POLICY: The uninsured, health care costs, and the insurance industry’s vacuous response

It won’t surprise regular readers at THCB but there are a lot of uninsured people in this country, and the problem is getting worse. Why?  Well some bright wonks (John Holahan and Allison Cook at the generally liberal Urban Institute) have some answers and a closer look at the uninsured in a special for Health Affairs. (And of course only liberals care about this stuff–I’m happy to say that unequivocally, and not even all of them do!). They’ve mined the CPS for the 2000-2004 period and have come up with these conclusions (which I quote from freely as many of you can’t get Health Affairs for free–something else that should be changed if any Foundations are listening). Here’s what they found:

(1) The number of uninsured Americans rose by 6.0 million between 2000 and 2004 (the U.S. population increased by 10.0 million). The increase in uninsurance occurred primarily because of the decline in employer coverage, which fell both because a large number of Americans were not working and because coverage declined among workers. The latter no doubt reflects increases in health insurance premiums, which rose much faster (12.2 percent per year) than wages (2.9 percent per year) during this period. The percentage of small and midsize businesses (3–199 workers) offering health benefits also declined, from 68 percent in 2000 to 63 percent in 2004). Employers seem to have tried to shift the cost of health insurance to workers, and it is likely that a growing share of workers chose not to accept employers’ offers.The change in coverage was affected also by the shift in employment from industries that historically have had high rates of coverage to industries that have not, as well as from large firms to small firms and self-employment. Employer coverage rates fell in all types of industries and firms, but the declines were particularly great in low-coverage industries and in small firms. The fact that employer coverage rates fell among workers, not just among those who lost their jobs, suggests that rates of coverage could continue to decline, even as the economy improves.(2) About two-thirds of the increase in uninsurance was among people below 200 percent of poverty. This is due to increases in both the size of the low-income population and the uninsurance rate of that group. Importantly, however, middle- and higher-income Americans were also clearly affected. The remaining one-third of the growth in uninsurance (2.0 million) occurred among those above 200 percent of poverty, even though this group only grew by 900,000. Thus, the lack of health insurance coverage is clearly beginning to affect middle- and higher-income Americans.(3) Much of the increase in the uninsurance occurred among young adults, whites, and the native-born. About 50 percent of the uninsurance growth was among those ages 19–34; about 55 percent among whites; and about 73 percent among native-born citizens. Thus, rising uninsurance is clearly not a problem affecting primarily racial and ethnic minorities and noncitizens. Further, more than half of the increase in the uninsured occurred in the South, where uninsurance rates were already the highest in the country.(4) Children actually gained health insurance coverage. The expansions of coverage in Medicaid and SCHIP that occurred in the late 1990s meant that children’s coverage was maintained, even with the loss of employer coverage. The expansion of public programs increased enrollment substantially. The result was actually a slight decline in uninsurance among children. Adults’ experiences were in sharp contrast, primarily because adults experienced the same declines in employer coverage but did not have the same access to public coverage. Also, people ages 55–64 actually saw improvements in both income and health insurance coverage. Without the gains seen for this group, the overall picture of rising uninsurance would have been much worse.The decline in employer coverage is likely to continue. Increases in health care costs, and thus health insurance premiums, are likely to continue to grow faster than workers’ earnings. The decline in employer coverage will be further exacerbated if the shift from working in large and midsize firms to small firms and self-employment and from high- to low-coverage industries continues

So to recap, the problem of uninsurance (which is a problem for everyone but mostly of course for those uninsured) is largely borne by a) the working poor (less than 200% of poverty)  — although its increasingly making its way up the income ladder, b) the young, and c) whites, d) southerners, and e) anyone likely to work for a small firm rather than a big one. What’s driving this is the higher cost of health care and the fact that employers are opting out of offering (affordable) benefits. Meanwhile public programs (i.e. Medicaid) are only picking up kids. Given the preponderance of lower income whites in the South who vote Republican, I’d be very interested in these numbers if I was a Democrat looking for new voters.

Of course as I’ve said many times on THCB, the presence of the uninsured is a safety valve allowing the participants in our health system to ratchet up costs as much as they can, because those who can’t pay can be jettisoned into the uninsured pool. No one is responsible for the global cost for the whole system, because if they were they’d bring it down for everyone, not just those uninsured, and the total dollars going into it would be less. (At least that’s how it’s done in every other country).

But the scale at which that jettisoning is going on (due to those cost increases) is even worrying those who make their living selling insurance. Here’s what the CEO of Independence Blue Cross (the Blues in Philly) had to say about the fact that premium for his PPO product is up 65% in the past 5 years and now costs $17,000 for a family:

One day soon, if the cost of health care continues to escalate, employers and families won’t be able to afford the solid coverage of Personal Choice,"

So what is he going to do about that? Well there is the odd nod to pay for performance and disease management, but no one will be surprised to hear that like his competitors, CHDPs and better technology are the cures for Independence.

