Obamacare is the law of the land

No?
I’m not sure I see the parallel.

Your letter represents your wishes. They should not be denied, even if doctors think them unwise.

But parents are representatives of their child’s wishes. They have the same legal force as the letter, and they should not be denied, either.

Although sometimes extreme edge cases can help us set guidelines, I don’t think the Charlie Gard case is a good example. The Charlie Gard case is a real outlier, with a very rare disorder that impacted a very young child very quickly, with severe consequences. Also, in terms of the health care debate, it’s not relevant to the US b/c no major player in the US is advocating a nationalized health system like the UK NHS.

I think we should consider the unfortunate case of Charlie Gard as a tragedy, not an exemplar of any point or principle.

And it’s kind of amazing that there aren’t even more cases like this to throw people into an anti-single-payer frenzy.

One brief point on the issue of “selling insurance across state lines” with Strollen using the example that people in eastern Oregon should be able to buy insurance from Idaho. That is currently perfectly legal. We do have inter-state commerce in this country and a resident of one state can buy insurance from another state.

So, if it is currently legal to buy and sell insurance across state lines, what is the GOP talking about when they say they want to “allow” it? It’s already allowed.

What they mean is, they want the regulations of the state where the insurance company is located to control instead of the state where the purchaser is located. In interstate commerce, to sell something in a state, the item must be legal in that state, which means complying with state regulations in the state of purchase.

In the US we made an exception for credit cards, where the law of the state of issuance controls rather than the state where the customer lives (with some exceptions). That’s what the GOP wants for health care. If you’ve ever fumed about the terms of your credit cards or those sneaky little fees, then you have a preview of what GOPcare with “selling insurance across state lines” would be like.

Ethics are different from legality.

In your example, the letter is a product of my adult, competent mind, regarding my own person.

In the case of the child, his parents are not equivalent. They are his guardians, but only so far as they protect his well-being.

It depends on the state in some cases, and there are some unique instances.

For example in California Blue Cross and Blue Shield are two separate payors. in Oregon it’s essentially Regence Blue Cross Blue Shield. You don’t really buy Anthem Blue Cross products in Oregon unless you work for a CA company. However, Blue Cross and Blue Shield is a bigger payor and their network is here. So whether or not you use Regence or Anthem, you’re looking at the same network in OR. In CA it is different so the benefit plan is not across state lines in terms of how they sell it.

When I played around with the exchange websites, the plans were definitely different and at different rates even if some of the Payors were the same.

Does that make sense at all?

What the GOP actually has in mind when they say that, who the hell knows.

Parents (or legal guardians) are completely responsible for what happens to the child, both ethically and legally.

And these ethics are put into practice every day. If a doctor wants to enroll a child in an experimental trial, then consent must be obtained from the parents. This is a foundation of medical ethics. The doctor cannot override the wishes of the parents who decline to subject a child to an experimental therapy. Even if the doctor thinks the experimental therapy would benefit the child.

But if doctors cannot override the wishes of parents who don’t want to try an experimental therapy, neither should they be able to override the wishes of parents who do want an experimental therapy. Which is what happened in this case.

That’s silly.
A doctor is absolutely able to override such a desire by parents… because parents are not experts in the field of medicine.

There are numerous cases where doctors’ views override the will of parents for the sake of the child’s well being.

Generally, it’s rare for doctors to override such decisions, but it does in fact happen, because the doctor has an ethical duty to the patient.

There was a girl (a fairly old one, 17) who had cancer and wanted to forego treatment… and her mother supported her decision. But the courts upheld the doctors’ right to force her to undergo treatment, because she was still a minor and not really able to make the decision herself, and her mother didn’t really grasp the details of the situation.

A parent’s wishes in such cases are not absolute. The well being of the child is the primary concern above all else.

I think you misunderstood that case.

The doctors didn’t’ override the parents, the state took custody of her and made the decision… completely different that the physicians doing whatever they wanted.

Also highly curable vs certain death due to a genetic disorder so rare it’s not really considered a curable so much as a 11% to 59% improvement… wholly different scenario.

Nesrie, the fact that the companies are offering different packages in different states (presumably with different networks) is just a marketing decision. Legally, there’s nothing stopping Anthem Blue Cross from selling insurance in Oregon, AFAIK. There may well be an internal marketing agreement between Regency Blue Cross Blue Shield and Anthem Blue Cross to split the market, but that’s not state law. I have represented numerous out of state insurance companies here in CA for CA workers’ comp so it’s definitely legal for out of state insurers to sell in a state. If the insurer adopts a marketing approach or group name based on the state of purchase, that’s purely a business decision, not something mandated by law. For example, some national insurers will set up regional claims offices in a particular state, to be closer to the customers, but the actual contracts of insurance will still be issued from an out of state underwriting company. Take a look at your policies of insurance - you may find that the actual corporation legally responsible to pay your claims is an out of state company, even if the broker and the claims office is local. As just one example AIG is a “business name” for a group of companies that sell insurance and handle claims in many states. I’ve worked on many cases where the claims office is an AIG office here in CA, but the insurer is out of state. For example, National Union Fire Insurance of Pittsburg, PA is an insurer that sells a lot of workers’ comp insurance in CA. It’s a PA corporation.

