Recently in Health Care Reform Category

Not perfect, but what legislation ever is? - Health Care Rx Panelists

Not perfect, but what legislation ever is?

| No Comments

Unlike so many, I find myself being more impressed each time I delve into the new law. This is, ultimately, a piece of legislation that WILL achieve many stated and even unstated objectives:

1. It will extend the Medicare Part A trust fund for just long enough to allow BOTH sides to discuss meaningful reforms to make it truly sustainable.
2. It provides a real commitment to our nation's poor; and strengthens Medicaid at the same time. Here, too, there are opportunities for additional reforms, but this makes clear what our priorities are; and, importantly, demonstrates our national humanity and compassion for those less fortunate.
3. It dramatically reforms our understanding of and right to health insurance. We have never had a federal definition of health insurance and this begins that discussion in a meaningful way.
4. It is financially sustainable, as long as our elected officials do not undo the tax and revenue-generating items.

What do we need to wait for and hope for?
1. Tort reform and/or Malpractice reform. This should have been firmly part of this law, but will have to wait.
2. Sustainable Growth Rate legislative reform: This is universally recognized as necessary and putting it off, even for a few months, is a big disappointment.
3. Implementation of insurance regulation and insurance exchange regulation will be the first real tests of the success of the law.
4. Taking the Medicare savings and law changes as a first step; and not ignoring the very real legacy costs that we still have to address. AND working with the private (for-profit and not-for-profit) sector to develop a structure and process for improving the delivery of high-quality health care with consideration of cost.
5. Revisiting the notion of better patient education and not being scared off by hateful rhetoric. Discussions around end-of-life and compassionate care should not be politicized or used for pure political gain.

I remain very optimistic about this country and about seeing our elected officials, of both parties, come together around common goals and purposes. In the mean-time, I am proud of the many elected individuals (and their staffs) for having stood behind their promises and made this a reality.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Electronic medical records is the previous category.

Health Care Reform is the next category.

Find recent content on the main index or look in the archives to find all content.

Moral courage - Health Care Rx Panelists

Moral courage

| 1 Comment

When I was in ninth grade, I returned home after a particularly inspiring world history class and announced to my mother that I wanted to be Secretary of State when I grew up. Far from being excited, she was worried. Politics, in her mind, was a corrupting profession that was more about self interest than service.

It's no secret that many people in the United States share her view. They have watched in frustration as the promises of politicians have faded into the status quo. They've watched with resignation as moneyed interests have rendered their opinions inconsequential.

For most of the year, the health-care debate did not inspire many to feel differently about politicians or the political process. But in the closing days, a different strain of passion emerged in the debate, most clearly from the President himself. It was the moral argument for health reform.

The moral argument for health reform is not new; people have been voicing it for decades. But in the back and forth of the last year, it has been buried under stories about sparring politicians, raucous town halls, and clashing protesters. Stories of people who suffered in silence with preventable illness are difficult to hear, and they don't sell many papers. But these stories are important to tell because they inform our motivations for taking action.

The health-care bill that has now made it through Congress is far from perfect. Personally, I would have liked to have seen a public option included and a national exchange to provide more choice and competition in the insurance market. But the legislation that was passed takes powerful steps forward. It increases coverage to 31 million more Americans, it regulates insurance companies and prohibits discrimination based on pre-existing conditions, it lays the ground work for doctors to deliver higher quality care to patients, and it takes major steps control cost. In these four areas, it does more than any piece of legislation in over half a century.

In a nation where over 40,000 Americans die each year because they have no health insurance, how could we have justified waiting to pass legislation that we know can save lives? In a country that values hard work and self reliance, how could we not have acted when Americans who have done everything right still have their insurance revoked when they get sick?

What we do when faced with such questions says something about who we are as a people. When we responded to the Pearl Harbor attacks and rose to Europe's defense in World War II, we didn't base our decision on the price tag. Our national conscience told us what was right, and we found a way to make it work. When disaster struck Haiti, we didn't base our decision to help on political risks and benefits. Gathering food, clothing, money, and rescue workers, we rose to meet the needs of our brothers and sisters overseas because we knew it was the right thing to do. It was a moment that should have made all Americans proud.

