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President Obama has been barnstorming the nation, pushing for passage of a health overhaul package. His Secretary of Health and Human Services, Kathleen Sebelius, recently singled out Oregon as one of six states where insurers are pushing for double digit premium hikes. Health insurance companies like BlueCross BlueShield of Oregon say their health care expenses are rising, and more healthy people are dropping coverage, leaving more expensive, sick members to provide for.
Critics of Obama's health care proposal — in no short supply — say the bill Obama wants on his desk would not do what's needed to control costs.
In the meantime, the newly created Oregon Health Authority is in charge of planning for expanded access at the state level. Whatever is or isn't done on Capitol Hill will certainly have an impact on the state's ability to make sure all Oregonians have access to health care.
Do you have health insurance? How do you pay for your premiums or your health care costs? Have your rates gone up recently? What would you like to see in national health care legislation?
Note: We'll also be catching up on what candidate races look like after yesterday's filing deadline and the unexpected passing of State Treasurer Ben Westlund.
GUESTS:
- Jeff Mapes: Political reporter for The Oregonian
- Jared Short: President of Regence BlueCross BlueShield of Oregon
- Peter DeFazio: Democratic representative for Oregon's 4th district
- Bruce Goldberg: Head of the Oregon Health Authority and Director of Oregon's Department of Human Services
Tagged as: rx
Photo credit: deltaMike / Creative Commons
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I own a small business in downtown Portland. We have always provided health insurance for our employees. It is good business and it's the right thing to do. Our rates increased almost 50% this year! We have shopped around and every other company we can find is still an increase of 30 to 40%. I believe the insurance companies and most of the health care establishment have lost touch with what average Americans are going through. The only logical option I see is a single payer plan. Basically Medicare for all. There is enough money in the system...but nobody wants their ox gored! For this to work everyone , including consumers, insurers, doctors, for profit health care companies and drug makers all have to give up something.
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Could you tell us what your premiums are? I don't think most people realize the cost of insurance. thankyou
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The Obama Administration's vilification of the insurance industry is a diversion. It smacks of populism and isn't grounded facts. In short, it is unhelpful. That isn't to say health care reform reform isn't needed. But the actions of the health insurance industry are a product of our bizarre system of regulations and subsidies - a symptom of the greater problem, if you will.
The insurance companies are businesses - unless there are laws against denying coverage, they shouldn't be expected to underwrite policies where they know they can lose thousands (or even hundreds of thousands) of dollars. They do make profits on certain lines, but they compete for those profits. And they compete with non-profits in many markets. Group Health & Kaiser Permanente have different business models, yet still fail to outcompete the for-profits for a lot of business. Why is this? And if the health insurance business is so lucrative, why aren't there more companies entering the industry? Heck, GEICO (a division of Berkshire Hathaway) has the capital and employs smart people, but I don't see them offering health insurance in Oregon.
One of the main problems with the insurance industry is underwriting - this is a huge expense that contributes nothing to improved outcomes for patients. But an insurance company without good underwriting wouldn't last to see the anniversary of its policies.
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The real problem is that we have two Americas. Healthy America which feels it is getting ripped off for health insurance. And Sick America that doesn't want to die for want of treatment -- so the people in Sick America cost a lot of money. The populations are dynamic - which is the wild card in this loosely shuffled deck. The current system is broken, with too many people falling through the cracks when they go from healthy to sick, healthy people overusing healthcare because they feel they "pay for it anyhow," and states openly rationing subsidized healthcare at random (by lottery, in fact!).
I suggest that we adopt mandatory health coverage, but rather than the current proposals which mandate an expensive high level of minimum coverage, encourage HSAs for healthy people so more of the health care pie is left for the truly sick. Health care for the sick Americans could be picked up by the taxpayers once a person's HSA balance has been depleted. They could effectively carry a negative balance in their HSA, and this debt would be forgiven at death. Tort reform and open rationing of care for non-life threatening ailments (President Obama's example of hip replacement for his grandmother during her final weeks springs to mind) could help to lower healthcare costs as well.
The insurance companies aren't the problem. Unless we make a real effort to bend the cost curve, any reform will likely spiral out of control. The cost would strangle our economy thereby limiting our ability to provide qulaity health care for all Americans.
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"The real problem is that we have two Americas. " This is wrong -- there is only one America. The young and healthy are paying ahead for the time when they will need health care; the potential cost of health care is spread over a lifetime so there is no devestating financial blow. By including the young and healthy we are lowering their health care costs when they get old or get ill. What the young and healthy are actually doing is paying for the care they will receive in the future, not giving away their hard earned money to pay for their parents health care.
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HSAs don't work. They are a terrible idea, not to mention gamble, that fix nothing.
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I am a consumer of the individual insurance market, because my employer does not offer me health insurance. Regence Blue Shield of Oregon has a monopoly on the Blue Shield/Blue Cross market in Clark County, WA (where I live) in Clark County you can not purchase insuance from Premera Blue Cross of WA even though you live in WA state. There are very few options for individuals. I am a non-smoker and have just had my rates raised to $396 per month. This is with a $2,500 deductible. This really results in no insurance at all because one can never meet the deductible. The lostest deductible Regence offers is $1,000. Every year they raise rates by outragious amounts and say it's because the cost of health care is going up. This is just an excuse. They fail to mention all the community events Regence spends money on supporting or the salaries of their administration. Soon I will be priced out by high premiums and will become one of America's uninsured.
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The human body is not a car, a home, a diamond ring, or a boat. The body is not an option or a luxury, it essential for life. To do without it, with our current technology, means death. The excessive privatization, capitalization, and the need for endless profits, based entirely around and upon the health of individual, living, breathing, fleshy masses---that think, talk, love, desire and want to generally wake up the next day---are not compatible. The desire to maintain a healthy body is not commensurate with the interests of a capitalist economy. This is not a decree against the free-market, it is simply time we wake up to the fact, not to mention the logic, that some aspects of the market are different---and, need different economic models in order to survive.
Insurance companies are inherently part of the problem, all the players are part of the problem. Companies are not people, they are money making constructs, that have none of our human desires, the only desire and sole purpose of a for-profit company is to make money. You cannot treat health-care like any other commodity or service, it is wholly different. Life and death cannot be left up to the whims of shareholders and executives. The reason costs are so high, is because of the system. The only thing that can fix the system is a single-payer or public option model. We have had a long run to test a private, free-market, health-care system---and, it hasn't worked! It is not that it is broken, or became broken, it was bad idea from the start, from the beginning---and, now, it has run its course. It is time to fix the American health-care system at its roots.
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I'm already among the uninsured because, when I lost my job, it just became a matter of throwing my money down a rat hole, so I live with the risk. I have tried to maintain insurance for what I think it should be for, covering risk, not covering care, but now it is too expensive for even that. And it is just annoying to have to jump through massive and elaborate hoops with my insurance company and my doctor to get basic care, when I don't expect to even come close to my high deductible. So I've gone back to paying my doctor directly for my visits (which he is OK with - I checked) and hoping nothing drastic happens which I won't be able to afford.
Nobody in the discussion has even mentioned what I want, which is a national single payer for wellness and preventive care, and insurance, if you choose to have it, for serious illness or catastrophic care.
I don't get the system as it stands right now. How absurd would it be if I had to go through my car insurance every time I wanted a tune-up or an oil change? or if I had to go through my home owners insurance to paint my bathroom or replace my refrigerator? When did ALL health care start going through insurance?
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"I don't get the system as it stands right now. How absurd would it be if I had to go through my car insurance every time I wanted a tune-up or an oil change? or if I had to go through my home owners insurance to paint my bathroom or replace my refrigerator? When did ALL health care start going through insurance?"
