Health Insurers Get Real
Health insurers are starting to subscribe to the old saying “If you can’t beat ‘em, join ‘em,” as the U.S. moves toward health care reform. But they’re not about to submit to changes that would brutalize them financially.
Americas Health Insurance Plans and the Blue Cross Blue Shield Association announced this week that it would be willing to end its practice of charging higher premiums for people with pre-existing medical conditions — or rejecting them outright — if the nation’s health reform legislation requires everyone to buy health insurance and if the health bill doesn’t include a public health plan. “The private sector can rise to the challenge of solving these problems,” America’s Health Insurance Plans’ Karen Ignagni said in a Los Angeles Times article.
But while insurers forge ahead with proposals that they believe would bring the uninsured back into the market for private insurance, liberal Democrats remain dedicated to the notion of a new government-run health plan. Insurers say this would result in unfair competition because the government plan would be large enough to put substantial cost pressures on private plans by driving down reimbursements to health care providers as Medicare already does. But proponents of the government system contend that without this provision, insurance companies could take unfair advantage of consumers.
Even if insurers stop charging the sickest people more for insurance, there will still be some risk factors that will affect premium rates for purchasers of private insurance. Health insurers say they will still vary rates by age, family size, and geography.
According to The Wall Street Journal, the House of Representatives is likely to include the provision for a government plan in its version of the health reform bill that will be introduced in late spring or early summer. ###
March 27th, 2009 at 4:20 pm
Too little, too late from these guys. The private sector hasn’t noticeably “risen to the challenge of solving these problems” to this point, so why should we think they will do so now?
March 29th, 2009 at 8:25 am
Most, if not all, employer health plans in companies employing 500 or more employees waive pre-existing conditions and always have - this is not new.
Small employers plans are subject to pre-existing conditions for the first twelve months - with a huge caveat - if the employer group is moving from one group plan to another group plan with a new insurance carrier, the new carrier will waive the pre-existing condition limitation. Again, this is nothing new.
Individual health insurance plans do include pre-existing condition limitations.
The way to allow individuals to buy as a group is easy. Let them join a group where large numbers of individuals will provide an adequate spread of risk.
Why is this not available now? Regulators and legislators in all 50 states and the District of Columbia only allow Unions, Government Entities and Employers to hold group health insurance contracts.
A single-payer plan or other government concocted arrangement will grow out of control and be funded be ever increasing taxes - see Massachusetts’ latest model.
Cost of claims (services from docs/hospitals/providers) is what drives the cost of insurance premiums. Until the cost of care declines, the cost of insurance will merely follow the cost of care upwards.
March 29th, 2009 at 12:03 pm
A common example used to further the cause of “Universal Health Care” in the United States is to point out how well it is working in countries such as France and Canada. However, those living in Canada know full well that their government run health care program is most certainly not working. As a matter of fact, many Canadian citizens choose to hire high priced brokers to find them quality health care right here in the United States because of the terrible bureaucracy that controls all forms of health care in Canada. For more about what is really going on with the Canadian health care system please watch these short but very informative documentary videos:
http://www.freemarketcure.com/brainsurgery.php
http://www.freemarketcure.com/twowomen.php
http://www.freemarketcure.com/thelemon.php
You Tube: Dead Meat by Stuart Browning
http://www.youtube.com/watch?v=KiXT0P3edfs
The number of actual uninsured’s in the US has also been grossly inflated as well. For the real numbers: http://www.freemarketcure.com/uninsuredinamerica.php
Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers and academics alike are beating the drum for a far larger government role in health care. Much of the public assumes their arguments are sound because the calls for change are so ubiquitous and the topic so complex. However, before turning to government as the solution, some unheralded facts about America’s health care system should be considered, says Scott W. Atlas, a senior fellow at the Hoover Institution and a professor at the Stanford University Medical Center.
Americans have better survival rates than Europeans for common cancers:
* Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom.
* Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway.
* The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
Americans have better access to treatment for chronic diseases than patients in other developed countries:
* Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease.
* By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.
Lower income Americans are in better health than comparable Canadians:
* Twice as many American seniors with below-median incomes self-report “excellent” health compared to Canadian seniors (11.7 percent versus 5.8 percent).
* Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as “fair or poor.”
Americans spend less time waiting for care than patients in Canada and the United Kingdom:
* Canadian and British patients wait about twice as long — sometimes more than a year — to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer.
* All told, 827,429 people are waiting for some type of procedure in Canada.
