGO 10/23/2010 — According to Van Gorder of Scripps Ihnstitute of San Diego.
"....the health reform plan, signed by Obama this year, was health insurance reform. It was not a reform that went to the heart of escalating health care costs.

But now Scripps Health, which runs 5 hospitals and 20 clinics in the San Diego area, is in the midst of a corporate restructuring they claim will make a big difference in cost. CEO Chris Van Gorder, in fact, believes their reorganization will eventually save $150 million a year.

Scripps Health was built from the union of several large hospitals. But the vertical corporate structure, in which each hospital had a chief operating officer who ran the place, remained intact. That meant every hospital within the system did things in a different way. They used different staffing levels and different materials. And that has required different levels of funding.

“We know, for example, that at one of our hospitals an open-heart case costs $3,000 more than it does to do the same kind of operation at another one of our hospitals,” said Van Gorder.

He said they’re trying to solve that problem by getting horizontal, in a corporate sense…. by getting rid of the silos and putting everything in one bin.

Van Gorder said the company has reassigned the top managers of its five hospitals to make them responsible for operations across the system. The goal is to standardize hospital operations and bring best practices to each site. This even applies to serving coffee.
“We’re spending $680,000 dollars a year for coffee and we’re using 15 different brands,” said Van Gorder. “If we standardize and buy at a larger scale we can get better buying power.”

Scripps claims it can save $200,000 dollars on coffee alone.

But if this is such a good idea, why didn’t Scripps do it five years ago? Van Gorder says strained relations between Scripps doctors and the company administration in the past have made it difficult to make dramatic changes.

Monday, August 9, 2010

Medicare revisited

Medicare celebrated its 45th birthday on July 30.

In 1965, President Lyndon B. Johnson signed the Medicare bill into law, providing government-sponsored health insurance for Americans 65 and older and younger people with disabilities.

Although every senior in the United States grew up without Medicare, most Americans today accept this single-payer, government-created and government-administered system as one of their rights as citizens, much like the right to vote.

Yet before we reach the age of 65, most of us don't have a clue how Medicare works. We only know it's there.

Misunderstandings about the Medicare program surfaced during recent discussions over the administration's sweeping health reform bill that finally passed in March.

Unclear on the concept, elders in some states vented outrage against the Obama administration, whose bill included Medicare changes, for "meddling" in "their" Medicare.

Others, also unclear on the facts, protested a provision in the bill that would have reimbursed physicians for time-consuming conversations with patients and family regarding the patient's wishes at the end of life. Mistakenly condemning these as "death panels," they raised loud and confusing voices, and the provision was removed from the bill.

But the uninformed ranters remain. To help clarify confusion, here are a few basic facts.

The health reform bill proposed by President Obama and passed by the
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Congress in March is called the Affordable Care Act. You will often hear bureaucrats referring to ACA. They mean the new health care law.

Among the most immediate changes:

# The infamous "doughnut hole," in which Medicare recipients must pay full price for their medication, will close completely by 2020. This year, those in the hole will receive a $250 rebate. Starting in 2011, a 50 percent discount will be available for brand-name drugs.

# The open-enrollment period, during which a Medicare recipient may choose a prescription drug program, will be extended.

# Starting in 2011, co-payments or deductibles will be removed for annual checkups and mammograms, colonoscopies and some other preventive tests. There will be no charge for these tests.

Other provisions are designed to improve delivery of medical care, prevent frequent readmissions to hospitals and, in the process, cut health care costs.

According to the Kaiser Health Foundation, nearly 18 percent of hospital admissions among Medicare beneficiaries in 2005 occurred within 30 days of being discharged from the hospital. Critics of high costs say that readmission can be prevented by better care in the hospital and improved coordination between patients and doctors after release.

Until now, hospitals, paid separately for each hospital stay, have had no incentive to prevent readmission, experts say. Under the new law, payments to certain hospitals with high readmission rates will be reduced starting in 2013, a spokeswoman for the federal Centers for Medicare & Medicaid Services said in a phone interview.

Among health care providers, pilot projects to streamline health care delivery and coordinate care are already underway.

These are only a few of the changes and modifications included in the new law.

For more information, call the Health Insurance Counseling Advocacy Program (HICAP) at 650-627-9350 or 800-434-0222.

Friday, May 21, 2010

New Health Care Rules begin in June

By Christopher Behnan • DAILY PRESS & ARGUS • May 16, 2010


Staring June 23, the law creates a health subsidy for retirees between the ages of 55 and 64. The program will subsidize 80 percent of approved claims totaling $15,000 to $90,000.

That program is planned to expire in 2014.

Also this year, employers with less than 25 employees that contribute at least 50 percent of premiums per employee may be eligible for a tax credit.

