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Letters to the Editor

Insurance claims

October 30, 2009

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To the editor:

As someone who started a small business 12 years ago and has seen our firm’s health care premiums skyrocket while our co-pays declined precipitously over that period, I would like to offer a related perspective on the current debate regarding public options and private insurers.

Despite the hard work of our health care providers, we pay more for health care but get less than citizens of other countries. What’s the problem?

To convince voters that insurers are not part of the problem, private insurers have recently reported very small profit margins. But if these numbers are accurate in the face of skyrocketing increases in premiums and declining benefits, then these companies are incredibly inefficient and should lay no claim to the efficiency benefits they are trumpeting in the media. If, on the other hand, they are efficient, then their figures must be masking huge expenses related to executive salaries, bonuses, marketing and PR expense, lobbying, etc. And if such expenses account for their apparent narrow margins, then the managed care organizations have even less claim to the high ground in the current debate over health care reform.

I have no doubt that employees of the private insurers are capable and well intentioned, but the time has come for the insurers to support their claims of efficiency and efficacy, not via clichés and scare tactics, such as references to “socialized medicine,” but by performance-based data. And the time to do this is now, while public option and other possibilities are on the table.

Comments

Roland Gunslinger 4 years, 5 months ago

mr_right_wing (Anonymous) says…

When Obama comes out in public (for the record) and says that he and his whole family will be covered by the same plan it will have my full support!

Liar.

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Ryan Neuhofel 4 years, 5 months ago

bozo, Basically we have two options . . . . 1) Pre-pay (via paycheck, taxes,etc) all your health care dollars to a third-party financial entity (private or public) and hope they properly 'manage' all your health care . .. the current standard arrangement. OR 2) Pay providers (doctors, etc.) of your choice directly for rountine and expected health care and have a 'back up' policy for the unexpected events (cancer, etc.).

Which arrangement seems like ore of a rip-off or primed for abuse/fraud?

Regarding grown-ups, non-medical people have been intervening in health care for the past 50 years - insurance companies, bureaucrats, politicians and financial institutions . . . and that's the root of the problem.

I am not advocating removing government assistance to the poor, sick or needy . . . but we need to change the basic foundation of all-inclusive third-party management of health care. It has proven to be an ineffective mechanism for delivery of care no matter how it's been tweaked and altered over the past 30 years.

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just_another_bozo_on_this_bus 4 years, 5 months ago

neuhofel--

I think your ideas have much merit, but in the current system, catastrophic policies are also ripoffs. I don' think your ideas will have much effect on medical costs if grownups don't intervene in some way,

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Ryan Neuhofel 4 years, 5 months ago

jafs,

Insurance should be a financial tool to protect against unexpected, expensive events - not a primary mechanism to manage health care. The level of "protection" someone should take will obviously vary with each individual's financial situation.

Anyone with chronic medical conditions or routine medications will certainly have more "out-of-pocket" expenses for at the point-of-care (payment to doctor, pharmacy) but the total costs would be reduced . . . which superficially seems like "more". . . . but hasn't the status quo given us our current situation? is it better to hide the inflated costs in monthly premiums? History and basic economics have proven that third-party management does not work!

You are correct that the government has discouraged direct payment for health care in favor of pre-payment to "insurance" companies or controlling the money themselves. The so-called reform will likely further the third-party management of health care dollars.

As a doctor, I feel that physician must return to a more direct relationships with patients. This would be very feasible for 70-80% of health care - including primary care, prevention/screening, minor care and disease management (diabetes, hypertension, etc.). I plan on creating such a family practice when I'm done with residency in 2011.

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M. Lindeman 4 years, 5 months ago

Just one question for those who think the goverment health option is the way to go. Please name me one program the goverment has runned that DID NOT run huge deficits? I don't know about others, but I don't want this goverment involved in anymore of our lives.

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mr_right_wing 4 years, 5 months ago

When Obama comes out in public (for the record) and says that he and his whole family will be covered by the same plan it will have my full support!

Until then...forget it...not a chance!

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jafs 4 years, 5 months ago

neuhofel,

I think that's a very good idea - in fact, if I had to deal with health care on my own (which I might have to do in a couple of years) that would be my plan.

Of course, if they require all of us to buy health insurance I may not have that option.

And it would mean paying full price for medication, which can be quite expensive.