"First," he said, "we must better respond to the emerging trends in health-care consumerism." IBC efforts in this area already include rolling out a variety of consumer-directed health plan options and launching its Connections Health Management program, which helps subscribers better manage chronic illnesses. <snip> Frick also wants to see the company expanding its use of technology to drive down administrative costs and improve customer service.

Now, as an actual health plan customer I’m in now way objecting to health insurers bring their customer service into the 1990s, but suggesting that this is going to cure the underlying cost of health care is rubbish. Meanwhile over at The New Republic, non-Volvo driving liberal Jonathan Cohn has a great article explaining why (again not news for THCB readers) that consumer driven plans are in general worse for poor and sick people. But don’t bother telling that to the insurance industry. it’s decided that CDHP is all it can sell, and it’s the only idea it’s got.

So I was interested in the response when in the middle of a mostly vacuous interview (PDF transcript here) Jack Rowe at Aetna last month was asked by a single payer advocate whether we should have an insurance industry at all.

BERNIE FEDDERLY [misspelled?]: And the one thing you would do to bring down a healthcare cost would simply be to go to a national healthcare plan – a single payor plan, which would eliminate those costs. The best thing we could do is probably get Aetna out of the healthcare field. How do you take on that?

JACK ROWE MD I think we disagree. I think Aetna’s part of the solution. It’s not part of the problem and I think there are lots of ways that private health insurers can improve the quality and access of care and help control the costs. I don’t think it’s proven that having a national system would help correct the healthcare cost problems. The costs, most economists agree, are driven up–not by health insurers, whose operating margins are, as you probably know, are well less than 10 percent on average but by demographic changes and technological advances. Neither of which are under our control. Those are a couple of other ways we disagree but I’m sure there are others.

Frankly if I was getting $18 million a year I’d have a better defense of my position than that, given that I’ve admitted that you could get 10% savings right off the top by nationalizing me, and given no reasons for not doing it. Especially when my business strategy (for all the BS in his talk about Aetna promoting racially sensitive health care) was to boot about half the people on my insurance rolls off them (no prizes for guessing whether they were the healthier half or not) and thereby add to the uninsurance and cost problems of the nation and its taxpayers because of it. Rowe’s lesser paid colleague Frick over at Independence at least has a bit more humility.

"I’ll be the first person to tell you we don’t have all the answers," Frick told DVHC members. "And I’ll be the first to tell you we don’t always get it right the first time, but we stick with it until we do."

Of course doing something that you know is not going to work expecting that it will is pretty close to the text book version of insanity. And his conclusion sounds frighteningly like that.

If health insurers gave a rat’s arse about the problems of the uninsured or health care costs, they would have a come-to-Jesus moment, get together and plot out a way that the uninsurance problem and the cost problem could be solved with them still remaining in the mix. That’s kinda of where they were forced to in the Clinton plan, and it still seems a better long-term option to me. As it is, they seem to be determined to take the short-term cash, and help the system break down to a point where a future government will be forced to take them out and replace them with a government-run plan. But there’ll be a whole lot more pain, suffering, and anguish before then.

Categories: Uncategorized

Tagged as: ,

42 replies »

  1. The global financial crisis contributed so much in the decline of the number of insured in the United States and I bet many Americans are worried not about their health. Such a very bad news but it is true. Actually even travelers are quite frightened already with the expensive health care services in the United State.

  2. Where is it that we come from?
    Our forefathers defined certain unalienable rights. Life, Liberty and Pursuit of happiness. The constitution enforces these rights and the right to protect ourselves.
    Government is empowered by our taxes to protect our common defense.
    Among the rights we are guaranteed are not clothing housing or health insurance. These are included in our pursuit of happiness and liberty to seek and earn live the life that we choose.
    Over time individuals of faith have felt the duty to assist others who have been born or found themselves with less fortune to rise to a better life than they would otherwise have. They gave gifts and developed organizations to improve the effect of their gifts. Locally Individuals and groups of individuals developed missions to work locally and afar to help others. They maintained their missions. Their gifts were appreciated.
    Some of those gifts were joined together to develop funds to ensure that if an individual within the group suffered an illness or injury, that they would receive care and their families would not suffer loss of all they had worked for through their life. The individuals within the group did not expect that minor injury or illness would be paid for by others but were assured that serious illness and expenses were covered. There was no expectancy of profit by any concerned. This insurance was a safety net. Individuals felt the responsibility to maintain the fund for the future and were cognizant of their own vulnerability and potential need at some point for coverage. They knew that reckless use of those funds would mean that in the end the insurance would no longer be available to them.
    In simple matters of health provision, care was simple and providers would sometimes give benevolent care or exchange services for those who could not pay. Individuals maintained autonomy, responsibility and gratitude as members of a social group. It was not socialism but independent individuals working together. Perhaps it was not always equitable. Consequences were certainly felt early. Individuals certainly felt the rewards of altruism and the shame of ignorance of the needs of others. These along with the vulnerability that but for the grace of God, instructed their behaviors.
    Today in our deserved attitude and capitalistic insurance industry the values of the past are gone. . .Capitalism has taken root and individuals care not about their decisions to spend or of their responsibility to the group. . .this industry can not survive without draining individuals and those who are the ones for whom the insurance began are precisely the individuals who will not have adequate coverage.

