3 keys to better understand the reform of health insurance in the United States

The reform of health insurance is currently paralyzing America: it sharply divides the U.S. population, it consumes a lot of political credit to Barack Obama, who sees his leadership questioned, and it provides a new impetus to Republicans until then barely visible on the political scene. From Europe, we consider especially the images of these American citizens showing signs in hand against the hand-up "socialist-Marxist" the U.S. government. We wonder, puzzled about what motivates Americans to fight hard against any reform that would both improve access to care and lower costs of an expensive medicine. But the debate is elsewhere. Here are some keys to understanding why the opposition to this reform is so strong, why the process is so complicated and what are the solutions to overcome the impasse. Different elements specific to the values and foundations of the United States are parasitizing the debate on health insurance.

On the one hand, Americans are afraid that their reform removes a fundamental right: the power to choose. The Republican propaganda to believe that the government require every citizen the doctor that he should see that fly in a country where freedom of choice is at the heart of its foundations. More generally, many Americans - especially the conservatives, who are, do not forget, still very numerous (1) - think the government did not decide whether an individual must be uninsured or .

The Americans also fear that increasing taxes and the federal deficit worse. Using the argument of the 46 million uninsured Americans to defend his plan, Barack Obama has raised many concerns about the cost of this reform. If he had started by putting forward the objective of cost reduction (which may ultimately make health care more affordable), the project would have generated less resistance.

The fear that the government acquires too much power also has the disadvantage of the reform. In general, Americans are reluctant to the idea of a law that would give the federal government the power to regulate an issue related to privacy.

It should be noted that the opposition comes not only from Republican ranks. Democrats are also opposed to this reform, particularly in southern states, more conservative and in favor of fiscal discipline (called Blue Dog Democrats). The elected Democrats in the South have indeed a conservative electorate and can not pass laws "too liberal" or risk losing their seats in the forthcoming elections. Having already supported a liberal reform, the energy (cap-and-trade), they probably do not support the Health Insurance.

Opposition to the reform of health insurance is very strong in the Republican Party and the South, where racial issues are still very pregnant. This can lead to wonder, as indeed is Jimmy Carter, if the arguments of opponents of this reform are primarily political or ideological.

During the election campaign, Barack Obama said he wanted to pursue an ambitious reform of health insurance, among other things, establish a mandatory public option. But it is the Congress that it is now drafting a law that will both please the voters and the president.

Each chamber of Congress has in its committees in charge of studying specific reform proposals and amend if necessary before the plenary vote. In the U.S., these committees are particularly powerful.

For a reform as complex as health insurance, several committees were mobilized three committees of the House of Representatives (Energy & Commerce, Ways and Means and Education and Labor) have begun to develop three different versions in spring 2009. On July 14, 2009, they proposed a joint text, subject to amendments. The text must be approved by a simple majority.

In the Senate, two committees are in charge of reform. The first (Health, Education, Labor and Pensions, more known as HELP) has announced its version of the law July 15, 2009. The second (Senate Finance Committee) has proposed a more conservative version September 16, 2009 (the Baucus Bill) version currently under discussion. The debate could last as more than 500 amendments were tabled. Both versions of the Senate must then merge into a final text that the Senators should approve by a simple majority.

The final text of the House of Representatives and the Senate's final version will then be merged by a bicameral committee on a bill, which must be approved by all members of each chamber and then by the President.

It is understood, it is a race against time that is now underway in Congress since the President would see the law adopted before the end of the year and that the Republicans will do everything to delay the vote. One of the rules governing the work of parliamentarians would allow to close the debate quickly and move on. In the House of Representatives, he need to do is get a simple majority. In the Senate, however, must obtain the majority of 3 / 5, the famous 60 votes that the Democrats are desperate to get to prevent the debate drags on. It is therefore to invoke "cloture" to end the filibuster, the filibuster by the opposition used to delay a vote on a law.

The majority in the House of Representatives can be obtained with the support of Democrats Blue Dogs, who hold 45 seats (2). In the Senate, besides the weight of the Blue Dogs, the seat of Ted Kennedy has still not been replaced, thus denying the Democrats the 60 votes. Without those 60 votes, Republicans may continue to prolong the debate for a long time. The time is for them because it allows them to consolidate the opposition to reform, to disrupt Barack Obama and to challenge the parliamentarians will have to appear before voters in fall 2010.

Ultimately, October 10th Congress opens next procedure "budget reconciliation" (budget reconciliation process): this date, the rule of 3 / 5 (and thus the filibuster) is suspended in the Senate so that all laws that impact on the budget (acts involving or affecting federal spending to taxes) are passed in time before the budget vote (in this case, the 2010 budget). With this procedure, the number of amendments and limited debate ended after 20 hours. For Democrats, this would be a way out, certainly not glorious, but practical.However, this procedure is not without risk. It could raise one hand the ire of opponents of reform, private discussion. On the other hand, if the reform goes through this procedure, it would have to be revotée each year (the budget). One can understand the opponents of reform do their utmost to ensure that the health insurance plan is not renewed next year. In addition, it will not be a radical reform, because enough not to vote again for it to clear.

