I have worked in health insurance for over 30 years. 30 years ago I could sell any plan to someone and they could pick and choose what they wanted in their plan. Every working person found it affordable.
In my state (Califorania) mandates began to be added. This means all plans were next required to contain certain covered items...like maternity is required for plans sold to 60 year old women, as well as young women so "there is no discrimination". There are many other examples, but this is one that comes to mind. There is no deductible for same and so there is no incentive for people to be concerned with costs for this procedure when it is done in a hospital setting so little negotiation to control rates.
Next, the State of California imposed "mental health insurance requirements" on plans. Claims for this are traditionally open-ended and possible VERY HIGH. This raised rates. There are many other examples. To whit:
everyone's plans in California are through the roof with these and other mandates. Other states have imposed their own ridiculous rules; I have to give examples of the state where I live as I'm most familiar.
Enter the Federal Government. Now we have mandated preventive care with NO ANNUAL LIMIT. Do you want to be a health insurance company where you cannot predict your expenses or control them with no past statistical information about these topics and no control because you don't set the rules for your own product? So the companies will be consolidating and leaving. The remaining ones are willing to submit "to the state" rules WHATEVER THOSE ARE...and if they can't pay, the taxpayers WILL.
Add to this the "rules" the government imposes for small employers. In the past I, and others, as brokers, advised small employers about tax deductibility and implementation of health plans and other benefit plans. This has been a valuable service to the small employer as they do not have full-time human resource departments. Today, the rules being implemented are understood by literally no one and I and others are hesitant to do any advising under the circumstances. The small employer has neither the time nor the resources to handle the problem as if he does the wrong thing he could be fined or sued. Consequently the small employer will (no doubt) not offer health insurance in the future.
Just for good measure, I now work in the senior health insurance market where in the neighborhood of $1000 a month is "allocated" by the federal government for the care of any senior=$12000 a year via the Medicare system. There is no limit for preventive care....this is an open checkbook. In an era of cost-cutting we have now opened the checkbook to unlimited preventive care. And you should see the list of "preventive covered care" items. As soon as the senior gets on their plan their doc has them in his office doing every preventive procedure on the list...one lady showed me her bill for the physical (she's a healthy 65 year old) IT WAS $25,000. I saw the bill.
I could write a whole book on it....so no---our plans now have no annual limit for claims. NO ANNUAL LLIMIT. A CLAIM CAN GO TO THE MOON. Nobody is even talking about this. I am probably going to leave the country soon as
I see it coming.
I see people each day who are living on 8-20 prescriptions when they could solve their problems with diet and exercise. People are lazy, and if they "question the doctor" it makes them nervous. That's enough of this, but suffice it to say, systemwise, I could not think of a worse system.....the US is a big country---accountability is lacking...smaller countries might pull it off as there might be a bit more accountability.....stay in Australia....eat delicious apples as they will cure acid reflux and pray for the USA that they wake up.
Sorry to be so long, but this needs to get out to smart people like you'all!
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