  3. all insurance company ripping up to people. Still goverment doing nothing. i paying 1100/month to away from medical expense. Also more expensive medical than all other country. People paying lot of taxes than other country still not beneficial for people.

  4. My Personal experience with Health Markets is one of deception, exploitation and usury.A agent knowingly and willfully took money from us. Knowing of my sons pre-existing Condition and knowingly had been aware of a state Guaranteed insurance coverage.This agent was aware that it would be rejected and still took a down payment.
    Applying the money to their bank account and we had to fight to get our money back. Some $75.00 was never recovered.

  5. We are a law firm based in Portland, Oregon.
    I recently met with several individuals living in Oregon who have had health insurance through HealthMarkets Inc., North Richland Hills, Texas, and subsidiaries MEGA Life and Health Insurance and Mid-West National Life Insurance.
    We are in the process of investigating the potential for a class action lawsuit in Oregon against these companies for unfair and deceptive practices in marketing and administering limited-benefit health plans sold to small businesses and individuals in the state.
    The carriers appear to have targeted the self-employed along with small business owners with products packaged as part of memberships in the National Association for the Self Employed, Washington; Americans for Financial Security, Irving, Texas; and the Alliance for Affordable Services, Dallas.
    These companies may have used unfair and deceptive marketing and other practices to convince Oregon residents to buy health plans with limited benefits. Oregon health care consumers must be fairly told what they are buying, and their premium dollars should be used predominantly to pay health care benefits and not inflated commissions, overhead and profits.
    If you or a loved one is an Oregon resident and has had health insurance with any of these companies please contact us to discuss your experience with them and your potential options.
    Roe & Associates, LLC
    333 SW Fifth Avenue
    Suite 505
    Portland, Oregon 97204
    503/796-3006 tele
    503/235-3005 fax

  6. I am aman, this article is very good. people who have quick respond in this matter. Now a days health care is important to us. Unfortunately If you are living without health insurance you are taking a big financial gamble. Even minor health care needs can cost you thousands of dollars that you cannot afford. Unpaid medical bills can lead to financial struggles, bad credit, and even bankruptcy. Don’t put yourself or your family at risk anymore. However the US government has to implement free medical policy for below poverty line people.

  7. “The costs, most economists agree, are driven up–not by health insurers, whose operating margins are, as you probably know, are well less than 10 percent on average but by demographic changes and technological advances.” a Jack Rowe MD quote has missed the supply and demand class – if 50% of busineses dropped their health plans, then the other 50% would have a large premium increase. Thus, year after year, rates raise 15% as the uninsured loose out on affordbility. If all insurance companies dropped rates and the membership pool doubles, then more money for them, more people insured, and no gov help needed. Wake up, get all insured at low, low rates as mike points out in his post (305,000,000)and the gov would be happy that all have insurance, and could use the medicare programs ($) to buy these low cost plans for all of their members. All companies would be able to afford paying into group plans and us individuals could afford health insurance.

  8. Consumer Directed Healthcare?
    As healthcare in the United States has gotten so expensive, and because delivery systems have become so inefficient, some experts suggest that putting more control and decision-making into the hands of consumers will improve the healthcare system. This type of initiative is called consumer-driven or consumer-directed healthcare.
    Why do Discount Healthcare Programs sound too good to be true?
    Middle class America is most affected by the healthcare crisis. Many are without benefits and cannot find affordable or cheap health insurance. They make too much to qualify for Medicaid, but too little to afford the high premiums of insurance.
    The Consumer Health Alliance was founded in 2002, Consumer Health Alliance protects consumers rights to choose affordable and practical non-insurance healthcare programs. Through Consumer Health Alliances advocacy work which is at the state level, CHA seeks to bring awareness and a voice to the national healthcare arena that focuses on recognizing and promoting fair and ethical business practices within the discount healthcare industry. The companies affiliated with Consumer Health Alliance offer discount medical cards to their members. Recent reports show that these discount health programs are gaining popularity because they allow consumers to gain access to healthcare they need without the exclusions, limitations and paperwork typically associated with health insurance. If you suffer from a medical condition and cannot obtain insurance due to lapse of coverage or a pre-existing condition; the advantages that a healthcare program or discount plan offer is that they will not exclude you. In fact, your medical history is of no concern to them. Why? Because their main purpose is to provide consumer driven healthcare to those who cannot afford high premiums; thus, bringing together the doctor patient relationship that has been long lost in our society today due to insurance companies dictating eligibility and services we as consumers should be provided. In fact, enrollment is affordable and your care is immediate. No waiting periods, no deductibles, no maximums, no exclusions, no limitations of services, no paperwork, no appeals and denial processes. Even if you have an affordable health insurance plan, you can still benefit from a discount healthcare program and receive deeper discounts. Too many companies are scaling back their benefit packages for their employees or are not offering them at all die to the rising insurance premium costs. Although a good dental plan is rated as the 2nd most requested benefit, it is also one of the 1st things to go when a company is forced to cut back due to the economy.
    How do these Healthcare Programs Work?
    For a low monthly fee; usually $19.95-$59.95 a month depending on the program of your choice, members and their household gain access to wholesale rates similar to what large insurance companies pay. When care is received at a participating providers office the member pays the discounted fee at the time services are rendered. It is a benefit not only to the member, but also the provider who is able to get payment up front with no paperwork to file.
    Why haven’t I heard of Ameriplan Health?
    Ameriplan Health offers a comprehensive package for the uninsured or under insured that includes doctors, specialists, dentist, vision, prescription, chiropractic and hospitalization. Ameriplan Health is one of the Consumer Health Alliance Founding Board Members as well as
    The National Association of Dental Plans, National Association of Health Underwriters, U.S. Chamber of Commerce.
    If you would like further information on how you can save up to 80% on your dental, medical, vision, prescription, chiropractic, hospitalization costs- feel free to contact me at SRoytan@ameriplan.net or visit my website at http://www.MyBenefitsPlus.com/40635609 or call (281)658-5167.

