Comments on: Jacoby on the ‘Public Option’

By: Anonymous

Anonymous — Wed, 04 Nov 2009 17:28:00 +0000

very interesting, thank you.

By: Anonymous

Anonymous — Wed, 04 Nov 2009 15:40:00 +0000

What is unclear, however, is whether they can set minimum standards for anyone selling insurance in their state. But yes, the Court has been very clear that you can’t treat in state and out of state insurers differently.

By: John Dewey

John Dewey — Wed, 04 Nov 2009 15:24:00 +0000

The Commerce Clause of the U.S. Constitution gives the U.S. Congress the power to regulate interstate commerce. Absent any other federal legislation, states cannot prevent an insurance company in one state from insuring a person in another state. So, absent any other legislation, a resident of California could purchase a health insurance policy from a Texas firm and not have to pay for all the mandates imposed by the state of California.Unfortunately, the U.S. Congress passed the McCarran-Ferguson Act in 1945. That Act gives to each state the power to regulate sales of insurance within state boundaries, until such time as the U.S. Congress passes future laws which do regulate the sales of insurance.The U.S. Congress could repeal the McCarran-Ferguson Act and enable interstate sales of insurance. The U.S. Congress could also establish national mandates which may be more extensive than state mandates in almost every state. I think the latter action is a more likely outcome as long as Democrats are in power.

By: Mr. Econotarian

Mr. Econotarian — Tue, 03 Nov 2009 22:55:00 +0000

” We need MORE doctors and nurses for sure.”

Actually the US has about the same number of physicians per capita as the OECD average.

But doctors make far less in other OECD countries that have physician price controls.

We would be smart to not require a second residency for doctors moving from OECD countries to the US (just pass the USMLE and have previously been a licensed doctor in another OECD country). That way we can get all their “starving doctors”.

By: Mr. Econotarian

Mr. Econotarian — Tue, 03 Nov 2009 22:52:00 +0000

“When that day comes and it seems your doctor is too busy for you or your nurse is flying by the seat of his or her pants just think of all of your health care dollars that are going to the legions of health insurance workers and not into delivering you better care.”

Of each dollar spent on health care in the United States 31% goes to hospital care, 21% goes to physician services, 10% to pharmaceuticals, 8% to nursing homes, 7% to administrative costs, and 23% to all other categories (diagnostic laboratory services, pharmacies, medical device manufacturers, etc.)

If the insurance (including Medicare) did not have the 7% administrative costs, then my premiums would be higher because of more insurance fraud. For example, Medicare fraud is around $60 billion per year as it is.

We can’t really compare Medicare and private insurance administrative costs beause they are very different patient mixes. Medicare “advertises” 2% administrative costs, but a better analysis that includes hidden costs shows about 5.2%, compared to private insurance 8.9%. But keep in mind that the sicker patients of Medicare lead to per patient administrative costs being higher for Medicare than private insurance. Plus it is likely that there is far more Medicare fraud than private insurance fraud, thus perhaps Medicare could save money by having a higher administrative cost!