The dilemma is as great to spend the Democrats will have to make some concessions, including the famous "public option". On 29 September the Senate Finance Commitee moreover rejected amendments to include an option in public law, so that the project supports the greatest possible senators and quickly put an end to the filibuster (3). But without this public option, the reform of health insurance Obama is not revolutionary. The most progressive aspects of the reform are likely to disappear for it to be passed by Congress.

The question is whether Barack Obama, resolutely decided to include a "public option" in its reform, will agree to sign a bill whose ambitions would be downgraded?

A draft public health insurance in the U.S. Senate rejected

The Committee on Finance U.S. Senate rejected, Tuesday, September 29, a bill introduced by Sen. Jay Rockefeller (West Virginia) aimed at establishing a public health insurance available to all Americans, as part of the establishment of health protection "universal", a central element of the program on which Barack Obama was elected. The committee rejected this proposal by 15 votes against 8. Its 10 members are all Republicans opposed it. They were joined by 5 of the 13 Democrats, including Sen. Max Baucus, Montana and elected chairman of the committee. He had recently seen its own project of "bipartisan compromise" unanimously rejected by the Republicans. All opponents of the project cited the fact that such public health insurance by offering lower prices, competition would be "unfair" to the private sector.

France-Insurance - Caution must remain strict -

If the insurance industry has managed to maintain solvency levels "sufficient" although decreasing in 2008, the crisis is not over and the industry must remain vigilant, says the Authority control and mutual insurance (CAMA). "We must remain vigilant. The behavior of insurers are not always careful and the crisis is not over," warned Monday Philippe Jurgensen, President of the CMAA, at a conference organized by body sector control. "There is no question of being worried. But we have every reason to be cautious," he added. The solvency margin of insurance has certainly suffered from the decline in assets in 2008 but has remained under Acam at levels "sufficient". "Finally, the results in 2008 (which fell by 18.5% on average) were not so bad, thanks to smoothing techniques allowed by the use of previously established margins," said Antoine Mantel, Secretary General CAMA.

CAMA, which has strengthened throughout the crisis testing his strength on the players insurance, also established a weekly survey on monitoring flows into life insurance, intended to eventually be able to anticipate a wave of Massive redemptions contracts. "In October 2008, the redemption rate was nearly double what it is on average (4% -5%), which was not really a wave of takeovers per se. And the movement has fallen very quickly, "said Marie-Laure Dreyfuss, Director of Cabinet of Secretary General of the CMAA. In early 2009, this rate had returned to average levels and it is now below the 2007 level, she said. The gross weekly collection, meanwhile, now well above that of 2008. The regulatory body also said to have estimated at 1.0 billion euros in total exposure to direct and indirect business to Lehman Brothers (only 0.1% of assets), to 1.5 billion exposure to AIG (0.3% of assets) and 550 million exposure to UCITS impacted by case Madoff.

Pay as you drive auto insurance or tailor-made

Unlike traditional car insurance, the PAYD or "pay as you drive" insurance is highly personalized. Instead of a plan year, the insured pays only for the miles he has done.
Pay As You Drive "* This expression is English because the offer has been designed in the United States in 1996. The objective was to reduce the auto insurance customers by not making them pay the actual use of their vehicle. This new type of tailor-made insurance was particularly developed in England and Italy between 2004 and 2006. In France, the Maaf tried placing on the market in 2005. But she ran into the Computing and Freedom Commission (CNIL), the latter believing that the data transmitted by the electronic box installed on the car of the insured were too intrusive. Insurance companies therefore improve the procedure and in 2007, Axa obtains authorization from the CNIL development of PAYD in France. Today the number of insurers offer, including Amaguiz (Groupama), Axa, the Maaf, Solly Azar broker or Aviva. Pay as you drive allows the insured to pay only for the miles he has done. It may well benefit from a reduction in the rate of its auto insurance 20 to 50%. In some countries, insurers set their prices according to various parameters (miles driven, type of road used, speed ...). In France, the CNIL has imposed restrictions: most insurance companies do not take into account the distance and sometimes time of day during which the vehicle was used. The broker Solly Azar offering insurance for young drivers, for example, included in its offer for a limited night driving. Each vehicle use between one and six o'clock in the morning, the insured must pay 20 euros extra. In case of collections of data traffic over large operators, they must "not be associated with a particular driver," says the Cni

Can you recover the money lost on the stock exchange on life insurance?

The life insurance contracts whose value has fallen contracts are so-called "multichannel" with units of account invested in stock market, and then indexed on the evolution of financial markets. If you have lost money on a contract of this type, two actions are possible. First, the contract may be canceled if the insurance company has not issued any information provided by law, including special conditions. Indeed, the subscriber has the option to abandon within 30 days after delivery of all documents. The law provides that this period is indefinitely deferred until all the information required by law has not been given to the insured. The cases in which insurers have not fulfilled their obligations are common, especially for contracts prior to 1 May 2006.
In canceling the contract, the insured will get the full amounts paid and therefore the losses and underwriting fees and interest.
The alternative is to order the insurer to pay for losses if it failed in its duty to provide information and advice. This is particularly the case when the client was advised improperly or when he was mistaken about the essential nature of the contract. For example, when a person has been encouraged to invest in units of account as prudence required it to focus instead on euro fund or if the insurer has not complied with the direction of an insured asking him 'steer money to the fund in euros. Or if the profile management (risky, cautious or balanced) announced during the underwriting contract was not fulfilled.