  9. Man, I feel the fool right now.
    It should have been 36 billion, 600 million dollars for those that can’t figure it out like me.
    I feel stupid, sorry.

  10. What would happen if for instance, we started paying the hospitals directly?
    By that, I mean instead of paying the insurance companies as a go-between or 3rd party, we pay the hospital direct. We pay the hospital that we want, that provides the care we are looking for and need.
    We send them monthly payments just like insurance but, for at least 1/2 the amount.
    Hospitals, would then have a pay schedule that would pay the doctors and their assistant. The doctors would collect from the hospitals a set fee for their service.
    In effect, the doctors would be sub-contractors to the hospital. This is not to say that the hospital has the right to send you to the doctor with the lowest price, but you would be able to decide.
    Take 305,000,000 people in the United States as of 2008. This figure is rough. Multiply that number by $10.00 per person and it looks something like $3,050,000,000. That figure would be $10.00 per person, per month. In an average home, with a man, woman, and 2 children, that equals, $40.00 per month per family. Multiply that number by 12 and you get something like $36,600,000,000 a year.
    For those that can’t figure this out, that is 36 trillion, 600 billion dollars a year.
    You as a consumer, would decide where you want to spend your money. If one hospital will not serve you adequately, you spend your hard earned money somewhere else. If the doctors will not work for that price, you find one that will, that you feel safe with. The price is up to the hospital and the care provider to deal with.
    You as a consumer, are willing to pay this amount. If the hospital or doctor are not willing to deal with you, go somewhere else.
    I am 52 years old, I have worked construction all my adult life. I am broken down and I foresee future problems with health. I am sure a lot of you are in the same boat.
    Insurance will tell you it won’t work. The reason it won’t work is because, it will put their sorry ass out of business. Boo-hoo, I really feel sorry for them.
    My neighbors son and his wife sell insurance, she just got a $25,000 bonus. He won’t tell me what he got. They aren’t even top brass. I can only imagine what their boss got.
    I don’t feel too sorry for any of them. They will always be able to screw the homeowners, and car insurance deals. If not, we could always kill two birds with one stone. Immigration would fizzle out with ex-insurance salesmen working the jobs that we normal people feel are beneath us. Yeah, cut that meat thicker would you? Put more mulch on that tree over there. Sometimes I wish I had a job that good.
    If we as consumers, as is the rule in business, put our money where it will work for us, the businesses’ will start pandering to our needs and wishes. If they won’t, then someone out there will just start their own hospital and we as consumers will watch the other hospital go broke. $40.00 a month per family, is a guess, but that is all the hospital gets per month. They will have to set a budget and stick with it. They will not be able to go to the government for a bailout. Sure they need to make a profit, but they don’t need to pay their top execs’ multi-million dollar wages. Sure doctors need to make a living, but they don’t need $1-3 million dollar homes and sports cars. If so, save for years like I did, not go out and get one because you did a heart by-pass Tuesday.
    Malpractice is running rampant in the streets. Limit awards. This is unbelievable when someone gets awarded $2,000,000 for a miss-diagnosis, when the patient admits they withheld important information because, they would have been embarrassed. This stuff happens people.
    My best friends wife is a doctor in Indianapolis, Ind. Her malpractice insurance is almost $100,000 a year, and she is damn good at what she does. Make it a law, that if a lawyer brings forth a lawsuit, and the judge finds it nothing but a nuisance suit. The lawyer has to pay for everyone’s’ time, expenses, and pays the person filing the suit ½ the asked for reward. Lets see how many BS suits go to court.