Choosing to pass a comprehensive health reform bill this week, contentious and complex as it was, was another defining moment for our country. We defined ourselves as a nation with rich ideas and a great deal of passion. We reminded ourselves that we are not just a collection of individuals but also a community that looks out for each other.

Most importantly, we defined ourselves as a people with moral courage who are able and willing to make extraordinarily tough decisions for the greater good of the nation. In the process, we also helped restore a sense of faith in everyday Americans like my mother that our flawed political system can still effect positive change.

"It is not the critic who counts, not the man who points out how the strong man stumbled, or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes short again and again, who knows the great enthusiasms, the great devotions, and spends himself in a worthy cause, who at best knows achievement and who at the worst if he fails at least fails while daring greatly so that his place shall never be with those cold and timid souls who know neither victory nor defeat."
- Theodore Roosevelt from a speech given at the Sorbonne in 1910

1 Comment

A good point, well made, Dr. Murthy! Some commitments we make as a society are driven by factors that supersede price and politics.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Crime is the previous category.

Economic crisis is the next category.

Find recent content on the main index or look in the archives to find all content.

Positive effects, deep flaws - Health Care Rx Panelists

Positive effects, deep flaws

| No Comments

The passage of the health insurance legislation has two overriding positive effects: it brings more clarity to the health insurance issue and it demonstrates the President's ability to govern.

The legislation also affirms that Americans should not face financial ruin from being unable to afford health insurance. It also makes good progress on prevention, on increasing the supply of health care professionals, on eliminating the flawed "doughnut hole" in the Medicare prescription drug system, and on beginning to address the long term care crisis. These are the good elements of this legislation.

As health insurance system restructuring, the legislation has deep flaws that must be addressed in subsequent legislation. We cannot guarantee coverage, prevent people from being subject to pre-existing condition exclusions, and prohibit insurers from canceling policies for those who become ill during the policy period without significantly increasing costs for all policyholders unless we cause healthy uninsured people to buy insurance, reduce what we pay health care providers, or levy more taxes on people to pay for increased subsidies.

The penalties for healthy people refusing to buy insurance are far too low and do not take effect for several years. Reducing payments to doctors and hospitals either drives them out of the system or causes them to drop Medicaid patients. Raising taxes on everyone to pay for these increased costs worsens our economic situation.

One situation illustrates my point: in the 8th Ward of Washington D.C., there is a severe shortage of specialists, including one urologist for a large population. Most people have health insurance or Medicaid. After this legislation passes, there will be even more people with insurance, but still a severe physician shortage. We have more work to do before our health care system is viable. Health insurance affordability does not produce health care access.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

This is it - Health Care Rx Panelists

This is it

| 1 Comment

No piece of legislation is perfect. After a very long and intense effort, however, we're probably as close as we're going to get with the current bill. From the perspective of a member of the cancer community, the landmarks achieved in this legislation are enormously significant:

• Access to health insurance for 32 million Americans who would otherwise be uninsured

• No more discrimination by insurers against those of us with preexisting conditions

• Ending arbitrary annual and lifetime caps on health insurance benefits

• Routine costs for clinical trials will now be covered by insurance

These four elements alone will radically change the lives of many Americans. And it's about time.

1 Comment

Now that you nanny-staters have saddled me with another 30 million dependents, do you think you could at least get one of them to come mow my yard or something?

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

The health care whipping boy - Health Care Rx Panelists

The health care whipping boy

| No Comments

Certainly the insurance industry bears a hefty amount of blame for Americans' dissatisfaction. Too many of us have heard too many stories -- especially in the cancer community -- of lifesaving treatments being declined for coverage and people being dumped by their insurer when they get sick. That kind of bad karma and terrible PR is tough to recover from as time goes by. In the minds of millions, the industry as a whole is perceived as heartless, callous and focused only on profit. (Recent bone-headed moves by some insurers, like hiking rates more than 30 percent at a time when the reform effort is daily front page fodder, didn't do much to help.)