Excellent point.
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I'm with you KatieD...I would strongly favour a single-payer system. America has plenty of allies across the globe who have Single-Payer systems that work -- from Canada to The U.K. to Australia to Taiwan (just to name a few).
Indeed, here in the U.S. we already have single-payer systems, provided you are a member of certain select groups (Veterans, Senior Citizens). Why can't we have that for all of us, regardless of whether we are old or have put on a uniform for Our Great Nation -- and it is a Great Nation, even if we disagree with the government from time to time.
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How would mandatory, compulsory health insurance really differ from the statutory requirement that anyone who wants to drive pay for Auto Insurance. (This sure seems to me to be an enforced subsidy of an industry on the backs of consumers. Anybody wanna refute this?)
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You can get a license without automobile insurance. You can use a motor vehicle on private property without insurance. If you own your own vehicle you need not insure it. The only insurance you must have is to cover damages to other people and their property while using your vehicle on public property.
I believe that any insurance a state requires of it's citizenry should be the responsibilty of the state to implement. Surely if our government can run as great a military as we claim, our government is more than capable of running a fantastic insurance program for we citizenry. If we elect officials that believe that government is good and do not allow the intentional sabatoge of programs that benefit real human people (not corporations) this issue of health care coverage need never arise. Don't believe me; ask any Republican if Medicare or Social Security should be eliminated and then ask them why they have been actively attempting to destroy both since the Reagan Devolution.
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Just a short note: your guest said something to the effect "way out east" in reference to eastern Oregon. That about sums up how eastern Oregon is seen and thought of by western Oregon--far far away and maybe not as relevant. A throw away comment, but telling.
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I am a new successful small business person (yahoo!!!!), who left a job with government to start my own business. And, business is booming, and I will have no problem paying my taxes, contributing to this communities tax base this year.
However, the biggest challenge that has me waking up--sweating bullets around my budget--is my health care premiums.
I consider myself very, very healthy (I frequently hike 20 miles plus). I do have one of those preexisting conditions that if I manage well, will be a non-issue for most of my life. However, that means, buying health care on the individual market isn't an option so I can continue to get one key drug at a reasonable rate. To keep healthy, I'm paying $600 a month as a single individual under the COBRA option--plus $50 bucks a month for my drugs. I can do so for the next 17 months, until COBRA runs out.
And that is cheaper that buying it on the open market.
Seventeen months from now, I'm out of luck. Unless there is a change on how we deliver healthcare, I'm going to have to take a desk job: so, a small business person who is actually successful will driven out of work by health care premiums.
Would a free marketier, a heath care industry representative, or someone that opposes the national health care plan explain to me how this makes sense? How, exactly, does the current system sustain the kind of economic growth that places like Oregon need? If a bill doesn't pass, how I am suppose to effectively contribute to the economy, pay my taxes and support the tax base.
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A free marketer would say that the obstacles to you being able to purchase health insurance are the goverment regulations that strangle the virtuous insurers from providing a good product to the consumer. Some people actuallty believe this. I don't and I don't believe that politicians or pr people that would espouse this do either. I think there is a lot of cynicism and lawyering in this whole debate. I hate to say it but I feel like if the economy had really gone into the toilet and un employment was at 25% we would see a populist push for health care/health insurance reform with real teeth.
Good Luck.
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Why doesn't health care reform include the ability to keep group insurance rates through COBRA for longer than 18 months? We will exhaust our COBRA eligibility in a few months. Our insurance cost will more than double even with a higher deductible and no dental insurance.
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As reported numerous times on NPR, a well respected public polling firm found, that across all socioeconomic divisions, the American Public wants:
* Everyone to have Healthcare Coverage
* Little to no restrictions on services provided
* Someone else to pay
Most of the comments posted today support these results - our elected leaders have an almost impossible job!
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I have great healthcare benefits through my employer. And I have a union to help maintain them intact as possible. So far, I pay no premium for my elected insurer. But every contract negotiation is a struggle.
One thing is certain: If I was responsible for even just half of the premium, I would not be able to afford it and would probably go without.
I support a single payer system.
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In 2005 I was in a near fatal car accident and thankfully, I was fully covered under my mother's health insurance. I filed a claim with the company and received the maximum amount of money the policy would allow to compensate for my injuries.
In 2007 I purchased my own health care coverage with Aetna at $186/month. It was a PPO, had low copays, included a very good woman's health plan (I was 25 when I purchased this coverage). Currently, without changing my plan at all, in two years my plan has gone up to $376/month. My copays are higher and the coverage is less. In addition, my plan was "dissolved" and Aetna has placed me into an HMO.
If I had not received an insurance claim for my car accident years ago there is no way I would be able to afford this, or any, coverage. I am 27 years old, generally healthy, and have a healthcare plan that is eating away at my savings.The current healthcare system does not work.
I support a public option.
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Obamacare is 2,700 pages long. Why is his plan this large? What is the plan hiding from the public? Pork? Will Obamacare provide $378 billion infusion to insurance companies?
I have no confidence that Obamacare is the answer. What happened to Senator Wyden's health care plan?
My $10k deductible, catastrophic coverage policy increased by 16.7% for 2010 with the blanket explanation: costs for providing health care has increased and we're passing the increase onto you.
I pay for health, dental and eye out of pocket - the insurance company denies all submitted claims. This "health care" is lousy because there is no preventive care.
I was denied by three insurance companies prior to getting my current policy due to BMI issues. I will never meet BMI/obesity standards until the crows and turkey vultures pick my bones clean.
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trurl9: BMI should not be used to deny you from getting health insurance. If you have were denied coverage by the major health insurers, do look into OMIP, it should provide you with better than catastrophic coverage.
Rather than counting the 2700 pages, try downloading and reading this 11-page document:
http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf
The reason it takes a 2700 page bill to paper up all the holes in "the system" is that it will take a lot to "un-do" the last 50 years of lawyering, lobbying and legislating that has created one of the most expensive systems with "15-th worse" or so health outcomes. Just read the 11 page proposal, please. And since you bring up that label "Obamacare" keep in mind that more than a few of the ideas were from the republican side, a list of those republican ideas can be found here:
http://www.whitehouse.gov/health-care-meeting/republican-ideas
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Why is there so little attention focused on the huge profit that private insurance companies make ad the huge salaries that the executives make on people being sick?
Is there any other country that profits from sick people in this way??
Lori
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My cost of insurance, with a decline in quality of coverage from
the group policy plan:2005 to mid-2006, CIGNA, under COBRA:
medical $317.75/mo, dental $34.96/mo
Preferred provider plan, $20 copays, dental and vision coverage.
This was the same plan I had as an Intel employee.
After COBRA, in the Oregon insurance pool:
mid-2006 , OMIP "Portability-750" plan
This plan has $750 annual deductible, no dental or vision,
maximum out-of pocket is $3000 annual in-network, $6000 out,
co-pay for most things is 20% in-network, 40% out of network.
Lifetime benefit: $2 million. Premiums are:
Age 45-49: $333/mo. Age 50-54 $411, Age 55-59 $420, Age 60-64 $422
Now the price increases.
By 2008 I was paying $415/mo for the same OMIP plan.
(Keep in mind in 2007 I turned 50, so there is an increase in premium
because I bumped into the next higher age bracket.)
As of January 2010, my premium was raised to $588/mo, same plan.
So from 2006, the policy for a 50-54 year old went from $411 to $588,
a 43% increase over 4 years. My actual costs went from $333 to $588,
a 77% increase in real cost that I pay.
The OMIP plan is administereed by, who? Regence Blue Cross, the
same folks who turned me down; I find that ironic.