  11. We say that we do not have socialized medicine, but in reality, we do. Just not the way we normally think of it. People who have insuance, or money to pay for medical expenses are carrying the costs of those who do not have insurance. Then there is Medicaid, the government aid plan that pays for the elderly, disabled, etc. If that is not socialized medicine on a limited bases, what is it. And is it all bad?
    Being an Oregonian, I find that the Oregon Health Plan really assists in cutting down the losses of the medical community, and it does so in an interesting fashion. The requirements for the Oregon Health Plan are stictly financial. Oregon then uses numerous health insurance companies to oversee the plan. This accomplishes 2 things. First, the provider gets paid, second, the insured get needed health care leading to a healthier population.
    If we could insure a greater percent of the population, we would cut down on financial losses, and we should have a healthier population. And maybe in the end, we can contain medical costs.

  12. Make sure you and your family are covered. Choose your own plan for discount health benefits, dental, medical, prescription, chiropractic and vision. Added pluses. It’s too costly to not be insured. I am 55 and recently lost my job. I know I cannot afford regular insurance. I am now part of a company that cares about me and you.

  13. We have neighbors who work hard but have jobs without health insurance. I found a prescription discount card that they could use to save on the price of their meds at the drugstore. It’s at http://www.rxdrugcard.com. The monthly family membership fee is only $4.95 and drug prices are on the website to check before joining.

  14. The rising cost of healthcare is a real problem for the average American citizen. Over 50 Million people today are living without health insurance. Small business owners are dropping coverage for their employees as cost continue to rise. Companies that do offer their employees health insurance are passing the cost increase onto the employee. As a result, many Americans are deciding not to take the healthcare benefits the employer offers because they simply cannot afford it.
    If you are living without health insurance you are taking a big financial gamble. Even minor health care needs can cost you thousands of dollars that you cannot afford. Unpaid medical bills can lead to financial struggles, bad credit, and even bankruptcy. Don’t put yourself or your family at risk anymore. Go to http://www.3aoo.com/healthcare.aspx and find out how you can get affordable healthcare.
    Save up to 30% or more on medical services!
    Our established network has approximately 750,000 Primary Care and Specialized Care Physicians, over 5,000 Acute Care Hospitals and approximately 75,000 Ancillary facilities including Skilled Nursing Care, OB/GYN, Outpatient Surgery, Counseling, Pediatrics, Cosmetic Centers, Alternative Care, Labs/Clinics, Radiology Centers, Rehab (Physical/Mental), Home Health Care and more!
    Everyone is eligible, no medical questions or exams are required.
    • No occupational or industry restrictions
    • No exclusions for hobbies or sports such as rock climbing, skiing, rodeo, etc.
    • No pre-existing condition exclusions
    • No waiting periods
    • No annual limitations or maximums
    There are great programs for families, groups and individuals. The benefits to members include medically related services, prescriptions, dental, vision, accident coverage and hearing benefits. We have partnered with organizations representing literally hundreds of thousands of healthcare providers, pharmacies, vision centers and dentists to provide the best possible value for our members.
    http://www.3aoo.com/healthcare.aspx contains helpful information regarding many medically related services that comprise of our program. These services are designed to save members money and are utilized on a regular basis. Plan members receive identification cards to be presented when using the Dental Program, Pharmacy Discount Program, and the Eyewear Discount Program, to name a few.
    Plans start as low as $10/month for individuals and $20/month for family coverage. Go to http://www.3aoo.com/healthcare.aspx to contact us about getting affordable healthcare today.
    Also, affordable group plans are available for small business owners to offer their employees. Highlights of the group plans are:
    • No waiting periods
    • No pre-existing condition exclusions
    • Huge national network
    • Zero deductible
    • No claim forms
    Visit http://www.3aoo.com/healthcare.aspx to get started.

  15. Affordable Health Insurance is available! One of the oldest and most successful Insurance companys in America is now in Tucson, AZ. Our goal is to provide Arizona with very affordable Health Insurance. If you already have a Major Medical plan, keep it and we will make it more affordable. We will literally put cash back in your pocket with our GAP insurance which will pay your deductibles and co-insurance for your major medical policy! If you need health insurance, we have over 40 diffrent policys that we can offer to fit your specific financial and health needs. Call Chuck Sabo at 520-465-9252 for a free quote!

  16. I worked for the federal govt for 14 years. I could no longer do my job, or any job, because of medical conditions. I filed for disability retirement at work and they also required me to file with SS. Of course I was denied & had to appeal & also hire a lawyer. While waiting for appeal, almost 2 years, they canceled my BCBS health ins. 8 months ago. I had been paying around $200 a month towards my benefits for 14 years.
    Now I not only can not work, I no longer have health coverage and I take medication on a daily basis that is
    not cheap, my husband is self-employed, and I have pre-existing conditions. What to do????? So much for govt helping their own. Health is declining because of this.

