Wednesday, February 28, 2007
Here's the deal.
Sent an application for individual health insurance to a carrier that (for now at least) will remain Nameless. The guy is a little chubby, about 10# over the limit for standard issue. Takes meds for cholesterol. Has borderline hypertension but the doc has not put him on meds yet. Had a bout with stress about 6 months ago. His doc prescribes medicine for anxiety. After 30 days the stressful issue is resolved, he stops the med with docs approval.
About 3 weeks after submitting the app, Nameless Insurance Company (NIC) declines to issue coverage.
Letter to the applicant to follow.
Being the wonderful agent that I am, I call my contact at NIC to inquire. I am told he was declined due to weight + HBP + cholesterol.
I call my client.
He reads me the letter which states he was declined due to "psychiatric history".
Now I look like a fool.
So I go back to the carrier asking a simple (and obvious) question. Which is it? His weight + blood issues or psych?
Later I discover a message from an underwriter is left on my voice mail. "We can't tell you because of PHI (protected health information) but what we can say is he was declined for reasons OTHER THAN (emphasis mine) weight, HBP, cholesterol or psych".
So . . . you can't tell me why he was declined because of PHI.
Can you explain why you can't tell the applicant either?
They are supposed to get back with me on that.
Just look for the blue guy. He is the one holding his breath . . .
And these new steps are?
Our argument is simple: all plans that expand the business of the private insurance industry are doomed to fail because they won't control costs. How can they when their profits, marketing costs and duplicated, look-alike plans currently waste 30% of every health care dollar they handle in California?
Why is it, lot's of folks talk about 30% admin costs but no one bother to validate that figure. This is almost 3x the figure I have seen in the past with carriers, yet too many accept it as valid.
Governor Schwarzenegger wants to cap the "administrative costs" of the insurance companies at 15%. This is a whopping 12% more than Medicare's 3% administrative cost which is roughly the same as the estimated administrative cost under SB 840 and in the health care systems in virtually every other developed nation!
And no one ever challenges the 3% admin costs for Medicare. For what it's worth, Medicare does not adjudicate or pay claims, they farm that out to the carriers.
You know, the same ones that supposedly charge 30% to administer health plans.
So what does Medicare do for their 3%?
That's a good question.
This next point is a valid one.
Why should we expect everyone to buy health insurance, which is even more expensive than auto insurance, when 25% of the drivers in the state ignore the existing "individual mandate" for auto insurance?
The rest of the article is fantasy.
That's a stretch.
While it is true that denying claims does protect profits but if claim denial is abusive then revenues AND profits are depressed.
When you take into account the present legal environment, the incentives are actually far worse than they appear in his article, as the Supreme Court through ERISA preemption (which protects HMOs from state law liability for negligence) and its recent punitive damage awards cases provide large incentives to cheat. I would commend those interested to read about the insurer's practices in STATE FARM MUT. AUTOMOBILE INS. CO.V. CAMPBELL (01-1289) 538 U.S. 408, in particular the manner in which State Farm not only created a conscious policy to deny coverage to its automobile insureds, but punished those employees that refused to engage in the company practices.
While there is a world of difference in casualty insurance and health insurance, the point is not totally lost. The author is suggesting that (in this case) State Farm purposely and maliciously denied claims based solely on a mathematical calculation.
What is overlooked is that State Farm also recently announced they would no longer write or renew certain lines of coverage in Mississippi due to litigation.
This runs counter to the authors argument that it is more profitable to deny claims than it is to pay them.
The insurer may collect premiums for coverage it has no intention of honoring. If less than 10% contest these decisions, it's a no-brainer; the corporations interest is in denial. If the coverage is even remotely fuzzy, then it denies. To protect itself from really bad facts, all it has to do is pay some of those claims. It's still better off, despite not having honored its obligations.
Refusing to honor its' obligations.
Interesting choice of words.
The fact is, claims are routinely denied for being extra-contractual. In other words, the claim is not a covered item according to the policy language. When the courts intervene and apply a broader standard than is allowed by the contract, a contract whereby BOTH parties agreed, then the risk to the carrier becomes incalculable.
