Looks like Medicare has the highest denial percentage. That's run by what insurer?
Its a numbers game. Theres about 43 million people on Medicare, and 53 million on Medicaid (as of 2006). In the summer, the conservatives were complaining that there was something like 160 million people that were 'happy' with their coverage and that the PO would only cover about 14 million more people.
Anyway, lets make a grand assumption that out of the 160 million insured, there are 43 million on medicare. So you have about 120 million in private insurance and 40 million (for simplification) on medicare. Thus private insurance is 3x larger and if the rates are the same, the private insurance is still denying a larger number of people from a healthier pool of enrollees. The average rate among those in that chart is 3.8 which means Medicare would have to deny 11.66% of its claim to be on par with the private industry.
If medicare enrollees are not part of that 160m, then that chart is even more misleading.
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As is the propaganda that there is wide spread denials of claims for the sake of profit taking.
Yes, in the form of former execs, underwriters, etc. giving their accounts of their practices from working in such firms. So misleading.
Care to actually address what I wrote about your graph?
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"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
I'm on Medicare, and find it very comprehensive, along with my retirement supplemental program. Medicare is VERY straight forward about what they do not cover in my experience. The issue really has not come forward for me, I understand that some experimental treatments are not covered. They tend to err on the generous side of things.
Yes, in the form of former execs, underwriters, etc. giving their accounts of their practices from working in such firms. So misleading.
Makes you wonder what the thinking is at Medicare - they're denying claims and losing money. And getting ripped off.
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Care to actually address what I wrote about your graph?
So if every one of the Medicare recipients (40 million) filed a claim 2.7 million would be denied and if all the insurance policy holders (120 million) filed a claim 4.6 million would be denied. Is that what you were getting at?
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Makes you wonder what the thinking is at Medicare - they're denying claims and losing money. And getting ripped off.
Its interesting that you use denied claims, losing money, and getting ripped off in the same argument without addressing the endogeneity of those factors. In any case, everyone is losing money right now (unless you work for Goldman Sachs) and SS/Medicare is very much tied to the economy.
As RobLL said, Medicare also lets you know up front what is and is not covered, unlike an insurance company which can rescind you at any time for anything you (or your parents) deliver. As the exec at Cigna and others have showed, what they are NOT thinking is how to trim as many unprofitable people as possible.
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So if every one of the Medicare recipients (40 million) filed a claim 2.7 million would be denied and if all the insurance policy holders (120 million) filed a claim 4.6 million would be denied. Is that what you were getting at?
Yes, on average.
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"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
This information has been hard to collect. A NYT article regarding a senate investigation reports as little as 66% of collected premiums goes to hospitals, doctors, etc. Large companies get about 84% pay out and small businesses 80%. My view on this is that there is a place for private insurance but it should be able to come within 3-5% of Medicare "loss ratio", i.e., payout.
Lulz, heres a run down of the Republican proposal which is basically tax cuts, allow current oligopolies to compete across state lines, creating separating equilibria, and tort reform Turns out to be more expensive and shuts out more people. I do agree with the analysis at the end about Obama.
In many ways, it's helpful and clarifying. The biggest news, it seems to me, is that the CBO judges medical malpractice reform to be capable of saving $41 billion over ten years - not exactly a fiscal life-saver but a measurable idea to control costs a little better. I see no reason why it should not be in the final bill. The bill also claims to prevent insurance company discrimination against pre-existing conditions, and sets up high-risk insurance pools. The result would be around a 3 percent reduction in premiums for most people in big company plans. It will cut close to $70 billion off the deficit in the next ten years.
Does it actually tackle the question of covering the 40 million or so people without access to insurance? No, it does not. It could insure an extra 3 million tops. Vast numbers of people would be shut out of access to insurance because they just cannot afford it. The GOP's response to this is: we cannot afford to help right now. Which is honest enough. But it doesn't exactly counter the fact that, according to the same CBO, the Democrats bill would save $104 billion off the deficit in the same time period. So, if affordability is what's at stake, why not back the Dems?
The honest answer to that would be: those CBO numbers won't reflect the final cost and the risks of such an ambitious scheme are too great for this moment of fiscal crisis.
And that's why this counter-proposal is helpful. It frames the core question here sharply: do we want to risk more fiscal imbalance by dramatically increasing the number of people with access to health insurance? Given everything else the federal government spends money on, my answer is: yes. With the proviso that real attempts to cut spending elsewhere - by raising Medicare premiums for the wealthier, by gutting corporate welfare, by deleveraging two unending wars - it's a good thing to do.
