Category: Private Health Insurance

Anthony Weiner Leaves Joe Scarborough Momentarily Speechless When Arguing for Health Care Reform | Video Cafe

Anthony Weiner Leaves Joe Scarborough Momentarily Speechless When Arguing for Health Care Reform Video Cafe:

“Isn’t it amazing what a little clarity to your argument can bring you isn’t it? Like arguing for real reform instead of the mushy middle. Anthony Weiner did a fantastic job on Morning Joe today and he actually left Scar speechless for a moment when trying to get him to answer just what the insurance industry does to benefit anyone. Of course Scarborough turned that around into ‘You’re arguing for a government takeover of health care’ shortly afterwards, but he never could give any decent defense of why this country needs the insurance industry.”

From Crooks and Liars, what a great video! An articulate advocate for Single Payer.

I’ll ask the question again: What value do private insurers add to health care?

Rationing? Say it ain’t so!

Blue Cross praised employees who dropped sick policyholders, lawmaker says – Los Angeles Times:

But documents obtained by the House Committee on Energy and Commerce and released today show that the company’s employee performance evaluation program did include a review of rescission activity.

The documents show, for instance, that one Blue Cross employee earned a perfect score of ‘5’ for ‘exceptional performance’ on an evaluation that noted the employee’s role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint’s Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

‘When times are good, the insurance company is happy to sign you up and take your money in the form of premiums,’ Stupak said. ‘But when times are bad, and you are afflicted with cancer or some other life-threatening disease, it is supposed to honor its commitments and stand by you in your time of need.

‘Instead, some insurance companies use a technicality to justify breaking its promise, at a time when most patients are too weak to fight back,’ he said.

Lawmakers — Republicans and Democrats alike — decried the practice of canceling policies of ill policyholders and grilled insurance executives about it.

Health Affairs – 2 articles on the cost of private insurers to the system

Two articles from Health Affairs regarding the cost of Private Health Insurers, for profit and not for profit, to physicians’ practices, bottom lines, time and aggravation.

Peering Into The Black Box: Billing And Insurance Activities In A Medical Group — Sakowski et al. 28 (4): w544 — Health Affairs:

“Billing and insurance–related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician. In addition, clinicians spent more than thirty-five minutes per day performing these tasks. The cost to medical groups, including clinicians’ time, was at least $85,276 per FTE physician (10 percent of revenue).”

What Does It Cost Physician Practices To Interact With Health Insurance Plans? — Casalino et al. 28 (4): w533 — Health Affairs: “Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least $23 billion to $31 billion each year.”

Study Links Medical Costs and Personal Bankruptcy – BusinessWeek

Study Links Medical Costs and Personal Bankruptcy – BusinessWeek:

“Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.

“Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings. This newest, nationwide study, conducted before the start of the current recession by Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School, Elizabeth Warren of Harvard Law School, and Deborah Thorne, a sociology professor at Ohio University, found that the filers were for the most part solidly middle class before medical disaster hit. Two-thirds owned their home and three-fifths had gone to college.”

The abstract is here, I cannot access the full text, unfortunately.

Missoulian: Single-payer mentions draw cheers at Baucus-sponsored health care talk

Missoulian: Single-payer mentions draw cheers at Baucus-sponsored health care talk

The hearing ranged broadly over the possibilities for reform, but what clearly resonated for McArthur was something Baucus’ chief of staff, Jon Selib, said a couple of times.

Discussing why a single-payer system of health insurance wasn’t viable, Selib made reference to the more than 150 million Americans who are covered by some sort of employer-provided health care.

“A lot of people like that,” Selib said.

When the time came for questions, McArthur stood up and asked a simple question. Looking across a standing-room-only crowd of about 275, he asked how many were happy with their employer-based health insurance.Less than 10 people raised their hands.

“The number is bogus,” McArthur said. “It’s not working for 95 percent of us.” McArthur drew resounding applause.

In fact, any mention of single-payer health care insurance brought raucous cheers and clapping.

Any other solution to health care reform – including Baucus’ “balanced” plan that would create a mix of public and private plans – was received more coolly.

Tuesday’s session was one of a handful of events Baucus is sponsoring around the state this week. He chairs the Senate’s powerful Finance Committee, and is the point man on health care reform.

He did not attend Tuesday’s meeting, but Selib did, and he heard what the senator himself has heard since he announced that single-payer wasn’t really on the table.

As Selib worked to massage that point, one man barked out, “Oh bull—-.”

Tom Roberts, president of the Western Montana Clinic and moderator at the session, asked the crowd to be civil, but the man had made his point.

McKinsey: What Matters: Way too much for way too little

McKinsey: What Matters: Way too much for way too little

The title says it all. A great review of the American health care non-system.

Goes over administrative waste (83 cents of premium dollars go to actual health care at most in PHI market), outcomes, costs and prices, administrative burden, practice variation, and rationing (QALY’s CER).

Some good response letters as well.

COST: Is This What They Went to Med School For? | New America Blogs

COST: Is This What They Went to Med School For? New America Blogs:

Excellent summary by Joanne Kenen at New America:

“Two new studies released this week online by Health Affairs examine how health care providers, particularly physician practices, interact with insurers. One study found that doctors personally spend the equivalent of three full weeks a year on billing and related insurance information. The overall cost to their practices (their time as well as other medical and clerical personnel) was about $31 billion a year (in 2006)—which as study author Larry Casalino noted, was about six times what we spent at the time on the State Children’s Health Insurance Program and nearly 7 percent of total national expenses on physician and clinical services. Primary care practices spent more time on these administrative tasks than specialists. Very little of the data—only about two hours a year for the doctor—pertained to quality data.

