My experience with private insurance before the ACA, and my thoughts re the viability of Obamacare.
FYI, gjohnsit has another fine essay out today, focusing on Obamacare. Originally I wanted to leave these words as a comment in that essay, but quickly realized that it would have been far, far too long, and so I decided to write my own "essay" instead. This piece is a collection of certain of my prior comments on TOP; I hope readers will find them useful. For those who are refugees from TOP, let me preface this essay with the fact that I tried to educate Brainwrap about HRC and Obamacare over on TOP, but in the end he chose to never shift in his support for HRC. Most of the comments below were addressed to Brainwrap.
http://www.dailykos.com/comments/1472738/59108032
Brainwrap, I've been following you for a while, but I disagree with you on this one.
I actually left an employer because of healthcare reasons — after working several decades for the company they decided that they would no longer subsidize future retiree insurance. At that point I learned the hard way about the realities of private insurance before ACA. Basically, they owned the bat and the ball, and if you didn’t want to play the game their way you had no choice but to go home.
During that time I learned that health insurance companies are basically heartless corporations that just want to make $$$, they LITERALLY don’t care whether people live or die. And they had discovered that they made the most money by doing their best to limit enrollment only to healthy people who don’t really “need” insurance because they basically are not sick. They were essentially doing their best to limit healthcare to only the people who did not need care. Because if you are sick, and you do need care, that was/is EXPENSE that ate/eats into their profits. The b*stards were doing stuff called “rescinding coverage” — i.e. RETROACTIVELY CANCELLING insurance when the insured (even for many years) became critically sick with something like cancer. At that point, they would scan the application that had been made years and years before, and if the applicant left off any prior condition on their app, as trivial as toe fungus, they would cry FRAUD, and leave the poor newly diagnosed cancer patient in a horrible, horrible state. I’ve had to fill out several of those d*mn applications, trying to remember every single friggin illness everyone in the family has had for the past ten years was not a trivial task, and anyone who never had the “pleasure” of filling one of those d*mn things out should keep that in mind.
Two takeaways for me were: 1) my prior employer, a large corporation, basically took a morally questionable action in the name of increasing their own profits, and 2) the health insurance companies, other large corporations, were doing morally repugnant things in the name of increasing their own profits, including withholding care to dying people and critically ill infants.
Large corporations have the personalities of psychopaths, did you know that? Their power over out country increases every day.
Also during this time I grew to become an incredible fan of Wendell Potter. Do you know him? You must, he was like a God during the ACA process — Bill Moyers did a fab interview, Wendell Potter on Profits Before Patients. Anyhow, he wrote a very interesting article early last year: Elimination of ‘Public Option’ Threw Consumers to the Insurance Wolves
When he was running for president, Obama regularly talked about the need for a public option. That was one reason why many health care reform advocates supported him instead of Hillary Clinton.
He kept insisting on a public option for months after he was elected. He said on July 18, 2009, “Any plan I sign must include an insurance exchange—a one-stop-shopping marketplace where you can compare the benefits, costs and track records of a variety of plans, including a public option to increase competition and keep insurance companies honest…”
Soon after that, though, he began to waffle. It became clear to me as well as public option supporters in Congress that industry lobbyists had gotten to him [...]
Knowing the industry as I did, I told the committee that if Congress failed to create a public option to compete with private insurers, “the bill it sends to the President might as well be called “The Insurance Industry Profit Protection and Enhancement Act.” Pelosi insisted that Congress had no intention of doing that.
The public option was the key mechanism that would keep insurance prices low. We are in an incredibly lousy place right now, as we are legally required to buy a product that is exempt from the Sherman Anti-Trust Act. And the insurance prices are starting to rise as a result.
Fixing the medical loss ratio to 80%/85% was a good thing, but the insurance companies are playing games to redefine the meaning of “healthcare” so that they can put non-healthcare expenses into that category to further increase their profits. Medicare has a ratio of about 95% according to Potter. For the insurance companies, it’s like shooting fish in a barrel, and we are the fish. We are the fish.
We need a politician who is willing to fight the powerful insurance industry so that us lowly common people aren’t eaten alive. I now think of banks and insurance companies almost like vampires, they want to keep us just barely enough alive so they can feed off of us and suck as much as they can out. I seriously doubt that HRC is that person, she is more into political expediency these days. And so I think you are gravely mistaken casting your vote based primarily on your wonky analysis of the healthcare programs that have been put forward. Promises are made during elections — for things like the public option, remember? — but they those promises get forgotten once the office holder gains power.
Many of us thought that the public option got pulled off the table far too early, remember? Good negotiators know that you start your bidding at a price that is much more than you want, so that during the negotiation you can “move to the middle” and end up at a price that you still like. It occurred to me that by asking for Single Payer at this point in the process, Sanders might very well be “starting with a very high price” in order to be in a better negotiating position. The logical, logical path forward to single payer is to simply offer a Public Option to the ACA. This very well might be Sanders short-term goal, for the many reasons that you mention. Any idiots who want to buy their expensive insurance from “private insurance compainies” can continue to do so, but others like me will choose the public option. And over time, more traffic will go to the public option and less to private insurance, and voila, single payer becomes a much more logical goal to all concerned (except the vampires).
Bill Clinton signed NAFTA with promises of “it will increase good-paying American jobs”, and he signed the bill that kill Glass-Steagall (which the banking industry had been seeking for decades, at least) and low and behold the stock market cratered enormously a few short years later. I don’t trust that Hillary Clinton will always have the best interests of the 99% in mind. I respectfully urge you to reconsider your position.
http://www.dailykos.com/comments/1473410/59134520
Brainwrap, you wrote:
So, what does Hillary Clinton have to say about her plans for healthcare in America, beyond her promise to generally defend and improve the Affordable Care Act? Well, she's posted the following "factsheets", each of which is at least as detailed as Bernie's entire 5-page single payer outline to completely overhaul the entire U.S. healthcare system (I'm only posting the main bullet points; the actual links give far more in-depth discussion of each):
How did you come across these magic URLs? They are not on HRC’s Issues/Healthcare page, and that seriously concerns me.
At this point I’m not going to even comment on the contents of these sheets, just say that it they are not prominently visible on the website, if they are merely buried deep in secret URLs, then it makes it difficult to hold her accountable to those promises once she is elected.
The second thing I want to say is that you are making many assumptions about implementation aspects of Sanders “plan”, and then finding his plan unacceptable based on those assumptions. The net effect is that you are inventing catastrophes and then judging Sanders plan as being too catastrophic.
The original promised cure for private insurance overcharging for health insurance was competition, especially the competition that would come from a Public Option. IMHO, Wendell Potter had it exactly right when he wrote the brilliantly titled piece: Elimination of ‘Public Option’ Threw Consumers to the Insurance Wolves
Soon after that, though, [Obama] began to waffle. It became clear to me as well as public option supporters in Congress that industry lobbyists had gotten to him [...]
Knowing the industry as I did, I told the committee that if Congress failed to create a public option to compete with private insurers, “the bill it sends to the President might as well be called “The Insurance Industry Profit Protection and Enhancement Act.”
The ACA without a Public Option was a wet dream for insurance companies. There is not a viable mechanism to keep costs down without legitimate competition for the profit-driven and literally inhumane insurance companies.
We are at the mercy of the insurance companies now. We are at the mercy of the wolves, and so many “Democrats” either don’t see it or don’t care. “Defending ACA” is a laughable goal in it’s present state, which will become increasingly obvious as time goes by. And I rather feel for you if your plan is to continue providing ACA metrics, because you will slowly see that in the numbers and remember the support you unwittingly gave HRC, and thus helped make it happen.
A recent NYT article (that an HRC fan helpfully provided to me) contains this:
And the big rate increases sought by some health insurance companies for 2016 are less significant than they appear, administration officials maintain, because most people buying insurance through the Affordable Care Act’s public exchanges receive federal subsidies that cover most of the premium. They do not need to worry about the “list prices,” officials said, and if they do, they can switch to less expensive plans.
Don’t worry about the prices charged by the insurance companies, because most people buying on the ACA are getting subsidies.
Translation: Don’t worry about the prices charged by the insurance companies, because Uncle Sam is picking up the tab.
Do you see the scam? Health insurance companies have managed to have laws enacted that make it a crime to not buy their product. They can still overcharge for their product — but those in charge of the ACA says not to worry, don’t worry about list price at all, because if you cannot afford to pay for it than Uncle Sam is going to pick up the tab. What a sweet deal for the health insurance companies — they make large profits, courtesy of the taxpayers.
Isn’t this essentially the same kind of sweetheart deal that BIG PHARMA got with Medicare Part D enhancements that contributed greatly to the national debt?
Do I need to explain the problems caused by the increased national debt? I’ll limit myself to saying that conservatives are currently using the high national deficit (that was primarily caused by two unfunded wars, unfunded enhancements to Medicare Part D, and the Bush Tax Cuts) as a rallying cry to cut Social Security and Medicare.