This is like going into a gas station, pre-paying for $10 worth of gas but continuing to pump until your tank is full and then driving off. Gas stations would not be able to stay in business very long if this became a habit and courts decided that the owner of the car was ENTITLED to a full tank, regardless of what their contractual agreement covered.
Tuesday, February 27, 2007
Monday, February 26, 2007
Sounds good so far.
According to FAH, the proposal would increase the $900 billion that federal and state governments spend annually on health care by $115.2 billion.
The proposal does not indicate a source for the additional funds, "raising immediate questions about the political viability of the plan," the Times reports.
The source should be obvious.
hospitals last year treated more than one million uninsured residents in emergency departments at an estimated cost of $1 billion to $1.5 billion.
Cost of treating uninsured, up to $1.5B.
Cost to taxpayers to cover everyone, +$115B.
So what is the extra $113.5B for?
Sunday, February 25, 2007
Friday, February 23, 2007
Thursday, February 22, 2007
Submissions for next week's CoR, hosted by Renthusiast, are due this coming Monday (the 26th).
You can submit your (or someone else's!) risk-related post via:
► Your blog's url
► Your post's url
► The trackback url (if applicable)
► A (brief) summary
PS We're scheduling hosts for early Spring '07, so don't wait too long to sign up!
Her employer, a landscape architectural firm where she is a drafter, doesn't offer health insurance, and she says she can't afford it.
Can't afford it, or doesn't deem it necessary to work into the budget?
Corona is the kind of Californian who Gov. Arnold Schwarzenegger says would be helped by his proposed overhaul of the state's healthcare system. But compelling everyone to obtain insurance -- the linchpin of his plan -- may not work for many Californians in need of aid, according to health policy experts.
Under the governor's plan, nearly 1 million middle-class people would be caught in a tough bind, those experts say: They earn too much to qualify for the insurance subsidies Schwarzenegger wants the state to provide but not enough to afford comprehensive coverage.
How much is too much?
Only those whose yearly earnings are less than 250% of the federal poverty level -- about $25,525 for individuals and $51,625 for families of four -- would qualify for the proposed subsidies.
OK. $25k for a single certainly won't allow you to throw back Cuervo Gold shooters every night, but there should be something left for health insurance.
People earning more would be required by law to have, at a minimum, a high-deductible catastrophic insurance plan. Such policies, which the administration says cost about $1,200 per person a year, would not pay for anything until a patient's annual medical costs exceeded $5,000.
$1200 per year, $100 per month. That's about 5% of gross income at the minimum threshold. Should be doable.
And families could owe as much as $5,000 more in co-payments before insurers absorbed further medical bills.
And your point is?
Most folks have less than $500 a year in non-reimbursed medical expenses. Even if they had a bad year and incurred $5k in non-reimbursed medical expenses, how long will it take to pay that down?
Considering the average car new car price is $28,400 and many folks buy a new car every 3 years, what is the problem? The liberal left makes a big deal out of $5000 in non-reimbursed medical expenses like it is a big deal. No one seems to worry about the average credit card balance of nearly $9,000 which is usually purchases of things you really didn't need in the first place.
How many Ginzu steak knives do you really need?
Wednesday, February 21, 2007
The program promises to offer comprehensive insurance plans at cheaper rates than farmers could get on their own and with more extensive coverage and benefits.
More coverage, lower premiums. Where have I heard this before?
U.S. Sen. Herb Kohl, D-Wis., helped secure $4.4 million in federal money that is being used as the initial capital for the program. State law was also changed in 2003 to get the program started.
Just felt my wallet being picked. Wonder what the "federal money" will be used for?
Oemichen said he expects farmers to have some skepticism as the plan is rolled out in March through a series of meetings across the state, but he hopes once they investigate what is being offered they will see it is a solid choice.
He did not have an estimate as to what the average cost for a person eligible under the plan would be, saying there are too many variables to calculate that.
Too many variables to calculate the cost, but promises to save money.
This may seem too obvious, but if you cannot estimate the cost how do you know the plan will save money?
Cihlar said her family health insurance carries a monthly premium of $2,200 and increased 25% last year. Cihlar said she can't switch to another provider because she had heart surgery in 1989 and no one will take her. She said she was "very confident" she will save money under the new program, which won't turn away patients with pre-existing conditions.