But that means that the flipside to this new endeavor must be a serious and persistent attempt to tackle the fiscal crisis after health insurance passes. If Obama wants to reassure independents that he is not another borrow-and-spend president, he will have to pivot off health insurance to steep entitlement and defense budget reform.
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"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
Debate is going on in Congress all day. Boehner & Co. are resorting to last minute scare tactics but their bullshit lacks any substance. It looks like the D's got the votes.
The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.
Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.
At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.
The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.
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Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.
How would this not increase the cost of health insurance for healthier people? If everyone is in the same pool, then won't premiums have to go up? Or are we to assume the insurance companies are currently making enough profit that it will cover the difference?
Also, I would imagine most younger people will get the lowest coverage possible, and then swap to a higher coverage if anything goes wrong. Won't this also cause problems?
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How would this not increase the cost of health insurance for healthier people?
They will go up regardless of whether you have a separating equilibria (as the current system has and premiums have gone up hundreds of percent over the last 10 yrs) and relegate people to ER for their primary form of care. The reason is because health care costs are multifaceted and tied to the general state of the economy. The free-marketeers should be hailing the anti-trust exemptions as this should force companies to provide a product and promise that is worth a damn, and also reduce the market power that has allowed for the increasing trends in insurance premiums.
Market power rarely benefits the consumers, insurance is no exception. With private insurance, there is ALWAYS market failure.
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If everyone is in the same pool, then won't premiums have to go up?
Pooling contracts are more profitable than separating contracts from a revenue and cost standpoint. So on that point no. The problem is that another company can come along and offer a better contract closer to something that healthy people would one and thus take away the more 'profitable' people. This assumes perfectly competitive markets (which insurance def does NOT have) and it is assumed that people have the option of buying no insurance (which is not happening under the Dem plan).
When you dont have those two things and you have a government option, people who didnt buy insurance will see 'increases' in premiums from 0 to whatever (just as one would if they bought a car). People can pay more based on their risk (again like car insurance), but they cant be denied coverage. Nowhere does the plan say you cant discriminate premiums if you want to for pre-existing conditions, you just cant deny coverage based on pre-existing conditions.
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Or are we to assume the insurance companies are currently making enough profit that it will cover the difference?
Not in and of itself, but more competition would definitely erode the profitability of insurance companies to pay such extravagant compensation and hence, either build up their product or face a price war. The fact that people can still sort themselves into plans and market power has been curbed will severely reduce insurance company profits, but Im not shedding tears over that.
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Also, I would imagine most younger people will get the lowest coverage possible, and then swap to a higher coverage if anything goes wrong. Won't this also cause problems?
Meh, you can always add coverage, even with the PO. Doesnt meant that its free or that it works retroactively. The PO isnt meant to be all encompassing, so if you want additional insurance beyond the PO, you have to buy it on your own. Kinda like car insurance. The law of averages will work here too, youll have people who are very cautious and will over insure even though nothing will happen to them, youll have some who get a regular amount, and then you have people who are so sick that they max out their insurance.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
People can pay more based on their risk (again like car insurance), but they cant be denied coverage. Nowhere does the plan say you cant discriminate premiums if you want to for pre-existing conditions, you just cant deny coverage based on pre-existing conditions.
That's interesting -- I didn't know that. So health insurance will work exactly like auto, life, and homeowners insurance? You pay more if you're a higher risk?
It makes perfect sense, but I never thought of it that way.
That's interesting -- I didn't know that. So health insurance will work exactly like auto, life, and homeowners insurance? You pay more if you're a higher risk?
It makes perfect sense, but I never thought of it that way.
I dont own a home so I cant comment on that. But short answer is yes. You cant discriminate on sex or medical history for coverage or insurance (esp retroactively). If you need more coverage because you are extra cautious or are in medical need then you have to purchase more insurance. So its not an all encompassing free-for-all where one size fits all.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
Just read about a guy on a randonneuring thread who has made a hugely impressive bike trip to the Arctic circle and now is on another journey: learning to walk again after he fell from a ladder inside his house.
It seems that he'd have greatly benefited from a better health care system as it seems he's losing the house he's built himself because costs are crippling.