Also, do you think there is much that falls in between the cracks - ie. between routine visits and catastrophic events?

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Ryan Neuhofel 4 years, 5 months ago

A suggestion to anyone who wants the limit the profit and power of private health managers (so-called insurance) -

1) STOP pre-paying all of your money to a HMO/PPO! (or demand your employer do so) 2) Get a catastrophic insurance policy to cover expensive, unexpected events. (premiums reduced by 30-50%) 3) Pay for your routine medical care directly to your doctors.

If most Americans cut financial third-parties (insurance) out of the loop for primary care, the phony 'managed care' industry would collapse and health care costs would be reduced.

In fact, the 'managed care' industry has done everything possible through legislative and legal process to keep this system intact.

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ghamon 4 years, 5 months ago

Ok, all you lib bozo's, so you want the feds to know all about your medical issues from hemorrids to hangnails. Do you smoke, do you drink, are you fat, use drugs, eat Big Mac's, how much do you make? Let them decide if you deserve health insurance. The insurance dudes are bad, but not as bad as it can get. Just give the fed's a chance and you will see. Government run health insurance will be the largest tax increase to all in the history of this country, it will not be free as most seem to think. Get out your check book bloggers, I need insurance.

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i_tching 4 years, 5 months ago

Single-payer, now. Medicare for everybody.

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JHOK32 4 years, 5 months ago

Millions of Americans have lost their jobs & their health insurance as a result of Wall Street greed that was blessed by Bush & the Republican Party. Now the Republicans do not want to help millions of our friends, relatives, and neighbors to get health insurance & healthcare, a basic human need. I say who cares what the Republicans think, they got us into this mess. Bush's war has already cost more than this health bill would cost for the next 10 years! The only people that have benefited from us invading Iraq are Bush's & Cheney's big oil buddies. I say its high time the little guy gets a break!

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edjayhawk 4 years, 5 months ago

Right Logicman. BCBS is our friend...Why would they want to not make a profit. I'll support BCBS as long as they provide comprehensive health care at the price of the public option...

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LogicMan 4 years, 5 months ago

Don't know, and it is definitely state-by-state. I'd likely support taking BCBS, and/or new versions, nationally, and having it/them be privately run but not-for-profit.

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LogicMan 4 years, 5 months ago

“Blue Cross Blue Shield of North Dakota used premium payments to fund $15 million in employee bonuses, cover $35,000 for a retirement party and pay for other questionable expenses, according to a state audit released Tuesday.”

Sounds as if the auditors are doing their jobs well there. Others too? Either way the government oversight is in already place; they just need to consistently and boldly do their jobs so as to discourage improper spending, etc.

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barrypenders 4 years, 5 months ago

Once Na Na Peosi and the Poser tax the doctors practices to death, alot will quit and Na Na will have to donate her doctor to treat all those people that can't make it in the evil capitalista enviroment.

Ants, pay for the grasshoppers.

Darwin bless you all

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Richard Heckler 4 years, 5 months ago

Why pay the most expensive medical insurance industry in the world anything?

Never never never forget… It is the private medical insurance industry that cancels YOUR medical insurance AFTER taking YOUR MONEY for years. Years and hundreds of thousands dollars later no one has any guarantee of any coverage.

Not only that if an employer makes a switch there is no guarantee any coverage or same coverage will be available.

Face it what wayyyyyyyyyyyyy too many healthy citizens pay out to insurance companies in a 12 month period they would never spend that much in 12 months no way jose'... with very very few exceptions.

So why are we giving a middle man who does NOT provide health care so much money? What's the point?

Paying out all that money is no guarantee the most expensive insurance industry will stick with you when the bills come rolling in.

Think about it. It's so many many many working people WITH insurance that are being forced into bankruptcy. Why pay an insurance company anything?

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just_another_bozo_on_this_bus 4 years, 5 months ago

"Oh, wait, that's what BCBS is, since the 1930s."

"Blue Cross Blue Shield of North Dakota used premium payments to fund $15 million in employee bonuses, cover $35,000 for a retirement party and pay for other questionable expenses, according to a state audit released Tuesday."

Read more at: http://www.huffingtonpost.com/2009/09/09/blue-cross-blue-shield-ex_n_281282.html"

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LogicMan 4 years, 5 months ago

So the profits are the problem?