  17. Government run healthcare?? Since I am retired military I have a little experience with that. “You will have healthcare for life……..” Well, not exactly, Congress reneged on that promise long ago. “Nothing is too good for the troops……….” the same folks who are surprised by the shortcomings of the VA or Walter Reed keep telling us that too. And they have provided tons of nothing.
    My healthcare in the military was second to none when I was IN UNIFORM and the provider of that care was also IN UNIFORM! Soon as civilians became providers it was all about money and not about care. Anyone think making a “Department of Universal Healthcare” won’t result in the worst parts of the VA care model becoming the standard for everyone?

  18. In Alaska where seniors can’t get a primary care doctor to accept Medicare and dental costs have gotten sky- high, more and more people are flying to Mexico or Thailand for treatment. How nuts can our healthcare situation get?
    On the horizon, I see that the insurance companies are crazily raising other types of insurance. How long until they put themselves out of business as citizens form their own non-profit risk pools? Remember when hospitals were non-profit?

  19. I found a company that does Blood Tests at up to 60% discount for uninsured consumers (www.econoLABS.com). And best of all they do not require a doctor’s order.

  20. I’ve seen a lot of this topic. But some peoplr try some wacky solutions. Like this whole “Transparency in Pricing” idea (here is a video about it http://www.convergentstreams.com/cgi/wp/?p=11) it is possibly the worst plan I have ever heard. People will not get treatment because of the cost, or go to the cheapest doctors possible, which will result in the lowest possible standard of care.

  21. I’ve been searching for objective comparison info on health plans. I need some advice! We’re self-employed; my son and I are on Mega Life and Health. Because my husband had a heart attack almost 2 years ago, and was on Blue Cross/Blue Shield, he’s still on that plan. Our premiums equal another mortgage payment! I found some info about Beech Street group healthcare, underwritten by Aetna (they say). Their family plan would be less than half of what we’re now paying, but they won’t cover anything related to his heart attack. Has anyone heard of this Beech Street group healthcare? How do I compare Aetna and Mega? Then there’s the question of what to do concerning my husband and his heart attack history. Any comments/advice/opinions would be appreciated!

  22. I’ve just found your blog while searching for a solution for myself. What can you even say at this point? The system is so far gone and no one seems to care.
    This whole situation just makes me sick. The healthcare crisis has finally hit home with me now that I’ve been denied for insurance. Add me to the statistics I guess.
    I wrote about it on my blog:
    Yes obviously I was mad when I wrote it. I had just gotten the rejection letter.

  23. The concept of Doc-pal is just like having a good old physician buddy help you, guide you and educate you regarding your healthcare issues. There is a bond & trust to exchange information and debate about the condition if any. His primary focus is in preventive care and disease management. He also wants to empower you in taking charge of your health.
    Are you ready for Doc-pal :
    Every day in the U.S., thousands of consumers are challenged by confusion and chaos in their healthcare system. What is missing from the equation is one to one connectivity with your doctor. Doc-pal will empower you to improve your overall status of well being by providing a one-stop solution for all of your healthcare needs.
    No need to reproduce your entire medical history when changing doctors or when faced with a medical emergency. Doc-pal:
    Minimize aggravation during suffering
    Provides annual exam and wellness planning
    Personal Health Record any where any time
    The ability to access lab results instantly
    Just on time appointment and availability
    Peace of mind while traveling
    Referral convenience
    eVisit, email and fax Availability
    Instant Prescription Facilitation
    Better understanding of your medical history
    Doc-pal offer consumers an alternative – access to qualified personal physician to help you achieve your wellness objectives – conveniently, confidentially, and self-directed. Physicians meet you in your home, office, or at their office. DocPal is a new frontier where patients and physicians are interacting in cyberspace or via cel phone to develop a personal bond. The familiar trappings of the office give way to electronic messaging, video connections and lightening fast communications among all of the parties – physicians, patients, pharmacies, diagnostic centers and labs. How much time is required for physicians to participate in? Physicians are asked to schedule members for physical exams in their offices within instant calling. Physicians can log in to 24/hours per day, 7 days per week to review EMR and medication requests.
    Dr. I-Net affiliated Doc-pals are renowned physicians in their area of expertise with limited patients in order to deliver comprehensive preventive care and personalized service to all patients. This approach to internal medicine can’t be offered in most traditional primary care practices. In that case, a physician would have no time available to deliver any care to patients other than the physical examination. Dr.I-Net’s Doc-pal have the time to provide both extensive preventive care and treatment of acute and chronic illness, with a new focus on individualized attention and lifestyle planning. After all, the best time to see a physician is before you really need one.
    For mor info: info@drinet.com or call at 954-969-9002

