The Flaw in What Obamacare DOES NOT Discuss Enough

Well, as an expert in this field for close to 20 years now, and having spent a considerable amount of my career in NYC, helping middle market companies combat health insurance premium increases, and "smart" benefit designs to prompt utilization that hopefully "slows" these carriers from ratcheting up premiums, I focus my attention on NYC specifically. There are some good intentions in Obamacare, honestly, but as an expert and listening to the often useless and almost nonsensical political jousting I get back to a place where the theme behind Obamacare has been in place, has not worked, and has pushed pricing to the SKY!!! NYC folks.... in NYC we have guaranteed-issue individual/family health insurance offered normally by just a few carriers (as they get forced to because they do tons of commercial business too) but in 2010 for example Empire Blue Cross Blue Shield, and Oxford Health Plans to name 2. We get calls daily of people looking for alternatives to their SINGLE rate of 985/mos to get an HMO plan, yes folks, almost $1,000/mos or a mortgage payment to have coverage that limits him/her to network only coverage. Well, that is exactly what Obamacare will deliver unless the young, healthy folks in this country are also forced to carry health insurance. The problem in NYC, is they can't deny coverage, and they charge the same rate whether you are deathly ill or healthy as a horse. The only catch for them to be able to apply pre-exisiting condition language is if you go beyond the 63 day "uncovered" HIPAA window (if you do not have coverage for greater than 63 days, you open yourself up to having pre-X language). So, when you get sick, you can jump in and buy, and not get denied, sounds great right? Wrong, that is how you end up with $1,000/month rate for a single 25 year old.

As such, we must have mandatory coverage like auto coverage, with a la carte plan designs, so if we want to buy hospital coverage and pharmacy coverage, but pay our own physician office visits, speech therapy, physical therapy and mental health visits, carriers should be forced to offer them....state and federal benefit mandates also kill the system(again another problem in NYC, where they mandate EVERYTHING to be covered in every offered policy - another way to DRIVE UP COSTS!).

So, let me lay this out again, a la carte plan designs, cheaper plan designs for higher deductible (my up front risk) and lesser benefits (no mental health, office visits, physical therapy, chiropractic care) and conversely, higher costs for folks who wish to have that coverage, AS IT SHOULD BE. We need to be paying a portion of the underlying benefits we consume, and others in our "risk pool" within insurance carriers need to be rated accordingly. Same thing for the "risk pools" of consumers with different product/plan designs.

I am not an actuary but have spent lots of my career around them and in HUGE institutions in which I used to work early on....smart people, who can figure out how to still get us what we need and make a profit, or perhaps not....maybe health insurance carriers should all be forced to be non-profit? Not sure on that, but strong arguement for it.

I hope this has given some insight in to the bigger problem with Health Care Reform...we do not need another NYC, nor Massachusetts (their mandatory system has absolutely imploded, for similar reasons to NYC)....

Let's go the route of how be must carry car insurance, and pay for what we actually have in benefits.