As for my opinion: not sure.. we have paid-for health care in our country but it's not always optimal. Seems the situation is worse in the UK where it's even more 'standardized'. Trouble is.. once you socialize health care it gets mediocre in quality . The main problem in the US seems to be the too high costs of lawyer insurance for medical professionals. But I'll back out now..
The main problem in the US seems to be the too high costs of lawyer insurance for medical professionals. But I'll back out now..
That's one factor, but probably not the main factor. Put glibly, I think the main factor is a tendency towards "overtreatment", i.e., investigating and treating too many people too aggressively when there isn't really much evidence for benefit.
Ever watch House? It's a good show, excellent actors, but they never show the patient getting the bill at the end. He'd be back in ICU with a heart attack.
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"A government big enough to give you everything you want is a government big enough to take from you everything you have."
People can pay more based on their risk (again like car insurance), but they cant be denied coverage. Nowhere does the plan say you cant discriminate premiums if you want to for pre-existing conditions, you just cant deny coverage based on pre-existing conditions.
I completely misunderstood this part. I thought part of this meant pre-existing conditions couldn't be included in calculating the premiums. This is good to know. But couldn't insurance companies just set a huge premium, which would in effect deny them coverage?
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"So many of our dreams at first seem impossible, then they seem improbable, and then, when we summon the will, they soon become inevitable."
- Christopher Reeve
I completely misunderstood this part. I thought part of this meant pre-existing conditions couldn't be included in calculating the premiums.
No. The company can offer you basic care coverage, and if you need more than what they offer (when you sign up), then you need to consider that. But if I have a plan Ive agreed to, and I get some sort of illness along the way, my company cannot charge me more or rescind me for a 'pre-existing' condition. This is as the house bill stands now. They still have to combine it with a senate bill and make something out of this, so stuff can change.
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This is good to know. But couldn't insurance companies just set a huge premium, which would in effect deny them coverage?
Depends on the pricing scheme and market power of the insurance company. Currently, thats possible, but its sometimes more profitable just to rescind. When you get rid of anti-trust protection, recission, and price gouging, you cant really separate your plans like that as much.
The reason is because as the market becomes more competitive and you inhibit the ability to discriminate among customers (i.e. ban gender ratings and remove pre-existing conditions), it is more profitable to pool people and charge a weighted average based on the probability of your customers being healthy or not, rather than to discriminate your pricing so much. The problem up til now is that it hasnt been enforceable when people have the option to opt out of insurance (but the bill prevents that) or when youre a monopolistic insurer.
Somewhere in the middle of this, there will be someone who is in the situation where this setup still doesnt function. It is an illusion to think that the insurance market is going to become 100% perfectly competitive, and since insurance is attempting to deal with the market failure of adverse selection, there is ALWAYS of risk of things breaking down for some groups. The answer to that is the public option and/or medicaid.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
.....
The reason is because as the market becomes more competitive and you inhibit the ability to discriminate among customers (i.e. ban gender ratings and remove pre-existing conditions), it is more profitable to pool people and charge a weighted average based on the probability of your customers being healthy or not, rather than to discriminate your pricing so much. The problem up til now is that it hasnt been enforceable when people have the option to opt out of insurance (but the bill prevents that) or when youre a monopolistic insurer.
Somewhere in the middle of this, there will be someone who is in the situation where this setup still doesnt function. It is an illusion to think that the insurance market is going to become 100% perfectly competitive, and since insurance is attempting to deal with the market failure of adverse selection, there is ALWAYS of risk of things breaking down for some groups. The answer to that is the public option and/or medicaid.
GQ - usually your economic comments are spot on. In this case, you are, imho, missing the point. The key drivers for effective insurance are diversity and price discrimination. What the house bill envisions effectively guts the theory behind insurance.
A National Requirment tending towards - community ratings, expansive mandates for coverage, and no price discrimination are completely at odds with our current system - no matter how you feel about that system right now.
The congress has taken a couple of simple tasks - expand coverage, create some degree of portability, and reduce costs - and transmorgrified it into a wholesale rework of the system. A rework that will not and can not pay for.
GQ - usually your economic comments are spot on. In this case, you are, imho, missing the point. The key drivers for effective insurance are diversity and price discrimination. What the house bill envisions effectively guts the theory behind insurance.