  24. New statistics recently released states that there are now 46.6 million Americans who do not have health insurance. These are not just people who live below the poverty line, many people are denied coverage because a pre-existing condition makes them a bad risk. In states where health insurance can’t be denied by law, the insurance carriers raise the rates to where it is simply not affordable. Many people can make a decent living and still find coverage unaffordable (I know several).
    The President has been pushing Consumer Driven Health Care and HSAs, however these are tied to a high deductible health plan managed by a health insurance carrier, hmmm.
    There is another alternative that seems to get no press or respect for that matter, that can help make health care more affordable for many of the 46+ million. There are several Discount Health Benefit providers that for a very low premium offers people access to thier network of providers where they can receive substantial savings on needed health care services. The most notable of these companies is AmeriPlan USA which has a growing network of over 400,000 providers and savings on services of anywhere from 20% to 80% on these services. True, you pay a discounted fee at the time of service, but the savings can be substantial. To someone who has a choice of either not going to the doctor or, paying 100% out of pocket or, saving up to 80% this is a viable alternative, which is why AmeriPlan has over 1.5 million customers and growing. I strongly feel that allowing people who fall into this category to open an HSA would add an even greater benefit. They and the companies they work for could add to the account allowing them to put money aside for their treatment. Think the insurance companies would stand still for that? I don’t.
    No, this isn’t the perfect solution, I don’t think there is one however, it is a very viable, affordable solution for many individuals, families and small business owners who otherwise couldn’t afford anything.

  25. I have read threw the posts and agree that insurance rates are out of control. With owning a health insurance agency I can shed some light on the problem. I have heard talk of socialized healtcare and it will probably go into affect but that is just a bandaid on top of a bandaid. The health insurance companies are becoming the scape goat for the mess. But acually it is 3 things. First is malpractice insurance. Doctors, surgens, and hospitals spend a large portion of income on malpractice insurance. They should cap lawsuits which would lower the cost of malpractice insurance and ultimatly the consumers health insurance premiums. Second, would be to limit coverage to illegal aliens. I know its harsh but hospitals are eating the cost and passing it along to average consumers threw high prices. An asprin does not cost 30 dollars a bottle. Third is to have blood tests needed to gain access to health insurance just like life insurance. This will make sure drug users, alcoholics, and clients with unknown std’s and other conditions from sneaking on an insurance policy. For clients with pre-existing conditions more states should have basic medical plans for high risk clients or clients should look at association healthplans like teamcorp. http://www.teamcorp.com/tpatti
    Socialized healtcare is not the answer. It would effectively double the price of healthcare and lower the treatment and quality options. Look at the VA it is very expensive on the taxpayer and vets don’t get the coverage that they deserve.
    Mike Patti

  26. Hello All,
    I’m looking to speak with people who work and are employed but can’t afford health benefits because their employer doesn’t offer them. Or, people who are freelance or self-employed and lacking benefits.
    The purpose is to help raise awareness of this issue and make it known that every American runs the risk of not having benefits, not just the super poor. I am currently working with an author who’s book just came out on this issue.
    Please send me an e-mail in confidence to kuglscribr@aol.com. In the e-mail please include a paragraph of info with your work situation, age and health benefits situation. I will respond with more information.
    Many thanks!

  27. My wife and I were lucky enough to retire in our early 50s.But,we hadnt give health care that much thougt.We were just excited that we were in the position now to not work.What a surprise now that were having to pay for our health care,it just is a big rip off.Now all I do is stress about how we are going to pay our insurance,we are on a limited income.So do I go back to work,not.Do we take a chance and go without?.This is just total bullshit,/this system is just fucked up.There has to be a better way.Now were shopping for cheaper insurance,now there saying we are over 50 and we have to do the physicals again,and all the bull shit that goes with it.They found in my medical records that I declined a certain test,now they dont want to insure me.Dont smoke,a beer once in awhile,good shape basically,but any excuse to not insure a person.And how they get all these medical records so easy,it just is a really fucked up system.I worked my ass off to retire early,now I cant enjoy it because Im worried that if something major happens they will get everything I own.A heart attack will set you back about 250000.00,Give me a fuckin break.What a person to do,all we here about is we are going to fix the health care.Bull shit,they have made it worse,its all about the money.Doctors and there fucking attitudes,my car is better than yours,my boat is bigger,my house is bigger,Well guess what?You all suck!!!!!!!!!Have a rotten day.Here is my rant,God I feel better.

  28. I feel if 100% of the popluation were uninsured then
    all of us could afford health care. You know the system is ladden with overhead and corruption when you can always obtain a cash discount if you don’t have coverage.

  29. I feel if 100% of the popluation were uninsured then
    all of us could afford health care. You know the system is ladden with overhead and corruption when you can always obtain a cash discount if you don’t have coverage.