Clinton is promising all kinds of good things, it sounds like a wish list created from focus groups. But without true competition, the industry that is exempt from the Sherman Anti-Trust Act is essentially going to be gaining tremendous profits that were paid for with the national credit card.
And Republicans will yell “Tax and Spend Liberals” and they will absolutely fucking be right.
Sanders it telling us he wants to fight for Universal Health Care. The most reasonable short-term compromise would be a Public Option as another choice available from the choices available on the ACA Marketplace. On what basis have you completely ruled this out as a possibility? On what basis have you reached your conclusion that Sanders will completely dismantle the ACA?
By denouncing Sanders goals, and not proclaiming support for a Public Option, Hillary is putting her full support behind the “The Insurance Industry Profit Protection and Enhancement Act.” BIG INSURANCE will be happy, and continue to give her big contributions.
Please, please think again about the recommendation you are giving so publicly. I sincerely believe you are going to regret it deeply if HRC becomes president.
FYI, Brainwrap didn't even respond to this comment at all. I think I was becoming an annoying troll at that point, lol.
http://www.dailykos.com/comments/1473410/59155408
RETIII Jan 21 · 10:44:00 PM
What is so wrong about the Affordable Care Act that Dems would want to make their next signature fight about overhauling the whole system to single payer?
I mean that sincerely — not what are the advantages of single-payer (which I understand) but what is so wrong about the Affordable Care Act? In terms of priorities, why wouldn't we focus for a while on income inequality and wage stagnation outside the area of health insurance? How is it that Democrats consider the overhaul of Obamacare to be such a top and urgent priority?
Don’t we now have more pressing problems and priorities (and ideas) following our success with the ACA?
Older and Wiser Now Jan 23 · 01:52:30 PM
I had a fascinating experience yesterday. I answered that very question in a comment that I made on this very thread:
[edited to remove the URL, it points to comment you just read prior to this one]
On this thread, my comment was completely ignored. No recs, no response from Brainwrap.
I decided to leverage from that comment, and put a very similar comment in another thread, this one here (warning: takes a while to load)
http://www.dailykos.com/stories/2016/1/22/1473620/--Some-Experts-Like-Kr...
This second comment received 27 recs, and I was asked to turn it into a diary. Which I did:
Wendell Potter:"Elimination of ‘Public Option’ Threw Consumers to the Insurance Wolves"
The diary received 57 recs, and made the Rec list too.
Wendell calls the current ACA “The Insurance Industry Profit Protection and Enhancement Act.”
Health insurance companies have managed to have laws enacted that make it a crime to not buy their product. They can still overcharge for their product — but those in charge of the ACA says not to worry, don’t worry about list price at all, because if you cannot afford to pay for it than Uncle Sam is going to pick up the tab. What a sweet deal for the health insurance companies — they make large profits, courtesy of the taxpayers.
Do I need to explain the problems caused by the increased national debt? I’ll limit myself to saying that conservatives are currently using the high national deficit (that was primarily caused by two unfunded wars, unfunded enhancements to Medicare Part D, and the Bush Tax Cuts) as a rallying cry to cut Social Security and Medicare.
Clinton is promising all kinds of good things, it sounds like a wish list created from focus groups. But without true competition, the industry that is exempt from the Sherman Anti-Trust Act is essentially going to be gaining tremendous profits that were paid for with the national credit card.
And Republicans will yell “Tax and Spend Liberals” and they will absolutely fucking be right.
Comment got no recs and no reply.
http://www.dailykos.com/comments/1474843/59183282
wd7179 Jan 25 · 09:43:37 AM
This one tells the real story about single payer...by the way tell us how many countries have single payer. http://acasignups.net/16/01/20/healthcare-i-have-side-hillary
Re “that one” —
[snip, repeat of stuff already listed above]
FYI, If you don’t know who Wendell Potter is, you really need to fix that. The most excellent place to start I think is here: a Bill Moyer’s interview conducted in 2009 called “Wendell Potter on Profits Before Patients.” His support made a huge difference in getting the ACA passed, he testified before Congress several times I believe.
Managed to get a response from brainwrap on that one, lol. He was mostly pissed that I called him out for not responding (I do have some empathy for him there), here is part of it:
Regarding Wendell Potter: Yeah, I know Wendell. HE CALLED ME a year and a half ago (unexpectedly) to discuss the ACA, open enrollment and my work with reporting the data. We spoke for a good hour plus about a great many things. He and I are even part of the same stable of freelance healthcare/ACA writers over at healthinsurance.org from time to time.
So please, spare me the “Gaba didn’t reply to me, therefore he’s turned into a corporate/Hillary shill” stuff. I never thought I’d be hearing this sort of crap about myself from the dKos community.
I guess I’m “Part of the Establishment” these days as well, just like Planned Parenthood, Human Rights, Paul Krugman, Ezra Klein, etc etc etc...
I responded with this:
Brainwrap, perhaps you don’t realize it but you are more of public figure now. People who admire you are using your endorsement and saying “Brainwrap says, Brainwrap says” in the same manner that they say “Krugman says, Krugman says”. They don’t necessarily understand the details of what you are saying, but they become self-righteous in their belief that because such a respected figure endorses it, they must be right. Which is exactly what wd7179 did right here. Your endorsement is a big fucking deal.
Yes, indeed, you have the right to not respond to any post. But I have rights too. So no, I’m not going to “spare you”. You still have the right to not respond, but I have the right to point out your silence regarding my concerns. ACA as it stands is the “The Insurance Industry Profit Protection and Enhancement Act.” That is a huge problem that threatens Social Security and Medicare, and I plan to bring that to the attention of as many people that I can. I respect you a great deal, and I’m sorry that we are standing on opposite ends of the spectrum on this.
There is more dialog, perhaps it gets wonky ... if you want to see it, you'll have to go to TOP, I'm afraid.
Then a diary by greywolfe359 was putblished:
Hillary's Fastest Flip-Flop Ever: We Know We Can Have Universal Health Care We Can Never, Ever Have
Brainwrap Feb 02 · 06:21:38 AM
Recommended for the truth that the premise of the diary is false.
However, it’s actually the other way around: Bernie’s plan may be Universal...but Universal does NOT HAVE TO BE SINGLE PAYER.
Brainwrap how on earth can you say that the premise of the diary is false?
The premise of the diary is that Hillary Flip-Flopped, which is absolutely true.
1) There is no reference on her campaign website to universal health care or to a public option. None. Zero. Zilch.
2) As the diarist noted, “Just a few days ago, she told us “we are never, ever” going to have universal health care in this country.”
"I want you to understand why I am fighting so hard for the Affordable Care Act," she said at Grand View University after hearing from a woman who spoke about her daughter receiving cancer treatment thanks to the health care law. "I don't want it repealed, I don't want us to be thrown back into a terrible, terrible national debate. I don't want us to end up in gridlock. People can't wait!"
She added, "People who have health emergencies can't wait for us to have a theoretical debate about some better idea that will never, ever come to pass.
Clinton is giving a false impression that Sanders wants to take away any good things that the ACA has accomplished and leave people without healthcare. while we wait and argue about universal health care. This is dirty, shitty politics to beat an opponent who actually has the courage to stand up for universal health care and fighting the outrageous greed of the healthcare industry.
When Chelsea told this same shit, the Sanders team issued a clarification statement, where he said positive things about the ACA. Yes, the ACA has mechanisms to achieve universal health care. The fucking question is how will those mechanisms be used? You don’t have any proof that Hillary is going to use the ACA, you just back her because you know she “could” use it. Meanwhile, when Sanders puts forth proposals to actually do such a thing, YOU DON”T GIVE HIM CREDIT and he has to endure attacks from the Clinton machine.
When Chelsea spread her bullshit about how Bernie wanted to dismantle the ACA, the Sanders campaign put out a statement which isn’t so interesting, but something inside of it is:
WASHINGTON – Arianna Jones, a spokeswoman for Bernie Sanders, issued the following statement on Tuesday in response to Chelsea Clinton’s attack on Sanders’ health care plan:
“It is time for the United States to join the rest of the industrialized world and provide health care as a right to every man, woman and child. A Medicare-for-all plan will save the average middle-class family $5,000 a year. Further, the Clinton campaign is wrong. Our plan will be implemented in every state in the Union regardless of who is governor.”
Click here for the truth about Bernie Sanders’ plan to create universal health care.
Do you see that bit about the Clinton campaign being wrong? They attacked him over the possibility of using the ACA at a state level because of the negative impact of Republican governors. Please explain to me why they were right to attack him and say that Sanders plan would leave healthcare in the hands of governors.