Was the insurance industry unaware of this perception or did they simply not care?

Regardless, it's coming home to roost now. Insurers are being vilified by President Obama and, rightly or wrongly, the blame for just about everything that's wrong with our health-care system is being laid at their feet. Insurers have become the whipping boy of the reform effort, even though escalating drug prices and the inefficiencies inherent in our health-care system can hardly be blamed on them.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

Yeah, insurers are scapegoated. But tell me again why we have this industry? - Health Care Rx Panelists

Yeah, insurers are scapegoated. But tell me again why we have this industry?

| 2 Comments

Insurers are a smaller part of the problem than Americans like to think. As far as I can tell, the whole supply side of the medical economy is happy for insurers to be the bad guy for defeating efforts that would increase the bargaining power of medical consumers. The Medicare buy-in and the public option would have passed both houses if insurers were the only political opponent. Patients are equally happy to blame insurers for our own refusal to acknowledge the need for reasonable constraints on medical service use.

Effective cost control requires painful measures that affect physicians, hospitals, pharmaceutical companies, device manufacturers -- not to mention patients. Most of these constituencies are more powerful, and probably contributes more to excess costs, than private insurers do.

Does this mean insurers are being treated unfairly?

Yes and no. Our collective desire to deny cost-control realities encourages a rather childish public debate. It's not insurers' fault that our society leaves poor people and sick people to the tender mercies of the insurance market. Regulating this industry--by itself--cannot address our most serious obstacles to universal coverage. Insurers are not the source, nor are they the potential solution to our worst cost control problems.

At the same time, the industry treats many people unfairly, and at times cruelly. Many of the industry's specific practices demand stringent regulation. More fundamentally, insurers face a special burden of proof because....well, there is no obvious reason for this industry to exist in its current form. Every other component in the medical economy creates tangible social value. Academic medical centers waste money, but they save many lives. Pharmaceutical companies like to overcharge, but they develop drugs that cure diseases and prolong life. I struggle to write a similar sentence about insurers, particularly those who compete through risk-selection in the small-group and individual markets.

I feel as if this debate has come full circle. More than two years ago, in my very first foray in the health insurance reform fight, I noted: "Increasingly, I and others scratch our heads to wonder: Why do we have this industry again?"


I don't believe private insurers are less ethical, as a whole, than soft drink manufacturers or manufacturers of plush carpet. I just can't explain what we are getting here....

Private insurers are too fragmented to promote needed efficiencies such as electronic medical records. A Chicago provider dealing with 20 payers is hardly swayed by the pay-for-performance standard of any one of them. In general, private payers are too fragmented to exert powerful market discipline on providers. The [history of Medicare Advantage] provides one of many embarrassments for those who assert the inherent superiority of the private sector.

Private insurers do have two advantages: They are more nimble than government is. More important, they can take the political heat for saying "no" when patients want some desirable but unjustified service, drug, or therapy. This is hard for government to do, and "no" should sometimes be said even when this is painful.

But maybe we have this backwards. It seems to me that even when insurers are justified in saying no... profit-making firms lack the legitimacy to deny anyone a desperately wanted treatment that provides some plausible benefit. Denying important treatments is an inherently political question. A transparent process, by financially disinterested parties, is required to secure public legitimacy.

If this is so, private insurers themselves have a strong stake in government assuming a larger role in scrutinizing costly therapies. And they have a strong stake in some larger regulatory structure to constrain the more predatory aspects of current market practice.

Two years later, these questions continue to puzzle me. I'm uncomfortable demonizing insurers when the ground rules of the individual and small-group market make the industry's excesses and cruelties almost inevitable. Like Jonathan Cohn, I do blame insurers for not openly acknowledging this fact. I also blame the industry for wielding its political muscle to oppose needed reforms.

