danivon wrote:

Doctor Fate wrote:
Again, why should a post-menopausal woman have to pay for maternity coverage?

Simple question. Answer it.

Several reasons...

1) There have been cases of pregnancy in women who were believed to be post-menopausal. In such cases, the chances of complications are much higher. So while the likelihood is low, the impact is high.

How "low" are the fertility rates for women in their 60's? Other than fattening the coffers of insurance companies, what is the real benefit?

2) It will be balanced out by other standard risks. Women who are older are at increased risk of cervical and breast cancer.

So, they should be forced to pay for coverage they don't need in order to balance out coverage they're not paying for? But, the ACA is based on making many pay more, so I guess you're being consistent with the "spirit" of the law.

3) As ricky is trying to explain, it reduces overheads to avoid complicated options for 'bespoke' plans, and it will sometimes save money on premiums. Similarly, when the Catholoc Bishops were agitating to take contraception and abortion out of plans, it was found that this would increase premiums.

Their objection was based on moral grounds. What does that have to do with forcing people to buy unneeded coverage?

You say that it is speculation to say that the woman's coverage did not include pregnancy. Why do you think she can't get $98 a month coverage anymore? Here is a memo from healthnet indicating that they used to have plans that did not cover for maternal care ( only for complications of pregnancy) http://www.intobenefits.com/index.php?o ... Itemid=214
It is not speculative but making a reasonable inference that this woman had only coverage for complications of pregnancy.
Of course you're right the ACA is depriving her of a choice--she now cannot elect home delivery without any pre-natal or post-natal care so that she could pay a low rate for health insurance..,

Doctor Fate wrote:

danivon wrote:1) There have been cases of pregnancy in women who were believed to be post-menopausal. In such cases, the chances of uomplications are much higher. So while the likelihood is low, the impact is high.

How "low" are the fertility rates for women in their 60's? Other than fattening the coffers of insurance companies, what is the real benefit?

I believe there are rules in the ACA to limit profiteering. Just because a policy covers something does not mean that much of a premium goes towards that coverage.

2) It will be balanced out by other standard risks. Women who are older are at increased risk of cervical and breast cancer.

So, they should be forced to pay for coverage they don't need in order to balance out coverage they're not paying for? But, the ACA is based on making many pay more, so I guess you're being consistent with the "spirit" of the law.

How much 'extra' is on a premium to cover pregnancy for a 60 year old? How much extra would it cost to have seperate policy types that all have different standards? Until you provide figures, your assertion that people are being charged more is just that.

But your first sentence is how insurance works - you only 'need' the cover when you come to claim, until then it is all hypothetical. So the things your plan covers that you never need to claim for are subsidising the things you do need. And this applies at a group level. Your risk profile will determine your premium, so if you have a close-to- or zero- risk of pregnancy, your premium will not include much (if anything) to cover it. However, your premium is not itemised by each risk clause.

3) As ricky is trying to explain, it reduces overheads to avoid complicated options for 'bespoke' plans, and it will sometimes save money on premiums. Similarly, when the Catholoc Bishops were agitating to take contraception and abortion out of plans, it was found that this would increase premiums.

Their objection was based on moral grounds. What does that have to do with forcing people to buy unneeded coverage?

Because it's an example that removing a coverage item does not always decrease premiums and can increase them. The reason for wanting it removed is not material to that observation.

Here is another: in the UK the legal minimum for car insurance is Third Party. But for many people it works out cheaper or only marginally more expensive to have a Comprehensive policy that covers far more. Why? Mainly because wanting TP only is part of a risk profile that is higher than someone sensible who wants to cover their own loss.

Similarly, it was cheaper for me and my wife when we added each other to our policies as named drivers. Because, even though it is additional coverage and you'd think having someone who does not own your car driving it would add risk, the point is that the risk profile of someone gets better if they are trusted enough to be a named driver on another policy.

freeman3 wrote:You say that it is speculation to say that the woman's coverage did not include pregnancy. Why do you think she can't get $98 a month coverage anymore? Here is a memo from healthnet indicating that they used to have plans that did not cover for maternal care ( only for complications of pregnancy) http://www.intobenefits.com/index.php?o ... Itemid=214
It is not speculative but making a reasonable inference that this woman had only coverage for complications of pregnancy.
Of course you're right the ACA is depriving her of a choice--she now cannot elect home delivery without any pre-natal or post-natal care so that she could pay a low rate for health insurance..,

Um, why is it not speculation for you to make "reasonable inference(s)," but it is for me? #hypocrisy

danivon wrote:

Doctor Fate wrote:

danivon wrote:1) There have been cases of pregnancy in women who were believed to be post-menopausal. In such cases, the chances of uomplications are much higher. So while the likelihood is low, the impact is high.

How "low" are the fertility rates for women in their 60's? Other than fattening the coffers of insurance companies, what is the real benefit?