The credit wouldn't be filed until next year's tax return, but employers should start calculating employee hours required to determine full-time equivalency data, Porta said.

The government will count a 4.98 full-time equivalency as four full-time employees rather than rounding it up to five, for a greater credit.
read more

In that case, employers can bump up their staff's hours slightly to obtain the higher credit, Porta explained.

"It can make a difference. You want to maximize the tax credit," he said.

Saturday, May 1, 2010

Health insurers end cancellations

Rueter's
Susan Heavey and Lewis Krauskopf - Analysis
WASHINGTON/NEW YORK
Fri Apr 30, 2010 12:51pm EDT
WASHINGTON/NEW YORK (Reuters) - U.S. health insurers are avoiding the controversial but rare practice of canceling coverage when a customer gets sick, but it is unclear how regulators will enforce the ban, which could affect thousands of policyholders.
read more

Friday, April 23, 2010

Companies Drop Employer-Sponsored Health Insurance

Clarifying Health
Thursday, April 22nd, 2010

The Health Care Reform bill signed into law on March 23, 2010 is the death knell for employer-sponsored group health insurance. And that’s a good thing.

read more

Wednesday, April 14, 2010

Agencies Seek Health Care Implementation Comments

LIfe and Health Magazine

Article by ALLISON BELL
Published 4/12/2010

"Federal regulators are asking members of the public for comments on how the government should implement the Patient Protection and Affordable Care Act..."

"..... how states define 'unreasonable rate increases,' rules for public disclosure of rate increase information, ideas about how to go about excluding plans that impose 'unreasonable rate increases' from the new state health insurance exchange system, and ideas about how to minimize the rate review process paperwork burden."

And now the real work of health care reform begins.read more

Sunday, March 28, 2010

Quick analysis of effect of new health care bill

Washington Post article 3/28/2010

Now that all the rhetoric is behind us (you think?) what does the new law mean to each individual. Well there is a site with a situation calculator. Requires just 4 inputs. 1. How you are/not insured now 2. how many in your family 3. Your adjusted gross income. 4. Your marital status. The resultant statement is clear and concise.

Click here for site to analyze what the new bill means to you

Tuesday, March 23, 2010

Personal Commentary

Posted 3/23/2010

President Obama has engineered a watered down semi-universal profit driven health care system. His accomplishment will go down in history as one of the major social legislation issues to have been undertaken in generations. To his credit he negotiated placated and modified his way into a victory for politcal accomodation that will (in spite of it's faults) stand the test of time as a Major step forward in American Health Care for all.

Machiavelli said 500 years ago "Change is hard. The losers know very well what they are losing and fight with passion to maintain the status quo. The winners have no experience to know what they are gaining, so are lukewarm in their pursuit" (quotation marks are mine and statements within approximate)

A huge portion of our great nation are currently involved in demonizing and denigrating what has been accomplished. How much better it would be if they stopped for a moment and reflected on their good fortune and proceeded in good faith to modify it to better reflect and adjust to what will become obvious with time needs to be modified.

Monday, March 22, 2010

More Commentary on New Health Ins Bill

The New Health Insurance Law and Your Money

by Smithee on March 21, 2010.

Small group (50 or less employees) health insurance Employers get this years tax break!


complete details of article here

New Health Care Law Summary

By CBS News Capitol Hill Producers Jill Jackson and John Nolen

March 22,2010

"Coverage:

* Would expand coverage to 32 million Americans who are currently uninsured.

Health Insurance Exchanges:

* The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.
* Separate exchanges would be created for small businesses to purchase coverage -- effective 2014.
* Funding available to states to establish exchanges within one year of enactment and until January 1, 2015.

Subsidies:

* Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.

Federal Poverty Level for family of four is $22,050

Paying for the Plan:

* Medicare Payroll tax on investment income -- Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals).

* Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan.
* Tanning Tax -- 10 percent excise tax on indoor tanning services.

Medicare:

* Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
* Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.

Medicaid:

* Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
* Requires states to expand Medicaid to include childless adults starting in 2014.
* Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
* Illegal immigrants are not eligible for Medicaid.

Insurance Reforms:

* Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition.
* Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
* Insurance companies must allow children to stay on their parent's insurance plans through age 26.

Abortion:

* The bill segregates private insurance premium funds from taxpayer funds. Individuals would have t * abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds.
* No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.

**Separately, anti-abortion Democrats worked out language with the White House on an executive order that would state that no federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother. (Read more here)

Individual Mandate:

* In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.

Employer Mandate:

* Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.