I expect health reform to pass, which will curb the worst industry practices. Insurers should hope so. Because I stand by my final prediction of that piece:


Ironically, then, insurers themselves have a stake in the success of the Democrats' proposed health reforms. If health reform dies -- particularly if private insurers have their fingerprints on the murder weapon -- millions more Americans will stop scratching their heads and will support a single-payer plan.

2 Comments

perhaps what Mr Pollack needs is a dose of reality. Maybe a spending a few weeks away from the ivory tower would improve Mr Pollack's grip on reality.

There is much to agree with in the above essay, but Mr Pollack engages in a rhetorical slight of hand that is simply beneath someone of his academic credentials. He asks a question that he can't answer. This is a trick anyone can perform. Watch how it works: I struggle to find an answer to a basic question: why do we have underarm deodorant? I can see the social value of plain old soap, but what societal good does the stuff Mitchum sells offer?

See how easy that is? If Mr Pollack doesn't know what good the insurance companies provide he's simply ignorant of the lives most Americans live. Not all of us are noted, and no doubt tenured, professors. Some of us work hard to amass a small asset pool. For many of us that small nest egg is what we rely on for current comfort and future plans.

Insurance PROTECTS that small asset pool. Buying a health care insurance policy is a clever way of avoiding the need to part with a house or a savings account to obtain treatment for a dread diseases.

Again, were the good professor part of the work a day world, instead of living in his isolated convent, he might understand that insurance companies sell peace of mind to millions.

Sure, its easy to blame the insurers for not reforming the industry. But isn't that a bit like blaming GM for the bad roads in my city? Certainly the struts on my car would last longer if GM spent some of its enormous profits on paving the local streets!

I am by no means defending the insurance companies, I have to deal with many of their heinous practices every day. But without some type of transparency in how much things cost, there will never be reform. We also need electronic medical records so other doctors and hospitals know what has been done before and not repeat the same treatments that didn't work or the same tests that were performed by another doctor just hours ago.

When a doctor treats you for something, you have no idea if what he/she is doing is covered under your insurance. And neither does the doctor! What if you went into Sears to buy a new refrigerator and there were no prices on any of them. You pick the refrigerator you want and Sears slaps it on your credit card that you sign the receipt for, but still don't know the price. You go home, your refrigerator arrives and 3 weeks later, you get your credit card statement in the mail and find out the refrigerator cost $3000! Would anyone in their right mind buy a refrigerator this way? I hope not, but this is exactly how the healthcare system works. If you go in a hospital, you sign all this paperwork that you will be responsible for anything insurance doesn't pay and you have no clue how much that might be.

The only time I have seen anything remotely reasonable from heathcare is on maternity, and its done mostly to make sure the doctor gets paid. When a pregnant woman's condition is confirmed by the doctor, they set up a separate appointment with the insurance person from the doctor's office. They will actually break down all the costs, what your insurance will pay and how much its going to cost you. They will allow you to make payments up to delivery time.

We are all to blame for this crazy system, not just the insurance companies.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

A lesson from a classic - Health Care Rx Panelists

A lesson from a classic

| No Comments

In the 1843 Charles Dickens classic "A Christmas Carol," Jacob Marley comes back to warn his former business partner Ebenezer Scrooge that serving humankind was his business; not business for business's sake. The U.S. health insurance industry seems to have forgotten this important lesson. Since their entry into the marketplace in the mid-1800s, the industry has moved from being more than a simple insurer of coverage. Today, these economic behemoths are the centerpiece of the system that is supposed to provide health security to most Americans. They are beginning to fail in this important task. They are a component of a overall health-care delivery system that is broken and, far too often, does not live up to its potential.