No underwriting for pre-ex. More coverage. Lower rates.
Does the coverage include a rabbit & top hat too?
farmers currently must buy individual insurance privately. Those plans typically are much more expensive and have fewer benefits than a group plan.
In whose world is an individually underwritten plan less expensive than a "we take all comers" group plan with no medical underwriting?
The new plan will have individual and family plans with deductibles starting at $300 for a single person up to $5,000 with a Health Savings Account for a family. Benefits include workplace injuries, something Oemichen said most farmers don't have with current plans, $500 worth of preventative care per member and prescription drug coverage.
$300 deductible. No underwriting. Better benefits. Lower cost.
Someone has spent too much time at the moonshine still.
The initials stand for Chartered Benefits Consultant, and is awarded by the National Association of Alternative Benefits Consultants. Very briefly, the designation reflects a more indepth knowledge of so-called "alternative benefits" (such as FSA, HRA, etc) with special emphasis on the burgeoning field of Consumer Directed Health Care.
Since I've been intimately involved in that last for some 15 years, it seemed logical to make it a bit more "official;" hence, the designation.
I'd like to thank the academy...er, uh, my co-blogger Bob Vineyard for manning the fort late last week, as I was in class for two full days finishing up (BTW, his post on Stupid Doctor Tricks garnered the most ever hits for IB -- Congratulations, Bob!). I took the test on Saturday; some multiple choice, the bulk essays on specific case studies.
Anyone interested in my final grade is free to ask.
Tuesday, February 20, 2007
Monday, February 19, 2007
“Poor New Yorkers will be entitled to free or low-cost medical treatment, under new rules meant to prevent hospitals from denying care to the uninsured.”
The new rules are actually final regulations implementing “Manny’s Law” - a mandate passed in New York about a year ago. That mandate strengthened earlier mandates requiring that hospitals give financial aid to indigent, uninsured patients. Among other things, the final regulations add a requirement to tell uninsured indigent patients that they are entitled to charity care. Sounds reasonable to me. After all why would a hospital want to keep that a secret, especially for a life-threatening condition? Read on.
“Manny” is Manual Lanza, a young New Yorker who was turned away from St. Lukes-Roosevelt Hospital in late 2005 because he had no insurance. Doctors and administrators at the hospital insisted he obtain Medicaid before they would agree to treat him. They did not tell him about other financial assistance available thru the hospital under existing New York law or, in fact, offer to help him enroll in Medicaid for which (I’m assuming) he was eligible. Manny subsequently died.
For many years, New York has mandated that its hospitals provide care to the indigent. Prior to 1997, hospitals tacked the cost of uncompensated care onto their bills for insured patients. Starting in 1997, New York began to tax insurance plans based on NY hospital benefits paid. Proceeds of this tax are placed into a pool managed by NYDOH and distributed among hospitals in New York. Of course, it’s the insured people who bear the ultimate cost of uncompensated care, whether financed by additional hospital charges or by taxes.
The state considers the provision of hospital services to be an entitlement for the indigent, and I agree the entitlement is necessary under present conditions. Because the entitlement is not called “insurance,” indigent persons receive hospital care and are still counted as “uninsured”. This meets the social need while pleasing the New York majority party, too, by not reducing the count of uninsured.
So what does this mean?
1. The uninsured “problem” is less serious than advertised. Despite the headlines and hustlers shrieking otherwise, “no insurance” does not really mean “no health care”.
2. Fix Medicaid, fix that problem. The number of uninsured Americans rises from the failure of Medicaid to fulfill its mission to insure the poor and working poor - because the clear majority of the uninsured are the poor and working poor.
“The case involved the theft and transfer of medicare patient information from the Cleveland Clinic in Weston, Florida. Defendant Ferrer Jr. purchased the patient information from co-defendant Isis Machado, a former Cleveland Clinic employee, who pled guilty on January 12, 2007 and testified against Ferrer at trial. The theft resulted in the submission of more than $7 million in fraudulent medicare claims, with approximately $2.5 million paid to providers and suppliers. According to the Justice Department, this is the first Health Insurance Portability and Accountability Act (“HIPAA”) violation case that has gone to trial in the United States.”