I'd like to point out also that the OMIP Portability-1500 plan, though
at cheaper rates, is kind of scary in the case of a catastrophic
event. The co-pays go up to 30%/50% for in/out-of-network, and
maximum out-of-pocket doubles from the other policy. But the
premiums are not half, they are $248/mo vs. $333, so about a 25%
decrease in premium but a 50% change in out-of-pocket. Just the
thing if I was 25 and didn't care, but not the ideal thing in my
50's. I think once you sign up for Portability-1500, you can't
bump up to the Portability-750 plan, but I'd have to double-check
that.
For those of you who don't want to have "governemnt tell you to buy
insurance," do you drive a car? Then you have auto insurance, don't
you? There is a reason people "have" to buy auto insurance: it
puts all drivers in the pool. Understand? -
Insurance carriers like Regence often argue that their premiums are driven by the increasing cost of health services. In reality current trends in health care costs are running around 5%; Regence premiums for individuals, however, are going up on the order of 20-25%.
Larry
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Insurance companies only have a 3.5% profit margin that is tiny. Most buisnesses have something between 10-20%.
The price keeps going up because if it costs your doctor $100 to see and treet you the and you are on medicare or medicade they only pay $60 so when I go to the doctor and I have insurance they pay for my $100 and the $40 that the government didnt pay for you.
So government is the problem not the solution. AND
If you thin k the insurance denies to much then think about this,
Last year medicare denied about 8.75% of its claims
The highes private insurer 6.5% denied
the average private insurer denide 4.75% and the lowest was just about 2.5% denied.
I dont think people understand that health insurance is like car insurance if you want more covered you pay more it doesnt cover everything so
I would sugest that people who want pulic heath care get some more facts I have yet to hear a fact that actually hold up to any scrutiny.
Like they keep raising rate yes true but because they are having to cover government
Jon
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frankj:
You raise the point that Medicare denies a larger number of claims ("last year 8.75%" in your message, 6.85% AMA report card for 2008) than private insurance. I'd point out that private insurers reject people from even getting coverage in the first place... But.
For insight into this, try a google search on:
denial rate of private health insurance claimsWhat I see at Health Care Economist seems, at first glance, to support your point. But read the comments posted to the article "medicare more likely to deny claims than commercial insurers." In the comments, Don McCanne MD notes,
"The implication that Medicare is not providing efficient claims processing is misleading. The 14 day delay is required by law. It has served as a budgeting gimmick to move two weeks of Medicare payments into the next fiscal year. (This is a criticism of governmental budgeting processes, but not of the administration of Medicare. The private sector uses similar measures such as shifting the completion and recording of sales between quarters to embellish their financial statements.)
"If you look at the AMA report cards, you’ll see that most claims denied by Medicare were due to billing errors (inadequate data on billing forms, wrong carrier, not enrolled in program, etc.). Also, some denials are for non-covered services such as routine physical exams. Medicare has been more effective in requiring compliance with the program, which is entirely appropriate considering that these are our taxpayer dollars that they are spending.
"In contrast, the relaxation of compliance standards by the private health plans has wasted funds that we have paid in as premiums. Charging us higher premiums so that they can pay dubious claims does not represent private sector efficiency. We are paying the private plans far more in administrative costs than we do for Medicare, yet they [private plans] are not providing the claims processing efficiency that we deserve. As an example, Medicare pays the contracted rate 98% of the time, whereas the private insurers do so only 66% to 84% of the time. The fact that they can’t get right the rates that they contracted for demonstrates the profound incompetence of the private insurance industry."
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frankj,
Yes, let's hold some facts up to scrutiny (by the way, where did you find yours?) For a link to AMA report cards on payments, try looking at:
http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard-short.pdfLook at it, then look up "claim adjustment reason codes" and you'll be able to decipher the most-used CARC code cited as the reason claims were rejected. Top reasons:
- For Medicare it was (CARC reason #16) the claim needs additional information (28.7% of rejections in 2008).
- For United Health Care was (CARC #27): Expenses incurred after coverage terminated (37.9% of the rejections)
- For Humanna it was CARC #27 also, 34.2% of rejections
- For Anthem BCBS was CARC #16, claim needs information (20.1%)
- For Coventry it was CARC #26, Expense incurred prior to coverage (occurred for 53.6% of rejections, wow)
- and so on
Now, you said, "I dont think people understand that health insurance is like car insurance if you want more covered you pay more it doesnt cover everything so... I would sugest that people who want pulic heath care get some more facts I have yet to hear a fact that actually hold up to any scrutiny."
Buying individual coverage outside of a group plan is not like buying car insurance. I'd suggest you consider the fact that health insurance companies deny the ability of us to buy coverage every day. They also exercise a right of recision: to deny coverage after you have been paying premiums for years (and they keep your money). Buying health insurance requires you to grovel and beg, knowing that any wrong answer on your 10-page application will result in rejection: doesn't happen as much in group policy underwriting, but happens all the time in the individual insurance market.
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I have experienced double-digit healthcare premium increases since
entering the individual insurance market in 2005-2006. (I share my
insurance premims later in a posting above.) I think the president's
11-page health plan advanced Feb 22 2010 is going to be the best
compromise, and I want to see it passed. The only way to run a
sane health insurance scheme is to have everyone in the insurance
pool. That is insurance-econ-101. If you want to see how it's
done in the rest of the world, read T.R. Reid's book from 2009,
"Healing America." It's very clear that the US could pick the best
features used in other developed countries. There is even room for
insurance companies to make a profit.Afer a career in high-tech, around the time I took time off to spend time with my dying father I decided to leave my Intel position. During that
time, I transitioned from my high-tech employer's plan to COBRA.
As the end of the COBRA 18-month interval approached, I asked the
insurance provider, CIGNA, what it would take to continue coverage:
sorry, although CIGNA was writing group policies for Intel in the
state of Oregon, they would not write an individual policy, period.Near the end of my COBRA period, I had a small health complaint,
but did not schedule follow-up checks soon enough. Because this appeared
on my chart and was an unresolved question, two insurers (Regence
Blue Cross and ODS Health Insurance) flat-out refused to write me
a policy. So I was denied due to what is essentially what "could
be a preexisting condition maybe," just on the chance that it could be
something worse. Left with this choice, I discovered Oregon ran a plan
for persons who had been refused insurance
(note this is distinct and separate from the Oregon Health Plan
(OHP) for low-income individuals, where I am not qualified to enroll
due to inheritance from my dad)I'm lucky to have a high income, but I still could not get health insurance
at all were it not for the state program.
If I have to move out of state due to my other parent being sick,
what will be my insurance options then, after being denied?
Being middle-aged and in the individual insurance
market is between a rock and a hard place.
And I thank State of Oregon for OMIP. -
For more information about rising healthcare costs and what the industry doesn't want you to know go to TheLundReport.org
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Thanks, thelundreport.org is an excellent website, I had not seen it before. And signing up for email updates is free.
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The Regence speaker hasn't addressed how much of premium goes to care vs administration. Also, Regence increased its MedAdvantage premium from $123 per month to $176 per mnonth. Fortunately there are 2 carriers with equal or better benefits at $117 per month. Why did Regence increase that much. There must be a reason beyond what the doctors are charging.
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In the last year I have gone from fulltime employment with fully employer funded health insurance to partime employment (same employer) with no health coverage and no ability to even get coverage thru my employer who is part of the OEBB insurance pool. My wife who also had coverage through her employer lost her job completly and therefore her coverage. WE now pay 60% of my take home pay for a $5,000 deductible health insurance plan. How sustainable is that? The only reason we can even afford to get coverage is because we have paid our house off and don't have a mortgage payment anymore. This year I turn 60 and my premium will jump up considerably even if there is no other increases by the company.Yes, I tried COBRA but it was even more expensive and was a nightmare to deal with.