The link in the statement gives you a fact sheet, which only says POSITIVE things about the ACA:Ultimately, this bill mirrors the legislative methodology of the health exchanges set up by the Affordable Care Act, as opposed to the Affordable Care Act’s Medicaid expansion provisions, which were invalidated by the Supreme Court. While GOP governors were able to refuse the Medicaid expansion, if they refused to implement a state health exchange, their citizens would merely be able to enroll in health care through the federal exchange. Through the Affordable Care Act, 13 states implemented state-based marketplaces; four others implemented state-based marketplaces, yet let the federal government do the IT-work by having their citizens use the federal healthcare.gov; 7 instituted state-partnership marketplaces that administer consumer assistance on the state level while allowing the federal government to handle the rest; and the remaining 27 states yielded all marketplace functions to the federal government. As a result, as of June 30, 2015, 7.2 million Americans in 37 states had enrolled in health coverage through the federal exchange, despite their states not implementing a state-based exchange.
I am convinced that one of the first steps that Sanders would take on the road to single payer would be to give us the Public Option on the ACA.
Hillary is making it very clear she is not going to work to give us a public option. Yes, there is a lever in the ACA that can be used to get us closer to universal than we are today. The question is, how will the next president use that lever? Give me your evidence, not your hopes and fantasies, that Hillary will actually pull that lever to push for universal, because not only do I not see it, I see the Clintons beating up Sanders for even discussing that possibility.
Hillary has neither a plan nor even the will to achieve universal health care. Your words simply astound me.
Please write a diary and show all of us both
1) Hillary’s plan to achieve universal health care without putting our country in great debt to the insurance companies, and
2) why it will be successful, especially why it is a better plan than what Bernie is advocating.
If you are right and I am wrong, I would be THRILLED. Thank you.
Got 1 rec with this one, but no reply from Brainwrap. That's usually what happens when your opponent is stumped and cannot give you an answer: you just get silence. Do they change their views because of the facts that you've shared? No, of course not. And now Brainwrap is even more in for Hill than ever before.
Brainwrap is a busy, busy guy, which affects his ability to respond to comments. At the same time, he has discovered he has a certain amount of "power of the pulpit" now, and so IMHO he needs to be accountable for how he has chosen to use it. He never provided responses to address my questions and concerns. I tried to educate him, but he did not listen. At this point, I am writing this diary to have a reference of my experiences and opinions regarding the ACA all in one place. I'm hoping that some others in the community may find it to be useful.
Comments
wished I'd read this before I commented on the other thread
But I think you earned your handle, Older and Wiser. Especially the bits about life before the ACA with respect to insurance companies and for profit healthcare. The ACA has made significant inroads there.
I think the next, incremental, logical step for the next administration to make is in fact a public option on the exchanges. If it is indeed true that insurance companies make no money, then they will exit and leave customers to the government. Oh, and maybe if you're not on the exchanges, you can't service Medicare, either.
That shouldn't stop us from continuing to bang pots and pans on pharma cost controls, Medicare negotiating drug prices, using trade agreements to import drugs from elsewhere, reining in hospital costs, and eventually, a full NHS.
If the Rethugs offered it?
Sure. If that's their STARTING position. We can work with that.
Hell no if it's coming from the Democrats, because as we all know it'll be a "Starting position" which they would then negotiate into a mandate that everybody pay more while shutting up because we're "Doing Something! SEE! We're on your side!"
I do not pretend I know what I do not know.
well, in the new reality ...
That was definitely our mistake. Not all of us saw how complicit / compliant Democrats were when they held slim majorities. I count myself among them. Overall, yes, the ACA was always a Republican plan, as I hastened to point out to my Republican friends screaming about it. Born and bred at Heritage, implemented by Romney (with a lot of help from a solid D Great and General Court). It still prioritizes private profit over public health, over universal access, as you'd expect a Republican plan to do. But it did add a level of cost controls, and the cost curves have bent down. That's good. But it's not enough. What we need to do is force insurance companies out of the loop, because all they are in this scheme is a very, very expensive billing service. That's now within reach, I think.
In the new realignment, my view is that there are no Republicans, there are no Democrats. There's the establishment, and there's the rest of us.
Nah, I say Prosecute them all.
Under the RICO act, and take no prisoners.
That's MY starting position.
And no, I'm not a reasonable person any more. The Establishment lost their chance at me being "Realistic" when they started rigging elections.
I do not pretend I know what I do not know.
Insurance is not subject to ordinary laws.
It is exempt from the Sherman-Antitrust laws. Strange but true. That was a factoid I picked up in 2008 when the idea of the ACA was being bandied about.
Lawmakers threw that fact out there when insurance companies were rescinding coverage once insured people had gotten desperately sick and needed expensive care.
~OaWN
I stand corrected.
And horrified.
I do not pretend I know what I do not know.
You are right to be horrified.
I am horrified too ... and most Americans cannot EVEN CONCEIVE that in our country, some business entities would be free from the rules that we rather think of as being fundamental to our country.
I want somebody to pinch me so that I can wake up. Sigh.
~OaWN
ERISA pre-emptions for those who get insurance through work
In brief, it says that if insurance you get through work ends up maiming or killing you b/c they withhold treatment, too bad - there are no remedies for you, Buddy. In general, no one learns this until they end up maimed or dead.
http://www.dailykos.com/story/2009/10/23/796117/-Its-time-to-END-the-ERI...
http://www.dailykos.com/story/2008/06/23/540792/-ERISA-FDA-Preemption-Ac...
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
TY MsGrin
It's nice to see you, as always. But I had to just take a deep breath when I read those diaries. Sigh.
~OaWN
My miscarriage and near death were from insurance denials
I didn't learn about ERISA when I was seeking legal help, was turned down b/c I had begun the pregnancy as a high risk patient, so the attys I spoke with essentially said that the company would get away with it on those grounds. If they'd done their jobs as attys, they would have told me I did not have a case b/c of ERISA. Really shook me to the core years later when I bumped into this.
The first unofficial reason I was given for the delays and denials was that they didn't even know if I'd get pregnant. I did in my first month of trying (we were motivated - wanted to try to scurry to bring a first grandchild while my MIL was still living, she was dying of lung cancer).
When I did get pregnant, even though there was a specialty company which worked with these issues with expectant moms, they wanted me to work with a start up that had never done the service I needed, and they wanted them to use a device intended for a different product and modify that. Since this same company had already BOTCHED working with me at least twice, I resisted. The pregnancy came to an end (which was also nearly my own, as you've read elsewhere) before I could make any headway. The stupid thing was that this insurance company absolutely contracted with the company my doctor sent me to - they were just trying to cut costs for working with a high risk pregnancy by sending me to a company with zero experience with the service I needed. Lovely.
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
OMG MsGrin, I'm so sorry
My heart is going out to you. I don't know what to say. Some people in this world are such scum, busy "doing their job" without truly comprehending what they are doing. At least I hope they don't comprehend ... if they did comprehend and still did it anyway, that's pretty much dog-eat-dog survival capitalism at work.
Such are the realities of the world we live in. I didn't see such things until I was past the age of 45 ... I didn't reallize that here in America, people could be so R U T H L E S S. I keep having to fight the huge disappointment that came along with my bubble being burst.
The only thing that comes to mind is the saying, "that which does not kill you makes you stronger". Pretty damn literally true in your case. You ARE a better person for it. Why is it all of my favorite people in life have been through horrific experiences? I hate that so much, but at the same time, I love their souls. LIfe can be so confusing.
Sending you love and and BIG {{{{HUGS}}}}
~OaWN
So sorry for your misfortune
I wish I could say I never heard this story, but I have dozens of times. And I get madder each time. It is said the 90% of banksters are sociopaths. I think 90% of insurance biggies are sociopaths too. Until we get public option we will be facing continuing denials of care for treatments which are standard for the condition prescribed.
"So, you have insurance, well, we've haven't met our expected quotas of deaths this month, so I guess your S.O.L."
I've known someone who sued, and won a multi-million dollar
judgment against their employer (a branch of service).
Anyhoo, theirs was a case of childbirth gone wrong--a difficult breach birth that should have been a Caesarean Section.
Result: brain damage.
Now, this was is the 1980's. The 'go around' was that the military member's wife filed the civil suit. (i.e., a non-employee)
We never knew a lot of details--the suit was settled shortly before we PCS'd to the Base. It was casually mentioned to us, when the couple 'filled us in' on the Base medical facilities. Actually, the Base had a large--and very excellent--Medical Clinic. The botched delivery took place at a large military hospital on another military installation, run by another branch of service--in a close-by Community.
I'd be curious to know if decades of neoliberal governance has changed the regulations or laws, that allowed for this.
Mollie
“I believe in the redemptive powers of a dog’s love. It is in recognition of each dog’s potential to lift the human spirit, and, therefore, to change society for the better, that I fight to make sure every street dog has its day.”
--Stasha Wong, Secretary, Save Our Street Dogs (SOSD)
National Mill Dog Rescue (NMDR) - Dogs Available For Adoption
Update: Misty May has been adopted. Yeah!
Everyone thinks they have the best dog, and none of them are wrong.