“The second study looked at the billing and insurance-related activities at one large multi-site, multi-specialty California group practice. The cost (in physician and clerical time) turned out to be $85,276 per physician, or 10 percent of operating revenue. (And that excluded the time the doctors spent recording procedure and diagnosis codes). And this California practice isn’t bogged down in paper; they already use electronic medical records for both clinical and billing data. (Some older studies, before medicine began its slow and not always so steady migration to Health IT, showed even more time and money spent on administration in the days of pure paper.)”

Additionally, from the second paper:

Impact of complexity. Previous reports have suggested that the complexity inherent in the current multipayer financing system is responsible for increasing the administrative burden associated with medical groups’ transaction processing.15 During our interviews, informants frequently described the contributions of complexity in the payment system to billing and insurance burden. For example, the patient population of our study site is covered by hundreds of insurance plans, each with its own rules about benefits covered and under what conditions, payment rates, and often billing procedures. This complexity adds burden to billing and insurance tasks, including procedure coding, drug formulary authorizations, discussions with patients, submission and appeal processes, and receipt of payments. The complexity also increases the chance for error and dispute, increasing the likelihood of payment follow-up and collections. Even high-deductible plans, which might appear to avoid administrative burden for initial services during the year, impose billing/insurance costs because each service, including those within the patients’ deductibles, must be evaluated and processed.

I’ve also classified this under Physician Income and Physician Autonomy, because these burdensome duties and their concomitant expenses impact both significantly. If you think your PHIs are paying you more than Medicare, you need to factor this into the equation.

Senate Finance Committee Hearing on Expanding Health Care Coverage

“Roundtable Discussion on “Expanding Health Care Coverage”
May 5 , 2009, at 10:00 a.m., in 106 Dirksen Senate Office Building

Over at the PNHP Blog, Don McCanne points out that the voices for single payer are being stifled and excluded because of the view of most in the Congress that it is a politically unviable proposition, though he “respects” their views.

Even more problematic was an exchange later in the hearings between Sen. Pat Roberts and Scott Serota, CEO of the Blue Cross and Blue Shield Association.

Sen. Roberts told the tale of how a group of surgeons and anesthesiologists surrounded him after his knee surgery and told him and said they’d all quit if we went to a national health plan or even, I believe, to a public option and their reimbursements were to be decreased.

I don’t have the transcript, but he went on to say something along the lines of how there was no way to control costs in a national health system and then asked Serota what he thought.

Of course, Serota explained in that patrician way of so many how there was no way in the world to produce high quality and lower costs than we have in the US now with private insurance.

Now, if Sen. Baucus doesn’t want single payer advocates around because he doesn’t think it is politically viable, that is one thing. But what he doesn’t seem to realize is that having a knowledgeable single payer advocate and someone knowledgeable about international comparative health care in the room would have resulted in the particular line of BS that Roberts and Serota were peddling to be swatted down without breaking a sweat.

That is why it is so critical to have a broader range of views at the table. There was no one there willing to point out the obvious: Reducing future surgeons’ income from $500 K to $400 K, for example, will not bring the world to a halt. Essentially every country in the world controls costs and maintains quality at massive savings compared to the disastrously inefficient US private insurance industry.

But there was no one at the table willing to tell them that.

Insurers shun those taking certain meds – Costs of Care – MiamiHerald.com

Insurers shun those taking certain meds – Costs of Care – MiamiHerald.com:

“Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

“This confidential information on some insurers’ practices is available on the Web — if you know where to look.

“What’s more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

“These issues are moving to the forefront as the Obama administration and Congress gear up for discussions about how to reform the healthcare system so that Americans won’t be rejected for insurance.”

No surprises here, just documenting.

But it does make an interesting contrast to a letter written to the New York times on their piece on a public insurance option by a rather alarmist (and ill informed) physician:

“The unfair competition from a public plan would destroy the private health insurance industry. The inevitable result would be the rationing and other horrors of a Canadian-style single-payer system, which most Americans neither wish nor deserve.”

Rationing, in America! God forbid.

The Concerns of “Harry and Louise” circa 1994

YouTube Link to videos here.

Because my daughter is working on her undergraduate thesis on comparing the health care reform policy environment in 1994 and now, we were looking at the old Harry and Louise videos.

It is funny, because there are two issues raised in the commercials. In the first, set “Sometime in the Future,”the concern is about having to choose among “insurance plans designed by government bureaucrats” and the lack of choice among doctors, hospitals, etc., should this happen. And the cute little line about, “Remember our old plan? That was a good one.”

Well, of course, those ships have all sailed. Our insurers now dictate our provider choices ever more restrictively. If you’ve ever changed your insurer, you probably have come to terms with looking through the provider book and figuring out which PCP practice to switch to, whether to go “out-of-network” to keep your old specialists, and whether to drive to a new hospital in your network. Unless, of course, you are in a federal plan, designed by bureaucrats, which generally will provide you with substantially more choice than your private plan.

It’s also worth saying that in most markets, insurance consolidation has resulted in ever dwindling choice in private insurers. So, the choice thing? Not so much.

The second commercial talks about the dangers of “community rating” to the premiums of the younger and healthier. This is exactly right, and Uwe Reinhardt has been warning about this lately. If not forced to buy insurance, those who are at lower risk of needing health insurance will opt out, driving up the premiums for those buying insurance, particularly small employers who can’t spread the risk out. A genuinely fair concern that is still in the mix of issues that need to be dealt with today.

So, how to deal with it? Everyone must be in. We must accept the societal bargain that when we are healthy, we subsidize those who are not. When our kids are healthy, we subsidize our neighbors’ kids with diabetes and autism and cancer. When our parents have chronic illnesses, we spread the risk amongst us all.