I love my job and would keep it until I retire except for the fact that there is no coverage available for part time employment and there is not much hope that will change. I am now looking for another job with benefits and will leave my employer as soon as I find anything with health insurance coverage. This is just one of many reasons why health care insurance should not be tied to employment especially at this time with so many people out of work.
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I agree, tying health insurance to work is a huge failing of the current market. That has to change. I lost CIGNA as an insurer because, although they write group policies in Oregon, they refused to write an individual policy in the state of Oregon. This illustrates how companies get away with cherry-picking clients state-by-state, where they should be forced to provide uniform services across all states in which they operate, or just nationally, period.
Speaking as someone who paid through COBRA for 18 months, I can say it was not a nightmare, and had very little paperwork. I don't know what was specific to your situation that led you to turn away from COBRA, but you passed up the only opportunity to extend the healthcare your employer provided.
I'm not saying it was cheap either, but I think I paid a little more than what my employer did.
What some people don't realize (because I hear it mis-stated often) is that COBRA is not a long-term or lifetime solution, it is an 18-month bridge betweeen jobs. You can only buy insurance through COBRA for 18 months! After that, you are out in the (cold) private insurance market, solo, or you have to find another job with health benefits. Due to your ages we both know that it is almost impossible to get insurance at all due to preexisting conditions that we all have at that age.
The crime is that the insurance industry gets away with insuring only healthy-young or no-risk people in the private market. At 10% unemployment (really 20%), they get to dump a large chunk of the population by the wayside. It's immoral.
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Raising premiums are only one way that insurance is getting more expensive. I receive treatment for what was once a severe eating disorder. Though my health has improved some, I need ongoing medical and mental health treatment to stay in good health. When Mental Health parity passed, I was so relieved that I would no longer be fighting with my insurance company to receive more than 14 therapy sessions per year. Now that parity is the law, my insurance company (Blue Cross) has decreased the amount they pay per session so that it is only about 50%. Further, they impose new rules telling me after the fact that I needed to have treatments pre-approved. They deny coverage because I didn’t call them to pre-approve my care. The implication with mental health treatment is that it is a luxury. I would be dead if it weren’t for the treatment I receive and the stress and anxiety of dealing with insurance companies to try to get life-saving treatment covered is criminal.
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I am a small business owner in Eugene. Last year Regence increased our premiums by 45%. My employees rarely use their insurance, there was absolutely no change in anything about the employee group and Regence stated it was an across the board increase.
Debbie Olsen
Home Instead Senior Care
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There has been a lot of discussion about the recent published profits of health insurance companies, both in raw dollars and as a per cent margin. I don't think either of these statistics are important. Non-profit organizations, such as the Red Cross, show zero profit, but can pay their executives bloated compensation packages and/or present high overhead limiting the resources directed at their primary missions.
I think of insurance companies as similar to non-profits. I don't really care if they profit or not except that the margin subtracts what is paid out in medical support for their customers. The important figure is the percentage of their premium income that is paid out as benefits to their subscribers. They fare poorly as compared to Medicare in this regard.
To make a profit, to the extent possible, they (1) insure people who never get sick; (2) deny benefits against claims; (3) exercise recission or skyrocketing premiums against subscribers for whom they actually pay out claims; and (4) apply larger and larger annual deductibles.
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I am sorry that is not how they make thier money.
They know that people will have a larg clame for some time after starting the insurance say 18 monthe so the money you pay in gats invested and grow for those 18 months. When you brake a leg they pull the money out of the investment to pay the claim.
so killing off the insurance companies will probably have some seriouse economic implication since all that investment will go away.
I may only be 35 but I listen far more than I speak and I only speak when I have a fair sertanty that what I have to say is correct. If more people did the same maybe REAL Change would happen instead of demagoging about an industry that isnt the probem the problem is the government and its inablity to do a damn thing correctly
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The basic concept is that if everyone is in the insurance pool, costs are spread over the largest possible population and net cost is lowest. That assumes no corruption driving up prices...
A few years back I heard a statistic (maybe head of public health policy at Harvard Med School or some such authority). He said 30%+ of the cost of providing health care in the U.S. is administrative cost, including rooms of people who review every claim and try to figure out how to deny claims of the insured. Let's review. We are paying 30%+ of our insurance dollar to people whose job it is to deny us coverage... to find a loophole that will reduce claims paid and thus control "loss" (increase profit).
That is why the reform elements of a healthcare bill are essential, and why it must be done across the board, not by regional markets or one state at a time. If insurance companies are forced by law (federal law, not different laws in each of 50 states) to cover preexisting condtitions, accept all customers, and pay claims, the screening cost will be reduced or eliminated. This is what has been found in many industrialized nations with better healthcare than the U.S. and administrative cost should be brought down, to a few percent. (See T.R. Reid's book "Healing America" for a comparison of worldwide health systems). That is a piece of the savings that should go hand-in-hand with reduced premiums, wider coverage, better coverage, lower out-of-pocket expenses.
(Actually, cutting administrative costs means some folks may loose their jobs. But at least they'll be able to get health insurance.)
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To try and clear up why many people (often including progressives) are against being forced to purchase health insurance from private companies: living is not a luxury! All other forms of insurance are different from health insurance. All other forms of insurance are a choice. You do not need to drive to live. You can choose not to have auto insurance. Humans should not be forced to support private businesses for the sole reason that they are alive.
I grew up in a family that could not get insurance because my father owned his own business, and my mother had a pre-existing condition. I grew up with the constant fear of getting sick, or that my mother would get sicker and we couldn't pay for it. I will not be forced to support the same insurance companies, that till this day will not insure my mother. Being forced to support a private company is at odds with democracy.
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I had BC/BS for 3 years as an individual and saw my premiums rise from $210/mo to over $450/mo for slightly reduced coverage. I never used even my deductible amount so I am a very low risk user.
I switched to Lifewise and currently pay $208/mo for a high deductible to cover just major emergencies. With that I get 6 office visits a year with a $25 co-pay (I don't use them all). So far it has covered all of my expenses for the last two years without having to pay on the deductible.
If Lifewise can do this, why can't BC/BS??
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I believe that lifewise is a for profit spin off from bcbs. If you are a new company you can skim low cost subscribers without having the overhead of a large pool of higher cost subscribers. You can offer lower rates to people like you and deny anyone who your underwriting tells you will be more expensive. The private insurance business is really an investment business. You get money from subscribers and invest it, making investment return before you have to return the premiums in the form of benefits. If they have to return less in the near term, you are young and healthy, they want you for now.
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I'd like to know why Regence BCBS decided to spend $60,000 of our premium money to try and defeat Ballot Measures 66 and 67 which I learned about by reading an article on TheLundReport.org. I find it alarming that they would use their money in this way and want an explanation
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As the wife of a newly graduated physician, I have not only seen the struggles that these people go through to make sure their patients get the best care, but I have also seen the cost for that education. We were destitute for years. With that said, my husband is extremely conscious of the cost of his services, as we have been financially strapped for most of our married life. He is sure to tell his patients what things cost but he sometimes refuses to give service to patients telling them to go and find another doctor if they are not willing to get certain medical tests. This is because our society is so litigous and honestly, doctors are scared to get sued. If they don't order the random test and something happens to go wrong, the doctor loses and his reputation is tarnished. My guess is that if you took the lawsuits out of the equation, medical costs would go WAY down.
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If we eliminated all the suing of Doctors we would not see any change in premiums or medical costs -- look at the numerous studies including those done by the GAO and various insurance companies.