Insurance borrower / Minutes: UFC-Que CHOOSE winner of 93 banks

Believing that the UFC-Que Choisir had abused the freedom of expression, 93 banks were assigned July 13, 2007, the association, its President, Editor in Chief and two of its employees.
By a ruling of September 23, 2009 subject to appeal, the Board of the Press Tribunal de Grande Instance of Paris ruled against banks of all their requests. Eight domestic banks have even been sentenced to pay to the UFC-Que Choisir and each employee in question, several hundred dollars in reimbursement of legal costs incurred. The court ruled that the evidence produced in court by the association showed that it had elements of investigation and serious consideration, such university, court decisions and internal documents to the banks on the legality assemblies in place. Judges also felt that the intensity of some of the remarks did not exceed the permissible limits of freedom of expression and were justified by the legitimate aim pursued by the association and the general interest of the case.

This decision reinforces the action of UFC-Que Choisir:
- To punish the excesses of the past, the association sued in May 2007 the NPC and the Savings Bank in order to judge the illegality of these practices. These actions are still ongoing but should, if they lead to favorable judgments, can be used by consumers to claim compensation.
- To rebalance the future the insurance market borrower, UFC-Que Choisir took the Competition Authority. Notice must be made very soon.
- Following the action of UFC-Que Choisir, Christine Lagarde has undertaken to improve the functioning of competition in this market. A provision of the bill reforming the credit passed the Senate in June and discussed shortly in the National Assembly, plans to let consumers choose their insurance contract. The UFC-Que Choisir hopes that its intervention will remedy the shortcomings identified in this market.

Life Insurance: 100% euro or a little action?

A good balance between investment and monetary units of account may be safer than any contract in euros. At the end of last year, deemed secure compartments of life had drained 1,000 billion euros, equivalent to the market capitalization of the Paris! While the units of account, a priori more risky, because they contain including stocks, accounted for only 182 billion. The stock market crash of 2008 caused a massive migration of savings into cash. Reaction understandable individual investors wanted to secure their assets. But in doing so, they have not forgotten too quickly to judge an investment over time? A contract of life insurance used to fund projects of long-term increase his pension to his family immune from difficulties. To address these needs, return on investment mainly cash may prove insufficient.
Security, but at what price? The contract says euro provides a certain security level of capital invested. Insurers must comply vis-à-vis policyholders commitment to reimburse the amount of savings invested at maturity of the contract (net of management fees). That's why managers invest mostly drained of capital to debt. However, the interest rate of the latter are also more profitable than before. In many contracts, reserves of any hidden thing of the past. Indeed, this explains why yields are so disparate from one company to another. If the most efficient yet provide between 4% and 5%, the least attractive already leveled off at around 3.5%. And it's not over! For surprises are expected in 2010.

Moreover, if inflation should return, interest rates are expected to go up to the curb. The low-rate bonds, as they are issued these days, will become obsolete. Unfortunately, they are the ones who feed the contracts currently undertaken. The second family of contracts, said that units of account, are a minority in the overall collection. This is simply because they are indexed to the performance of equities, said in substance Stéphane Girardot, Marketing Director of Sal. Oppenheim. And observe: "Do you know the future direction of the CAC 40? Watch the movements of subscription contracts in life insurance." When investment shares are higher, attention, stock markets will fall. Conversely, if the lowest is that the recovery is near!

Distrust of investors for financial markets is understandable. Stéphane Girardot considered the case of an unfortunate who have subscribed, March 7, 2001, a contract exclusively invested in equities. If he has loosened the legal issue, March 7, 2009, he has lost an annual average of 6.45%. In other words, for a bet of 100, it recovers only 58. However, this scenario is the worst of all those computers could grind. Otherwise, the median performance stands at 9.16%, which will double the capital in eight years. The best contract observed on eight carries a performance by 400%. Three quarters show a gain of 70%. And to return as unlucky, he might cancel his loss by applying its investments as follows: 61% euro and 39% in equities.
The ideal combination It is not necessary to be fully invested in equities to capture performance. A reasonable proportion sufficient to ensure safe gain. However, many life events can occur before the normal expiry of a contract. If the savings must be liquidated prematurely, and that just as a typhoon falls on stock markets, he must know how to fix the threshold limit of what someone is willing to lose. If tolerance does not exceed 15%, it is necessary, as calculated by Stéphane Girardot, opt for a mix 70% euro and 30% shares. With such distribution of assets, a contract product in the worst case a cons-performance minus 13%. But in the best case scenario, it is a gain of 173,000 euros, from an investment of 100,000 euros. Investors can therefore safely increase the proportion of equities in their contracts. Paradoxically, they are less likely than remaining exclusively invested in bonds and cash