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	<title>Comments on: 2009/10/29</title>
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	<link>http://www.john-goodman-blog.com/20091028/</link>
	<description>Insights on Health Care Reform &#124; NCPA</description>
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		<title>By: Bret</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47756</link>
		<dc:creator>Bret</dc:creator>
		<pubDate>Thu, 29 Oct 2009 21:52:20 +0000</pubDate>
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		<description>I agree with Tom. The Capretta/Miller proposal may not be Obama lite, but it is definitely liberal lite.</description>
		<content:encoded><![CDATA[<p>I agree with Tom. The Capretta/Miller proposal may not be Obama lite, but it is definitely liberal lite.</p>
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		<title>By: Tom H.</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47750</link>
		<dc:creator>Tom H.</dc:creator>
		<pubDate>Thu, 29 Oct 2009 20:34:24 +0000</pubDate>
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		<description>Why wouldn&#039;t it be much better to have personal and portable insurance long the lines suggested in the NCPA&#039;s book on state health care reform?</description>
		<content:encoded><![CDATA[<p>Why wouldn&#8217;t it be much better to have personal and portable insurance long the lines suggested in the NCPA&#8217;s book on state health care reform?</p>
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		<title>By: John R. Graham</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47735</link>
		<dc:creator>John R. Graham</dc:creator>
		<pubDate>Thu, 29 Oct 2009 17:42:11 +0000</pubDate>
		<guid isPermaLink="false">http://www.john-goodman-blog.com/?p=6323#comment-47735</guid>
		<description>I must have ate some bad fruit for breakfast this morning, because I find myself partially disagreeing with Capretta &amp; Miller, which has never happened before (and I hope will never happen again).  C&amp;M want to tighten up HIPAA &amp; COBRA, such that the continuous creditable coverage provision that precludes underwriting for pre-existing conditions when a former employee leaves his job should be extended directly to the individual market without exhausting the group coverage that COBRA offers.  But the real problem with COBRA is that it gives the former employee two months to elect COBRA (perhaps longer if the employer, broker, and carrier execute their responsibilities to notify at the end of their mandated periods).  This creates adverse selection which C&amp;M&#039;s proposal does not solve.  Maybe if the law demanded that the former employee elected continuation coverage on the same day he left work (and handed over a check), you could get away with outlawing underwriting pre-existing conditions but that is simply not realistic in the case of a lay-off.</description>
		<content:encoded><![CDATA[<p>I must have ate some bad fruit for breakfast this morning, because I find myself partially disagreeing with Capretta &amp; Miller, which has never happened before (and I hope will never happen again).  C&amp;M want to tighten up HIPAA &amp; COBRA, such that the continuous creditable coverage provision that precludes underwriting for pre-existing conditions when a former employee leaves his job should be extended directly to the individual market without exhausting the group coverage that COBRA offers.  But the real problem with COBRA is that it gives the former employee two months to elect COBRA (perhaps longer if the employer, broker, and carrier execute their responsibilities to notify at the end of their mandated periods).  This creates adverse selection which C&amp;M&#8217;s proposal does not solve.  Maybe if the law demanded that the former employee elected continuation coverage on the same day he left work (and handed over a check), you could get away with outlawing underwriting pre-existing conditions but that is simply not realistic in the case of a lay-off.</p>
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		<title>By: Bart Ingles</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47734</link>
		<dc:creator>Bart Ingles</dc:creator>
		<pubDate>Thu, 29 Oct 2009 17:42:03 +0000</pubDate>
		<guid isPermaLink="false">http://www.john-goodman-blog.com/?p=6323#comment-47734</guid>
		<description>&lt;blockquote&gt;&quot;...when premiums are not actuarially fair, people face perverse incentives...&quot; &quot;What am I missing?&quot;&lt;/blockquote&gt;

How about the fact that when premiums ARE actuarially fair, there are also perverse incentives?

That&#039;s the problem with this whole debate.  Everybody seems to approach it like a trial lawyer, only acknowledging points that bolster his or her own position.

I don&#039;t buy all of the Capretta and Miller
suggestions, but I like their analysis.</description>
		<content:encoded><![CDATA[<blockquote><p>&#8220;&#8230;when premiums are not actuarially fair, people face perverse incentives&#8230;&#8221; &#8220;What am I missing?&#8221;</p></blockquote>
<p>How about the fact that when premiums ARE actuarially fair, there are also perverse incentives?</p>
<p>That&#8217;s the problem with this whole debate.  Everybody seems to approach it like a trial lawyer, only acknowledging points that bolster his or her own position.</p>
<p>I don&#8217;t buy all of the Capretta and Miller<br />
suggestions, but I like their analysis.</p>
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		<title>By: Brian W.</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47732</link>
		<dc:creator>Brian W.</dc:creator>
		<pubDate>Thu, 29 Oct 2009 17:32:47 +0000</pubDate>
		<guid isPermaLink="false">http://www.john-goodman-blog.com/?p=6323#comment-47732</guid>
		<description>Dr. Douglas may have just found the cure for cancer!