Doctors should have the option to offset the cost of their training by agreeing to practice for x number of years in areas that have shortage of physician -- eg. Eastern Oregon. Trading service for education has worked well in this country ever since the GI bill. My doctor worries enough about his patients; my doctor should should not have to worry about paying off his school loans or insurance bills or...
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emilatt:
During the president's February all-day health care reform summit, I think the figure discussed was that tort reform--- i.e. eliminating all the cost of medical malpractice insurance---would result in a 2% change in the total "health care economy." So, as a practitioner, I can sympathize that your malpractice insurance is a meaningful part of the cost of doing business, and the benefit of less agressive testing might lower some costs. But in the big picture, the systemic problems are much deeper than the cost of extra tests, frivolous lawsuits and malpractice insurance.I tend to think the notion that "extra tests" and malpractice insurance are not the problem that has driven my premiums up 77% in 4 years; I think that's a red herring being distributed to take our attention from more substantive issues. Like: why would a ten-cent asprin cost $10 when administered at a hospital, or why do U.S. patients pay double the price for prescription medications that are sold for less elsewhere (the exact same pill from the exact same factory). As the legislator said, just say, "anti trust."
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Everyone with a graduate degree comes away from college with proportionately larger (to income) debts than physicians. Every graduating doctor will go directly into a well paying job. Only a certain percentage of Master's or doctorate degree holders will go to work at once. That is a declining percentage.
About random x-raying. There is no safe limit to radiation exposure. Few doctors ordering these random. defensive x-rays have any idea how many exposures a patient has already undergone in his lifetime and how many more he faces. The effect of all radiation is accumulative.
Most instances of alleged malpractice never get beyond the medical profession's own peer review process. Maybe 1 in 30 move to the courts. Few of those succeed simply because the doctors insurers can afford more and better lawyers.
Americans put up with the worst, most costly over-all health care delivery system in the civilized world. They accept it only because of ignorance of how well universal systems work elsewhere. The medical profession purposely holds down the number of practicing doctors in order to keep that high and lucrative patient to doctor ratio. Are doctors over worked? Yes! And my wife's doctors never recalled her name or condition and had to spend all of a singled high priced minute reviewing her file every visit. I lost my wife a few yrs back to a cancer than might have been halted if her med insurance company and MEDICARE and doctors had not combined to contront us with a mountain of red tape, long waiting periods, and other delays that required so long to resolve that her cancer spread and became impossible to control and treat. She was murdered by the system just as are hundreds of thousands of sick people in this country every year.
The toughest obstacle to a decent health care delivery system for Americans is the medical profession. The sicker the system allows us to become, the more money the profession makes. This is inverse to the patient's interest. In a rational system the doctor's fee should be tied to his skill in keeping his patients well and NOT becoming wealthy only as his patients become ill.
Gereng
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Agree. The system as it stands today is obscene and immoral. I'd rather see the single-payer govt system. Or force the industry to make a fixed rate of return.
It seems time to decide which is more important: the people, the citizens of this country, or corporate entities. Since the Supreme Court ruled (this year) that corporate money can flow unchecked to finance political races, even from overseas, you will see corporate lobbying like never before. If the health industry is not nipped in the bud this year, health reform will never happen, ever.
But talking heads on major media have been on a rant that essentailly says non-profit healthcare is somehow, un-American, anti-capitalist. The U.S has the highest incidence of people who declare bancruptcy because they had to put their life savings, their house, everything they had into paying for a catastrophic medical event. Highest rate! Is this a part of capitalism that we want to cherrish to the grave? How many people die a year because they have no health coverage? How many mentally ill are there who go without treatment?
Single-payer does not preclude having a viable, for-profit insurance industry. In Switzerland, I think, and several other countries, the govt provides single-payer healthcare for all, but the insurance industry is not dead. They still have for-profit insurers picking up the holes in the government plan, i.e. to provide elective surgery, or procedures not covered by the govt plan like cosmetic surgery.
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Insurance as a concept dates back easily as far as the wagon trains of the migration to the American west. The men on the wagon train would all join in the buffalo hunt and the wagon master would hold the skins that they acquired as “insurance” for the wagon that might have a problem on the trail. And the wagon train travelers only ask for help as a last resort.
What we have lost in the evolution to our current insurance system is the community value aspect of the concept. We the members participate and pay the “wagon masters” who have become profit makers as a margin on top of any cost we incur. They have strong motive for increasing the overall cost and NO motives to contain those costs. And, at the same time, once the premium is paid, we the insured tend to treat any assistance as an entitlement. We buy drugs based on TV ads, abuse the frequency of doctor visits, and do NOT take seriously the responsibility to take care of ourselves with respect to common sense personal healthy living.
So long as we the people shirk our responsibilities, so long as there are those among us that abuse the system, and so long as we allow TV ads to entice the over use of expensive drugs, we will be in the hands of the ever more greedy insurance exectutives.
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Insurance dates back over 2000 years in the Western world and probably further back then that in China. Our big insurance company problems date to the Reagan Devolution when insurance companies such as Blue Cross/Blue Shied were allowed to demutualize thus insuring that policyholders had no say in their insurance company.
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Recently I needed a noninvasive test with some urgency. The Care providing company’s total billing rate as near as I can calculate was $7920 per hour. My cost from them was only $37.00 per minute after insurance which costs me in round numbers $0.59 per minute 24/7, 365.
Not until the laws apply to every member of congress will there be reform. -
How about rate transparency? I'm 46 and I have a portability policy which costs 600 moving to 700 a month for 1000 ded. 20 80 coverage. I can't get an individual policy because of pre existing which seems like a joke as we are talking about osteo arthritis, minor. Right now I can tote the note. If everybody had to pay for there insurance out of pocket I think you would see a political shift that might have some effect on cost. What irks me is I have payed 40,000 dollars to Pacific care over the years and if I can't keep paying none of it will go to my health care and I will be un insured.
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How about we all cancel our current health care for, say, 2 months. What would happen to the insurance companies then? Maybe we would find out we don't really need insurance companies!
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Cancel for 2 months? 50% of you would not get back on insurance after the 2 months is up, because the company woudl review your chart and find you have preexisting conditions.
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The one thing that voters won’t stand for is inaction. Most people will support a person who stands for and supports a difficult decision no matters how unpopular.
I am VERY dissatisfied with the Democrats. They are unable commit to health care reform, regardless of the evidence supporting the absolute need for dramatic changes. Unfortunately, the screaming, irrational right frightened the Democrats from doing what is right and necessary.
How is it that an obvious GOP puppet president can lead us into an irrational, illegal war in Iraq, with lies, and the Democrats cannot pass rational, necessary health care reform when 62% of all bankruptcies in the U.S. are medical bankruptcies and ¾ of those bankruptcies had health insurance (See: www.law.harvard.edu/news/2005/02/03_bankruptcy.php ).
“For-profit” medical insurance companies are morally duplicitous institutions. They cannot cover medical care, and maximize returns for their shareholders. To me this is an obvious dichotomy that is not part of the health care reform debate.
A national health-care exchange that includes a public option is a good starting point. The next, necessary step is a single-payer system like that of Japan, Germany or the U.K..
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In all these health care discussions I rarely hear about insentives to stay healthy. Obesity is adding substantly to the health care costs. Should there not be a tax on junk food as there is on cigaretts or rebates to those who stay healthy. It seems that responsible people are penalized.
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The media barons and other opinion molders make certain that the health care debate is confined to 'cure for fee' medicine. Most Americans have little or no idea that a good health care system is designed to keep people well!!!
Curing people when they become ill is the last line of defense in the system. Common sense and discipline in the habits that affect one's health in later life are key to hitting mid life in good health. But that doesn't fill the coffers of the drug and medical profession, so there is no interest on the part of our doctors and drug companies in a sound, holistic health care system.
