Matthew Holt

Protest Music at AHIP meeting

This is much more fun and better sung than traditional protests! And given that AHIP would benefit from a public option, I suspect Karen Ignagni hired them. It looks like it happened in the closing session of this AHIP conference on Friday although having sat in many of these conferences I do need to tell the protestors that no plotting is done in these Forums. That happens elsewhere…

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8 replies »

  1. jd- The health insurance industry enjoys a Federal anti-trust exemption and I think you know that. They meet regularly and discuss provider fees and premiums prices. I think you know that too. No other industry in America has this power.

  2. interesting points jd. I think a few politicians out of greed and ignorance are the problem, they allow themselves to be tools of the lobbies and special interest. I don’t know a way to stop this except to stop allowing government to pass foolish rules. Doctors, pharma, and carriers are always going to want to make more money and will always be willing to bribe politicians to do it. What changes can you make that would eliminate that inherant desire to prosper? I think that desire is healthy, it is only when politicians artificially elevate one interest over all others that we create systemic problems.
    I believe every problem in healthcare today can be traced back to a single or couple event of government interference. Minus said government action the natural forces of nature would have kept things in balance and they wouldn’t now be problems. Do we not stand a better chance of correcting government then we do a force of nature?
    I noticed THCB has been erily silent on the study just released showing insurance ranks 35th with a 2.2% profit margin.
    Also not a single mention of the Medicare fruad story from 60 minutes. If THCB is being out leftied by the AP and 60 minutes we are really to far gone for good honest debate.

  3. Nate, one of several differences between you and me is that when we look at the failure to control costs you blame government and I blame the industry forces and their ability to influence our culture.
    Government has too often gotten in the way of cost control, but it is because of lobbying from providers, pharma, etc. AND because those lobbies and hundreds of thousands of individual physicians talking to their patients and neighbors have helped Americans to believe that (1) high costs are caused primarily by greedy insurers getting rich and (2) Those greedy insurers are getting rich by denying vast amounts of needed care, much of it apparently founded on deceptive business practices. Never mind, of course, that denial of care reduces health care costs and so (1) and (2) are in conflict with one another.
    Government is the vessel of the power of lobbies and of the misguided public, so I don’t focus my ire on the intermediary. I know you are convinced that government is the instigator, but I still hold out hope that you can stop obsessing about the HMO act of 1973, or whatever, and focus more attention on the present driving causes of our problems. Government is reacting to power, and not just from the “foaming left!”
    Also, when insurers hold back on hard-line negotations over fees with hospitals, they do so not primarily with an eye to government, but with an eye to public opinion. Because they know that even when they are on the side of the angels, as it were, they are going to be condemned as greedy bastards. The public is not convinced that 10% lower medical costs will translate into 10% lower premiums. They have no idea that insurer profit margins are in the low single digits, not 20% like big Pharma. They think that insurers will go from taking 20% of every dollar in premium to taking 30%, which is absolutely nuts. Yet I’d bet that well over half of Americans believe something roughly like this.

  4. I agree Matt that was the most persuasive argument yet for the liberal’s version of reform. It won’t save money, it won’t improve care, it won’t avert the budget crisis, and it won’t work, but by golly it was in Key!
    To follow up on jd’s points, can any of the foaming liberals name one time this supposed anti-trust exemption has been utilized? I live in NV and know very well UHC jumped through hoops to get their two deals done. I have seen a number of mutual companies go public at a cost of billions given to state charities. The only time I have seen anything close to price fixing has been in government mandated regulation. Take it back, it doesn’t mean anything, just another ignorant lefty argument that shows how little they know about the true workings of health care/insurance in America.
    I would also add every time I design a great new took to control cost the government comes along and takes it away, then admonishes me for not doing a better job controlling cost. It’s almost like they want private insurance to fail.

