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The Sad Case of the Patient Protection and Affordable Care Act
- Thread starter FreshFish
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Re: The Sad Case of the Patient Protection and Affordable Care Act
To me, self insure means that the entire risk is on the company, not palmed off to a 3rd party insurance agency.
leswp1
Well-known member
Re: The Sad Case of the Patient Protection and Affordable Care Act
stupic code won't let me smile!!les & jenny - for you (and any others i forgot)
Re: The Sad Case of the Patient Protection and Affordable Care Act
Pretty close. Self-insure means your risk pool is limited to your own employees, and you have to pony up the excess claims cost or pocket the excess premium income (it is virtually impossible for premium income + investment income = claims outflow as rates are always set prospectively while claims are always incurred retrospetively, so to speak). Many times a "self-" insured entity will also have excess stop-loss coverage from a commercial insurer to protect against catastrophic claims experience. Many self-insured risk pools are run merely to break even, which also makes them more affordable since you don't need to include a margin for profit.
Insure with a separate insurance company means your risk pool is spread out over the insurance company's risk pool and in the short run the insurance company ponies up for excess claims or pockets excess premium income; however one year's experience (or rolling average of several years) becomes the basis for the subsequent year's premiums.
Insurance companies are roughly like the house in Vegas: you smooth out any one individual's experience over the experience of a large number of people, pay out most of what you take in, and keep a relatively small amount as profit.
In Scooby's model, he cannot forbid employers from offering insurance as that would run afoul of the First Amendment's right to free association; however we can sever the link between employer and employee generally throughout the economy while still allowing self-insured employers to offer coverage to their employees; it would merely be a slight reshuffling of paperwork under the aegis of the state insurance commissioner.
Pretty close. Self-insure means your risk pool is limited to your own employees, and you have to pony up the excess claims cost or pocket the excess premium income (it is virtually impossible for premium income + investment income = claims outflow as rates are always set prospectively while claims are always incurred retrospetively, so to speak). Many times a "self-" insured entity will also have excess stop-loss coverage from a commercial insurer to protect against catastrophic claims experience. Many self-insured risk pools are run merely to break even, which also makes them more affordable since you don't need to include a margin for profit.
Insure with a separate insurance company means your risk pool is spread out over the insurance company's risk pool and in the short run the insurance company ponies up for excess claims or pockets excess premium income; however one year's experience (or rolling average of several years) becomes the basis for the subsequent year's premiums.
Insurance companies are roughly like the house in Vegas: you smooth out any one individual's experience over the experience of a large number of people, pay out most of what you take in, and keep a relatively small amount as profit.
In Scooby's model, he cannot forbid employers from offering insurance as that would run afoul of the First Amendment's right to free association; however we can sever the link between employer and employee generally throughout the economy while still allowing self-insured employers to offer coverage to their employees; it would merely be a slight reshuffling of paperwork under the aegis of the state insurance commissioner.
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Re: The Sad Case of the Patient Protection and Affordable Care Act
Joe-Jenny sends a big kiss!
Les & Jenny - for you (and any others I forgot)
Joe-Jenny sends a big kiss!
Re: The Sad Case of the Patient Protection and Affordable Care Act
Did she go to RPI? If so, I think she violated the 'tute Code of Conduct by kissing a Techer.
Re: The Sad Case of the Patient Protection and Affordable Care Act
Back in the 60's when I was at RPI-there was nothing on campus like her. Most of what was there needed to have chromosomal testing to be sure they had 2 XX's.
Back in the 60's when I was at RPI-there was nothing on campus like her. Most of what was there needed to have chromosomal testing to be sure they had 2 XX's.
unofan
Well-known member
Re: The Sad Case of the Patient Protection and Affordable Care Act
So tell me again why we don't just go single-payer through an entity that inherently does not have a profit motive?
So tell me again why we don't just go single-payer through an entity that inherently does not have a profit motive?
Re: The Sad Case of the Patient Protection and Affordable Care Act
Administrative incompetence and lack of a viable alternative if they screw up.