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I am in my late 70s and take no medication and am in good health. I drink only beer and that not often. I have not smoked since I read the first story linking smoking to cancer in 1956. I have never used drugs. I exercise daily and eat carefully and simply.
The point is, everyone should be responsible in the first instance for their own health. Eating like hogs, drinking too much booze and taking drugs, sitting on one's arse for most of every day is a sure regimen for poor health.
Since the powers arrayed against a decent health care system for Americans will never be over come by mere citizens, the best we can do, is take care of ourselves.
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My husband found out he had colon cancer so he started looking for a doctor in network. When he found a Doctor he checked with our insurance and the doctors office checked as well. Everything seemed kosher. Then right before he was about to go through surgery we found out that the doctor was not in-network. The doctor urged us to proceed with the surgery as time was of the essence and told us that he would deal with the insurance agency to make a deal and work things out. He told us starting from scratch with another doctor would take several months as they would have to review the case and do their own analysis before even getting to the point where they could do surgery. We agreed if insurance confirmed it would be approved so the doctor sent in letters and we did too. We received an approval confirmation from our insurance that had the doctors name, hospital and procedure that was to be done listed on it. So we went ahead with the procedure only to find out afterward that the insurance would not be covering the doctor. When we faxed them the approval they gave to us they said that the approval was only for the hospital and the procedure not for the doctor. We said we were confused as his name was listed right there on the paper they said read the bottom. There in tiny print was a waiver that all of the above was subject to change. To me this says that they can back out of anything they approve at anytime and it is very misleading. This now meant that we owed eight thousand dollars. With the economy the way it is and with people losing their jobs do people have eight thousand to spare? It seems unfair to me that we took every precaution to make sure we did things correctly and that they can change their mind at anytime.
I think health care is a huge issue. I think that they should be held accountable. We pay for our health insurance and had never needed or used it before other than regular doctor visits. So when we needed them to pay for what we have been paying them for I think they should have been there. I am tired of the changes they make without advising their clients. Would any other company be able to do business like that? I do really hope that we start fixing health care for everyone's benefit because as I know it to be there are some major flaws.
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Please tell us the name of the insurance company.
Thankyou
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The vast majority of those that claim satisfaction with their health insurance have never really needed their health insurance.
When those that have never needed their health insurance are removed from the equation, the vast majority (of those that lived and their loved ones) are furious at our current crop of insurance companies.
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But we do have trillions to spend on these Israel First wars and the Wall Street bail out. Meanwhile the insurance companies and medical profession write the health care bills. Which is tantamount to letting the Foxes build the chicken coop.
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On the sore subject of Insurance
Insurance was a good idea in the beginning, but they have become big powerful leaches, have now ruined the concept and the system. They have squandered our money on big ivory tower buildings, corporate jets, fancy cars, political lobbying, CEO bonuses etc.
"THE WHOLE SYSTEM IS BROKEN" WE HAVE TO MANY "FREELOADERS" in the system, earning a lot of money and producing nothing.
Health reform bill is not going to fix it.... doctors, pharmaceutical companies , insurance companies and attorneys are ALL OUT OF CONTROL do you know a poor doctor?, or insurance company owner or executive? TOO MUCH FAT, not enough money really goes toward health, because of too much "Litigation" doctors have to do to much testing, TO COVER THEIR "blanks" from lawsuits and to generate billions of dollars to pay steep malpractice insurance, they have to charge heavy and create more business.
The insurance companies are collecting on both ends
This is not hard to figure out.... as a Nation or as a person everyone needs to cut back and quit charging too much.
This is not a new problem. the last 3 or 4 government administrations have not come up with an answer, and I am pretty sure this one won't either... or it would have been done by now. or we will end up like the price gouging mortgage companies and banks.
I learned from a wise business man, "any business deal has to have benefits for both partners,or the deal will be to hard and overload one side, if he goes broke or something goes wrong with his health because of stress the deal will go bad in the long run"
Lucky for me I am healthy now, if I get sick before our "healthcare system" gets back to"affordable"
I'M dead J.A. :o)
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I think everyone is dancing around the true issue due to a lack of awareness. An awareness around how it is that we think about health, disease and medicine. The true issue is not how we pay for it but what it is in fact that we are paying for. The type of care that our country leans on for primary care is an emphasis on emergency medicine. This should only be a very small portion of true health care. This is not health care, this is disease care. Surgical procedures and pharmaceuticals ARE EXPENSIVE! This should not surprise us. Why should we expect it not to be expensive? What needs to be changed is the model of health and disease from which we view health care. This involves a major restructuring. While there are not enough MD's to do this there are enough health professionals such as nurses, DC's, DO's, licensed ND's, NP's etc. It is so expensive because everyone is so diseased. This of course touches on the food we are eating, subsidies to mass agriculture producing inedible corn, soy and wheat, pesticides and herbicides we coat our fruits and vegetables with, and many, many other factors in the way in which live. This is an overall disrespect for our bodies, our earth, and unconventional ideas and perspectives that emphasize this. It is time that people stand up and take back their health care from capitalism and the AMA.
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Hear, hear! Couldn't have said it better myself. People who are poor and undereducated have poorer health as a general rule. There is a direct correlation. But our country values so many other things before equitable systems and education. We value war, organized sports, pork for large corporations. It is a spiritual problem on so many levels.
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I love the crowd that tries to blame all the health-care woes on us, on the consumer. Get real! Oh, no! The terrible sick people are screwing over the insurance companies, sucking up all the unneeded services. What? Oh, yes, that is so, totally, the entire problem. Well, we figured it out folks. How smart we are! Oh, wait, I forgot, shouldn't the free market fix this? Shouldn't the all-knowing insurance industry be able to control this problem? Shouldn't they be able to whip us into shape. So what are we suggesting exactly? Do the insurance companies need help to do their job, to maximize their profits? Sick, greedy people, did not create this mess. The system created this mess. And, yes, insurance companies are a big part of the system. If they cannot survive then they should shut down---close up shop. No one is forcing insurance companies to stay in business. But, we need to stay alive, we the people. If insurance companies can't make enough money, then maybe it is a bad business to be in. Maybe there is an inherent flaw in the model, and not in us, the sick people of the grand old USA.
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The heath care debate has been narrowly channeled into a discussion centered on 'cure for fee' medicine. In any decent health care scheme, keeping people healthy and away from the doctor ought to be the primary aim of the system. Having to see a doctor is, in a way, a failure of the health care system (HCS).
A good HCS should educate and counsel people on ways inwhich they may keep themselves healthy. A majority of Americans think of health care only in terms of going to a doctor. In fact each individual is the primary care taker of his own person. Most people abuse their bodies for 40 yrs and then when their own behavior has undermined their health, they go to a doctor and drugest and expect the system to undue what his own dissolute and/or indisciplined behavior has produced.
The medical profession, and the drug companies encourge this popular understanding of health care. The medical profession and drug sellers make their billions only when everyone is sick and needing cure. The sicker we are, the more money they make.
The last thing the medical profession wants to see is a broad discussion of a holistic approach to health care in America.
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Healthcare is the US is so dysfunctional it would take a week of shows to cover it properly.
1) Where are the *care* dollars spent? No one ever considers where the money goes. Before you can bring down cost, you have to know where you are spending the money. A household trying to cut back looks at how much they spend on the mortgage, dinners out, car payments, etc. Cutting 50% on $100/month in dinners out while your mortgage is $3000/month is not going to help your financial situation. Are most care dollars being spent on Herculean neonatal intervention, end of life, obese middle-agers? Some one knows, but it's never discussed in public discourse/debates such as these.
