Reply #13: that's how you sell group plans [View All]

[zipplewrath]

A not so insignificant portion of the market is in large group plans. Large employers are "self insured", which means that they pay the actual costs of the health care. They just hire insurance companies to "manage" the costs. i.e. do the billing and paying. They "win" those contracts by controlling the costs to the companies. When health care really turned into a commercial, for profit, industry, there was a thought that profit was achieved by controlling costs. It is what really started the HMO movement. It didn't work. Oh, they wrung some costs out of the system, but it didn't really work all that well.

It is one of the true sicknesses of our system. Grayson was only partially kidding about the "die quickly" approach. The reality is that finding and detecting disease early really doesn't save anyone any money. It just runs up the bill, because you don't die. It is much better for the guy paying the bill if you don't get any health care until it's too late. HMO's and managed care were based upon the "early detection" assumption. You could lower costs if you detected disease early. Unfortunately what they found out was that all that does is keep you healthy, so you can get ANOTHER disease they have to treat. Worse, they find "chronic" conditions that require continuous treatment. For the guy paying the bills They'd rather not know you have high blood pressure until you actually die of it.