Are insurance companies the only one to blame? Of course not. But their business practices are a major part of the problem. Much of what is proposed in health-care reform is the result of an industry that has not addressed the need to have a system with everyone in and no one out; a system where avoiding providing the needed service to many drives the business model; and a system that pays for the volume of services delivered and not the quality of them. In a truly competitive world, they would go out of business because someone else would serve their customers cheaper, faster and with better customer service. Because insurance companies are essentially monopolies, this does not happen.

Health insurance companies are the target of public ire because everyone knows they are the one group with the capacity to make the most dramatic changes to the fragmented system as we know it today and have not done so. They control more than premium costs. They control costs through provider payments; they control access to care through the decisions they make on which practitioners to include on their provider panels; they make coverage decisions through the design of benefits; and impact quality through payment and other program strategies.

As a product in the marketplace, health insurance costs too much and is becoming increasingly undependable. It seems like the business of insurance has overtaken the reason for providing it: health security. They are certainly not the only problem in the health care delivery system, but they are a major component that needs fixing.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

They have all the power - Health Care Rx Panelists

They have all the power

| 4 Comments

While insurance companies have enjoyed unprecedented profit and growth, they have failed to do anything to address or prevent the problems we are facing with health insurance today. Instead of finding a way to include those in America that can't afford their own insurance, they established rates and policies to eliminate them. Instead of showing they are willing to extend a cooperative and inclusive hand to reform, they arrogantly raised their premiums for millions of Americans. The insurance industry has had decades to get it right and instead they decided to get as much as they could.

The problem with health care in America is not the health care itself. We are all agreed that it is among the best in the world. The problem is access to this great health care because of the cost of insurance. Even those that have insurance are deluged with co-pays and exclusions. Practices that limit treatment aren't because of providers but because of insurance policies. Health care is an essential service, without options outside of insurance companies they have all the power to weigh our access against their profits.

Insurance companies have already spent hundreds of millions of dollars lobbying against health-care reform and the public option. Next, I expect we will see millions of dollars poured into advertising to urge Americans to keep them in business; big business. The question Americans really face is whether their health care should be about profits or about people.

4 Comments

What Kathy-Ellen fails to recognize is that the insurance companies, by and large, are not making huge profits - at 3% (stated by KidCharlemagne) is a drop in the bucket of the bigger problems.

More importantly - what so many have failed to acknowledge is: Why are the costs of healthcare so high? The Doctors are not getting rich. Hospitals are having a hard time staying open. Equipment manufacturers barely make a profit as they reinvest millions into continued R&D to stay on the edge of technology to ensure the very best is available...no the people who ARE getting rich are the 'ambulance chasers' who sue at the drop of a hat.

Go ask a doctor, a hospital administrator, an equpiment mfg or a pharmacutical company exec what their biggest expense is and you will likely find it is malpractice/liability insurance. Why? Because it is easy money for the laywer and their client. Most cases are settled out of court - not because the doctor/hospital are wrong - but becuase they can't afford to go to court.

But you will NEVER hear this argument made in our congress - too many of our elected scum came from the legal community. Can't bite the hand that feeds you...

So, only when people like Kathy-Ellen Kups look at the WHOLE picture will we get an understanding as to why healthcare is so expensive. It's not the doctors, not the hospitals, and not the insurance companies...it is the 'ambulance chasing' greedy lawyers who file petty suits on behalf of clients with no self respect - leaching money - and subsequently health care availability - away from the average citizen.

You want affordable healthcare? Start with tort reform.

Wow, where do I start...maybe with tmfotter who is on the mark with his comments.

It's well-documented that profit margins for health insurers is around 3%. Name another business sector that comes near that. State insurance departments annually scrutinize insurer cost, and they often reduce the insurer requests for needed increases on behalf of the public. In particular, insurers bid for group business based on admin costs and claims discounts which results in the market dictating price to a large degree.

Medicare, Medicaid, VA (Tricare), and the Federal Employee Programs are being held as shining examples of how costs can be held down. Has it dawned on insurer critics that it is the health insurers that bid on and administer these plans on a statewide and regional basis? For example, a BCBS plan derives 30% of its total income from administering Medicare Part B for a region. These programs are a very large part of an insurer's book of business.