I'd bet technically the laws are the same, but in this
"nobody deserves nuttin" mentality, winning is a lot more difficult.
Please check out Pet Vet Help, consider joining us to help pets, and follow me @ElenaCarlena on Twitter! Thank you.
What did anti-trust have to do with rescinding coverage?
Seems to me like that's a violation of contract, trust or no trust.
Please check out Pet Vet Help, consider joining us to help pets, and follow me @ElenaCarlena on Twitter! Thank you.
Good question
SITUATION: In 2008, Congress was interviewing insurance CEO's about their practices re rescinding coverage. In other testimony, Congress heard stories like the woman who had had insurance for a long time (10?-20? years) and then was diagnosed with breast cancer. You pay for insurance in case you need it, right? She paid, and paid, and paid, and then when she needed it, they retroactively rescinded (voided) her coverage.
Why? Because way back when she originally applied for the insurance, 10?-20? years ago or so, she had not mentioned that she had had a case of toe fungus (i.e. a relatively trivial disease) at some point. And so the insurance company cried FRAUD! because she failed to list it on that application. Which is rather ridiculous to most human beings, right, but the law is The Law, and what they were doing was apparently LEGAL. When somebody got sick, the insurance companies would go over their original application to see if they left anything off, and I mean ANYTHING. If they had, policy was rescinded.
Congress critter were shocked and appalled, and were basically trying to get the CEOs to confess their sins and promise to go forward and sin no more. But CEO's basically said, "No, thank you" to the Congress critters. They were not going to budge because apparently they had been making lots and lots of MONEEEE by doing this shitty, shitty thing.
Congress critters were not happy that CEOs were not bowing down to them, and some of them basically said, "Hey! You guys! You know about that special law just for insurance companies and baseball teams (yes, that is also strange but true, baseball teams are exempt because national sport or something?) ... you know that we can take that away at any time don't you?" Bottom line is that Congress was trying to use that special law as LEVERAGE to get the CEOs to play ball with them, but even then, the CEOs were not making the kind of sqawks that Congress wanted them to be making.
So when ACA passed, CEOs are not allowed to rescind coverage anymore, but they are still exempt from Sherman.
The End
~OaWN
Thank you! I didn't remember that.
I have had individual insurance for many, many years though, and noted when I applied that I signed a statement that basically said, "this is true as far as I remember it," and was happy that I didn't have to swear "this is every tiny disease I have ever had".
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When I signed up, the "sales" folks were basically saying
that you only needed to worry about the most important / major type things, but that is not what the words on the page said. And I was paying attention to the congressional hearings, and hearing the horror stories, so I did my best not to leave anything out at all ...
What those companies were doing was obscene, IMHO.
~OaWN
I did the same; but can't swear I remember every single
time I went to the doctor and exactly what it was for, so was glad I wasn't swearing I told them absolutely everything, just that I told them everything I remembered.
I'm sure that wouldn't protect me in court when they have all the advantages, but I prefer to tell the truth whenever possible. Unless made-up stories are funnier.
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I actually have a very strange memory
I remember certain details, like all of the nuance of healthcare reform, lol, amazingly well. But when it comes to historical family stuff, I'm lousy. I don't remember much of my childhood, sadly. And even worse, I've forgotten a lot of the details of my daughter's childhood too
As an assignment from school, she asked me for a bunch of stuff like how old was she when rolled over for the first time, spoke her first word, took her first step? Swear to god, if I hadn't written some of that stuff down on a special calendar, I would not have been able to remember it.
The insurance companies were simply setting up and playing a game of gotcha. Heads they win, tails we lose.
And you know me, I'm almost anal when it comes to being sincere and honest. Maybe I actually have REACHED anal, ha ha ha. What's the difference between being anal and being almost anal anyway, lol? Strangely I both want to know the difference, and also think that maybe I don't want to know, ha ha ha. But as you say, I don't think that would have protected you in a court of law. But now you are safe, thank goodness.
Now I'm thinking of you making up stories and writing them down on your healthcare application
I bet you can tell a really funny story when you want to ...
~OaWN
The one good thing about ACA was eliminating
the pre-existing disease exclusions, which were a bane even under company health plans. Interstingly this is the point that HR has shown willingness to negotiate, i.e. compromise in industry's favor.
Private, for profit health insurance
is NOT health care. Once we get past that fallacy, then perhaps those who support Obamacare can finally understand what the REAL problem is with our health care system.
Older and Wiser, thank you for this fantastic and very well documented essay.
Do I hear the sound of guillotines being constructed?
“Those who make peaceful revolution impossible will make violent revolution inevitable." ~ President John F. Kennedy
Yes, the situation is very complicated
Health insurance companies are not healthcare providers. A public option will not require nationalized medicine, but much of the citizenry does not understand these truths and the propaganda providers do their best to make sure that things stay that way.
TY for the TY! I do think there are number of little details buried on those comments, I'm so glad that I can leverage from that work to make it available here. I'm actually a sucker for compliments, did you know that
~OaWN
Public option won't cure lots of health care problems
But the only thing that will cure it Medicare-for-all. Medicare-for-all will crush Big Pharma's stranglehold on our drug costs. The U.S., despite the rip-off in drug prices, is still a heavily medicated (and in my opinion, overly medicated) society that has as a whole enormous purchasing power. I cannot imagine any pharmaceutical company doing business in the U.S. wanting to give up their bite of the apple.
Some are already leaving on their own.
If enough of the insurance companies pull out of the exchanges they'll HAVE to do something.
I say this as someone who's had socialized health care for poor people in both a liberal state and a republican state (garbage), and now with a garbage plan through my work.
This shit is bananas.
That's a good point
~OaWN
Your comment is lovely to hear because I wrote to supplement
what gjohnsit wrote. So thank you very much, fred! And you flatter me, but thank you. My handle was intended to say "I've been around the block one or two time", nothing more. I am quite familiar with the state of healthcare in this country, sadly, by virtue of all of the strange experiences that I've had with it myself. It is my belief that those who receive insurance from their company do not realize the kind of snake-pit that was available to those who needed to buy insurance from the "private" marketplace before the ACA was implemented.
I think a public option is the only way to go. Instead of 20% of "the take" going to insurance, get that number back to around 5% where it belongs. **It is simply not moral for anybody to be making a profit off of the misery of others**, especially not insurance companies who do not provide value in the kind of way that doctors, drug-makers, and hospitals do. They are simply middle-men, nothing more, but they are now the gate-keepers of a product that is the difference between life and death in many cases. How much would you someone pay so that they don't die? A fucking lot, right? And that is why we pay these outrageous prices - because we think we will die if we do not do it. And so they charge us according to what we are "willing" to pay.
In the final solution, there do need to be incentives to keep prices down from health-care providers, and that includes pharmaceutical companies. Medicare should be able to negotiate for lower prices based on volume, that is how things would normally be done in a capitalistic society. The fact that we have to put up will all of the shit from a capitalistic system, and not gain the benefits, is outrageous and obscene, nothing less. The politicians are doing what is in the best interest of the monied class, not "we the people". It is corruption, nothing less.
~OaWN
and with that ...
... you should run for office. I will vote for you.
Everything you say, dead on. Especially the line about how people who get their insurance provided have no real idea what kind of snake pit individuals face. That far and away was the biggest obstacle I had of convincing people that ACA was actually a step forward. In systems where people are insulated from the costs, they think things are free (this is also a cautionary tale about pure socialism, too). That we now have a system that's essentially socialism for the rich that we subsidize without the benefits that competition and capitalism would normally give, well, that's backwards in any respect. Immoral, when it comes to healthcare.
Ok, then, 1 vote down, 300 million or so to go!
ha ha ha, I have no idea what the future will bring ... I'd love to be a "public servant" and try to fight for the public good ... unfortunately I think it is a thankless job. I seem to have a bit of writing talent, I've been trying to figure out how I might use those skills. We have a huge problem with propaganda in this country I think. People do not know what is true and what is false, and those with their own vested interests do their best to confuse innocent voters.
As far as those getting insurance from work - THEY don’t realize that the money that might have been given to them in raises is instead being given to the insurance companies because the costs are so huge. So in some ways they win, but in other ways they lose, big-time, but they don't even realize how they too are getting shafted in the process ...
We need to restore democracy, plain and simply. The current system is owned by the rich, most of whom are consumed by greed and self-interest.
~OaWN
When public servants fight for the public good,
there are ugly consequences. Life can get very unpleasant when you do that. People can hold on for varying amounts of time before they give up. And they can also move your desk into a closet and not let you deal with anything meaningful.
Sort of like what Schumer and the Hilldroids have threatened
to do and will do to Sanders, Canova, etc, etc.
In olden days, 1999, one used to go to an agent or
two and get best quote. It was very easy. A combination of factors made it worse, but include elimination of agents and centralization on the web.