* In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
Source: Scott W. Atlas, “10 Surprising Facts About American Health Care,” National Center for Policy Analysis, Brief Analysis No. 649, 3/24/09 http://www.ncpa.org/sub/dpd/index.php?Article_ID=17770
Because of how the Single Payer System is designed Canadian citizens have NO WHERE NEAR the choices that we as American citizens do. As a matter of fact, until very recently (2005) it was simply not possible for a Canadian citizen to pay for their own health care or to purchase private medical insurance that would “bump them up the long waiting list” for medical treatments. The reason Canadian citizens now have the right to do so (and it is still limited) is a direct result of long hard battles (many that are still being fought) that have been waged by brave Canadian citizens like Dr. Jacques Chaoulli who took his clients case all the way to the Canadian supreme court and won! Dr. Chaoulli (http://www.healthcoalition.ca/chaoulli.html) and his patient, George Zeliotis, launched their legal challenge to the Canadian government’s monopolized healthcare system after waiting more than a year for hip-replacement surgery.
Canada’s high court found for the plaintiffs and in doing so issued the following statement: “The evidence in this case shows that delays in the public healthcare system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public healthcare. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital healthcare result in physical and psychological suffering that meets a threshold test of seriousness.” Furthermore, Justice Marie Deschamps said, “Many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life. The right to life and to personal inviolability is therefore affected by the waiting times.”
Furthermore, the Vancouver, British Columbia-based Fraser Institute which keeps track of Canadian waiting times for various medical procedures. According to the Fraser Institute’s 14th annual edition of “Waiting Your Turn: Hospital Waiting Lists in Canada (2006),” total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 17.7 weeks in 2003 to 17.9 weeks in 2006. Depending on which Canadian province you live in, a simple MRI requires a wait between 7 and 33 weeks! Orthopedic surgery could require a wait of 14 weeks for a referral from a general practitioner to the specialist and then another 24 weeks from the specialist to treatment! For even more real life horror stories about Canadian citizens left in the lurch by the Canadian healthcare system read the well researched and fact based Wall Street Journal article entitled “Too Old For Hip Surgery” here: http://online.wsj.com/article/SB123413701032661445.html?mod=article-outset-box This is what happens when you put government in control of your health care decisions. Doing so in this country, would be nothing short of a train wreck. Anyone who thinks otherwise is simply uninformed or “willfully ignorant”.
Real healthcare reform can be accomplished through consumer education, weeding out abuse of existing Federal entitlement programs (via a legitimate needs assessment) and continued funding of State sponsored Risk Pools so that people who are declined for insurance have an affordable option to continue coverage if declined on the individual major medical market. Following these few simple steps will go a long way towards not only maintaining our current health care system, but also towards keeping the bulk of our nations risk where it belongs, namely with the private health insurance sector. In light of the recent multi Trillion Dollar “Bail Outs” and many other failing corporations coming to the table with their hats in their hands (and their private jets on the tarmac) the last thing our government should do is start cutting more blind “bail out” checks in an effort to “reform” the U.S. health care system.
States such as Massachusetts and Illinois bear evidence against furthering the cause of Universal Health Care.
I have been an insurance broker in the state of Illinois for the past 13 years and I have seen first hand what happens when an over burdened, tax funded, Government controlled, entitlement program like Medicaid is offered to those with incomes well into the middle class. Last year, SCHIP covered about 7 million low-income children and Medicaid covered an additional 23 million. This year, the U.S House of Representatives passed the H.R.2 SCHIP Expansion Bill. This bill adds another 6.5 million children to Medicaid. In fact, according to U.S. Census Bureau data, 42 million children will now be eligible. The bill also allows States to receive federal reimbursement for adding more immigrant children and pregnant immigrant mothers, and removes the 5 year waiting period now required for legal immigrants to be eligible. This would enable immigrants to come to the United States and qualify for benefits the moment they get here.
The present income eligibility cap is $44,000 for a family of 4. The new bill raised the Medicaid limit to $66,000. New York will even include families who earn $88,000 and other state’s allow families to subtract from their income calculation what they spend on rent or mortgage or heating or food or transportation. So children in some families with incomes well over $100,000 will now be eligible. With the median U.S. household income being $50,000 and 60% of U.S. households earning less than $62,000, this means that 3/5ths of American households will now qualify for free health care for their children. The other 2/5ths have the burden of paying for all of this!