Just don&#039;t mention cancer.  The problem will go away.</description>
		<content:encoded><![CDATA[<p>Dr. Douglas may have just found the cure for cancer!</p>
<p>Just don&#8217;t mention cancer.  The problem will go away.</p>
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		<title>By: Charlie</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47731</link>
		<dc:creator>Charlie</dc:creator>
		<pubDate>Thu, 29 Oct 2009 17:15:41 +0000</pubDate>
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		<description>Somebody should point out to Dr. Douglas that in health care areas where money is more of an issue (where insurance and government isn&#039;t involved) prices haven&#039;t been increasing and quality has been.  

This is just the opposite in the areas that government is involved (making money less of an issue).</description>
		<content:encoded><![CDATA[<p>Somebody should point out to Dr. Douglas that in health care areas where money is more of an issue (where insurance and government isn&#8217;t involved) prices haven&#8217;t been increasing and quality has been.  </p>
<p>This is just the opposite in the areas that government is involved (making money less of an issue).</p>
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		<title>By: Devon Herrick</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47726</link>
		<dc:creator>Devon Herrick</dc:creator>
		<pubDate>Thu, 29 Oct 2009 16:08:43 +0000</pubDate>
		<guid isPermaLink="false">http://www.john-goodman-blog.com/?p=6323#comment-47726</guid>
		<description>Jason Shafrin is right to suggest the fallacy of ignoring costs.  If left unreformed, medical spending will literally erode our standard of living over time as we are forced to dedicate (through tax subsidies and wage reductions) increasing proportions of our income to pay for health for ourselves (or other people).  For the sake of argument, what happens a century from now when, say, 80% of each individual&#039;s lifetime earning are going towards health care? Will Bruce Douglas agree that might be an appropriate time to discuss costs?</description>
		<content:encoded><![CDATA[<p>Jason Shafrin is right to suggest the fallacy of ignoring costs.  If left unreformed, medical spending will literally erode our standard of living over time as we are forced to dedicate (through tax subsidies and wage reductions) increasing proportions of our income to pay for health for ourselves (or other people).  For the sake of argument, what happens a century from now when, say, 80% of each individual&#8217;s lifetime earning are going towards health care? Will Bruce Douglas agree that might be an appropriate time to discuss costs?</p>
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		<title>By: Larry C.</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47725</link>
		<dc:creator>Larry C.</dc:creator>
		<pubDate>Thu, 29 Oct 2009 15:45:53 +0000</pubDate>
		<guid isPermaLink="false">http://www.john-goodman-blog.com/?p=6323#comment-47725</guid>
		<description>I wonder if Matt Holt is as joyful seeing the protestors trying to disrupt Pelosi&#039;s rally.</description>
		<content:encoded><![CDATA[<p>I wonder if Matt Holt is as joyful seeing the protestors trying to disrupt Pelosi&#8217;s rally.</p>
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		<title>By: Linda Gorman</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47722</link>
		<dc:creator>Linda Gorman</dc:creator>
		<pubDate>Thu, 29 Oct 2009 15:08:49 +0000</pubDate>
		<guid isPermaLink="false">http://www.john-goodman-blog.com/?p=6323#comment-47722</guid>
		<description>Note to Dr. Douglas: when the local orthopod practice tries to rip me off by &quot;prescribing&quot; an ankle brace that I can buy at Walgreens and which I know doesn&#039;t work because I already have one, and then has the temerity to say &quot;don&#039;t worry, your insurance will pay for it,&quot; you&#039;d better believe that we are going to have a discussion about health care dollars and cents.</description>
		<content:encoded><![CDATA[<p>Note to Dr. Douglas: when the local orthopod practice tries to rip me off by &#8220;prescribing&#8221; an ankle brace that I can buy at Walgreens and which I know doesn&#8217;t work because I already have one, and then has the temerity to say &#8220;don&#8217;t worry, your insurance will pay for it,&#8221; you&#8217;d better believe that we are going to have a discussion about health care dollars and cents.</p>
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		<title>By: Bruce</title>
		<link>http://www.john-goodman-blog.com/20091028/comment-page-1/#comment-47720</link>
		<dc:creator>Bruce</dc:creator>
		<pubDate>Thu, 29 Oct 2009 14:27:57 +0000</pubDate>
		<guid isPermaLink="false">http://www.john-goodman-blog.com/?p=6323#comment-47720</guid>
		<description>Mahar is an airhead.</description>
		<content:encoded><![CDATA[<p>Mahar is an airhead.</p>
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