2) Many people, especially law makers, confuse health insurance with healthcare. The health insurers have inserted themselves into the system as middlemen skimming a percentage healthcare dollars. How much does it cost to have insurance companies with their high executive salaries and legions of claims processors? How much does it cost to have doctors offices and hospitals with their admin staffs to comply with the insurance billing requirements? Again no one knows. At best we get a dubious statistic like the insurance companies spend 9x% of every premium dollar on claims. Well if that includes salaries, IT and infrastructure, and lobbying, I am not impressed.
3) How much does Medicare & Medicaide cost-shifting add to the insured folks that are trying to play by the rules? Everyone agrees it exists, but again, no one wants to do the hard work to put a number to it.
4) How much does the broken malpractice and torts system cost us.
5) Doctors have huge overhead from school loans to foregone compensation for their many years of school to malpractice insurance to ridiculous billing overhead and rejected claims. They are the only profession which cannot charge for the *time* of their expertise, only for procedures. How does this bias to do procedures effect the healthcare delivery and drive up costs from unnecessary procedures?
6) Prescription drugs and drug companies have been a two edge sword. Drugs can save costs (and lives) tremendously in some cases, but seem to drive up costs overall from dubious look-a-like new drugs that replace perfectly good and cheap old drugs.
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In each of my above items there is some one whose livelihood is dependent on the dysfunctional system the way it is now. These are the "special interests" we often refer to, and they are the barriers to real reform. The reason health reform has failed at the national level is because it has only concerned itself with addressing health insurance costs with various stop-gap band-aides. Instead we needed of a holistic look at what we are spending *for care*, how to build a system that most efficiently delivers care, and pays for the care in a socially equitable and individually responsible manner.
The hyper-active attention spans and biased, polarizing media and political system prevents a slow, deliberate, and rational discussion of holistic healthcare reform to the detriment of everyone not a special interest in the current dysfunctional system we now have. Everything we have today is all sound bite and anecdote. it doesn't help anyone make a decision as to what _ought_ to be.
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I am amazed that no one yet has mentioned the high cost of maternity care. American women (or their insurance companies) pay more for birth and prenatal care than anyone else in the world, and yet we have some of the worst birth outcomes (infant and maternal mortality, illness, and complications) of developed nations.
I gave birth last year, and my insurance company paid for about half of the cost of my planned homebirth, which was $2000 total, including excellent prenatal care with two experienced midwives. A friend with the same insurance plan recently had a hospital birth that ended in cesaerean (like about 1/3 of U.S. women), costing over $30,000. She paid her deductible, and nothing more. Why are insurance companies paying less, or declining to pay at all, for homebirths, which are vastly cheaper and statistically have as good or better outcomes as hospital births?
In addition, most health insurance companies do not pay for doula support (trained labor coach) for laboring women although doulas have also been shown to statistically improve outcomes and experiences for moms and families. (Disclosure - I am a doula)
Reducing the cost of maternity care could make a difference in health insurance rates. I believe that we can reduce the cost and at the same time increase the quality and outcomes of maternity care. OPB, please help bring this idea into the health care debate!
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Well, I mentioned it. :-) I too suspect it is a huge vacuum of healthcare dollars, but without knowing any of the actual numbers, who can say?
You can bet the health insurance companies know, but they never share. I think it's because there is massive cost shifting going on, and if people knew the details there would be open revolt.
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Re; This morning's think out loud per health insurance, Regence BC-BS, etc. I was unable to get through on the phone and I don't have home interent service. Thus, the reason for this tardy submission.
ATTN: Emily Harris
Last year (2009) Regence was granted a 14.6% premium increase for individual policy holders. When my notice came it indicated an increase from $410 to $480; simple math revealed an increase of more than 17%. Over the next months Regence tried repeatedly in letters to me to 'prove' that 17+% was actually 14.6%. Two different times BC-BS presented math equations that were so patently incorrect that a competent middle school math student could have seen the errors. Ultimately 'actuarial' sent an equation that was one you use to calculate a rate DECREASE. About 3 months later, and after a complaint filed with the applicable state agency, BC-BS, rather than ever acknowledging their persistent math errors, defended the 17+% increase as represnting a mere "statistical average,' that is, some premiums went up less than 14.6%, others more.
Fast forward to 2010. In light of last year's experience, and given the announced 16% increase approved for 2010, I sought to find out the precise increase for me this year. It took no less than four different phone calls over two weeks to BC-BS. Ultimately, I discoverd that in the SAME calendar year, individuals with the exact same policy (here: Blue Selections Premier, $2500 annual deductible, age 60-64) pay different premiums. How? Individual policies renew quarterly, depending upon when the policy first activated--the quarterly renewal dates are Jan. 1. April 1, July 1 or October 1. Here's the rub. A person whose contract renewed Jan. 1, 2009, saw the monthly premium increase to $450.50. Those renewing on April 1 paid $475, July 1 (mine) $480 and Oct. 1, $505.
In short, my experience has been that seeking accurate information from BC-BS represents a grand exercise in aggravation.
Thanks for listening.
Greg Marlowe, Silverton, OR 97381
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I have been a psychologist for 9 years and have watched reimbursement levels drop 25%. The saving belongs to the insurance company. I also notice that deductibles and barriers (required authorizations and treatment plans) have increase dramatically. While everyone needs to share in cost reductions and I am willing to, the issue is the lack of checks and balances. Psychologists cannot band together and push back when insurance companies just decide to lower reimbursement rates. Their only recourse is to drop off the panel. Then consumers wonder why their favorite therapist doesn't take their insurance. Experienced therapists won't tolerate abusive practices for long.
There is a need for all voices/stakeholders to be at the table of reform. I fear that insurance companies and big pharma are well represented at the table. I'm not sure who is watching out for the smaller interests.
Cheryl
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Two more comments.
One of the insurance companies that recently reduced reimbursement for me by 20% just hired a friend of mine, who after two weeks of work received a large year-end bonus.
I am for medicare for all. Government exists to provide that which is too big for any other entity to provide (common defense, roads, etc.)...health insurance falls into that category.
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I used be an individulal member of the Oregon Medical Insurance Pool administered by Blue Cross Blue Shield of Oregon. Three years ago, in an attempt to save money on my monthly premium I changed my plan from a $500.00 deductible to $1,500.00. This made sense to me as, although I am diabetic, I kept my blood sugar well regulated, and was generally quite healthy. Furthermore, I had never exceeded the yearly $500.00 deductible in the 14 years I had been on the plan anyway.
According to the usual three-tiered table of premium values for the contract year of 2007, the $1,500.00 deductible plan would save me nearly $100.00 per month. As a sole-proprietor of my own business, this was quite significant. However, three months after the plan went into effect, I received a notice basically saying "apparently there has been some confussion as we have heard from many of those who opted for the $1,500.00 plan. What was not understood was that this level of plan includes an additional $1,000.00 deductible for prescription drug benefits. We apologize for any inconvenience this may have caused." Inconvenience? What an understatement. Nowhere on this page did I see anything regarding this, not even in fine print.If this was not bad enough, effectively nixing any hope of saving money that year, within three months of that I received another notice. "We regret to inform you, but due to increased healthcare costs we are forced to raise premiums half way through this contract year by (I think it was $50.00 to $60.00) per month".
Long story short, within six months my out-of-pocket costs not only exceeded that of the previous year (on the old $500.00 deductible plan), but I was now locked into a virtual $2,500.00 deductible plan ($1,500.00 + $1,000.00) !!! Within a couple of months I ended up having to choose between paying my insurance premium, or paying for my daily dose of insulin and other medications. I'm sure you can guess which one I chose. The only one that would at least keep me alive. -
If you haven't heard of it yet, you may try googling "Paleo Diet". A lot of diabetics have had good results by all but eliminating the carbs they eat. No carbs, no insulin. Best wishes.