Read the whole Justice Department report here.
This theft of data led to fraudulent Medicare costs – paid for by our tax dollars. There is no reason to believe that private health plans are immune to similar thieves who want to cash in on fraudulent insurance claims, thereby driving up the cost of your insurance and mine. How much of this happens? The scary but true answer is: many have estimates, but no one really knows.
Patients, their family members, doctors, insurance companies and even lowly benefit managers have expressed frustration at the privacy rules arising from HIPAA. It’s true, these rules sometimes seem calculated to stop all the wheels of commerce at one swell foop. However it's important to understand more of the total story.
This case reveals a bit more of the total story - what the government is trying to prevent. Note that this is the first HIPAA violation that has gone to trial. If this is the kind of culprit that the feds are going after using HIPAA, I say more power to them.
Sunday, February 18, 2007
Thursday, February 15, 2007
For the last several years, my family has been covered by a small business plan from Blue Cross of California. We’ve had one of their better PPO plans, with a $250 deductible and a $20 doctor’s office copay. Each year, as our renewal came around, the price has jumped up…most recently from a monthly rate of $1183 to $1358.
$16K per year for health insurance is simply too much. We just switched to Blue Cross’ $2400 deductible HSA plan. The premiums dropped by $785 per month…$9420 per year…for a plan with a family out-of-pocket maximum of $5500. This year I’m saving more in premiums than the worst-case annual claims. On top of that, there’s the tax savings on expenses that are run through the HSA account. Altogether it’s not a bad deal.
But, now when I go to the pharmacy, instead of paying $15 or $25 per prescription, I’m paying full freight, at least until I meet my deductible. So I decided to call around and see what a few local pharmacies would charge for a month’s supply of my latest cholesterol med, Simvastatin (the generic form of Zocor). The results were illuminating: Walgreen’s: $146 Longs: $88 Target $55 Costco: $13.56. That’s almost an 11:1 range in prices.
When I was paying a flat price per prescription, convenience was the determinant factor in filling a prescription. Walgreen’s is around the corner. Costco is 6 miles away. Sorry, Walgreen’s. From now on, I’m driving to Costco.
A lady called looking for health insurance. Seems she has no insurance now and hasn't had any for over a year. She is in good health except . . .
You can see it coming.
She has been having pain in her hand so she went to the doctor. During the exam the doc noticed an enlarged thyroid and drew blood for lab work.
The doc told her to call back tomorrow for the lab results on the blood.
As for the hand, there is no way to know until further testing is done which might include X-rays and/or MRI. The doc told the patient these are very expensive and "you need to get insurance before we do these tests".
Right . . .
I told my caller that no carrier will touch her until she has a diagnosis for the enlarged thyroid and the hand issue. Her comment back to me was, you guessed it, "I can't pay for the tests until I have insurance".
Well, even if you could GET insurance, the carrier will not cover these conditions (or any testing) until you have a diagnosis. Even then, they may not pay for any treatment of the conditions.
"So why do I need insurance if it won't pay for anything"?
Let me put it this way. Suppose you had an auto accident yesterday and did not have insurance. Do you think you could call and get insurance today for the accident that happened yesterday?
"No, that is just silly".
So then, you understand my point. Health insurance is something you take out BEFORE you need it and BEFORE symptoms, illness or injury occur.
"Well if I can't get insurance to pay for my tests, or for any treatment, then how do I pay my medical bills"?
That is something you should have considered before now.
This is one of those times.
While the story is about a multi-line carrier and their P&C block, the ramifications show what can happen when the courts are involved in interpreting contracts after the fact. This kind of situation can affect other lines of coverage, including health insurance, should the circumstance arise.
NEW YORK (Reuters) - State Farm Mutual Automobile Insurance Co. said it will stop writing new policies for homeowners and businesses in Mississippi following a legal battle over damage claims there from 2005's Hurricane Katrina.
"It is no longer prudent for us to take on additional risk in a legal and business environment that is becoming more unpredictable," Bob Trippel, senior vice president of the largest home insurer in the United States, said in a statement on Wednesday.
