Insurer Plays “Mother, May I?”

Yet more proof that the "free market" in health insurance is anything but free: A South Dakota insurer is merging with a company in North Dakota. It would like to offer insurance in North Dakota.

But first, Sanford Health needs to wait at least two months for the North Dakota insurance department to review its application.

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

The All-Competent State versus Sharing Ministries

South Dakota is considering legislation that would outlaw health care sharing ministries. Such groups are attacked on the grounds that they are trying to offer insurance without being regulated as such, and disingenuously claiming a religious liberty rationale. Throw in accusations of Jim Bakker-like lifestyles on the part of these ministry's leaders (nothing like a charge of hypocrisy to rouse the hounds), and you've got a slam-dunk case against such efforts.

Or do you?

Paul Hsieh offers some reasons for the Christian, agnostic, secularist and atheist to all oppose efforts to outlaw this form of voluntary cooperation.

These groups, and those like them, aren't for everyone. Then again, few things are–at least until the visible foot of government comes in to stomp down private choices.

Rationing Nursing Home Beds

One common criticism of government-funded health care is that it leads to rationing. Want to see that in action? Look at the situation with nursing home beds.

South Dakota already ranks #7 in the country in its percentage of population over 65, and that population is expected to grow by twice the national rate over the next 17 years. That has some people in the state worried.

Medicaid pays the bulk of nursing home expenses, which means that the state will be on the hook for millions more in spending.

Aside from paying for it, there's the problem of finding beds for people who will need them. South Dakota law puts a quota on the number of nursing home beds. As you might expect in any situation where supply and demand are determined by government, not freely interacting individuals, there's a mismatch. The Argus Leader says "As the population has shifted, some nursing homes in rural areas have been left with more beds than their demographics dictate."

On a positive note, a state report does recommend looking at ways to encourage people to buy long-term care insurance, so the burden of care doesn't fall on taxpayers.

Brokeback Mountain: Are Health Costs Killing Ranchers, Farmers?

One of America's health care zombies that refuses to die is the notion (created by the Commonwealth Fund) that millions of people who have health insurance are "underinsured", largely due to policies with high co-payments and high deductibles.  This results in "medical bankruptcy", another exaggeration.

The Commonwealth Fund's conclusions have been picked up by an organization even more committed to "social justice", The Access Project, which advocates for ranchers and farmers in the heartland.

The Access Project has just published the results of a survey of ranching and farming in a number of states – with dire conclusions.  The facts are a little less dramatic than advertised.

Nobody argues the case for health reform more vigorously than the bloggers at SPN, but when nine of ten ranchers and farmers have health insurance (as TAP reports), it's hard to conclude that the home on the range is surrounded by the bleached bones of homesteaders driven into medical bankruptcy.

Like the Commonwealth Fund, TAP defines "underinsured" as spending more than ten percent of a household's income on health care in one year.  Clearly, this definition is inadequate because it ignores the lifecycle of earning, saving, and spending.  If you spent one percent of your income on health care for thirty years, and eleven percent this year, you are "underinsured".  If you spend nine percent every year of your life, you are considered adequately insured!

Also, like the Commonwealth Club, TAP dislikes people buying health insurance which we prefer, in the individual market.  Instead, TAP prefers the group market, where the tax code drives most of us into the arms of our employers to use health plans that they prefer.

This is because TAP is unwilling to understand that, although the individual pays 100% of his premiums directly in the individual market, he pays only a small fraction of the premiums in the group market.  (According to TAP's survey, median spending on premiums and out-of-pocket payments for individually insured households was $11,700 in 2007, versus $5,600 for those covered in the group market.)

Nevertheless, the person insured in the group market pays more indirectly, because his wages are decreased by the amount that his employer pays for his plan.  Thus, the individually insured, overall, pays somewhat less for health care.  (Other research, although "spun" in opposition to individual policies, calls this "actuarial equivalence".)

Consumer-directed, individually purchased, health policies are not just for us arugula-eating, chardonnay-sipping, San Franciscans.  They're for ranchers and farmers in America's heartland, too.

South Dakota fills the high-risk pool

South Dakota and 29 other states have received a federal grant to help pay for a high-risk pool, reports the Argus Leader.

High-risk pools are a decent stop-gap measure, letting people who might otherwise not qualify for insurance in the individual market obtain insurance. They make a public subsidy explicit , which is good for transparency.

Medica Rolls out Comparison Tool

If patient-centered care is ever going to take hold in health care, we're going to need some tools to help people figure out which doctors, hospitals and clinics are doing the best jobs at the lowest prices.

Fortunately some tools are being developed. One is Angie's List, which is expanding its "tell your neighbors" approach from lawn care services to health care.

Meanwhile Medica has developed Main Street Medica, which lets you rank physicians, clinics, and hospitals by price, number of patients seen, and other criteria.

It's far from perfect, but it's a good start.