In fact, several Medicaid “expansion” programs have been enacted in our State by recently impeached
and now infamous Governor Rod Blagoyevich (Democrat). More on how he handled Medicaid in Illinois:
http://blogs.wsj.com/health/2008/12/18/blagojevich-a-childrens-hospital-and-medicaids-stingy-ways/ In fact, our state was the first to expand these Medicaid entitlement programs to include the “All Kids Covered” plan www.allkidscovered.com the “Mom’s & Babies” plan:
http://www.allkids.com/pregnant.html and the “Family Care” plan http://www.familycareillinois.com/
These entitlement programs not only have provided free health insurance coverage to all low income women who are currently pregnant (”Mom’s & Babies”) and all children - here legally or otherwise (”All Kids Covered”) but they also provide free health insurance to all low income mothers of children who are insured under the “All Kids Covered” program (”Family Care”). One does not need an actuarial degree to quickly conclude that these types of entitlement expansion programs simply can not continue to work without massive and endless influxes of Tax Payer Dollars. In fact, the State of Illinois is currently $1.5 Billion (yes that’s BILLION) behind in payment of claims to medical practitioners who have provided treatment for Medicaid recipients. Furthermore, submitted claims by unpaid practitioners have accrued a potential liability of $81 million in interest due to payment delays over the past 8 years! http://www.mysuburbanlife.com/broadview/archive/x1874998363/Illinois-must-fix-Medicaid-woes Quick update: As of January 2009 a moratorium has been placed on the sliding scale portion of the Illinois Family Care and the Mom’s & Babies program. One can only wonder why. Could it be due to lack of funding?
Illinois was lauded as the “Flagship” state for all others to follow regarding the expansion of the Medicaid entitlement programs. If this is the template for all others to follow, then god help us all, or at least those of us that actually fund the Medicaid system through our hard earned tax dollars. Weighty decisions such as expanding the Medicaid system to virtually “All Kids” regardless of their actual need, simply can not be made based entirely on emotion! Prudent decision makers must weigh the DESIRE to help all mankind against fiscal REALITY.
There simply is not enough money to provide such irresponsible expansions of the Medicaid program. Most especially with the $780,000,000,000 (BILLION)”Porkulus” Bill just passed in the Senate. This is why President Bush vetoed the SCHIP program http://www.nytimes.com/2007/10/03/washington/03cnd-veto.html which was pushed irresponsibly forward by the Democratic Party. The Conservative side of the House shares the same concern for those truly in need. This side of the House wishes to help those who are deserving of such entitlements e.g. legal residents of this country who actually qualify during a legitimate needs assessment. Most certainly not a needs assessment that includes the middle class who can and should insure themselves against medical risk.
Expansion of these entitlement programs to anyone else is a well meaning, but fiscally irresponsible act. One that, in the end, will end up crippling the already over burdened Medicaid system. This will especially be true when the “Baby Boomers” all start entering the assisted living arena without Long Term Care coverage to help shoulder the burden of the ever increasing cost of professional care that will, without a doubt, be needed for this gigantic population of new senior citizens. This can all be avoided by shifting the risk where it belongs. Namely, the private health insurance industry. This is where the money is, and always has been, to shoulder this burden.
Expansion of these entitlement programs to anyone else is a well meaning, but fiscally irresponsible act. One that, in the end, will end up crippling the already over burdened Medicaid system. This will especially be true when the “Baby Boomers” all start entering the assisted living arena without Long Term Care coverage to help shoulder the burden of the ever increasing cost of professional care that will, without a doubt, be needed for this gigantic population of new senior citizens. This can all be avoided by shifting the risk where it belongs. Namely, the private health insurance industry. This is where the money is, and always has been, to shoulder this burden.
Those of us who are in need of health insurance have many options to choose from. These options are priced very affordably, most especially so if one takes advantage of the recently expanded tax incentives awarded to those who own HSA qualified HDHP’s http://www.sbisvcs.com/Health%20Insurance%20products.htm Even if one can not qualify for the aforementioned HDHP option due to underwriting restrictions, then there are many other options now available to those who have been rendered “uninsurable” in the individual health insurance market.
These options include the following:
1) State Insurance Risk Pool Coverage provided under HIPAA http://www.naschip.org/states_pools.htm
2) Small Group or Employer Sponsored Health Insurance which contains the all important “Guaranteed Insurability” clause.
and
3) HIPAA certified “Defined Benefit” Health Insurance policies issued on an individual basis to anyone regardless of medical history http://www.sbisvcs.com/guarantee_issue.htm
An integral part of making fiscally sound responsible decisions, means you must explore ALL of your options before leaning on a Medicaid system that is already over burdened by those deserving, and most recently, those who are undeserving.
This is why it is always prudent to consult with a reputable and knowledgeable health insurance broker (not a captive agent who can only offer one company’s products). It does not cost a penny more to buy your health insurance using a broker than to purchase it blindly on the internet. That being said, why not take advantage of the wealth of knowledge accumulated by insurance brokers all over this great country of ours? The majority of them truly have your best interests at heart, and will do their very best to guide you in the right direction to properly secure your financial future. This is most important now, since one can only assume that the quality of care (e.g. ordering expensive follow up tests to properly diagnose a condition) that a Medicaid recipient receives, must inherently suffer. Simply due to the fact that the practitioner knows in advance that payment for services already rendered is behind, and payment for future services may never come! http://www.mchenrycountyblog.com/labels/Kids%20Care.html
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