State Farm joins other insurers -- including Allstate Corp., its biggest national competitor -- which are cutting back in coastal areas. Among them are American International Group Inc., the world's largest insurer, and Nationwide Mutual, the parent company of Nationwide Financial Services Inc..
This next line is quite telling.
"Hurricanes can be insured against, but litigation can't," said Robert Hartwig, head of the Insurance Information Institute, which provides insurance statistics. "Those costs are extremely high."
While some will disagree, carriers are in the risk MANAGEMENT business, not risk avoidance. Managing a particular risk involves weighing known variables based on past experience and projecting those variables in to the future. Dollars of the many are exchanged and managed to provide dollars for the few that can be scientifically expected to incur a loss.
Insurance contracts are aleatory in nature. In a commutative contract parties give up goods or services of equal value. An example is swapping cash for a home or auto.
Aleatory contracts involve amounts that are unequal in nature. In this case, a homeowner may pay $500 per year in exchange for a contract that could potentially pay out several hundred thousand dollars.
The amount at risk for the homeowner is small . . . only a few hundred.
The amount at risk for the carrier is substantial. When the risk allowance is compounded by legal fees the cost of doing business is too great for the carrier to absorb.
Contract language is quite specific as to what is covered, what is not. In this case it appears that emotion over the magnitude of the loss may have impacted the legal decision.
This is not the first time emotion has resulted in substantial payouts not predicated in contract or law. The loss of life in the WTC disaster prompted numerous suits against parties not directly responsible for the loss. Many of those suits are still unsettled to this day.
Litigation carries a cost that must be factored in to the cost of doing business. When litigation becomes excessive and unreasonable, a carrier's only choice is to pull the plug and walk away.
It is possible that State Farm could have stayed in the game, provided their rate structure would be approved by the DOI in Mississippi. As a regulated industry, State Farm is quite literally caught in the middle. They are being forced to pay claims that are not viewed as contractual obligations and any attempt to recoup with higher premiums could be stymied by the DOI.
Recently it was reported that many people who live & work close to ground zero in New York continue to have health & respiratory problems. One wonders what kind of impact this may have on health insurance availability and premiums for those in New York.
Wednesday, February 14, 2007
New Jersey has 40 of these mandates. Should a resident want to buy a policy that doesn't cover, say, in vitro fertilization, sorry — the government has decided that everyone must have that coverage.
In vitro is a VERY expensive procedure. The cost must be shared by all which, in the big scheme of things, may not amount to that much. Still, it is a provision that will benefit only a handful.
And the dimes add up . . .
The approximately 47 million uninsured in America are a significant problem, but the proposals under consideration do little to address the primary reason for the lack of coverage — very expensive insurance.
Cost is a factor.
Of course there are those who can well afford coverage, but simply choose to go bare. If they have a job, or assets, or both, that is a decision they may well regret.
And why are those costs spiraling upward, seemingly without limit? One major reason is government meddling in the market for health insurance, particularly through the imposition of restrictive mandates and regulations.
Give this lady a prize! Looks like she "gets it".
It would make far more sense to give individuals the freedom to purchase policies that suit their specific needs. A bill like the one sponsored by Rep. John Shadegg, R-Ariz., if it had passed, would have allowed individuals to purchase insurance across state lines.
Maybe I spoke in haste. Apparently John & Sally have no idea of the MEWA/MET fiasco from just a few years back.
So it should come as no surprise that the universal program placing mandates on employees and individuals — passed in Massachusetts last year — is already destined to fail because it is prohibitively expensive.
Yup. This has been noted before at InsureBlog.
Estimates now show that the monthly costs for an individual will be $380, almost double what the designers predicted. A movement is afoot to exempt those earning up to three times the federal poverty line, or $60,000 per year for a family of four. Exemptions like that hardly constitute a universal plan.
The $380 figure is almost double the state estimate. Not a good sign.
Let's hope New Jersey learns from the heavy-handed approaches of other states and opts for a more effective approach — like ending the silly requirement that all insurance policies cover things like alcoholism, which most people will never need.
I'll drink to that.
Tuesday, February 13, 2007
Not the kind of exposure the Society would want . . .
Excuse me, but I don’t have health insurance, by choice. And when I or other members of my family get sick, we go to see our doctor and we pay for it out of pocket.
It’s cheaper that way.
