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End open enrollment periods
Enrollment should always be open.
It’s not like I can only buy groceries one week per month, open a cell phone plan in the spring, or register and insure a car during some magical 8-week period at the end of the year. There is no good reason restrict access to purchasing insurance to one short season per year.
Well
The idea of insurance is that you always pay into the pool so that collectively there is money available for when you need medical services.
If there was an unlimited enrollment, people would just wait until they got sick or injured to buy insurance which defeats the purpose. At that point it's not insurance, it's just a big discount over paying the full amount after every procedure.
One of the good arguments for single payer healthcare is bypass this game. Just raise taxes and automatically give everyone coverage.
So what?
Who gives a s***? How is that my problem? Also, is it an an assumption that people won’t buy insurance until necessary, or do we know this to be true? Why should I be deprived the opportunity to fork over a not-insignificant amount of my monthly income to theses corporations because there may be a chance other consumers will act irresponsibly?
I always hear how corporations are innovative and great at solving problems, well it should be their problem to solve. Their profit margins, executive bonuses, and shareholders are being prioritized over my ability to purchase health insurance. Also, if you restrict access to purchasing health insurance to 3 months a year, then you have many months of people not being allowed to pay into the pool who want to.
The argument you make is the argument they have been selling us since Romney Care become the law of the Commonwealth, however, I don’t think it it is a good argument.
I'm not going to argue in
I'm not going to argue in favor of our current system, because it's not perfect, but it's not completely misguided. The current system assumes you have insurance at any given point in time (it is the law to have it, after all, and was in MA before it was nationally). If you lose insurance coverage outside of open enrollment, that triggers a qualifying even to be able to enroll in a different plan.
I think you know that a big argument made against mandatory health insurance was that people should not be forced to "buy" something that they do not wish to purchase, even though it is in their own best interest to do so under our current system of healthcare financing. So yes, I do believe that people exist who would choose not to have health insurance even though it is their best interest and within their financial means.
Can we do much much better? Absolutely.
Losing insurance
When I have found myself in a gap between employer-subsidized insurance coverage, I have found it prohibitively difficult to qualify to buy insurance off cycle—this past summer being the latest episode.
Baring real reform (public option, single payer, etc), health insurance should be a financial product that you want to buy. I want to buy insurance. I did not enjoy being uninsured during a hundred-year pandemic. I have never used my renter’s insurance, but for the last 15 years I have bought insurance for every year and every apartment. When I own a car, I enjoy having a good insurance plan.
Massachusetts extending the enrollment period this year suggests that rationing the enrollment period just may be BS and is a policy that protects corporate profits and hurts public health.
Perhaps instead of the negative incentive of restricting enrollment periods to coerce consumers to buy insurance, the insurance companies make health insurance products that people want to buy? For instance, my current plan through the connector is ~14% of my average take home income from the previous 3 years and have a $7,000 deductible.
Like what is even the point? I’d probably be better off not buying insurance, putting my premium+deductible in a savings account over the next year, and if costs exceed what I have in the bank just default on my medical bills. My point is that while it is not smart to go with my crazy alternative idea, the reason people don’t buy into a health plan is not because they are irresponsible and want to wing it until they get sick/hurt (as the open enrollment rules supposes) it’s that the plan options are so useless—baring catastrophic injury, cancer, etc—especially with insane deductibles, it makes skipping insurance and paying all health care costs out of pocket an attractive, almost rational choice for many healthy-ish individuals.
If I can insure a car, an apartment, or a home at any given point in the year, then I should be free to purchase health insurance anytime I want without having to “prove” some special circumstance.
An interesting perspective from an article about U.S. healthcare
"After some research on hip replacement surgery prices in the U.S, I came to the realization that getting trampled by the bulls in Spain is a cheaper alternative than getting a hip replacement in the US.
Ok, here is how I figured it out: (Some math ahead! You have been warned.)
Cost of hip replacement in the US = unknown.
What do you mean "unknown?" Won't hospitals give you a cost?
Hard to believe…but true. Only 10% of hospitals in the U.S will give you a complete price for a hip replacement before you get one. The rest reserve the right to tack on extras like $200 painkillers. (I've heard that smiling is not included in the price, but I can't confirm this.) Independent studies show that hip replacement prices can range from $30,000 to $125,000, depending on the location, the color scheme of the hospital, and the perceived thickness of your wallet. Ok, let's say that the average is about $60,000 US.
Cost of hip replacement in Spain = $8,000 (I rounded up from an actual price of $7,300.)
Cost of round-trip flight from New York City to Madrid = $1,350.
Now, despite what you may think, the running of the bulls doesn't happen in Madrid. It happens in Pamplona. So, you have to add the cost of a flight from Madrid to Pamplona in July when the running of the bulls takes place. (And yes, I used July, 2014 to get the ticket prices. That's how nerdy I am.)
Cost of round trip flight from Madrid to Pamplona = $400
Cost of 8 nights (for the full Festival of Sanfermines experience) in the best suite in Pamplona's best 5-star hotel (including the most expensive breakfast) = $23,000
So, I can fly to Madrid, have a hip replacement, fly to Pamplona, stay 8 nights in the best room in the best hotel, eat like a king, run with the bulls, get trampled, fly back to Madrid, have another hip replacement to replace my broken hip replacement, and fly back to the States for $41,000 US.
And that would still be cheaper than the $60,000 price I'd have to pay at home for one hip replacement."
