Maybe I'm Wrong (I Often Am)

[mr715]

But healthcare reform is about getting health care to citizens in need.

It is not about punishing unscrupulous insurance agencies.

Health care reform will save peoples lives but it might not hamstring insurance agencies.

(Senate) HCR opponents, does your dissatisfaction arise from the government not slapping down insurance companies enough?

[RaleighNCDUer]

1. Two points:

HCR is what we ALL want.

This bill is NOT HCR. It is health INSURANCE reform, and the reform is all in favor of the insurance companies. Getting INSURANCE to people is NOT getting CARE to people. Insurance doesn't do a damn bit of good if you can't afford the premiums, deductibles and co-pays. And just because some schmuck in Washington SAYS you can afford the premium doesn't mean you can.

The bill, as it stands, will do more harm than good.

[TheDebbieDee]

4. You're right. That schmuck in Washington that SAYS

you can afford the premiums probably makes $200k a year.

[tavalon]

5. It's actually health insurance bailout

It's not any kind of reform.

[CTLawGuy]

10. im unclear about this distinction

is there something wrong with health CARE, i.e. the means by which doctors et al administer treatments? The fact that people can't pay for and thus don't have access to health care is an INSURANCE problem, isn't it?

[RaleighNCDUer]

13. No, it is not an insurance problem. It is a money problem.

Having insurance does NOT give you money. It only reduces costs if you already have money.

There are plenty of people today who have "good" insurance who can't afford to buy the prescriptions they need, that the doctor they see tells them they need. There are plenty of people with "good" insurance who can't afford the $45 just to walk into a doctor's office.

Right now, I myself, with "good" insurance, have a peculiar sore which refuses to heal with topical OTC anti-biotics, and am beginning to wonder if I should dish out for the doctor visit in case it is some kind of skin cancer. If I am REAL lucky, it isn't, and my visit will only cost $45 for the doctor, $140 for the lab, and $10 for medication. Almost $200 for a minor visit on a minor problem which is easily dealt with (assuming it is NOT something worse) - and that is WITH INSURANCE.

$200 is a stretch for me - and I know there are many, many people who looking at such an expense would continue to do nothing but smear on a little more triple-antibiotic and cover it with a band aide.

Health care has NOTHING to do with health insurance if you have no discretionary money.

[AzDar]

15. + 1

Well-put.

[shraby]

2. It's not slapping down, it's keeping the insurance companies

from stealing the money from the people paying for insurance by not paying for coverage they promised, raising premiums to the point where for many it's the difference between making a living wage and not. It's removing caps on what they will pay. It's keeping the insurance companies from jerking around the doctors when it should be the doctor making the calls on what treatment the patient needs. My nieces husband had lukemia and needed a bone marrow transplant done. The insurance company called it "experimental" and refused to pay until finally after fighting the company a period of time, they relented and it was too late. He died from the lack of the treatment he needed. If you want to call it slapping the insurance companies down, so be it. I call it requiring them to provide the coverage they say they will when a person takes out the policy.

[FrenchieCat]

3. 85/15 vs. 65/35 is the ratio which will not only bring more health care to more people,

but will force Insurance companies to minimize their profits.

That's in the health care bill as well.

[tavalon]

6. How does it force insurance companies to minimize their profits?

[HughMoran]

7. Guess math is not your specialty

lol

[FrenchieCat]

8. From the Senate Bill:

Section 2718 "BRINGING DOWN THE COST OF HEALTH CARE COVERAGE".

‘‘(1) REQUIREMENT TO PROVIDE VALUE FOR PREMIUM PAYMENTS.—
‘‘(A) REQUIREMENT.—Beginning not later than January 1, 2011, a health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan) shall, with respect to each plan year, provide an annual rebate to each enrollee under such coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the issuer on costs described in paragraphs (1) and (2) of subsection (a) to the total amount of premium revenue (excluding Federal and State taxes and licensing or regulatory fees and after accounting for payments or receipts for risk adjustment, risk corridors, and reinsurance under sections 1341, 1342, and 1343 of the Patient Protection and Affordable Care Act) for the plan year (except as provided in subparagraph (B)(ii)), is less than—
‘‘(i) with respect to a health insurance issuer offering coverage in the large group market, 85 percent, or such higher percentage as a State may by regulation determine; or
‘‘(ii) with respect to a health insurance issuer offering coverage in the small group market or in the individual market, 80 percent, or such higher percentage as a State may by regulation determine, except that the Secretary may adjust such percentage with respect to a State if the Secretary determines that the application of such 80 percent may destabilize the individual market in such State.