BTW having lived in AUS, NZ, Japan and worked in many other countries, US healthcare is the most difficult to get and most.expensive in the world. Americans think ACA is improvement because they have no experience with anything else. As far asI can tell under current structure there is no path nor incentive to move to a single payer option unless of course all insurance cos merge into one, which is more likely.
I got a
final solution for those fucking vampires all right.
Good post OaWN. Ty.
Ya got to be a Spirit, cain't be no Ghost. . .
Explain Bldg #7. . . still waiting. . .
If you’ve ever wondered whether you would have complied in 1930’s Germany,
Now you know. . .
sign at protest march
You're going to lose people
with the use of the word "incremental", just sayin'. It's kind of a four-letter word to some readers....
Incremental
One thing that bothered me about the conversation at DKos about the ACA during the health care debate was the notion that the ACA was a step toward single payer. It was not. If anything it moves health care more down the capitalist healthcare provider/big Pharma/capitalist health insurer road and makes it, if anything, harder to get to a single payer system. An incremental step that might have moved us in the right direction would be to allow individuals and companies to buy in to the Medicare system. An even smaller step would have been to drop the age of eligibility to 60 or 55. This would have left a lot of problems unsolved but it would have been a genuine incremental step in the right direction, whereas the ACA (although it improves some things) moved us in the wrong direction.
RB, unsubsidized Medicare premiums--for those who don't
pay the additional Medicare surtax--were figured to be approximately $600 to $633 per individual, several years ago.
That is what health experts believe that FSC (Former Secretary Clinton) is suggesting that she would consider, BTW.
Several weeks ago, I posted the transcript of WJC suggesting this same option--opening up Medicare to folks younger than age 65, but with unsubsidized premiums--in one of his last State Of The Union addresses.
Mollie
“I believe in the redemptive powers of a dog’s love. It is in recognition of each dog’s potential to lift the human spirit, and, therefore, to change society for the better, that I fight to make sure every street dog has its day.”
--Stasha Wong, Secretary, Save Our Street Dogs (SOSD)
National Mill Dog Rescue (NMDR) - Dogs Available For Adoption
Update: Misty May has been adopted. Yeah!
Everyone thinks they have the best dog, and none of them are wrong.
You certainly did try very hard to get through to him, OaWN
I'm sorry he didn't listen, but can't say I'm surprised. As I said on the other thread, I rather quickly wrote him off as soon as it became clear he was all about rationalizing and pushing Hillz, rather than really caring about the issue. Still, you told your story, which is good. I hate the medical insurance industry with a passion, they are indeed vampires. Good description.
I know, right? I really did try.
This year I've been learning a lot of lessons about politics. Sadly, I think it is almost completely not about reason in many cases. It is more about identity politics, and "us" versus "them" thinking.
~OaWN
It's simpler than identity politics really
It's about greed. Pure, unfettered, unremorseful greed.
I'm so frustrated now
I am searching for a quote, I think made by Gore Vidal, going something like
Politics is simply a discussion about who gets what and who pays for it
but alas, after an hour or so I still cannot find it. I freaking love that quote, and I clearly cannot remember it. Now where on earth did I put it? !*&(*&(*&
~OaWN
Gaba is running for some office because
he had street cred with the early statistics. He was good, I give him credit.
BUT...as usual, the Republicans call something doomed to fail because of their anti-socialistic philosophy, while the Democrats simply cannot do the fucking math.
Typical that the rank and file Republicans hate anything proposed by Democrats, and rank and file Democrats hate the same thing because it is of fucking Republican origin.
Best examples are the ACA and Hillary for President.
Older, you were awesome, completely intellectually swamped Gaba.
*edited to move the word "hate" in a sentence.
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
Wow. thank you on the cusp :-)
I did think that I had brought a pretty solid case before him, lol. And I thought he was a "good" guy that I could reason with.
I still think he is a good guy, he's just bought into certain propaganda. And once one joins a certain team, I think we get our own identity mixed up in there too, which makes it VERY difficult to realize that maybe one has joined the wrong team. We had previously thought of our team as being the "good" guys - to realize that they are not actually what you thought them to be is highly distressing. I think the words cognitive dissonance are an appropriate description. And so, like Stockholm Syndrome, we elect to "stay with our abusers" (if I can totally STRETCH that metaphor) instead of walking away from them.
It's actually very nice to hear the positive feedback now, I felt rather lonely about it at that time, and also confused why he wasn't realizing the error of his ways, lol. So thank you very much, on the cusp, you've made my day.
~OaWN
We are so propagandized.
My pal I travelled the world with is a Reagan Republican. She went into some frenzy in Venice about how she hated Hillary. She was frothing at the mouth.
I told her I despise Hillary as well, but because she is a Republican. I made an effort to agree with her on ACA and Hillary, but because I did it from a very liberal stance, it was just not good enough.
Regrettably, I now travel solo, but do not have to listen to screeching.
And you did great with your debate against Gaba.
You creamed him.
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
(No subject)
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
Have I told you lately that I love you?
That word "creamed" - I'm finding it so very delicious
~OaWN
Van Morrison version.
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
The ACA is a set of contrivancesnot legislation to fix an issue.
The key fact is that the Federal Government already spends on par or more than the socialist European democracies on health care.
Brainwrap and Clinton and the rest of the shrillbots can argue about impracticalities and impossibilities, but the efficiency of Public health care is not theoretical, we have examples throughout the developed world. Even where health care is delivered vi private health insurance the government is not subservient to the insurance companies and regulation keeps them in check.
actually, I understand we spend
twice what the canadians do, and we get worse overall outcomes. If we were to take what we spend today and spent it on a nationalized system like they have ....
Our government itself spends more per capita on health care than
France, for example (where they get excellent health care will little out of pocket expense). If you add in what citizens and companies spend independent of the government it goes to the 2 X Canada figure. Our system (if it can be called a system) is monumentally inefficient--a stunning rebuke to anyone that says that capitalism always drives toward efficiency.
We don't have a health care system.
We have a give money to insurance companies system.
Now interviewing signature candidates. Apply within.
This is f*ing briliant!
~OaWN
I agree with you, but we need to figure out a viable way to get
from HERE to THERE.
The more that I think about it, it seems to me that the root cause of this and many other problems is propaganda. The folks who have a vested interest in keeping the status quo do everything in their power to keep the $$$ flowing in their direction. When we "spend more", the guys who are now "getting that money" fight like the Dickens to keep that mother's milk flowing to them.
~OaWN
Calling it a "crime" not to carry insurance is a stretch.
It's not a felony; it's not even a misdemeanor if a person opts out of the insurance market.
For people who fall into the pool of required purchasers, if you opt not to buy insurance, you get hit with the equivalent of a tax penalty. But even as tax penalties go, it's weak. There is no possibility -- right now at least -- of wage garnishment or a tax lien, which is more typical of tax penalties. The only real recourse that the feds have is gobbling up any federal tax refund. If there is no refund, there's no real penalty.
Having said all that: Overall my opinion of the law is mixed. I buy my insurance in the individual insurance market, and have purchased through the ACA exchange the past three years. I like the fact that it is possible to comparison shop, and in markets where there is actually competition, the law is OK.
Obviously single-payer has a lot more advantages. The failure to include a national public-option is a clear statement of the corruption in our political system, and in retrospect its absence makes the whole project look even worse -- this is especially true in markets where there is no real competition. The public option offered a clear benefit to consumers, politically it was probably the most popular single part of the law, and from a taxpayer perspective, it was projected to save money as well. So the fact that a fiscally responsible, politically popular, consumer-friendly part of the law didn't become part of the law, speaks volumes about our political dysfunction and the legalized forms of corruption.
I think this is part of where Sanders argument was more realistic about what is actually sustainable. The problem with the ACA is that, over time, greed and corruption may end up destroying the parts of the law that actually work politically. It didn't take people 8 years to figure out whether or not they liked Medicare or Social Security. The ACA right now is nearly that old and public opinion is still deeply divided over the law with overall opinion still slightly negative.
Brainwrap has done some good writing about the law. But, I don't really see the lack of specifics in Sanders plan as a problem.
There are obviously major political challenges involved with getting single-payer passed into law, which have to be overcome first. Once there is actually political pressure to do it, you also don't transition our current health care system into a single payer system overnight. There are technical challenges that will take time to work. But, these technical challenges are not the problem. The biggest challenge is political, and it is a massive one. Winning the White House isn't sufficient, and if Congress isn't on board with a president who is, the possibility of getting the law put into place also is near zero. I don't have a problem with people focusing on the challenge and being realistic about the political reality. However, I don't accept the idea that the political calculation on the question is statistic and fixed for all time, or that a single-payer law is not technically feasible. Obviously, political calculations can and do change with organized public pressure, and the technical challenges will be resolved if there is sufficient political will to do the right thing.