Source: https://www.newswire.com/getting-trampled-by-the-bulls-cheaper/267332
You can't compare buying
car and home insurance to health insurance. Car insurance you have to have before you can even put your car on the road. You can't wait to get a dent in your car and then decide to buy insurance and file a claim. Home or renter's insurance you have the option of buying or not but if something happens (theft, fire, etc.) and you don't already have the insurance in place, you won't be able to get insurance after the fact and get your claim covered. If there was open enrollment all year long, some people would wait until they get sick before buying insurance but it's the premiums of all that help pay an individual's health claims. Buy insurance or don't. Is it a risk you're willing to take?
Uninsured drivers
Why, then, do we often see news reports/articles of accidents involving uninsured drivers? And for every uninsured driver we read about, how many are there driving around that we don’t know about?
According to a website for the Insurance Information Institute, Massachusetts, while amongst the lowest state in percentage of uninsured drivers, still boats 6.2% of the driving population as uninsured.
I don’t think it takes a giant leap to believe that if car registration and insurance was restricted to a 3-month open enrollment period, then Massachusetts would see an increase in uninsured drivers.
Who cares, besides the insurance companies who are generating record revenues? I should not be punished with having to wait months to buy insurance because these companies can’t figure out how to make buying insurance more attractive and less like a scam.
Build in a 21-day waiting period or something. No one is breaking their leg and signing up for insurance on their iPhone in the back of the ambulance to Beth Israel.
Insurance companies whole business model is assuming risk in order to return profit to shareholders. Maybe it’s time we shift risk away from public health and on to these corporations.
I don't think it's a good system either
But that's how insurance works.
If I could wait until I'm hit by a car or get cancer to buy insurance it would save me $10,000 a year and I'd do it in a heartbeat. But as of right now I'm looking a fixed $10,000 year or a unexpected $100,000+ bill. I'm not much of a gambler so I opt for insurance.
Heath insurance shouldn't be a thing. If the government paid all bills and the government was paid via taxes we'd all be better off.
FITFO
I replied to Brian before I reading this comment, but I still think it’s obscene that I can insure objects any day of any month of the year, but I can only insure my self during one quarter of the year.
a.) I think a lot more people just want to buy health insurance and be done with it rather than “gaming the system” where they pay nothing until they are in dire need. I want to see evidence that this is how people act when they have good, affordable health insurance ready to purchase
and
b.) So what if people do wait until the last minute to buy health insurance? The regulations should give good-faith consumers like me who just want to cut a check and have insurance the benefit of the doubt and not privilege profit margins and shareholders. You want to accesses to the Massachusetts insurance market? Figure it out. Your product needs to be easily available 12 months per year. It strains credulity that these incredibly lucrative businesses can’t figure out how to provide their health insurance product year-round when all of their other products are available anytime.
I don’t think there is this large swath of the population who want to wait until the last minute to buy health care. Even if there are, I don’t think a limited window is changing any of those people’s minds to the point of “well, it’s January, I better buy insurance l”. If they’ve gone that long can then they are not incentivized by a window.
Furthermore, it’s not me who should bear the burden of my neighbor’s decision to not insure. That’s for the rich-in-resources insurance companies to figure out.
We'll see
Thanks to GOP/Trump there's no obligation to buy insurance federally so we'll see what happens in the long run as some people decide to go without plans for whatever reason.
One is sure so far: Prices aren't falling and care isn't improving.
I agree
And health insurance company revenues have been off the charts over the last decade. I think because of all that, implementing more consumer-friendly policies such as ending open enrollment restrictions is a no brainer. These companies aren’t going to feel any pain. If a few people float by and don’t buy insurance until they get sick...so what?
This is a very cynical post.
This is a very cynical post. You realize the majority of insured individuals in MA are covered by a non profit insurance carrier right? Bcbsma, tufts and harvard insure over 2/3 of residents... which greedy shareholders are they in the pockets of??
Harvard Pilgrim did $1.9B 2019
Harvard Pilgrim did $1,900,000,000 in revenue in 2019 and reported $971,000,000 in assets. What value do they add to people’s health care that justifies sequestering almost $1 billion from the local economy?
If you have $1 billion in assets, let me buy health insurance 12 months per year. You’ll be ok.
Also, is it an an assumption
No, it's a substantiated fact.
Cool.
Show your work.
On the face of it, a single payer/
universal coverage sounds great but in the long run, it will have problems. I know in the UK, nurses have protested over the cutbacks in staffing which could jeopardize patient safety, there are long wait times (months) to see a specialist, doctors can't order repeated tests for patients if it's within a certain period of time due to costs, etc. In any healthcare system, it's always going to come down to costs.
Ask UK or Canadian residents if they want to switch?
Ask any resident of the UK or Canada if they are willing to swap their system with what we have in the US. A vast majority of good-faith responders would reply with an emphatic “hell no!”
It’s crazy that, our of all the people who declare bankruptcy due to medical debt, 77% of those people had insurance. It’s almost (almost) rational to not by expensive health insurance with insane deductibles save money by paying out of pocket for your yearly check up, and if your health goes sideways you were probably going to declare bankruptcy anyway so use that as a safety net. (Yes, I know this argument edges towards absurd; don’t do this folks. But the existence of health insurance companies are absurd, too.)
But, to my original point, I’m really only here to suggest ending the arbitrary open enrollment and side with consumers over corporations.