Cheaper . . . to a point.
Routine doc visits, most testing and even many meds can easily be paid for out of pocket and insurance is unnecessary.
So what happens when you need a $1500 CT scan? The results come back and you need surgery.
The hospital wants to be paid for the expected 3 - 4 day stay.
The surgeon wants to be paid.
Do you have an extra $40k or so laying around to pay in advance for your procedure? If not, you may find the hospital will not admit you and the surgeon will not schedule you until they know in advance you have the ability to pay.
Yeah, I know. That's a real bummer.
(I know, I may have overdone that last)
Given the theme, it seems only fitting to highlight this Diabetes Mine post, a letter to her pancreas. Well done, Amy!
The Wall Street Journal today (13 February) reports the introduction of a Mental Health Parity bill in the Senate. This Bill would build on the Mental Health Parity Act of 1996 and require that, if mental health expenses are covered in an employer group insurance plan, they must be reimbursed the same as other health expenses in the plan i.e., cost-sharing, inpatient care, and outpatient care. Despite its name, the 1996 Act did not require full parity with other health benefits. The current Bill would produce full parity and therefore represents an expansion to mental health benefits in group insurance plans. The Bill requires States to go along, perhaps simplifying the rules for plans whose participants are located in more than one State. Employers having fewer than 50 employees would be exempt.
As reported, this Bill claims not to “mandate” inclusion of mental health in group health plans. Plans that presently do not cover mental health expenses would not be required to add such coverage, and plans now offering mental health benefits could delete them; as both of these possibilites seem far-fetched for employers having more than 50 employees, in practice this Bill is effectively a mandate.
There is a cost test – if benefit parity would require an increase in cost of more than 2% in the first year and 1% per year thereafter, the plan sponsor may “opt out” from the parity requirement although the nature of future cost tests is not mentioned.
The reporting is not clear whether the requirement applies only to insurance companies or also to the group plan sponsors such as employers, labor unions, governments, etc. Understanding this would help clarify whether the requirement falls only on insured plans or might also affect self-funded plans.
Apart from cost, I wonder about the effectiveness of outpatient behavioral care. I believe it’s still true that generally-accepted “best practices” and treatment protocols are not so well-developed and uniformly applied for behavioral health as in other branches of health care (where, BTW, substantial variation exists), which I think means there is less assurance of effective care. That is one reason why benefit plans have historically limited the coverage for such care. One thing for sure, the cost of the added coverage will be measured in tangible dollars.
The National Institute of Mental Health estimates that 25% of all Americans have at least one “diagnosable mental health disorder”. The providers represented by that organization stand to gain financially from this Bill. I believe NIMH and the behavioral health providers owe plan sponsors and the public in general, tangible and specific explanations as to how patients will benefit from the additional care, were this Bill enacted into law.
Monday, February 12, 2007
ADDENDUM: This week's Carnival of the Capitalists is finally up, but I won't be linking to it.
Why not, you ask?
While I'm no fan of "themed" carnivals, I can appreciate that a prospective host may choose that route, if for no other reason than to keep the number of entries manageable. However, it is incredibly stupid to do so without announcing -- in advance -- that one is doing so, and what that theme is.
Sunday, February 11, 2007
Saturday, February 10, 2007
Unfortunately, life has imitated art, after a fashion: Jordan’s Arab Bank has set up a quasi-insurance plan for families of Palestinian homicide-bombers. The “deal” is fairly simple, if not disgusting:
“In February 2002, a similar ad was placed in another publication, Al Hayat Al Jadeeda, again asking families of "martyrs" to go to the Arab Bank in order "to receive the tenth payment, totaling $5,316 for each family, donated by the Saudi committee." The generous donors ended up giving $1,594,980 to some 300 families in the occupied territories via the Arab Bank.”
Basically, the terrorists’ families are instructed to open an account at their local branch, into which will be deposited some $5,000. It’s not really “life insurance,” since there’s no underwriting or an actual policy (among other issues). But since someone has to die in order for a “beneficiary” to collect, it certainly mimics such a plan.
Words fail me.
Friday, February 09, 2007
Thursday, February 08, 2007
Walking for breast cancer.
Smoking for kids.