Seems to be that you are quibbling over semantics re "crime"
I was always taught that when one breaks the law, one is committing a crime. I even looked up the definition in a dictionary, and therefore stand by my use of this word. If one does not buy insurance, one faces a legal punishment. The penalty has not been such a big deal so far, but was designed to become increasingly harsh over time.
You say that "Brainwrap has done some good writing about the law." Apparently you felt the need to stand up for him, I guess. I'm not sure what to say. I happen to believe that his ignorance about the ACA contributed to the negative attitude towards Sanders supporters over on TOP, and that Sanders supporters being muzzled on TOP contributed in some degree to HRC's victory in the primary. Your comment reminds me of an old joke, "But other than that, Mrs. Lincoln, did you enjoy the show?"
I tend to think differently than you about the problem with the ACA. What I see is that it forces citizens to buy an overpriced product, and is yet another form of corporate welfare. Initially I viewed it as a good thing because the people who were "forced" to buy it were actually people who WANTED to buy it but were unable to because of pre-existing conditions. Now the product is becoming increasingly expensive and crappy at the same time; being forced to buy it under such conditions, so that insurance companies can make large profits, is unconscionable to me. Taxpayers now pay taxes so that Uncle Sam can help pay for the overpriced, crappy product that is provided at a discount to certain lower income persons (like my family).
I see the core problems as being that
1) insurance is a for-profit product, which is obscene and immoral;
2) it is overpriced, and the system lacks any kind of incentives to bring the cost of this life or death product down;
3) Congress (including the bulk of Democratic politicians) cares more about meeting the needs of the insurance companies / rich donors than about the lack of affordable health care for it's citizens.
The only silver lining that I see is that the system is unsustainable. Only when it comes falling down and the pain of that affects more people will there be sufficient political will to make the changes that are necessary. But I'm afraid that much pain is in store for us as a nation before we get there.
~OaWN
A lot worthwhile to read here
especially after having first gone through the gjohnsit link you posted at the start. So I'll just hit a few specific points.
1. The 80%/85% minimum medical loss ratio really isn't that tough on insurance companies, as it's approximately what a Senate study said they were enjoying without any such restrictions in 2008-2009. So gaining tens of millions of new, mandatory customers whose premium payments would be subsidized gave them around a 10% increase in total profit without decreasing the percentage profit margin, and as you pointed out they're already finding ways to game some of their income into the medical loss category as well.
2. Obama had already negotiated away the public option in back-room meetings with the industry (the transparency in government which he campaigned upon suffered the same fate early on that so many other promises did) months before he stopped offering public statements about how important it was, so whether he ever actually intended to push it is not clear: it's easier to believe that it was merely a shiny object designed to distract progressive critics until the opposition's 'death panel' and associated arguments had sufficient opportunity to take hold that a "Gee, folks, we really tried but it just wasn't possible" defense became salable to those who weren't watching very carefully.
3. The public option as you seem to envision it would not be much more appealing to insurers than a full-scale transition to a single-payer system would be: consumers may often be easily led astray but they do know how to price-shop, and when given the choice of a public plan with a 15% lower price than the competing individual private plan (the simple difference between that 80% (for the most part) loss ratio and Medicare's 95% loss ratio (at least - some claims are 97%, and dealing with an on average younger and healthier population could raise it even higher) private insurer profits would fall through the floor unless they managed to restrict the availability of the public option to a subset of consumers that they didn't mind losing (not, I suspect, what you had in mind).
4. Eliminating private insurers from the equation (even without using the single-payer result to try to negotiate further savings in health-care provider pricing) has a significant additional effect upon total health care cost over and above the 15% difference in medical loss ratio efficiency: providers incur something like 10% of their total costs by having to deal with over 1,000 private insurers, each with its own coverage and billing quirks that can occur multiple times in each single service instance, so moving to single-payer results in around a 23% (15% + (10% of 80%)) reduction in overall health-care costs right off the top.
5. At some point someone (may have been you) observed that Obamacare is doomed simply due to the absence of cost controls (something I've maintained since before it was passed), because absent such controls everyone in the loop has every incentive to see prices rise (even many if not most consumers have no interest in seeing them fall as long as Uncle Sam subsidizes their costs adequately). The problem, of course, is that Uncle Sam will at some point (my own guess has always been by the end of this decade if not sooner) call a halt to uncontrolled subsidy increases (unless we undergo a radical revolution in the way we look at the national debt, which I'm not sure I'd wholly support either) and let the chips fall where they may - as usual, on those least able to bear that burden.
Anyway: is health care inequity the worst problem that we face? Possibly not, but it's certainly a damn important one and perhaps more to the point the way it's been mishandled may be the most blatant evidence of the more general problems we need to deal with and it puts a very personal face on the need to deal with them - so thanks for bringing it back to the fore again.
many excellent points Bill eom
Excellent comment, Bill. Are you my long lost brother, lol?
So crisp and succinct, I love it!
1). Yes, the 80/85 MLR was essentially a freeze of what they had in that moment in time. However, did you know that the insurance companies were "working the room" in order to obtain something more like 60/65%? Here is a fabulous article from 2009 that I highly, highly, highly recommend: What Vegas Can Teach Congress
2. Yes. Those meanie Republicans are always the favorite scapegoat.
3. Yes. Public Option is bad news for Insurance companies because people soon wake up to the fact that the reason for most of the high healthcare costs is the very high profits obtained by many players in the system.
4. Yes, yes, one thousand times YES! Every insurance company has their own fucking coding system - people are being trained on all of these "languages" instead of just standardizing on one, which would save money that is basically stupid for us to be spending. Doctors have to spend good money to "deal with the insurance companies" as you describe, and we patients fucking get charged for it! Outrageous!
5. Maybe it was me, I don't know, but I've said it before. It turns out that runaway healthcare spending is a bit of a national emergency that the government cares about because of Medicare; those high costs run up the national debt. Of course there are two ways to solve this problem: either bring down healthcare costs, or cut medicare benefits. The elites would prefer option B, because they are making moolah with the status quo. But they are stupid idiots in that regard. Their greed blinds them. The situation is like a growing bubble - it is not sustainable, it cannot last, and when it pops things are going to get ugly.
~OaWN
To Bill and OaWN
The 10% physician overhead fee is grossly understated. In my practice, depending on the year and patient volume 30-50% of my overhead was due to dealing with insurance companies, with regard to the need for extra employees and the time they needed to do insurance-related things. In the new era, when private practice is becoming extinct and medical care is dispensed by private doctor corporations and hospitals, more physicians are employed by these entities, costs for dealing with insurance may have decreased. Although I am fully on board on Medicare-for-All, I see too much physician bashing in various comments in c99. This is not to say that there aren't plenty of crappy doctors delivering crappy care. Insurance reimbursement has been falling steadily for 25 years on a case-by-case analysis. To compensate for this lowering return of pay for effort, the public is seeing medicine being operated as an assembly line. In fact Medicare-for-all will absolutely not reduce physician tendency to take less time per patient. Why? Universal health care and no pre-existing condition exclusions will change the medical landscape. In the days when I was at GOS, I wrote several diaries about this--i.e., neither private/public option or even Medicare-for All will not undo the many problems in our current medical
dysfunctionsystem.Hi Ed, thanks for adding your perspective here.
I didn't realize that you were a doctor, you are not just a cute alligator but a smart one too
I believe that what you are saying is true regarding physician overhead fees. I don't know where 10% came from, did I quote something? I believe that the overhead required to deal with insurance is likely much more than 10%, as you point out. Re physician bashing, I don't mean to be bashing anyone per se (except for the insurance companies) but physicians are caught in the middle of a strange and perverse system. I believe that many/most doctors chose their profession because they wanted to help people. They are forced to operate in a very strange world that is not subject to the normal checks and balances and laws of supply and demand. And human nature being what it is, IMHO, they are just as susceptible to temptations that might come their way as the next guy.
The laws of supply and demand don't apply. A patient cannot shop around for medical services in the same way that one shops around for other products and services. We cannot ask to see a price list, for example. And from what I can tell, pricing itself is perverse because rather outrageous LIST prices are used that are set in a way that presumes that the insurance is going to knock off a huge percentage. The poor schmucks who cannot afford insurance are then forced to pay the LIST price, which strikes me as insane. But I have also been on the receiving end of medical services (actually dental, but whatever) essentially donated to my family by a huge-hearted man of medicine. My beautiful daughter had a tooth knocked out/broken at a basketball game, within a week of having the braces taken off. An esteemed endodontist basically did not charge us for his services (we paid a very modest fee) because we lacked insurance.
Until I walk in your shoes, I have no idea what the world looks like from your vantage point. I don't mean to judge, I mean to point out systemic problems. IMHO doctors for the most part are on the whole better than other persons regarding moral scruples. But I don't feel comfortable in a system that does not have adequate checks in it, I simply don't.
The whole issue space is a complicated can of worms. No solution is perfect, but I sincerely believe that the system we have now is a house of cards that is going to collapse sooner or later because of the natural tendencies of various players in the system.