OK, start a big not-for-profit health insurance organization. That way any profit can be funneled into improved benefits or reduced premiums.

Oh, wait, that's what BCBS is, since the 1930s.

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Richard Heckler 4 years, 5 months ago

If 3 million healthy insured dropped their policies in the next two weeks not only would they save thousands of dollars the insurance industry would faint in disbelief that this many people actually are awake and give a damn.

Then they could afford to pay out of pocket.

Sooner or later another few million would do the same. Suddenly all of america would realize the medical insurance business has been doing nothing but making tons and tons of profit by way of fear mongering.

At that point all would see that america could have insurance at a much much lower rate such as 225 a month for the best coverage in the world that includes the entire family.

Makes dollars and sense to me. More money to invest smart instead of supporting corrupt special interest campaign contributions, high rollin executives and shareholders.

Maybe get on with that home improvement with cash instead of borrowing from the bank.....just maybe.

Maybe go to Jamaica for a few weeks instead of supporting high rollin executives and shareholders.

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Tom Shewmon 4 years, 5 months ago

That may be on Obama's list of things to do---thorough gov't. performed audits of all insurance companies.

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Richard Heckler 4 years, 5 months ago

http://www.pbs.org/moyers/journal/blog/2009/10/bill_moyers_michael_winship_in.html#more

If you’ve been watching the Senate Finance Committee’s markup sessions, maybe you’ve noticed a woman sitting behind Committee Chairman Max Baucus. Her name is Liz Fowler.

Fowler used to work for WellPoint, the largest health insurer in the country. She was its vice president of public policy. Baucus’ office failed to mention this in the press release announcing her appointment as senior counsel in February 2008, even though it went on at length about her expertise in “health care policy.”

Now she’s working for the very committee with the most power to give her old company and the entire industry exactly what they want – higher profits – and no competition from alternative non-profit coverage that could lower costs and premiums.

A veteran of the revolving door, Fowler had a previous stint working for Senator Baucus – before her time at WellPoint. But wait, there’s more. The person who was Baucus top health advisor before he brought back Liz Fowler? Her name is Michelle Easton. And why did she leave the staff of the committee? To go to work – surprise – at a firm representing the same company for which Liz Fowler worked – WellPoint. As a lobbyist.

You can’t tell the players without a scorecard in the old Washington shell game. Lobbyist out, lobbyist in. It’s why they always win. They’ve been plowing this ground for years, but with the broad legislative agenda of the Obama White House – health care, energy, financial reform, the Employee Free Choice Act and more – the soil has never been so fertile.

The health care industry alone has six lobbyists for every member of Congress and more than 500 of them are former Congressional staff members, according to the Public Accountability Initiative’s LittleSis database.

Just to be certain Congress sticks with the program, the industry has been showering megabucks all over Capitol Hill. From the beginning, they wanted to make sure that whatever bill comes out of the Finance Committee puts for-profit insurance companies first -- by forcing the uninsured to buy medical policies from them. Money not only talks, it writes the prescriptions.

In just the last few months, the health care industry has spent $380 million on lobbying, advertising and campaign contributions. And -- don’t bother holding onto your socks -- a million and a half of it went to Finance Committee Chairman Baucus, the man who said he saw “a lot to like” in the two public option amendments proposed by Senators Rockefeller and Schumer, but voted no anyway.

The people in favor of a public alternative can’t scrape up the millions of dollars Baucus has received from the health sector during his political career. In fact, over the last two decades, the current members of the entire finance committee have collected nearly $50 million from the health sector, a long-term investment that’s now paying off like a busted slot machine.

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Richard Heckler 4 years, 5 months ago

I'm sure the public was being manipulated per usual by the most expensive medical insurance industry in the world.

The question would be ..... what was the gross profit? Not the net? Radio news was revealing a 25% profit.

The 2010 increase is coming in at 25%.

For sake of clarification the insurance industry is NOT the health care provider not by a long shot.

Unfortunately the medical insurance industry is a road block to health care and the level care is dependent on how much money one is able to afford the insurance industry.

The medical insurance business is about PROFIT,GOLDEN PARACHUTES,SWEET EXECUTIVE SALARIES,SALES COMMISSIONS,STOCK OPTIONS, SHAREHOLDERS and SPECIAL INTEREST CAMPAIGN CONTRIBUTIONS not health care.

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