HEALTH PLANS: Insurers getting lambasted

First, 24 hours after being shamed in the LA Times, Wellpoint has backed down on getting docs to check up on whether their patients should have their insurance recisionned (is that a word?). It’s good to know that someone’s setting insurance policy in this country even if perhaps Lisa Girion wasn’t actually elected to the job!

Then it gets announced that the AG of New York state (traditionally a post filled by a  kick-ass hungry Democrat, these days Andrew Cuomo) is going after UnitedHealth sub Ingenix and a whole raft of insurers it works with on price fixing/reimbursement rate manipulation. What particular part of a health plan’s business practices Cuomo is going after it’s hard to tell. There’s usually plenty of choice!

But it is clear that if anything gets done about health care in the next cycle, insurers are front and center in the politicians sights.

And if you think this is just me talking, check out libertarian Arnold Kling, who for some strange reason manages to get his stuff on the op-ed pages of the WSJ. He basically agrees with me.

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DJMichaelAnn Malone, RNjd Recent comment authors
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Let’s blame the insurance companies, it’s easier than taking any personal responsibility. How about the lawyers, the AMA, and the providers? There will always be the usual suspects, but maybe it’s time for the truth: You’re not big boned, you’re fat because you make bad lifestyle choices and when your health goes south it’s someone else’s fault. Want the truth? Read ‘You Have an Ugly Baby’ http://www.amazon.com/You-Have-Ugly-Baby-unpleasant/dp/1419681974/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1203170120&sr=1-1


Again, if the reimbursement is going down to doctors and patients while the co-pays, deductibles and premiums are all rising one must ask “where’s the money?” We do not need health care reform…we need health insurance reform.

Ann Malone, RN

Re: “A UHC model like in MA, or proposed in CA” The MA Plan is on its way to going down in flames (as it should). Exhibit A: MA Connector Proposes CommCare (the state subsidized HMO policies) Premiums and Copay Increases http://blog.hcfama.org/?p=1442 Exhibit B: New report issues scathing critique of Gruber’s methodology for the individual mandate http://www.consumerwatchdog.org/healthcare/pr/?postId=9181 Health reform activists here in Massachusetts are suffering from extreme burnout and seriously low morale, so thanks jd for your comment – it helps me feel just a bit better: “Insurers may be inviting legislators to fashion a very short leash, and a… Read more »


Scratch that last sentence. I don’t think it’s too late, in that I don’t think single payer has a realistic chance of passing in the foreseeable future. However, what could very well happen is that a multi-payer UHC model would be more punitive and severe in its treatment of insurers.
Insurers may be inviting legislators to fashion a very short leash, and a collar with the spikes turned inward.


What Cuomo is going after is the alleged practice of skewing the data that establishes “reasonable and customary” rates. Insurers pay a set percentage of these rates for out of network providers. While insurers have some control over contracted rates, they have no direct control over the reasonable and customary rates, because they are supposed to be set by whatever is typical for the area. Whatever formula is used to set that is going to be complicated, and it’s easy to see why people on both sides have an incentive to game it. Here is what I don’t understand about… Read more »