I sincerely hope my comment addresses your concerns. Does it? And/or is there another piece that I am missing in order to be fair to physicians?
~OaWN
Thanks for your reply OaWN
Please do not think my remarks about physician bashing applied to you. They didn't
Yay! <3 My general policy is to keep alligators happy ;-)
~OaWN
10% as the added cost of dealing with private insurers
comes from one or more studies frequently cited by single-payer advocates like Healthcare-Now! and the Physicians for a National Health Program. IIRC it's what was found large institutions incurred in additional overhead, so it's entirely understandable that a small private practice might incur a far higher percentage relative to its total costs.
Edit: With respect to your observations about time spent per patient, some proposals include provisions to change fee-for-service payments to a system where payments are more dependent upon patient outcomes, which would seem to help in this area though might be far more difficult to manage effectively.
No, I hadn't seen the Daily Beast article
but I can't say that I'm surprised by its content, save perhaps the "As recently as the early 1990s, 95 cents out of every dollar paid to insurance companies in premiums was used to pay claims" part: that's about what tightly-regulated European insurers pay out in universal health-care systems in countries that don't go the single-payer route so the fact that our insurers did so so recently without nearly as much regulation is interesting (perhaps it was the 'greed is good' Wall Street mantra suddenly taking real hold that caused the following dramatic upsurge in profit margins).
Re 95% MLR in the 90's
Wendell Potter mentioned this factoid in his "Profits before patients" interview with Bill Moyer. Essentially the private insurance folks had the same MLR as Medicare.
I think that one of the contributing factors was that the for-profit mania hadn't really settled in - something about when hmo's were new, they had to be non-profit, but somewhere along the line in the 90s that changed. When they became for-profit, surprise!, that's when healthcare prices began to rise meteorically. I'm about 90% sure that I'm correct on how that went down, but my memory has gone a bit vague on the exact details of what transpired at that time.
Back in the 90's the business model seemed to be to negotiate hard with healthcare providers, and profits came about from the amount of savings the insurance companies could squeeze out from them.
But now the model is completely different. Insurance companies aren't working nearly as hard to keep provider prices down, and as pointed out elsewhere, under the ACA they actually make money as provider prices rise, so they don't really have an incentive to do so.
~OaWN
I found ACA to be a nightmare
It was difficult to enroll, the low cost plans were junk, and allowed limited prescription options. It also increased the costs of and reduced medicare coverage. HRC appears to be coming around to more of a public option, bt it is almost impossible to tell whether sh would stick with this if elected. She has been all over the place on this.
HRC has also at times this year proposed more draconian solutions to ACA including making patients more directly responsible for cost control. In her words 'controlling costs by placing burden on consumers.'
Did you ever try shopping for an individual policy ...
... pre-ACA? How did you even get to the point where you were comparing plans?
I've been buying my own
I've been buying my own insurance since 2000. Before the ACA I used aggregator sites like ehealthinsurance.com.
Aggregator sites for health as well as other
insurance. Plus there was no threat of being put on medicaid, which in CA can result in forfeiture of assets.
The ACA systems have had their share of problems, true.
Frankly, the technology challenges were pretty daunting I think, so on one hand I don't blame them. By that, I mostly mean that I understand why things were clunky, especially at first. I cannot talk about medicare coverage, i'm not old enough for that ... but that confuses me. I thought that once people were eligible for Medicare, they would not need to be on the ACA anymore. Am I wrong about that?
HRC is simply saying what she needs to get elected. No way do I expect her to deliver a public option. No fucking way. She'd rather be friends with the high rollers than to see that the poors are able to get healthcare.
HRC = draconian = yes, exactly! But she is only being pragmatic, lol. That's a good thing, according to her fans.
~OaWN
OAWN, once an individual is Medicare eligible--age 65
at present, until the eligibility age for 'regular' (non-disabled) seniors is raised, which most likely will be either this Lame Duck Session, or under the Queen of Austerity--one is no longer qualified, or eligible to participate in the ACA Health Exchanges.
Mollie
“I believe in the redemptive powers of a dog’s love. It is in recognition of each dog’s potential to lift the human spirit, and, therefore, to change society for the better, that I fight to make sure every street dog has its day.”
--Stasha Wong, Secretary, Save Our Street Dogs (SOSD)
National Mill Dog Rescue (NMDR) - Dogs Available For Adoption
Update: Misty May has been adopted. Yeah!
Everyone thinks they have the best dog, and none of them are wrong.
Your comment meshes with my current understanding
I was responding to this comment:
I don't know what is meant by the comment, "the ACA reduced medicare coverage".
What I understand is that I must be on the ACA until I am eligible for Medicare. At that point I will be on Medicare and no longer on ACA. And per your feedback, I won't even be ELIGIBLE to be on ACA anymore.
Maybe the comment was saying that funds for Medicare were stolen in order to pay for ACA? That/is was a RW talking point, IMHO. I haven't seen any evidence that it is actually true. I'm not even sure what the evidence would look like to prove such a comment to be true ...
~OaWN
Two issues. My wife is under 60 so not eligible for
medicare, hence need for ACA. As far as medicare goes part of cost containment was to transfer billions to medicaid and to put more cost on consumers. For most retirees medicare cost has increased by 15-20% since ACA.
Diatibe that it is RW talking point not warranted and sounds Hillaryesque. Even AARP has noted the increase in costs and reduced benefits. Part of that is due to removal of subsidies for medicare, but others due to cost transfers.
Just want to say two things
Hi Shigeru,
First, I said that IMHO it was a RW talking point. IMHO. That remains true. The right uses that comment all of the time in order to get those on Medicare to become politically opposed to the ACA. It's a scare tactic.
I also said that I was open to hearing the evidence as to why that claim is true, which I am. I'm pretty sure that the costs under the ACA have also risen 15-20% since the first year of it. Year 2 over Year 1 was about 5%, Year 3 over Year 2 was about 10%.
Healthcare costs were rising significantly every year, prior to ACA. As discussed in this essay, a key problem with the ACA is that cost containment is not really a feature of the program. Healthcare costs are still rising!
Just because the cost of Medicare has gone up does not mean that the government is robbing Paul to pay Peter. That is another tactic of the right - they blame all rising health insurance costs on the ACA. They assume that the costs are going up because they are being forced to pay for the poors. In politics, scapegoating is a well-practiced art.
~OaWN
See below from unabashed liberal.
716 billion never went to medicare. Went to sevice cuts, medicaid, and increase in fees.
In fact in addition to lifetime payments (in my case 50 years) from work, there are 250 month in payments and inceased copays beyond basic costs as ACA implemented. Given that historically medicare costs have inceased minimally this is significant. Finding a dr that accepts it is now a major issue too due to cost conainment.
It is not a RW attack. It is a fact.
Respectfully, I disagree. Medicare recipients were not affected
11 Myths About Health Care Reform
As I recall, the overall Medicare program was cut by $716 million, but that does not necessarily mean that benefits to recipients were cut. And per the above article, benefits were not cut. It's from the AARP, I'm not quoting it as the Bible or definitive proof, but it does document what I had recalled about the situation, and so that is still my opinion until I see convincing evidence to the contrary.
The whole point of health care reform was to minimize the amount of money that the government has to pay for healthcare related programs (at least, that was the political motivation for why the government wanted to do it). We want the government to be spending money wisely, right? Saving money should be viewed as a good thing. But of course it all depends on where the savings come from. According to the above, the savings did NOT come from reducing the benefits that Medicare recipients receive.
I am just going based on what I have learned, I am not a Medicare recipient.
I don't quite understand your writing, Shigeru, I'm sorry. It sounds like as a retiree, you were eligible for "lifetime payments" (I don't recognize that term), but since the ACA passed you now have to pay $250 more per month and also increased copays? And because of that, you think that money was taken away in order to pay for ACA? If that is true, I think I both understand your perspective, but I still need to disagree based on the evidence that I have seen. There is an expression, "correlation does not imply causation". If two things happen at the same time, it is easy to believe that one caused the other, but that is not necessarily a true assumption. I suspect that might be happening. But at the end of the day, I think that proving whether or not this happened very likely would be a time-consuming exercise, and if so, I'd rather just agree to disagree with you if that is possible.
~OaWN
The following quote is an actual fact, not RW propaganda
In California, almost no physicians accept Medicaid (known in this site as Medi-Cal). Those poor souls do have to be on the verge of bankruptcy to even qualify for the program. Those illusory physician reimbursement hikes have yet to materialize, unless perhaps referring to GPs Pediatricians. Specialist payments are not only stagnant, but in some cases actually decreasing. For this reason many physicians have stopped seeing Medicare patients--decreasing reimbursements
Yes there a docs who game the system and probably have yachts, etc. As far as ACA reducing "fraud and abuse", that hasn't happened. L.A. is notorious for bogus medical charges, of which only a small percent are prosecuted--for reasons unclear to me.