Immigration:

* Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money."
More info

Thursday, March 11, 2010

Truth is we can improve healthcare and reduce deficit

New England Journal of Health
March 11,2010
Article by Len N Nichols Phd

The Congressional Budget Office says current version of Health Care Reform bill will in fact offer Health Insurance to 30 million not now covered and will reduce healthcare costs over time and reduce our deficit. Conservative myth makers say otherwise. Dr.Nichols full statement here

Friday, February 26, 2010

Health Economists Urge Passage of Reform

Friday, February 26, 2010
New York Times By DAVID LEONHARDTE
Excerpts

An impressive panel of 88 Professional Health Economist sends a letter to Obama urging him to use reconciliation to pass a merged version of already passed Senate and House Health reform bills.
read whole article here

Thursday, February 25, 2010

Senate easily approves jobs bill; House passes health-insurance antitrust bill

Washington Post Article
By Ben Pershing and Perry Bacon Jr.

Thursday, February 25, 2010

Comment: It would seem that our congress is having the same problem grasping the whole Health Care Reform bill all at once that we are. By breaking it down into understandable smaller units we seem to see them actually working on getting it done. Who Knew? read actual article here

Sunday, February 21, 2010

Major Health Insurers raise rates after record profits

Sunday Feb 21,2010
Excerpts from an Editorial in The Tennessean
Tennessean staff writer Getahn Ward contributed to this report.

After a year (2009) of record profits Major Health Insurers are raising premiums to record levels
read whole article

Saturday, February 13, 2010

Economy Down, Health Insurance Industry posts largest Profits ever

February 12, 2010 6:39 p.m. EST
Topics: business, economy, business and finance, health, United States
Linda Young - AHN(All Headline News - Digital news media) Editor

Washington, D.C., United States (AHN) - While businesses and individuals struggled to cope with ever-rising health insurance costs, health insurance companies lined their pockets with profits of $12.2 billion in 2009 - an increase of 56 percent from 2008.

Those staggering statistics were revealed in a report by a coalition of liberal advocacy groups and labor unions, Health Care for America Now.

"The five largest U.S. health insurance companies sailed through the worst economic downturn since the Great Depression to set new industry profit records in 2009, a feat accomplished by leaving behind 2.7 million Americans who had been in private health plans. For customers who kept their benefits, the insurers raised rates and cost-sharing, and cut the share of premiums spent on medical care. Executives and shareholders of the five biggest for-profit health insurers, UnitedHealthGroup Inc., WellPoint Inc., Aetna Inc., Humana Inc., and Cigna Corp., enjoyed combined profit of $12.2 billion in 2009, up 56 percent from the previous year. It was the best year ever for Big Insurance," Health Care for America Now wrote in a statement on its Website.

Part of the shocking profits were made by dropping the sickest policy holders, Health Care for America Now noted.

In addition, although many people view health care as a necessity, health insurance companies price it like it's a luxury.

Health Care for America on its Website quoted Andrew Kurz, former chief financial officer of Wisconsin Blue Cross-Blue Shield as saying, "Insurance company profit margins put the industry in the top 10% of all industries, up there with cigarette manufacturers. Insurers price their products like a discretionary luxury, not something essential for health and well-being

Read more:

Thursday, February 11, 2010

Anthem BlueCross Increases Calif rates 39%

Anthem Blue Cross a division of WellPoint Insurance Company has announced a March 1 rate hike of 39% for individual heath insurance plans in California. see SF Chronicle Article here

Sunday, January 31, 2010

Demo contemplate piecemeal legislation

CNN Politics January 31, 2010 5:16 p.m. EST


White House press secretary Robert Gibbs says passing a health care bill is "still inside the five-yard line."


* Instead of overall health care reform, health insurance reform gains traction among Dems
* White House press secretary says health care bill "still inside the five-yard line"
* House Speaker Pelosi says Congress "must take whatever time it takes" to pass bill

Washington (CNN) -- Democratic efforts to pass a health care bill have stalled a bit, and the immediate focus may be shifting toward health insurance reform instead of quickly trying to pass a comprehensive bill, White House officials signaled Sunday.read whole article

Saturday, January 23, 2010

Demos working on side issue legislation

January 23, 2010

FoxNews.com

House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid reportedly are considering a new list of changes to the Senate health care reform bill that could be passed separately as a way to advance the suddenly stalled overhaul of the health care system. Read whole story here

Monday, January 18, 2010

Doctors drowning in insurance paperwork

Posted on Sun, Jan. 17, 2010

By Jane M. Von Berge
Philadelphia Inquirer Staff Writer

Administrative expenses cost the U.S. health system hundreds of billions a year. The goal? A standardized, digital process.
read whole article

Sunday, January 17, 2010

Possible effect of Proposed Insurance Exchange

Los Angeles Times
By Kim Geiger

January 17, 2010

HEALTHCARE Q & A


"My family's current policy costs more than $400 per month, which is not affordable for us. Will we be able to afford insurance under the healthcare bills?"