The language is convulted but the result is simple, insurance companies can no longer make money by ensuring people who don't make claims.

Under the current business model of private insurers the goal is to recruit insurees who in all likelhood won't make claims, while denying those who are certain to either because of pre-existing conditions or simply by falling sick. The bill directly outlaws those practices but under 2718 they wouldn't have the desired effect anyway. Take the hypothetical case where your entire risk pool is made up of healthy young adults whose claims are mostly limited to broken bones from skiing or biking accidents. Under 2718 unless those claims across the risk pool don't add up to 80% or 85% depending the insurer has to rebate the extra premium. At the extreme the company would have to rebate the entire premium and so go out of business having no revenue to even pay employees. Under the new model the only ways to increase profits are one, to compete on the basis of volume, or two to reduce administrative costs, which is a 180 from the current model of hastling claimants into dropping coverage or simply finding excuses to rescind coverage.

Similarly 2718 limits or eliminates the utility of simply raising premiums because it would require a parallel increase of provider payments on an 85 to 15 ratio, otherwise the rebate provision would trigger. And while collusion between provider and insurer can't be excluded the benefits would flow more than 5 to 1 to the provider while the price differential with other plans falls entirely on the insurer. The same effect occurs by eliminating a category of coverage, even if you didn't fall afoul of the Acceptable Benefits Package requirements once again you risk triggering the rebate provision.

The words are not used in the bill but the result is nearly automatic cost controls. And enforcement is relatively easy, most of the information needed to calculate MLR is readily available in SEC filings and IRS returns, you don't need HHS auditors rummaging around in the records, the SEC, the FBI and the IRS are already on the job.

This language is not in the House Bill, at least not with the same effect, and we can expect that insurance companies will start working on the usual suspects to kill the bill on final. Which in my mind is reason tojust get this bill signed to nail 2718 into law.

Because on its own it has many of the same benefits on the overall system that the Public Option was supposed to deliver.
http://www.angrybearblog.com/2009/12/medical-loss-ratio-revisited-cost-and.html


I post about it here.... http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=433x221735

[depakid]

11. It doesn't, as Oregone explained rather clearly

More than that- a lot of that additional money is NOT going toward "producing health" but is being wasted in marketing and administrative costs- a good bit of which is diverted to PREVENTING patients from receiving treatment that they need- or toward denying claims and portions of claims.

[ChicagoSuz219]

9. Health insurance = Healthcare...

...when you don't have one, you rarely have the other.

Certain reforms will go into effect immediately.

Whether or not the Public Option goes into effect now, there will still be opportunities for people to buy cheaper insurance, forcing the insurance companies to become more competitive or go belly up.

Down the line, the Bill can be tweaked and made stronger &/or new Bills can be proposed.

[Bluenorthwest]

12. We will be the first nation ever to mandate purchase of for profit

products. In other nations that mandate purchase, it is a crime to profit from providing those mandated products. So all these people who are pushing the idea that it is great because they will pocket less of your kid's health care dollar to buy Prada shoes are promoting something that would be a crime in say, France or the Netherlands.
To mandate that all citizens contribute to profit under force of discriminatory tax laws will be uniquely American. Other nations see it as a joke on us.

[Vinca]

14. Health insurance companies make money by denying care or

paying bargain basement prices to providers who then make up the difference by gouging the uninsured. The whole thing stinks. Whether you live or die shouldn't be part of any company's profit motive. Who hasn't heard a story of a medical procedure waiting insurance company approval that goes on for weeks and weeks and . . . surprise, surprise . . . the patient dies before getting it. Ka-ching. Ring up more bucks for the insurance company. I despise them.