I believe there are rules in the ACA to limit profiteering. Just because a policy covers something does not mean that much of a premium goes towards that coverage.

2) It will be balanced out by other standard risks. Women who are older are at increased risk of cervical and breast cancer.

So, they should be forced to pay for coverage they don't need in order to balance out coverage they're not paying for? But, the ACA is based on making many pay more, so I guess you're being consistent with the "spirit" of the law.

How much 'extra' is on a premium to cover pregnancy for a 60 year old? How much extra would it cost to have seperate policy types that all have different standards? Until you provide figures, your assertion that people are being charged more is just that.

But your first sentence is how insurance works - you only 'need' the cover when you come to claim, until then it is all hypothetical. So the things your plan covers that you never need to claim for are subsidising the things you do need. And this applies at a group level. Your risk profile will determine your premium, so if you have a close-to- or zero- risk of pregnancy, your premium will not include much (if anything) to cover it. However, your premium is not itemised by each risk clause.

3) As ricky is trying to explain, it reduces overheads to avoid complicated options for 'bespoke' plans, and it will sometimes save money on premiums. Similarly, when the Catholoc Bishops were agitating to take contraception and abortion out of plans, it was found that this would increase premiums.

Their objection was based on moral grounds. What does that have to do with forcing people to buy unneeded coverage?

Because it's an example that removing a coverage item does not always decrease premiums and can increase them. The reason for wanting it removed is not material to that observation.

Here is another: in the UK the legal minimum for car insurance is Third Party. But for many people it works out cheaper or only marginally more expensive to have a Comprehensive policy that covers far more. Why? Mainly because wanting TP only is part of a risk profile that is higher than someone sensible who wants to cover their own loss.

Similarly, it was cheaper for me and my wife when we added each other to our policies as named drivers. Because, even though it is additional coverage and you'd think having someone who does not own your car driving it would add risk, the point is that the risk profile of someone gets better if they are trusted enough to be a named driver on another policy.

So, to you, it is perfectly reasonable for people to pay for coverage that they don't want, will never use, just so others can pay less?

Okay.

I wonder how many people who are being forced into said coverage agree with you?

Watch this video and tell me the President didn't lie . . . over and over again.

DF, perhaps you did not read my post, perhaps you did not comprehend the meaning, or perhaps you are deliberately arguing absurdly...

My point is that you have not established that people are actually paying more for pregnancy cover if they have zero risk of being pregnant.

danivon wrote:DF, perhaps you did not read my post, perhaps you did not comprehend the meaning, or perhaps you are deliberately arguing absurdly...

My point is that you have not established that people are actually paying more for pregnancy cover if they have zero risk of being pregnant.

If you are 45 and and a woman who has had a hysterectomy? Does she need to pay for pregnancy coverage? How about abortion services? Perhaps she need birth control? Do those services cost money?

Please don't say that this woman has the possibility of pregnancy.

This woman should have the choice to not have to pay for the services.

danivon wrote:DF, perhaps you did not read my post, perhaps you did not comprehend the meaning, or perhaps you are deliberately arguing absurdly...

My point is that you have not established that people are actually paying more for pregnancy cover if they have zero risk of being pregnant.

Perhaps you might do a bit of research to disprove my assertion (and that of a number of individuals I've cited)?

Oh, now I am being absurd. Why should you have to do anything? The burden of proof is always on those who would DARE to question anything associated with the ONE!

I have an absurd notion. I'll go to the most absurd site in the history of the Internet and see what form of absurdity is required.

The essential health benefits include at least the following items and services:

Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (such as surgery)
Maternity and newborn care (care before and after your baby is born)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

So, yeah, so much for choice. Wait. Maybe you want to argue what "all" means?

bbauska

This woman should have the choice to not have to pay for the servic

es.

If the choice ends up creating ineffiiciencies and helps raise the cost of the entire system - whats the point of that choice?

Fate

Oh, it's "easier" all right.
One size fits all is "easy," comrade.
How is it necessarily "more efficient?"

Whats wrong with one size fits all, it it does indeed fit all? If it does indeed meet every ones needs? And if at the same time its cheaper?
The point being that in every country that has largely eliminated "choice"...that is every first world country in the world - universal coverage doesn't allow people to pick and choose what risks they want to cover and which they wish to gamble upon. And yet it turns out that this produces systems that deliver health care far ess expensively. The current US spend on health care is 17.7 % of GDP.... If everything is covered, and everyone is covered, and there is only one plan ....... at say 11.3% of GDP - one size does fit all a whole lot better than your complex "shopping cart".

A lot of that is because there is a fetish for " the appearance of choice". And the insurance industry has relied upon complexity and a myriad of choice to maintain their margins and profitability.
That the ACA standards eliminate some of the policy offerings that were largely boondoggles, whatever the recipients thought of the insurance when they were claiming, is a small step towards efficiency and an improvement on how consumers can actually measure their products empowers a truer consumer market.

rickyp wrote:bbauska

This woman should have the choice to not have to pay for the services.