Maybe GA (and 14 other states where SCHIP is failing) should be watching.
Whoa! Federal money? Are these the same folks who want to EXPAND the SCHIP programs and provide Medicare for all?
Georgia faces a $131 million shortfall in federal money for PeachCare, and state officials have said it could run out of money as soon as next month, although key state lawmakers have said they will try to kick in state cash if necessary.
$131M shortfall. What is Washington doing with our (taxpayers) money? Aren't children a KEY target?
Georgia is one of at least 14 states facing a federal shortfall for its state Childrens Health Insurance Program. Iowa's Hawk-I plan, which insures more than 30,000 children, expects to exhaust its budget by the end of June.
14 states in the red.
Are you listening Hillary? Obama? Edwards? Romney?
Wednesday, February 07, 2007
As far as I know, the muumuu's only came in one size and everyone wore that size.
Now we have states designing health insurance in one size.
The board charged with getting insurers to come up with low cost health care plans will take another crack at setting standards for those plans Thursday, board chairwoman Leslie Kirwan said.
The goal is to produce health care plans that offer solid coverage but can be afforded by anyone earning more than three times the federal poverty rate _ or about $29,400 for an individual.
"We will have a discussion about providing revised specs to providers on which we would expect the new round of bids to be based,” Kirwan said Wednesday in an interview with The Associated Press, adding the board has to make sure it isn’t ”asking for something that the industry can’t deliver.”
Call me crazy, but isn't this something that should have been addressed BEFORE drafting legislation?
The decision to take another look at minimum standards for health care plans in Massachusetts comes after insurers complained that previous standards set by the Commonwealth Health Insurance Connector _ charged with turning the state’s ambitious health care law into a reality _ were too strict.
That's a good word.
Impetuous is another word that comes to mind.
The goal is to get monthly premiums closer to the $200 mark suggested by former Gov. Mitt Romney.
After the last meeting, the board and Gov. Deval Patrick urged insurers to try to find ways to shave costs.
The move came after members of the board were told that the average price for the new plans could cost about $380 a month.
Mitt Romney? Isn't that Mr. Bojangles?
Kirwan, who also serves as Patrick’ budget chief, said the board has little choice but to take a second look at what constitutes minimum coverage.
”Without revisions to the specs, we couldn’t get meaningful bids,” she said. ”We want to be clear about the options and then see how those bids come back.”
Time to punt on third down.
Yesterday, after addressing a gathering of conservative lawmakers in Baltimore, Romney told reporters that he cannot be held responsible for decisions that Beacon Hill lawmakers make about the sweeping plan now that he is out of office.
"I hope they take action that makes it work even better than I could have thought of," said Romney, who is exploring a campaign for the 2008 Republican presidential nomination. "But if they take action that makes it unworkable, I'll point that out. I'm not going to sit on the sidelines and not have a comment to make."
Sounds like he was in favor of the plan, before he was against the plan.
Why does this seem familiar?
But this morning, in an extraordinary meeting in Washington, the chiefs of Wal-Mart Stores and the Service Employees International Union will stand together and agree on a series of goals for achieving universal health coverage, according to people briefed on the matter.
The two men might even shake hands.
And the lion will lay down with the lamb . . .
So during today’s meeting, Mr. Stern and Mr. Scott will announce a campaign to seek public acceptance of several principles of health policy. One goal is universal health coverage by a specific date, somewhere around 2012. Another is the idea of shared responsibility, emphasizing that individuals, businesses and government all play roles in financing health care and expanding coverage.
And they are not alone.
Executives from AT&T, Intel and several nonprofit organizations will also participate in today’s meeting.
So what makes this any different from other proposals?
the icy relationship between the men began to thaw after Mr. Stern wrote an op-ed article encouraging large corporations to work with unions to create alternatives to the employer-based health coverage system, which he said was collapsing. Mr. Stern sent the article, by certified mail, to hundreds of chief executives seeking their help.
A shared responsibility between individuals, corporations and government. Other proposals have been one sided with taxpayer bearing a significant portion of the load. This idea seems to incorporate personal responsibility more than other proposals.
Or maybe it just seems that way . . .