Certain markets like individual and small group plans are loss leaders for insurers largely due to state mandates and guaranteed issue rules across America. Simply put, it's close to $1 in premium and $1.20 out the door in claims expense. To offset those losses, insurers have expanded their offerings to include dental, life, disability among others. These other lines of coverage provide significant dollar gains for insurers, and it's these lines of business that are largely responsible for some of the big executive pay and bonus levels. It's NOT on the back of Joe the Plumber as popular spin would have it.

Insurers continue to attempt to engage group plans and individuals to improve their health. It's been a slow sell, and that's been exacerbated by HIPAA privacy restrictions. Citizens need to clean up their act, eat better, avoid smoking, and exercise often to avoid the chronic care that results from heart disease and our current spate of diabetic onsets. It's 20% of the population that are responsible for 80% of the claims costs.

Do folks honestly think that these organizations (as a whole) are scheisters trying to wipe people's savings out? The people that work at these insurers are your neighbors, simply attempting to do a better job than the competing insurer to retain business.

Underlying cost is the issue here, and Congress and our President are failing us with this current attempt to turn the system upside down. Access only is the cornerstone of the House and Senate bills.

Finally - a blogger on this topic that isn't simply a proxy for the insurance industry! Way to go Kathy-Ellen!! However, you forget to mention the insidious way the insurance companies treat physicians. Not only do the insurance companies reduce the amount that they pay physicians on an annual basis in lock step with Medicare annual reductions, but they also make physicians wait more than 60 days for payment as well as routinely reject claims multiple times in order to make it more difficult for the physicians to get paid! The cost of administrative paperwork and refiling alone eats up over 10% of every dollar paid to physicians. To be clear, the insurance companies are not looking out for their customers as they are nothing more than another cash generating cog in the greed ridden, immoral Wall Street, insurance and banking machine that has brough this great country of ours to it knees.

In the economic structure of health care, the insurance companies are not the price setters. They are price takers, pure and simple.

In the DC area, MRIs cost anywhere from $500 to more than $2000 (with MRI centers linked to hospital firms like Inova being the most expensive). If the insurance companies had the power she claims they do, pricing would be much more normalized.

Insurance company profit margins have remained remarkably stable and small for 20 years, generally growing in proportion to the costs of service. If Kups had anything close to a point, this relation would not exist.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

Bashing insurance companies does not get at the root of high rates - Health Care Rx Panelists

Bashing insurance companies does not get at the root of high rates

| 5 Comments

Huge rate increases by health insurance companies are largely caused by market conditions and misguided government laws and regulations, but insurance companies also have to bear responsibility for being resistant to change. I disagree with those who blame insurance companies for major rate increases:

• As people get sicker and use health care more frequently, health care costs go up and insurance goes up with them.
• Large providers with market power are all raising prices significantly.
• State governments worsen the problem by increasing coverage requirements under every state-regulated insurance plan.
• States also limit the ability of insurance companies to reduce costs by limiting wellness incentives and other tools that could take overall health care costs down.

The proposed health insurance reforms, such as guaranteed insurance policies, prohibitions against pre-existing condition limitations, and terminations when someone gets sick, are all good ways of expanding access, but they will drive up costs. Limiting price increases, profit margins and medical loss ratios are all bad ideas, since they will prevent insurance companies from making enough money to improve their customer service and improve efficiency.

However, insurance companies are partly at fault. While insurance CEOs like Ron Williams (Aetna), Angela Braly (Anthem), and Dave Cordani (CIGNA), and Jay Gellert (HealthNet), to name a few CEOs I know, are inspiring, caring, and brilliant leaders, they sit atop organizations transitioning to new ways of making profits, but sometimes resistant to change. The insurance industry is not as supportive of patients or doctors as it needs to be, and often has antiquated information systems and business processes, which contributes to its image of being highly insensitive or uncaring. However, the proposed health insurance reforms, unless significantly modified, could make the situation considerably worse.