Administrative incompetence and lack of a viable alternative if they screw up.
walrus
Wind up workin' in a gas station
Re: The Sad Case of the Patient Protection and Affordable Care Act
This will happen everywhere until Congress writes a law that says companies can't do that or they go single payer and it won't matter
unofan
Well-known member
Re: The Sad Case of the Patient Protection and Affordable Care Act
Because the current insurance companies are the paragon of administrative competence? And what viable alternative do we have when they screw up?
Because the current insurance companies are the paragon of administrative competence? And what viable alternative do we have when they screw up?
ScoobyDoo
NPC
Re: The Sad Case of the Patient Protection and Affordable Care Act
None. Fighting insurance companies is not easy.
None. Fighting insurance companies is not easy.
Re: The Sad Case of the Patient Protection and Affordable Care Act
No argument there.
At the same time, if you had to fight, which of these two do you choose for your opponent: an insurance company, or the IRS?
No argument there.
At the same time, if you had to fight, which of these two do you choose for your opponent: an insurance company, or the IRS?
ScoobyDoo
NPC
Re: The Sad Case of the Patient Protection and Affordable Care Act
I'd rather move to Iceland.
No argument there.
At the same time, if you had to fight, which of these two do you choose for your opponent: an insurance company, or the IRS?
I'd rather move to Iceland.
unofan
Well-known member
Re: The Sad Case of the Patient Protection and Affordable Care Act
The IRS at least has to follow administrative rules which are codified and set forth in the Federal Register. If they fail to do so, your appellate rights are set out for you.
If an insurance company fails to follow its own rules, there's almost nothing you can do. You can sue them for breach of contract, but it's almost always less costly and far easier to win an administrative appeal in front of an administrative law judge than it is a full fledged civil trial.
As someone who's been on both sides of the table, I'd rather go up against a government agency than a mega-corporation any day of the week and twice on Sunday.
No argument there.
At the same time, if you had to fight, which of these two do you choose for your opponent: an insurance company, or the IRS?
The IRS at least has to follow administrative rules which are codified and set forth in the Federal Register. If they fail to do so, your appellate rights are set out for you.
If an insurance company fails to follow its own rules, there's almost nothing you can do. You can sue them for breach of contract, but it's almost always less costly and far easier to win an administrative appeal in front of an administrative law judge than it is a full fledged civil trial.
As someone who's been on both sides of the table, I'd rather go up against a government agency than a mega-corporation any day of the week and twice on Sunday.
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Government lawyers make less than corporate lawyers.
unofan
Well-known member
Re: The Sad Case of the Patient Protection and Affordable Care Act
But I thought us government employees were paid more than the private sector, what with our lavish honda civics and offices that get renovated every third decade?
But I thought us government employees were paid more than the private sector, what with our lavish honda civics and offices that get renovated every third decade?
Re: The Sad Case of the Patient Protection and Affordable Care Act
Add Papa Johns to the list.
http://www.huffingtonpost.com/mobil...tter_n_2104202.html?ncid=edlinkusaolp00000003
Add Papa Johns to the list.
http://www.huffingtonpost.com/mobil...tter_n_2104202.html?ncid=edlinkusaolp00000003
Foxton
Banned
Re: The Sad Case of the Patient Protection and Affordable Care Act
Kind of like that Applebees guy needing an extra 50 cents a sandwich. How poorly is your business doing when that's going to make or break your entire franchise?
Clearly these guys treating their employees as disposable assets is a good long term business plan.
So he no longer wants to add an extra nickel and dime to the price of a pizza he's just going to part time employees? Which will actually force him to hire more employees to fill in those hours. I guess he's got some job creation going for him. Although he'll probably just make fewer work harder.
Kind of like that Applebees guy needing an extra 50 cents a sandwich. How poorly is your business doing when that's going to make or break your entire franchise?
Clearly these guys treating their employees as disposable assets is a good long term business plan.
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