  5. DrWonderful manages to get so much wrong.
    The care is fine? There is an enormous literature on unfounded practice variation and overtreatment, medical errors, failures of care coordination, and defensive medicine waiting for DrWonderful to read it.
    Regarding the anti-trust “exemption:”
    First, it isn’t an exemption so much as giving the states the first priority in regulating insurance, including anti-trust legislation. If states don’t do an adequate job, the Feds can step in.
    Second, the states do often have adequate protections. For example, when United recently purchased Sierra and Pacificare, it had to divest itself of some of its holdings. You can Google it if you missed it the first time around.
    Third, almost all cases in which one insurer so dominates a market that it would trigger anti-trust scrutiny come from Blues plans that have dominated their market since the beginning of health insurance (that’s no hyperbole, the Blues basically created health insurance in the US and they began as something like co-ops). Imposing a uniform federal standard now would only affect about a dozen Blues plans, mostly in rural states. I’ll repeat that: imposing a uniform anti-trust standard now would only affect about a dozen BCBS plans, mostly or entirely in small rural states: ND, MS, AL, etc. How much is that going to change national health care costs?
    Fourth: if you increase the number of insurers and decrease the market share of the largest, you DECREASE the ability of health insurers to negotiate lower rates with providers. You don’t increase it. Since the vast majority of our health care costs come from actually providing and supplying care (only 7% is insurer overhead when you look at the total cost of health care and only 15% is when you look at commercial insurance alone). So, you have diminished the leverage insurers have in controlling 85% of health care costs. I’m not saying they’ve done a good job thus far. They obviously haven’t done a good enough job. But to think they’ll do a better job just because the market share of the largest insurer dropped from 80% to 50% in a given market is really not supported by evidence or theory.
    We need different kinds of change than to keep focusing on scapegoating of insurers. For one thing, we need to either stop paying for quantity and start paying for quality of care, OR we need massive federal intervention to set rates uniformly, impose utilization controls, and destroy the entreprenurial culture of medicine in many places. I’m thinking the former is more likely to occur in the US than the latter.
    Insurers are struggling to keep costs down, it’s just that they aren’t very successful at it because their toolkit is pretty weak. And it’s pretty weak because the stronger toolkit they used for about 5 years in the mid-90s created a backlash (America wasn’t ready for it, and when some insurers got too ham-handed physicians and hospitals were able to swing public opinion decisively against cost controls).
    You write: “One must ask if premiums, co-pays, and deductibles all sky rocket while fees to providers drop yearly…where is the money?” I can answer that one: you posed a trick question. Providers, in fact, are getting more money every year.
    Think about the whole issue of the Medicare rate schedule and that over $200B cut that is threatened but never happens. Why is Congress supposed to cut so many billions from the fees paid by Medicare? Because in an attempt to balance the budget, they wrote legislation in the 90s that forced cuts in rates if total costs increased faster than inflation. Well, total costs have increased faster than inflation to the tune of hundreds of billions of dollars, and since we’re talking about traditional Medicare this money is going to providers, pharma and device manufacturers, not private insurers.
    The fees for old procedures are not increasing, but new procedures are coming in with much higher fees and in many cases these are replacing the use of the old procedures at their lower fees. On top of that, as you must know, physician “productivity” has become an obsession so that more procedures are done now per hour than 20 years ago.
    Seriously, how can you not know this stuff? It’s like Health Care Policy 101.
    Still haven’t viewed the video.

  6. Let’s not miss the point here. We do not need health “care” reform but rather we need health “insurance” reform. The care is fine.
    Having said that we will never actually have health “insurance” reform until the insurance industry loses it’s anti-trust exemption. Currently they are allowed to collude and price fix and very obviously that is what drives up the costs of premiums. If we repeal this exemption they will actually be forced to compete.
    Right now health insurance companies compete for nothing. They do not compete to lower premiums, they do not compete to lower deductibles, they don’t even compete to lower co-pays. They certainly do not compete to keep providers on their panels happy. So we are to believe they want more competition?
    As it is they are massive corprate entities that just lay there and rivers of money flow to them. The only thing they work hard at is developing the illusion that they are suffering and struggling to the keep costs down on behalf of bettering America. They do that so well because…they can collude on a message and then price fix the premiums.
    Do they deserve to keep this exemption? No. If we repeal this exemption would prices plummet…you bet. why? Because they’d actually have to compete.
    One must ask if premiums, co-pays, and deductibles all sky rocket while fees to providers drop yearly..where is the money? Where is the competition? It’s fixed.