Those are effective drivers because theres always a cream skimming effect and people have the option to opt out of insurance, hence leaving a perfectly competitive firm in an unprofitable position. In reality, people cannot opt out and firms are not competitive, so the firms are making an excess profit out of this system and it is safer for the firm to move towards a pooling equilibrium for general coverage.
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A National Requirment tending towards - community ratings, expansive mandates for coverage, and no price discrimination are completely at odds with our current system - no matter how you feel about that system right now.
Do you feel car insurance is not effective? There is diversity and price discrimination the coverage of autos for both driving history and the moment you get into an at-fault collision, as well as universal mandates (usually liability) if you own a car. Akin to that, everyone would need some sort of 'liability' health insurance, and those that want/need more elaborate schemes or coverage will have to pay extra for that. Since companies will eventually not be able to take history into account, they will have pool their pricing and then offer tiered care. If its too expensive someone in need, then the public option will have to address this market failure (which claims to offer cheaper and more effective health insurance in the first place).
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The congress has taken a couple of simple tasks - expand coverage, create some degree of portability, and reduce costs - and transmorgrified it into a wholesale rework of the system. A rework that will not and can not pay for.
Ironically, it saves more and covers more than the Republican plan that basically consists of tax cuts, allow current oligopolies to compete across state lines, creating separating equilibria, and tort reform. I have also pointed out that if Obama is serious about deficit spending, then after this health insurance reform his focus needs to be on military spending cuts, and I would add tax reforms to encourage hiring but tax profits and meaningful financial/banking reform. Getting out of the ME would be fiscally prudent as well.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
On another thread we touched briefly on efficiency -- getting more work out of fewer people.
Is there any industry other than health care in which we now have more people processing paperwork, rather than fewer? If I go to a doctor I haven't seen in a year or two, inevitably there are more people working in the office than there were the last time.
We know why they're there. Insurance companies look for reasons not to provide coverage, so doctors need more people in the office to make sure claims go through so they can get paid. I assume there are more people at the insurance companies as well.
And the end users of health care have to spend more of our time triangulating between the doctors' offices and the insurance companies to make sure we get what we've paid for.
That's why I get a kick out of hearing anti-reform protestors complain about the size of the bill, like something with a lot of words has to be bad for America. Never mind the volumes of paperwork insurance companies generate that are deliberately opaque to consumers. That type of Byzantine complexity is okay, but a law reforming the industry is supposed to look like a series of Twitter posts.
Just tossing something out, don't think it is controversial. It has struck me that 'medical insurance' as a term is somewhat of a misnomer. House insurance, auto insurance, term life insurance, even flood and earthquake insurance are classic examples of insurance. One can easily envision going a life time without collecting. Medical coverage is in a lot of ways more akin to a utility. Most of us are going to be heavy users several times during our lifetime. It seems to me that this confusion in the dynamics of financing health care muddies the water in serious ways, and contributes to the problem.
Those are effective drivers because theres always a cream skimming effect and people have the option to opt out of insurance, hence leaving a perfectly competitive firm in an unprofitable position. In reality, people cannot opt out and firms are not competitive, so the firms are making an excess profit out of this system and it is safer for the firm to move towards a pooling equilibrium for general coverage.
firms are not competitive because there is no unitary market. if this is a "National" problem, then the first ox to gore should be the state insurance regulators - but political solutions don't usually require the sacrifice of other politicians.
Do you feel car insurance is not effective? There is diversity and price discrimination the coverage of autos for both driving history and the moment you get into an at-fault collision, as well as universal mandates (usually liability) if you own a car. Akin to that, everyone would need some sort of 'liability' health insurance, and those that want/need more elaborate schemes or coverage will have to pay extra for that. Since companies will eventually not be able to take history into account, they will have pool their pricing and then offer tiered care. If its too expensive someone in need, then the public option will have to address this market failure (which claims to offer cheaper and more effective health insurance in the first place).
I hope we are not talking past each other. of course auto insurance works 1) it is optional - you don't have to drive 2) the number of required mandates is very low and 3) the firms can price discriminate.
auto insurance also provides a good example for the uninsured. private firms are required to take a number of participants from the general pool "the uninsurable" in order to do business in that locality. why couldn't that mandate be a model for expanding health ins?
Ironically, it saves more and covers more than the Republican plan that basically consists of tax cuts, allow current oligopolies to compete across state lines, creating separating equilibria, and tort reform.
This an unknown. to date the congress has been unwilling to inflict the cost suts on either medicare or seniors that already exist in law. on what basis are we to assume the congress will start to behave this way.