Here, I found a list of AIG insurers

In the last 10 years, let’s see, I’ve handled cases arising for policies of insurance sold in CA, from the following out of state insurers:

American Home Assurance, incorporated in NY
Commerce & Industry Insurance, incorporated in NY
Granite State Insurance, incorporated in IL
Nation Union Fire of Pittsburgh PA
The Insurance Company of the State of Pennsylvania, incorporated in IL (yes, weird)

That’s just one insurance group - I’ve probably repped a good 20 different out of state insurers for insurance policies sold in CA in the last few years. So selling insurance across state lines is definitely currently legal. It’s just a matter of regulation.

It’s not “just” marketing. Anthem is a different entity. They’re organized that way. Different filing, Tax IDs… everything. Anthem and Regence are literally different entities.

There are certainly laws about selling insurance. I can’t wake-up tomorrow and just start selling insurance.

I don’t really have to look at my policies either, I have to talk to these Payors, on the phone, different requirements… they’re different bodies with different requirements and let me tell you Anthem is a lot less fun to deal with than Regence.

I’m not really saying it’s illegal either just that it’s not really being done in the exchanges, for whatever reason.

Again, as far as I know, the fact that the companies are operating separately in separate states is not something required by law; they could sell insurance across state lines if they wanted to. It may just be that as a business matter, it’s not worth the cost of trying to set up competing networks in other states. Or another possibility is that the companies are set up to comply with the regulations in the state they are doing business in, but would have make adjustments to comply with the regulations in another state. As an example, in CA, for Third Party Claims Administrators, the actual adjusters have to meet certain qualifications under CA law. So if your workers aren’t qualified in CA, you can’t administrate claims in CA. But that’s just the normal way interstate commerce works in the US. Changing that is a form of deregulation.

Well car insurance can be sold across state lines too, but NJ had some weirdo law where they didn’t get most of the big payors in their market until recently. And there are changes per stay in those products too.

Maybe the exchanges don’t a llow it. I literally do not know what the requirement is for a insurance company to offer a benefit plan a specific states listing. I just know that there are several large companies that don’t offer the same product across state lines, for whatever reason, and more than a few of them have their organization split, beyond just marketing, like literally separate entities. Hell Kaiser has two of them just in the state of CA.

Sees that this thread has 60 new replies since this afternoon. Wow, I wonder what we’re…oh.

I guess by “marketing” I mean “business reasons”. Kaiser is weird; it has a northern and southern CA division which I believe is historical in nature but persists in that they are separate corporations (KPMG in norcal, SCPMG in socal). Also, many “separate” entities are still part of the same “insurance group” (like the AIG example above).

Bottom line is, selling insurance across state lines is already perfectly legal, with the caveat that the insurance must comply with the law and regulations in the state of purchase.

I thought one of the Republican plan allowed states to form a cooperative where if say IN,KY, IL, MO got together and agree. An insurance company you could sell Health Insurance if it got approval in one state instead of getting approval in all four states.

Is that allowed now?

Of course, because in that case each of those states would have individually passed laws setting their insurance standards and regulations to whatever had been collectively agreed on.

That’s fundamentally different from the federal government stepping in to force states to permit the sale of insurance plans that don’t meet their standards, just because some other state has approved them.

And the Gard case is legally, if not formally, basically the same. It’s nothing to do with the NHS being single payer, except in so far as that reflects cultural differences. The same situation could have arisen had Gard been in private care, though in practice private hospitals here don’t really do this sort of care.

It’s fundamentally a child welfare case. The hospital applied to the court to prevent the parents from, as they saw it, harming the child, and the courts (in the UK and the ECHR) ultimately agreed (on an interim basis).

In fact, here’s what the judge who decided the application had to say on that:

This is the core of it, here.

There is nothing stopping an insurance company based in State A from selling insurance in State B today, except lack of familiarity with the local laws, medical practices, doctors’ networks, and perhaps some tax incentives/penalties that would make such a move difficult.

When the GOP talks about “selling across state lines”, what they really mean is “ignoring state-by-state restrictions”. In their perfect world, the State A-based company would be able to sell insurance in State B and ignore State B’s rules about, say, paying for physical therapy after ACL surgery. The result (they feel/hope) would be increased competition that would lower prices. Detractors say that such a move would simply spur a race to the bottom with states being unable to customize care for their constituents’ needs.