Having these dialogs is always difficult
I was responding to the major point, which is the concept that money had been taken away from Medicare in order to pay for the ACA. As I understand it, this was not true for Medicare recipients, their services were not cut. However, payments to healthcare providers were reduced. And because of that, I can see how doctors would be increasingly reluctant to take new patients.
It is helpful, I think, to have your added perspectives on this essay. Thank you for sharing them.
~OaWN
OaWN, you may be talking about the $716 billion in cuts . . .
Below's a blurb or two about them, straight from a propaganda arm of ObamaCare.
BTW, we've been forewarned about Medicare Advantage (MA), which in spite of having an enrollment increase of approximately 25% over the past decade or so, can be a risky proposition due to the narrow provider networks--especially in non-urban areas.
Anyhoo, that's a topic for another day, I suppose.
Supposedly, the $716 billion dollars in cuts were 'reinvested,' and 'improved' Medicare. (cough, cough!)
and,
Everyone thinks they have the best dog, and none of them are wrong.
Thank you Mollie
I ended up replying to Shigeru up above ... I recall that $716 billion in cuts to Medicare were announced, but as I understand it, the savings came in the area of payments to healthcare providers rather than cuts to the benefits that Medicare recipients receive.
I don't know what the language of the bill looks like, but I don't know that savings from one program are actually literally used for another program. That is an expression that politicians tend to make, but as I understand it, budgets are enacted for the entire system. A number of programs get cut, a number of others get additional funding. I don't have a detailed understanding in that area though, I'm just talking about how I think that it must work. The link that you provided is higher-level, marketing fluff, as you pointed out ... I provided a different quote from an article in the AARP. And thank you for participating in the dialog!
~OaWN
Hey, OaWN, I agree--when we discussed the various
pieces of Medicare legislation (which contained cuts) at Evening Blues (EB), we often reference the bill, or a summary of the bill. Whether it's a legislator's website, a candidate's website, a Dem Party advocacy group's website (AARP), the DNC's website, or the White House website--all one gets anymore, is 'spin'--a very polite word for lies and distortions.
It's my custom to post what I find out about a bill at Joe's EB, for several reasons. Obviously, over there, there's a lot of so-called 'hard news,' not just opinion. And there are quite a number of Bluester's who've been following O's efforts at negotiating a Grand Bargain since December of 2010--when the Bowles-Simpson's recommendations were first proposed.
From time to time, Joe has written excellent essays outlining the various reform proposals--most often, before the House and/or Senate cast their votes. On a couple of occasions, we did our best to alert the entire DKos Community of pending legislation containing entitlement cuts--but usually, to no avail.
I say that since it appeared that many Kossacks had drank the Kool Aid (for lack of a better expression)--believing that Democrats wouldn't cut Medicare, Social Security, Social Security Disability Insurance, or Medigap Insurance. All of which they have done, of course, during the past 7-1/2 years.
I'm doing my best to follow the 'tax reform' proposals that have been negotiated and/or proposed. Lawmakers are being very tight-lipped. It's important, since we know from the initial Grand Bargain negotiations that if/when marginal tax rates are slashed--entitlements will almost certainly be slashed as offsets.
I'm sure that you know that corporatist Dems believe in 'pay-go.'
IOW, for every new expenditure, there must be a cut, or spending offset. That was the main reason Democrats opposed GWB's Part D (RX Program). IOW, it wasn't because it was a 'private sector' program, it was because GWB didn't insist on (totally) offsetting the new spending, at the time that the bill was pushed through.
The sad truth is: more and more, it's the Democratic Party who are the fiscal austerians. For them, everything is about 'offsets,' and achieving a 'balanced budget.' That's one reason many Repubs are flocking to FSC. I have never checked out FSC's ridiculous agenda/proposals--but, I guess that I'm going to have to.
I say this because not long ago, I heard former (SD) Republican Senator Larry Pressler say (on XM Radio) that the reason he is voting for FSC this cycle, is that she intends to tackle the budget deficit. I know Pressler from C-Span--he is a major deficit hawk.
Former Rep/Senator Pressler also spoke glowingly of WJC's balanced budgets during the 90's. (He was a Senator during that period, IIRC.) He authored the 1996 Telecommunications Act, which WJC signed into law.
Hey, off my soapbox . . .
I'll keep my eyes peeled for your essays, especially when the topic is health care and/or entitlements--my favorite topics.
Have a good one!
Mollie
“I believe in the redemptive powers of a dog’s love. It is in recognition of each dog’s potential to lift the human spirit, and, therefore, to change society for the better, that I fight to make sure every street dog has its day.”
--Stasha Wong, Secretary, Save Our Street Dogs (SOSD)
Everyone thinks they have the best dog, and none of them are wrong.
Agreed! Yay!
It sounds like there is a treasure trove of information at Evening Blues, which is great to know.
Now I'm kind of feeling like I accidentally stirred up a hornet's nest, which I didn't mean to do, I only meant to supplement gjohnsit's essay a little bit.
The problem space is huge and complicated, no easy answers. I do know about PAY-GO, so now that you mention it, folks need to have a "how are we going to pay for it?" answer when proposals are made to spend money, so my previous answer was incorrect to some degree. So I will stand corrected on that. And I agree with you - most everyone's comments have to be reviewed closely for spin, it seems to be part of the world we live in.
Thank you for you kind words. You sound like a smart cookie, I look forward to talking with you on future essays
~OaWN
And ill people are always shopping for hospital care, riiight.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
Excellent diary and comments!! REC'D!!
Boy, I have endured the US Healthcare Nightmare, and lived to write about it. Mebbe one day, I will.
Inner and Outer Space: the Final Frontiers.
I hate unsurance companies. And corporate medicine.
I've experienced the 10-fold increase in prices from the hospitals for the uninsured, I've experienced rejection because of low B12 from 10 years prior, I've been flat out rejected by a clinic that didn't like my insurance, and I've suffered under the governorship of an insurance crook. I'm about to turn 65. Will I buy "Medicare Advantage", or a Medigap plan, or Medicare Part D? HELL NO! I refuse to give the bastards any more business.
It sounds like you've been though a lot, poor thing
I'm so sorry to hear that. Our system really sucks. I'm trying to send some positive energy your way - hang in there.
~OaWN
Yeah, pity poor, poor me. ;^)
When it comes to actual medical problems, I've been relatively fortunate. I broke my back a few years ago ( no nerve damage), and obliterated a fingertip a year later, both my own stupid fault. Otherwise, nothing worth mentioning. But when it comes to insurance and corporate medicine... ARGGHHH!!
I hate to say it...
but until one (or a few) of the healthcare CEO's experiences severe loss, like a child or something like that, because the "system" fucked up, their views will never change. And no I'm not talking about something premeditated or shit like that, but over 400,000 people die each year from preventable medical mistakes, I'm just speculating it's going to take one of these preventable mistakes, that kills one of their children or loved ones, before they are going to wake up.
It's sad and a shame that healthcare is not regarded as a human right. And of course with political candidates like Mrs. Clinton, who are experts in linguistic gymnastics like "Affordable Healthcare is a basic human right". What the fuck does that even mean? Holy cow, who determines what is "affordable"? Why would a basic human right "cost money" to be able to exercise it?
Affordability has ZERO to do with healthcare or human rights, it only means you have to have some type of income to BUY a commercial product from a for profit "corporation".
This idea that we some how have to make a profit from healthcare, is a sickness, a fucking mental health problem.
(Excellent Essay Older and Wiser)
C99, my refuge from an insane world. #ForceTheVote
TY RR.
We are a Christian nation that has a strong tendency to "eat our own", lol. I say lol but of course it is not funny at all.
It occurred to me that in many ways, our system is pretty much a new form of cannibalism. The elites basically hunt and "kill" the poors to increase their own wealth. The elites don't care whether or not the poors live or die. And the wannabe elites are blind to the reality of what is actually going on. I love your comment, RR, TY for dropping by.
~OaWN
As I commented on another
As I commented on another site's diary pertaining to this issue, I stated that we have reached the end of the ACA Health Care Insurance rope, and there isn't any room for "tweaking" anything, anymore, by anyone no matter what they said in the campaign days.
Period.
Time to face reality and evolve to the next chapter of health care reform for ALL Americans, be it Single Payer, Public Option, Medicare For All, or something that hasn't been brought forth or designed yet for analysis and discussion to the commons.
Enough, is enough. No more health care by spreadsheet, as millions are suffering everyday.
"Dissent is the highest form of patriotism." - Howard Zinn
I am with you brother, but I am afraid that there is too much
propaganda out there that must be conquered somehow before we can get the change we need.
All of the excess profits in the system flow like mother's milk to the recipients, and they will kick and scream and do their very best to keep that flow going. And most importantly they will lie, using politicians such as Clinton, who has a forked tongue that some people / many people are unable to "hear" for what it is. We need to keep up the good fight.
~OaWN
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