Tuesday, February 06, 2007
But in the real world, Gardasil is getting used less than doctors would like. Pediatricians and gynecologists from Arizona to New York are refusing to stock Gardasil because of its $360 price for the three doses required and "totally inadequate" reimbursement from most insurers.
"I still don't have the shot and now I have to decide whether I want to make a $1,200 investment to get them vaccinated," she said. "I really don't want to deny them what I think is right."
So your daughter has a RIGHT to be vaccinated? What about parent responsibility? Isn't the health of your daughter WORTH $1200?
Dr. Michael Blum, senior partner in a big pediatric practice in suburban Kansas City, said it only provides Gardasil to patients who pay $450 up front, then tries to get insurance reimbursement for them. Only a half-dozen patients have done so.
Can't afford $450 to protect your daughter. Someone needs to get their priorities straight.
"The bottom line is we're asking everybody to share in the responsibility of making health care work in this country.
Higher taxes. Asking everyone to share.
"Yes, we'll have to raise taxes. The only way you can pay for a health-care plan that costs anywhere from $90 [billion] to $120 billion is there has to be a revenue source," the former North Carolina senator said on "Meet the Press" on NBC.
$90B+ to cover 47M. That's about $1900/year per uninsured.
Wonder where he got those numbers?
Edwards said his plan would aim to provide health-care coverage for the 47 million people who now lack it and reduce the cost for middle-class families, partly by making health-care programs more efficient.
More efficient. This from a guy who made millions filing med mal suits.
To accomplish all this, Edwards said he would expand Medicaid and a program that now provides coverage to 6 million people, mostly children, and provide federal health-care subsidies.
Well there are a few issues with this. Medicaid is failing in most (if not all) states. Federal funding has been cut back. Many states are kicking folks off who were previously covered and making it more difficult for new applicants to qualify.
Doesn't anyone bother to check the facts before taking politico's at their word?
Monday, February 05, 2007
"They need to get the message that they need to help us make this new law work," Sen. Richard Moore, D-Uxbridge, told the Boston Business Journal.
Let me see if I understand this.
The state issued the mandate.
The state set the benefit levels.
The state estimated the cost would be $200/person.
The carriers said the plan would cost closer to $380 per person.
Now the state is telling the carriers to get their pricing in line if they want to be a player.
You don't suppose carriers will simply refuse to offer coverage if they can't get their price?
Moore said his comments are a warning to insurers that some legislators and health care advocates will push for the regulation if the revised rates aren't affordable enough.
You WILL comply with our demands!
MA may have a bigger problem on their hands than they ever anticipated.
Initial proposals filed earlier this month by health insurers in the state carried an average cost of $380 per month for individuals who make above 300 percent of the federal poverty level.
The Connector Authority required the proposed plans cover at least a few doctor's visits not subjected to a deductible, and insurers say that state laws mandating insurance coverage of a variety of medical procedures will make it harder to come up with an affordable products.
Moore told the Boston Business Journal he envisions an "affordable" health plan having a monthly premium of between $250 and $280.
Same coverage as before but for 25% less premium.
Sure. That's going to happen.
Bundled up against the chilly wind, people began arriving at 2 a.m. outside the tents and doublewide trailers offering free care in eastern New Orleans. By the time the first 50 had been called into the registration tent, they numbered in the hundreds.
I have as much empathy as anyone for the survivors of Katrina, but I have to wonder how many are really in need of care, and how many are just gaming the system?
Penny Anderson, her daughter, and three small grandchildren came to see a dentist. ``My daughter went online to try to get health insurance for me and my husband,'' she said. ``It was $799 a month! That's a house note!''
What kind of coverage?
My experience with folks looking online is, they want the best plan available but only want to pay $50/month.
I would really love to drive a Maserati but I can't afford the payments. Guess I will have to settle for the old Volvo. Why can't the government buy me a new car?
Or even Janis Joplin?
"Oh Lord, won't you buy me a Mercedes Benz"?
The health fair is open to anyone from the greater New Orleans area, but is specifically aimed at those who no longer have insurance, are unemployed or who otherwise cannot pay for regular health care. By the end of the week, 10,000 patients are expected to be seen.
Free health care.
Anyone want to guess how long the lines will be if we have Hillary-Obama care?