If the choice ends up creating ineffiiciencies and helps raise the cost of the entire system - whats the point of that choice?

The point is people have the freedom to made a decision that is based upon their preferences. Some people do wish to have Pre-birth, Post-birth and Maternity care. My mother who had a hysterectomy when she was 42 would not want such services.

Does a man have to pay for these services, since all plans need to have the coverage?

First, you brought up an example that appears to be clearly questionable, DF. Secondly, as far as my questioning when you make reasonable inferences (1) I am not sure which ones you are referring to, (2) some inferences are reasonable and some are not, and (3) it is certainly fair to point that an inference may not be conclusive (there may be other inferences from the same set of facts that could be true).

As for the example, let's see how see reasonable my inference is. If HealthNet was getting $98 a month to insure the set of child-bearing women (let's round off to ages 15-45), then they would have to pay on average for two pregnancies for each woman. If the average cost of each of those pregnancies was say $15,000, then they would be paying out $30,000 to a woman over those 30 years. That pretty much would absorb all of the premiums paid out over 30 years, without any allowance for other medical issues or any allowance for profit. Can you point to any of the above premises that is not true? If not, then that woman did not get insurance that covers maternal care for $98 a month.

That's a reasonable inference...

Doctor Fate wrote:Perhaps you might do a bit of research to disprove my assertion (and that of a number of individuals I've cited)?

Well, your individuals are not real examples of the question you are asking - unless you can prove that they are where the previous policy is only different in that it provides pregnancy cover.

Part of the problem is that I can't see exactly what your evidence is in detail - and the reality is that it does not work like that: the policies differ in a load of other ways.

Oh, now I am being absurd. Why should you have to do anything? The burden of proof is always on those who would DARE to question anything associated with the ONE!

No, the burden of proof is on those who make an assertion. Proving a negative is not possible. I can't really disprove your point when what it seems to boil down to is demanding I explain why "hypothetical person" has to pay more just because their policy includes "single item of coverage" out of a list of several - when you have not actually established that it does.

Or that having a system which adds to choice actually reduces costs. More choice means more different products, which is not so bad for consumer goods, but not so good for products that are financial instruments - because you need more administration to deal with all the differences between them. That additional administration costs money, and gets reflected in everyone's premiums.

So, yeah, so much for choice. Wait. Maybe you want to argue what "all" means?

Nope. I'm trying to explain how insurance works in general, so you can get a basic picture of why it's not necessarily correct to look at a single category of coverage in a list of standard coverage terms and point to it to say 'if it was not mandatory, the insurance would cost less'.

in order to demonstrate that covering pregnancy is making a difference to increase premiums for people who cannot get pregnant, and larger than offsetting factors, I think you need to provide data.

Until then, I see no point trying to answer questions that are based on accepting the assumption that they do.

bbauska wrote:Does a man have to pay for these services, since all plans need to have the coverage?

Yes. Once again, "all" means "all."

rickyp wrote:bbauska

This woman should have the choice to not have to pay for the services.

If the choice ends up creating ineffiiciencies and helps raise the cost of the entire system - whats the point of that choice?

No, wrong, incorrect.

You do not create "inefficiencies" by declining to pay for services you CANNOT use.

In fact, the government is forcing bloated policies on people in order to cover the inefficiencies of the system they dreamed up.

Fate

Oh, it's "easier" all right.
One size fits all is "easy," comrade.
How is it necessarily "more efficient?"

Whats wrong with one size fits all, it it does indeed fit all? If it does indeed meet every ones needs? And if at the same time its cheaper?

I'd like to give you the benefit of the doubt and believe you can read. However, I cannot give you the benefit of the doubt about whether you actually DID read what was written.

It is not "meeting everyone's needs" to force a 60 year-old single man to pay for maternity coverage and pediatric coverage. Anyone with an IQ or a pulse can discern that. I'm sure you fit into one of the two categories.

The point being that in every country that has largely eliminated "choice"...that is every first world country in the world - universal coverage doesn't allow people to pick and choose what risks they want to cover and which they wish to gamble upon.

Is it a "gamble" for a 63 year-old woman to waive maternity coverage?

That the ACA standards eliminate some of the policy offerings that were largely boondoggles, whatever the recipients thought of the insurance when they were claiming, is a small step towards efficiency and an improvement on how consumers can actually measure their products empowers a truer consumer market.

No, wrong, incorrect again. There are many policies that were tailored to suit the customer. A 22 year-old single male may not have needed more than catastrophic coverage. Now, unless he has parents whom he can attach himself to, he's stuck with an expensive plan, no matter what his actual needs are. Because the "efficient" Politburo has determined what he must have.

Again, you may think this is ideal. Many people will disagree with you.