  30. Eric, I used to work for a billing company that skimmed over 20% off the top of all doctors’ bills to make sure all of their claims got paid correctly and on time. We honestly provided a tremendous service, but only because the healthcare marketplace is so ridiculously complex that it takes a team of 300 highly trained healthcare policy specialists, computer programmers, operations staff etc. to get a frikkin’ clean claim out the door to 10 different payors with different billing standards, rules, etc. HIPAA did adress some of that, but the fact remains that doctors are smart to give 20% of their money away just so they can get the rest of it.
    Now I work for a Medicaid eligibility company that also takes 20% of hospitals’ money to help our customers find Medicaid coverage. If we had national insurance and everybody were covered at all times, my company would be irrelevant and hospitals could keep all of their money.
    Nationalized health insurance would go a long way to reducing the need for companies like my current one and the one I just left, which exploit the complexity of the healthcare market for financial gain. And that’s just in my limited experience. I’m sure there are companies out there exploiting other inefficiencies I don’t even know about, taking more money out of the healthcare system. Money that would stay in if we had a simplified system like single payer or more tightly regulated managed competition.

  31. As I have been saying for months- intermittently on this site, and on the radio– the first step (to go along with your later post today) that substantive tax reform and increased transparency (something along the W2 lines presented by Reinhardt) is essential in any reform.
    I also firmly believe that the debate over care needs to move from the Insured/unsinsured to one that better reflects healthcare utilization (also stated by me on the blog elsewhere). HSA and CDHP are actually a good thing for the 70% of the population that is generally healthy. In the short run, those people win with lower premiums and better involvement in healthcare decision making, and in the long run, they win with accumulating savings to health offset emergency expenses.
    But, because 30% of the population accounts for 80% of the cost– additional solutions must be put in place. Here, too, a personal stake in managing one’s own healthcare must be implemented- perhaps along the lines of unemployment insurance eligibility or welfare reform (showing an effort to lose weight, manage blood sugar, stop smoking, exercise). This must be combined with better coordinated care for many of these poeple.
    Still waiting for the “universal healthcare” proponents to say specifically how that will “reduce costs by at least 10%”. Please just do not say by providing more efficient, low overhead medicare. As Matthew and I recently discussed, the overhead figures for Medicare are rather artificially low– due to higher payouts with an older, sicker population, and likely inadequate management oversight.
    No large government program (and healthcare is hardly one program) can possibly run more efficiently than the private sector. Imagine the department of defense multiplied x5 and you would get national, government run healthcare.

  32. There’s a new article up at The New Republic discussing how CDHP has been a failure in South Africa, and the government is even moving towards banning them.
    Great article. I love seeing the insurance industry millionaires trembling over the realization of their irrelevance.

  33. The diversity of ideas expressed on this site appears to reflect the spectrum we observe across the healthcare market place. Irrespective of how one envisions the ideal model, we can concur empirically that when a patient presents in the ED, they will be inserted into the healthcare system. As a result, short of arguing this fact is alterable, net costs to the system are incurred. Personal responsibility is of high value to our social fabric but not applicable at the level of mandated care provision. As a point of linear thinking, how can we logically not provide universal coverage?

  34. Trapper. Only a universal health insurance system of some form can solve the problem of uninsurance, and that requires compulsion for people to acquire insurance in some form. I have yet to see a libertarian (and I have respect for that position, unlike for those of the loony Conservative “let them eat cake” persuasion) bite that bullet. But I await being proven wrong!

  35. Thanks for the great article, Matthew.
    I think that you’re quite prescient when you identify the end of health insurance as we know it… probably not tomorrow but in the not-so-distant future.
    If the CEO of one of the largest health plans in America deems his organization unable to control healthcare costs, then they are little more than a claims processing shop… albeit one that’s prices go up double-digits every year. And that’s not a business that’s hard to duplicate (for less).
    Managed care and capitation shifted risk to providers. They pushed it back onto insurers. The past few years have seen the burden pushed onto employers in the form of runaway premium increases.
    Now the shift is onto consumers… the lowest rung on the risk food chain…and the most vulnerable.
    As an aside, after how many years of success in shifting members into CDHP will the remaining risk pool of HMO and PPO products be so sick that plans just get rid of these products (or employers will cease paying for them)?

  36. Matthew, nobody who makes money off of the health care system is going to offer up their own share in order to bring total costs under control.
    We are currently governed by people who think the best answer is letting everyone be responsible for their own health costs. The whole notion of insurance is not-so-slowly and surely being undermined. The rise of consumer-directed plans and health savings accounts is a big step in that direction. Coupled with the new bankruptcy restrictions, the unsocializing of health costs will eventually lead to a whole new underclass: former middle class families living in poverty due to their medical bills. I’ve pretty much decided that this particular underclass will have to get quite big before we’ll see the political will to truly reform the health system.

  37. I should be able to have more than 10 lines to comment on Matthew’s 1000 lines of total propaganda. The Math: In NJ a 30 yr old couple with 2 kids costs over $2,700 a month with Blue Cross for insurance. In Lansing, MI it costs under $200 a month. I explained this on another blog that has 500,000 visitors a week who don’t censor me like here.
    It’s TIME for Z-Truth. Tripod Economics.