Comment: The answer seems to be a qualified yes
read article here

Wednesday, January 13, 2010

Courts likely to uphold tax to pay for Health Care.

excerpts from Wall Street Journal Jan 10,2010
By JESS BRAVIN

WASHINGTON -- As congressional Democrats try to iron out differences in the House and Senate health-care bills, Republicans are attacking the legal premise of the legislation, saying Congress has no power to make people carry health insurance or pay a penalty or tax. However, courts usually defer to lawmakers, and Democrats could smooth the way further by using language in the final version that clearly asserts Congress's power under the Constitution to levy taxes -- which the House bill already does.

Since the New Deal era, the Supreme Court has broadly interpreted congressional authority under the Commerce Clause.

The House version explicitly includes a "tax on individuals without acceptable health-care coverage."

Congress has broad power to tax -- and courts have been highly deferential to the way it is exercised.

"Given the precedent of Medicare, courts are likely to uphold Congress if it imposes an income tax to pay for a government health-care system,".
read whole article

Sunday, January 10, 2010

Pelosi Has her work cut out for her

From the Politico
PATRICK O'CONNOR & CARRIE BUDOFF BROWN 1/9/10 9:58 AM EST

Speaker Nancy Pelosi is telling her caucus not to believe stories that the House will simply roll over and accept the Senate’s hard-fought health care bill.

“That’s not true for one second,” Pelosi told her agitated rank-and-file in a call this week.

But she may not have a choice.

Any major changes to the Senate bill threaten to upset a delicate d├ętente Majority Leader Harry Reid (D-Nev.) built over months of cautious negotiations to hold together 60 votes in his divergent caucus.

The public option is out. Employer mandates could prove too tough to change. And the president has already taken the Senate’s side in the fight over a tax on high-end health care plans.

“Each of the provisions at issue has already been negotiated ad nauseam in the Senate,” said a Senate Democratic aide. “The physics of this are unlikely to change much.”

Pelosi even seemed to concede one of her top priorities during the call – suggesting she could live with pushing the start date for reforms from 2013 to 2014, the date in the Senate bill. That alone would save $100 billion in the House bill, according
several congressional aides, money the speaker told her caucus could be plowed into making insurance more affordable.

So the ever-practical Pelosi is setting her sights on achievable goals: boosting insurance subsidies, strengthening oversight of insurers and setting up a national exchange to make sure the federal government sets minimum standards for coverage under the reforms.

Even those could prove to be a tall order.

Two key moderates – Sen. Ben Nelson (D-Neb.) and Sen. Joe Lieberman (I-Conn.) – have favored the state-based exchanges over national exchanges. The question now is whether it will prove make-or-break for either.

It’s not just the Senate. Pelosi, who relishes a good fight, finds herself locked a duel with President Barack Obama over the so-called Cadillac tax included in the Senate bill – a 40 percent levy on insurance plans that exceed $8,500 for individuals and $23,000 for families.

To win this skirmish – or any other – she needs to convince Obama her math is tougher than Harry Reid’s.
read whole article

Saturday, January 9, 2010

Why we all must have health insurance

Updated: 01/08/2010
Excerpts from article By Scott Schaefer

Scott Schaefer, associate dean for academic affairs and David Eccles Professor of Finance at the University of Utah's David Eccles School of Business.

Why an individual mandate to buy health insurance? We've heard a lot of debate on this question lately. But it seems a lot of the talk doesn't reflect much knowledge of why some think an individual mandate might be a good idea.

Reason 1 » It's because of uncompensated care. it's about 1.5 percent of our overall health care expenditures.

Reason 2 » Because you have to get auto insurance, right? Maybe. A mandate makes sense here because there's a general tendency to think too little about harm we might impose on others. But this reasoning doesn't apply for health insurance.

Reason 3 » It's a plot by the Democrats to take away our liberties. I guess I can't definitively disprove this one,

Reason 4 » To prevent unraveling of the insurance market. This one's kind of complicated, but it's also the right answer. And to understand it, one needs to understand the effect of "asymmetric information" on insurance markets. Asymmetric information is when I know something and you don't.

Let's think about how this applies to health insurance. Some people know they're relatively less likely to get sick, and, for them, insurance is a bad deal. They figure they'll pay in more than they get out, so they don't buy. And if healthy people don't buy, it's harder for insurers to make up the costs of those cancer drugs, which means the price for insurance goes up, to a level far higher than it would be in a market where people weren't asymmetrically informed about their health status.
It's this unraveling of the insurance market that makes it so expensive. A mandate may stop this unraveling, and help bring prices down.read whole article