I have also pointed out that if Obama is serious about deficit spending, then after this health insurance reform his focus needs to be on military spending cuts,
it is somewhat ironic to see a call for reduced military expenditures (see previously clinton cashes in the peace dividend 92-96) on the 20th anni of the fall of the wall
and I would add tax reforms to encourage hiring but tax profits and meaningful financial/banking reform. Getting out of the ME would be fiscally prudent as well.
On another thread we touched briefly on efficiency -- getting more work out of fewer people.
Is there any industry other than health care in which we now have more people processing paperwork, rather than fewer? If I go to a doctor I haven't seen in a year or two, inevitably there are more people working in the office than there were the last time.
We know why they're there. Insurance companies look for reasons not to provide coverage, so doctors need more people in the office to make sure claims go through so they can get paid. I assume there are more people at the insurance companies as well.
And the end users of health care have to spend more of our time triangulating between the doctors' offices and the insurance companies to make sure we get what we've paid for.
That's why I get a kick out of hearing anti-reform protestors complain about the size of the bill, like something with a lot of words has to be bad for America. Never mind the volumes of paperwork insurance companies generate that are deliberately opaque to consumers. That type of Byzantine complexity is okay, but a law reforming the industry is supposed to look like a series of Twitter posts.
Lou - lots of things are more complicated - I haven't "tuned" my cars in years. yes there is more paperwork, but it is not just insurance companies - they are just too easy a target.
I have a friend here in Boston who works as a Periodontal Surgeon. His problems are with the state & medicare. His private insurance pays right away. They also pay more, as the state & medicare schedule doesn't pay him enough to run his practice.
firms are not competitive because there is no unitary market. if this is a "National" problem, then the first ox to gore should be the state insurance regulators - but political solutions don't usually require the sacrifice of other politicians.
Im not convinced of the unitary market argument because on average, there has been increasing agglomeration over the last 15 years among health insurance firms and the same handful of insurance companies have at least 75% of the market in every state. With anti-trust protection, Im skeptical that these same companies wouldnt be oligopolistic if state line rules were erased.
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I hope we are not talking past each other. of course auto insurance works 1) it is optional - you don't have to drive 2) the number of required mandates is very low and 3) the firms can price discriminate.
Firms can still price discriminate on the basis of how much coverage you want, just not on medical history or retroactive reasons to deny current coverage (i.e. pre-existing conditions). As for opting out, yes you dont have to drive, but if you do drive you have no choice. For health insurance, theres no analog to not driving (maybe choosing not to get any medical care no matter what) but that goes against the healing mission of the medical field. As long as we as a society find that morally unacceptable, then the alternative is to mandate insurance.
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auto insurance also provides a good example for the uninsured. private firms are required to take a number of participants from the general pool "the uninsurable" in order to do business in that locality. why couldn't that mandate be a model for expanding health ins?
Because, as you said, the number of required mandates is low. Given that firms are monopolistic or at best oligopolistic, a high mandate basically tells them that they need to take up these uninsurables. If you keep the mandate low, this results in shelving the coverage problem and the problem of overuse of the ER.
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This an unknown. to date the congress has been unwilling to inflict the cost suts on either medicare or seniors that already exist in law. on what basis are we to assume the congress will start to behave this way.
The CBO estimates just look at the effect of inserting either plan given the current and projected economic forecasts. Of course congress can muck things up further down the road.
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it is somewhat ironic to see a call for reduced military expenditures (see previously clinton cashes in the peace dividend 92-96) on the 20th anni of the fall of the wall
Indeed.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
They also pay more, as the state & medicare schedule doesn't pay him enough to run his practice.
I keep hearing about how medicare pays so little that many Physicians won't take it.
However that is not the case here in Florida.
We have physicians up the wazoo where I am. Whenever I've called for an apppointment for my wife or I they give us one right away.
And everytime I've ever been in a waiting room practically everyone else in there is on medicare.
The Docs seem to be thriving on it.
At least they have big houses and nice cars.
Maybe it's because they are so many old farts down here with medicare that it works so well, which leads me to believe if everyone had Medicare it would work fine everywhere, just like it does in Canada.
Differing states have differing compensation to medical providers. Ironically the more efficient a state is at providing good care at lower prices the lower the rate. Florida is one of the least efficient states at providing medical care. It is a national scandal that all of this is so.
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