5 Comments

Boy, what a cheery commentary. Because we go to the doctor our rates will raise. How fortunate for us. I read all the time from conservatives about how regulation is the root of all evil. Well, the alternative is Wall Street and they certainly showed us how responsible practically unregulated free-market systems can be. Oooops. I forgot. Wall Street also blames regulations for their abuses, too. I don't understand how med care can be equated to cereal, meaning we are supposed to shop around med care for the lowest prices every time we need help. Someone please explain that me. By exactly what mechanism do we do this? How do we do this? In an emergency how do we do this?

response:

Dear ron_in_seattle,
You have no idea what you are talking about.
Prices for health services have not gone down. The US Health and Human services website shows that medicare paid $57.75 for a doctors office visit in Manhattan, NY in 2000 and $70.16 for the same service in 2007.
Health Insurance premiums have not gone up 10-50% each year. Some individual premiums may go up that amount one year, but a premium which was $100 per month in 2000 would be $250/mo if rates rose at 10% compounded, about $1000/mo at 25% compounded and $6000/mo at 50% compounded. So if the insurance industry raised it rates anywhere near your suggestion, all their clients would have dropped their policies.
Finally, Insurance company profits are less than 1% of health insurance premiums.
Please get actual facts before spouting off with ill-informed blather.

States do put limits on wellness programs. Many states have laws that do not permit employers to discriminate agains people that use lawful products, such as tobacco. Accordingly, employers and insurers in those states are unable to offer products geared towards encouraging people to quit using those products by offering incentives.

Apparently Michael needs to do his homework as he has absolutely no clue as to how the system works. For over a decade, Medicare has reduced provider (i.e. physician and hospital) payments each year thereby annually reducing the cost of services. The insurance companies tie their payments rates to Medicare reimbursement so they too are paying providers LESS each year as well for the same services. However, the insurance companies anually raise their rates 10 to 50% each year! Granted, utilization may be going up as the population ages. However, in addition to rate increases, the insurance companies have also raised out of pocket limits, deductibles and co-pays. Therefore, the insurance companies are paying providers less and providing less coverage. In most industries, this would result in either lower or stable prices, not 10 to 50% rate increases. All anyone has to do is take a look at the increased profits and executive salaries (even in this economy) of the insurance companies to see where all of the savings and costs reductions are going. Based upon the above article, it would be interesting to find out whether or not some of those profits were finding there way to Michael as well! If not, he should be charging them for what I believe to be is more of the insurance industry's propaganda and mis-information.

>Large providers with market power are all raising prices significantly.

You're actually arguing the other side of the street here. Yes they are all raising their rates, because they have the leverage (market power), not because their costs are going up. While their rates are going up, the share they return to their "customers" is declining.

>States also limit the ability of insurance companies to reduce costs by limiting wellness incentives

This is not true. What state puts a limit on wellness investments? What is the policy rational for that?

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

What WERE They Thinking?? - Health Care Rx Panelists

What WERE They Thinking??

| No Comments

Throughout history, there are examples of clearly bad choices about which are endlessly asked, "What WERE they thinking?" New Coke; auto company execs taking private planes to Washington to ask for bail-out money; the mullet; Gigli.

But the Anthem Blue Cross decision to raise customers' rates by as much as 39 percent may set a new record in tone deafness. Were they oblivious to the reform conversation that's been going on these last nine months? Did they think no one would notice?

An insurer rolling out a hefty rate hike during a time when the nation is focused on insurance horror stories may illustrate why reform is necessary. If the industry is so out of touch or so heedless of what the rest of America is thinking, we can no longer buy the argument that they're acting in good faith, particularly in California where the economic crisis has arguably manifested itself more harshly than anywhere else in America.

Leave a comment

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.

About this Archive

This page is a archive of recent entries in the Health Care Reform category.

Employer health plans is the previous category.

Health costs is the next category.

Find recent content on the main index or look in the archives to find all content.