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HEALTH PLANS: I beat Lisa Girion!

This might be my proudest moment in blogging. Anyone can be ahead of the WSJ by 5 years. But on THCB I connected the dots between LA Times coverage of the dumb public relations of Wellpoint in California, and New York AG Andrew Cuomo’s assault on UnitedHealth Group yesterday afternoon.

That’s at least 6 hours (maybe 7) before Lisa Girion did it in the LA Times. I emailed Lisa to crow about it this morning…..of course she’s probably too busy being the de facto head of health insurance reform in California — and now the US — to email back, admit defeat and come work on THCB instead!

Being serious for one second, Lisa’s work in exposing the behavior of health insurers may be the most important series of work in health care journalism in the last few years—even more so than the series which exposed the problems at King-Drew and Walter Reed. There’s no question in my mind that it will lead to significant legislation which will go some way to cleaning up the health insurance industry.

And it’s not as if Lisa was mailing this in. She found the recission (retroactive insurance cancellation) stories herself, she did the digging in the courts, and she got what at first blush sounds like a very unsexy type of story to be a major issue in California’s most important paper day after day.

To my mind she’s become a national treasure and I hope that the powers-that-be at the NY Times or perhaps Pro Publica are paying attention!

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JimmattMatthew HoltAnn Malone, RNPeter Recent comment authors
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Ann Malone, RN
Guest

First a reply to Peter, then Jim. Peter – Ouch! you either mis-read my comment above or I wrote it poorly. I’m with you so why rub my face in the MA mandate mess? HR 676 is the ultimate reform goal (676 is John Conyers bill for Improved Medicare-for-all reform). And I have consistently railed against the MA Chap 58 law, since even BEFORE it was passed. It IS BAD POLICY AND WILL NOT WORK. Google my name with “MA Chapter 58” or “MA health reform” and you’ll find that I regularly dissect the ways in which the MA faux… Read more »

Peter
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Peter

“Someone needs to show me a model of a single payer system that actually works.”
What’s your definition of “works”?

Jim
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Jim

Someone needs to show me a model of a single payer system that actually works. Lots of folks who are uninsured can afford it but choose to be self insured. John – I have never seen an MLR as low as 55%, what are you smoking? Most carriers shoot for 69% but feel good about hitting 72%. The truth about risk selection is this; in the individual market carriers introduce new products every 3 to 5 years because the U/W has warn off and they need to reset the price to remain competitve. At renewal time they encourage those who… Read more »

matt
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matt

There is a big difference between legal risk selection and health insurers “cherry picking” their customers.
If this weren’t the case, then plans would have large and advanced underwriting groups….not that I blame them…because that’s what “the market” demands.
Much more constructive competition would involve reframing competition in a way that requires plans to actually improve member aggregate health and cost in order to profit. That’s simply not the case today, though.

Matthew Holt
Guest

John you are too smart to really believe that health insurers don’t make rampant profits on risk selection between large and medium groups and even more money in the individual market. There’s a reason Blue Cross/Wellpoint objected to the MLR rate being set at 85% in the recent legislative kerfuffle. That’s cos their MLR is something like 55% in the small group and individual market and it’s where they make a bunch of their profit. BTW Mega Life and Health’s MLR is closer to 30%. And if you think there isn’t risk selection in Medicare managed care, well I have… Read more »

John R. Graham
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Matthew, What risk selection? Risk selection has never happened in large groups, was mostly outlawed in small groups in pretty much all states in mid-1990s, so can only be practiced in individual market, and even then not in large states like NY, MA, etc. Also, subtract Medicare, Medicaid and other government programs and I’d bet less than 5% of the U.S. population are in a health insurance market where risk selection is allowed (by insurers, at least: perhaps employers do so). (By the way, we need more risk selection, not less: the number one risk-rating is for smoking. Can people… Read more »

Peter
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Peter

“Peter and John -it’s not an either or scenario, we need both areas of reform that you each mention, and more.” Ann, while I have commented on the need for cost controls outside of the insurance industry and understand that insurance is not the front line of cost creation, reform of our health system starts with insurance reform. To think that somehow keeping the present insurance model is key to better healthcare is like thinking perpetual war is key to a better future. Starting with an insurance model got MA the healthcare they deserved, and I hope they enjoy the… Read more »

Matthew Holt
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Here’s a quiz, John. See if you can pick the right answer Q1 when health plans really tried to keep costs down via managed care(mid-late 1990s) profits were a) high b)almost non existent Q2 when health plans went back to strategies of risk selection and increasing premiums faster than medical costs every years (2000-present) their profits were a) worse than in the 1990s, or b) sky high with stock values to match. If John thinks that health plans really want to keep health care costs down, it appears that he’s lost his faith in the incentives emanating from our most… Read more »

Ann Malone, RN
Guest

Peter and John -it’s not an either or scenario, we need both areas of reform that you each mention, and more. I agree that a nat’l everybody-in-nobody-out Improved American Medicare-for-all would go a long way toward those needed reforms. We desperately need a Lisa G. in these parts (Massachusetts). Trying to get the health reporters to do any kind of investigative reporting has come up nil. For years. And there’s lots to dig up and a reporter wouldn’t have to go that deep. It would make for a potent expose’ on the profit-driven behavior of so-called nonprofit healthcare sector. Here’s… Read more »

Peter
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Peter

“In Los Angeles, City Atty. Rocky Delgadillo has assembled a team of investigators and prosecutors to probe industry practices such as canceling patients’ coverage after they get sick.” Yup, that’ll keep those pesky healthcosts down. “For example, he said, a market survey showed physicians typically charge $200 for a routine visit. But the insurers, using Ingenix data, claimed to their members that the typical rate was $77. Applying the 80% reimbursement rate, they covered $62, leaving the patient to pay $138 out of pocket.” Yup, more honesty from the insurance industry. That’ll also keep costs down. Gee John, what would… Read more »

John R. Graham
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Well, that’s a very nice Valentine’s card, Matthew. Yes, she’s doing outstanding work. But I wish she’d turn her guns away from the only parties in U.S. health care that are trying to contain costs. It’s easy to beat up on for-profit health insurers (or non-profit ones too, I suppose), or Big Pharma. How about doctors who needlessly order extra lab tests, upcharge their claims, refuse to join the 21st century (or, for that matter, the 1980s) with respect to using information technology, resist being measured for quality, and then moan and groan about how 3rd parties are trying to… Read more »