Re your comment
"IF THE QUESTION IS: What can insurance companies to to maintain their profits? Using actuarial tables for premiums, excluding the sick, denying any benefits they can get away with, and dropping people based on technicalities -- well that's the way to go."

But do they actually DO this? Well, obviously they do, for their individual policy customers - but is that simply because they can (like someone holding a gun on you will take all your money, not just a little) or because they need to?

Apparently they don't "need" to do any of that actuarial stuff for their big customers, like the government workers negotiating unit I'm part of. They fall all over themselves to be one of the providers available to these big groups (we union members get 4 or 5 each different plans to choose from). They don't differentiate between the male and female, young and old, sick and well, pre-existing or not yet sick.

What's the difference? Sheer numbers is all I see.

So ..... if all the uninsured and underinsured and small business owners, etc., etc got together as one purchasing unit (call them individual policy holders for convenience) couldn't they, too, get relatively low-cost, nondiscrimanatory coverage from the private companies now in business? And what is there in an idea like that that even a conservative, Republican, free-market believers would object to?

In fact, what about this proposal:

Every State has a plan - a pretty good plan - for their State workers, right? And that plan, between the employee and employer contributions, costs $X per person. (In the case of my plan, it's about $30 employee + $320 employer = $350 per month). What if, right now, they passed a law that said this: anyone who can get health insurance on their own (individually or through their employer or some other group)for less than $X can go right ahead and do so ......... and anyone who can't get it for $X or less is eligible to become a participant in the State employee plan, with the only difference being that they would pay the full amount not just the employee contribution amount. And the Fed government would provide subsidies for those who couldn't pay, essentially doing away with Medicaid (and, I bet, being a good bit cheaper than Medicaid).

I don't think that's what they are talking about as the "public option" because there's nothing there that would put the ins co's out of business - it would just organize their customers into nice, neat, large, efficient blocks.

And I don't think it's what they are talking about as "co-ops"? - because my impression is that there would be a bunch of co-ops, of varying sizes, and their negotiations with insurers would be carried out by NFP boards, inevitably of varying abilities .... not one huge group of State-employees-plus-individuals with negotiations conducted by the experienced people who are already negotiating for the State employee group.

I know this doesn't address the cost of medical care, but it also doesn't add much public cost and it eliminates the worst inequities, of gender, etc. and of employment status ... which would be a heck of a good start. ----------- And for the life of me I can't figure out who would object to this proposal (except perhaps the ins cos who want to keep gouging the individual policy holders).

Has anything like this been proposed --- or, more likely, what am I missing that would make it unworkable?

I think it is the point -- because if they don't use the actuarial table data to determine the cost for people whose insurance is paid for by employers, what is the justification of using it for people who pay for it themselves?

I'm trying to look at this from the insurance company's point of view (not because I empathize with them but because I want to know when I'm being fed malarky). Say an insurer has 1,000 customers: 900 of them employees of one large employer and 100 of them individuals such as yourself. They charge the employer $350 per person - flat fee - no inquiry into the health status of who is employed or will be hired in the future. But they charge the individual purchasers varying amounts but *all* more than $350 per month, some up to $900 per month, based on their particular risk factors.

When they are paying for my medical treatment or for your medical treatment, however, they are paying for 1 out of 1,000 customers, doesn't matter who is paying the tab.

So ..... if actuarial data is actually being used, then amounts they pay out for those 100 individual purchasers must be greater, on average, than their pay-out, on average, of the 900 individuals in their other pricing plan. AND they must charge less than $350 for an individual purchaser who is young and healthy, because not all of the 900 are young and healthy by a long shot.

If they can't prove either of these things -- (1) that their average pay out for individual policy holders is greater than their average pay out for an employee-policy holder and (2) that they charge less for young, healthy individuals than they do for an employee-policy holder -- then I think they have to give up this "we have to charge more because of actuarial factors" BS .... and we and those drafting legislation have to give up believing them.

Since my healthy daughter, once she turned 25, certainly wasn't going to be charged LESS than an individual policy under my employee plan, and since I doubt that they are going to pay out three times as much as someone like Wendy than they are for someone like me, I am getting the feeling that those who are required to pay through the nose for individual policies may be, well, "subsidizing" those of us who are employed and able to purchase our insurance as part of a group ....???? In other words, they charge you far more than they will ever pay out so that they can lower the price for us and grab the "big contract."

And if THAT isn't one of the most disgustingly unfair things you've ever heard, I don't know what is. Does our country really want to use (abuse) its citizens like this?

Something to keep in mind as the politicians intone things like "Well, of course, the insurance company has to make its profit, and some people are definitely going to require a lot more treatment than other people....." Only, it seems, if those people don't happen to work for a large employer.

I go back to the point I made in the other thread: one doesn't pay more school tax on their property if they have a special needs child or less if they have no children. It simply evens out. And while few things are as fundamental and vital as education, health is one of the ones that is.