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Well whoever it was bemoaning the paltry 5% "profit" of the health insurance companies, that is only the percentage that they have to pay taxes on. What do you think happens to the BILLIONS of dollars of income to these companies? Like a previous post said, ROOMS full of people figuring out how to deny (or refuse) coverage. Bloated salaries, perks, benefits, bonuses and gold-plated retirement for the upper echelon. I'm not against anyone making a profit. There is a BIG difference between making a profit and PROFITEERING. Laissez-faire capitalism, unregulated big business, is more aptly described as the latter.
And who/where is the health insurance company offering premiums for a "mere" few hundred bucks??? All that I can find and believe you me I have LOOKED long and hard - as an individual at my age and with pre-existing conditions the cheapest I can find runs nearly $2,200 PER MONTH and that is WITH caps and deductibles and co-pays.
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I'm re-listening to the show. The Regence Blue Cross representative, when talking to caller Kathlene, claims that two years ago, Regence policyholders experienced a decrease in premiums. Kathlene said she didn't get a decrease that year. I did not, I got an increase that year as I have every year since 2006 when I joined OMIP (administered by regence Blue Cross of Oregon). Mr. Short, will you post a reply on this website to tell us, in the year you claim RBC issued lower premiums:
1) how many policyholders got that premium decrease?
2) In that year overall, how many got an increase, how many stayed the same, and how many got the decrease?
3) What was the mean and mediam dollar amount or percentage increase/decrease?
My guess: his reply will show that a very, very small number of people got a decrease, and it was probably for a group (employer) policy that had major bargaining power. So, Kathlene's question stands: who represents the little guy in gaining pricing leverage in the individual market? No-one. And that is why the individual is getting gouged first in this mess. If I'm wrong, appologies in advance to Mr. Short and I'll eat my words.
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A re-posting, but think on it: the four necessary criteria for Healthcare:
+ Security
+ Justice
+ Freedom
+ Efficiency
I heard this years ago, from a leader at Harvard Med School and former head of the AMA, and again on radio, I think it was Marketplace 11/25/2008 -
If you haven't heard of it yet, you may try googling "Paleo Diet". A lot of diabetics have had good results by all but eliminating the carbs they eat. No carbs, no insulin. Best wishes.
AllanFolz — Wed March 10th 12:19p.m.
Thank you, Allan, for your best wishes and advice. I will definitely check into the "Paleo Diet" but being that I am a classic insulin resistant type (I firmly believe that I have been all my life), I don't know how well this will really work. It is all worth a try though, for sure. I have always been thin, hyper-active and more-less wore my pancreas out from years of dumping my natural insulin into a body that refused to absorb and utilize it correctly. Anyway enough about that.
As for rj oregon's comment asking "who got premium decreases", I think the Executive from Blue Cross refered to the "false" decrease by way of deductible choices that I experienced (and the hidden fine print of additonal prescription drug deduction) and the immediate subsequent rate increase MID-CONTRACT (6-months into a yearly contract). Wouldn't it be nice to be able to write a contract, have it signed by your customer, and change it at will with no conscience or consequence? I could never do this as a matter of conscience and as a sole-proprietor of my own small business, I could never get away with it anyway! -
Furthermore:
We ultimately need a single-payer system, but a real public option is the only way to start on the path to real reform.
During the last "square-table" forum with the President and Members of Congress, one congressman ( can't recall who, but it was a Republican ) talked about how important it is to "have everybody in the pool, especially the young who are less of a tax on the system" in order to guarantee solvency of ANY system - thus a need for a mandate. During the same session, it was either he or another Republican seemed to enjoy pointing out that Medicare will go bankrupt in the foreseeable future in if we don't do something. When I heard this I couldn't help but jump up and shout at the T.V. "EXACTLY !!! THIS IS WHY, IF WE ARE GOING TO MANDATE HEALTHCARE INSURANCE COVERAGE WE NEED TO HAVE AN OPTION FOR EVERYONE TOO BUY INTO MEDICARE. WE COULD MAKE MEDICARE POTENTIALLY SOLVENT FOREVER !! - oh boy, ... now you got me started !!!
We must fight for this like we have never fought for anything before. Let's fight this good fight and not give up
It's an old cliche' - If you don't have your health, you have nothing. If the Nation-at-large is unhealthy, we have an un-healthy nation. (Now there's a pun in there somewhere!) -
I think it's no use of just discussing the insurance cost. The medical cost in this country is ridiculously high--no wonder so is the insurance. My 6 year old daughter recently had a wart removed from her foot at her pediatrician's office and the cost for it was $178 (before insurance). I was surprised. On the statement, it was described as "surgery," but actually it was a simple procedure with long stemed cotton swab and liquid nitrogen. Of course it needed some professional knowledge and skill--but $178?? Crazy.
This procedure was done during my daughter's 6 year old check up and cost for it was $181. All we did was--just talk. 10 minutes, really.
I am from Japan and my mom is still there. She was recetly diagnosed as age related macular degeneration (AMD). It's eye disease. She told me she underwent thorough tests and all she paid was $10. She says insurance (like medicare here) covered 90% which makes the original cost for the whole tests $100.
I simply wonder why the medical cost is so high in this country!
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The Japanese are snarter than we are. They control their politicians. While ours are so busy playing in celebrity golf tournaments with lobbyists, actors and network news casters they have no time for real work. That is why the lobbies write most legislation.
This is one reason we will never have a universal health care system. The other reason is the politicians are not afraid of us. We are so pathetically easy to frighten and manipulate.
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The idea that drug and device development companies are 'greedy' and that's why they need to make a profit is just rediculous.
It cost > $100millions on average to develop a new drug. A device, comping from university research to the bedside can cost up to $100million. That money comes from somewhere...think about it. It comes from investors that make these VERY RISKY investments with the idea that one out of 10 will be profitable.
Without profitability on 1/10 new drug/devices, these investors CANT INVEST, and the drug/devices will not be available.
Don't complain about greed, that frankly naive and childish.
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As long as we have the fee for service system, physicans will continue to treat their practices like a business, since they make money from each thing they do. It benefits them for the US population to be sick and in need of care.
If the culture in the US was more focused on being well, then having the latest scan, we would perhaps save a little money.
Diet is a big part of being well and staying that way.
-Gluten free
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"I don't get the system as it stands right now. How absurd would it be if I had to go through my car insurance every time I wanted a tune-up or an oil change? or if I had to go through my home owners insurance to paint my bathrooms or replace my refrigerator? When did ALL health care start going through insurance?"
It makes sense to me!
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I thought the whole idea behind the new health care bill was to reduce the costs of health coverage making it accessible to more people, especially those who couldn't afford it before. But a double digit increase in health insurance would make it highly undesirable.
Narconon
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I learn how to make an application that we can use in any windows. Coz many application cant be use if they have different platforn from each application. This can be a problem sometimes for every person. free business listing -
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income tax attorneys I just read the thing about carving Sad It seems odd that we wouldn't be able to carve the cake, since that is a very typical way to decorate irs problems
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The medication I am on, Provigil (Modafinil) costs about $20 per pill at Costco's pharmacy. Even though my doctor prescribed Provigil for me and it significantly helps me my insurance company refuses to cover this medication. As I can not afford the medication, I get the medication through Canada for $1.47 per pill. The medication comes from India; the package states "Maximum Retail Price Rs. [Indian rupees] per strip of 10 Tablets Inclusive of all Taxes" of 126.00. This works out to about $0.28 per pill. How can this type of price difference be justified when Cephalon (the developer) has more than recouped all developement costs and made $2,192,308,000 in 2009?