Competition lacking among private health insurers

[George Gervin's Afro]

Competition lacking among private health insurers



WASHINGTON – One of the most widely accepted arguments against a government medical plan for the middle class is that it would quash competition — just what private insurers seem to be doing themselves in many parts of the U.S.

Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.

For Democrats, the answer is a public plan that would compete with private insurers. Republicans see that as a government power grab. President Barack Obama looks to be trapped in the middle of an argument that could sink his effort to overhaul the health care system.

Even lawmakers opposed to a government plan have problems with the growing clout of the big private companies.

"There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant."

Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association.

Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn't have to turn a profit.

A study by the Urban Institute public policy center estimated that a public plan could save taxpayers from $224 billion to $400 billion over 10 years by lowering the cost of proposed subsidies for the uninsured, while preserving private coverage for most people.

"Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."

"The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan.'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."

Insurers contend their industry is extremely competitive, and a public plan is unnecessary. About 1,300 carriers operate across the country, although many only have a small share of the market in their states.

"You can have a very competitive market and still have companies with a high market share," said Alissa Fox, a top Washington lobbyist for the Blue Cross Blue Shield Association.

Fox points to the federal employee health program, which also covers members of Congress. It offers a total of more than 260 options and 10 nationwide plans. Despite all the choices, about 60 percent of federal workers pick a Blue Cross plan.

"Insurers need to be of a significant size to best serve their customers and make sure that people get the best value," Fox said.

Nonetheless, lawmakers are concerned. Big insurers are getting bigger. Small businesses in particular have fewer and fewer options for getting coverage.

Congressional investigators this year looked at insurers catering to small employers around the country. The Government Accountability Office found that the median _or midpoint — market share of largest carrier increased to 47 percent in 2008 from 33 percent in 2002.

There's widespread recognition among lawmakers that a health care overhaul should foster more competition among insurers. The debate is over how far to go.

The basic framework lawmakers are looking at would encourage competition, even without a government plan. It calls for setting up a big insurance purchasing pool called an exchange. It would be open, at least initially, to individuals and small businesses. The government would offer subsidies to make premiums more affordable.

Consumers would find it much easier to shop for a plan through the exchange. For one thing, they would be able to readily compare benefits and premiums in different plans. Also, participating insurers would have to take all applicants and not charge higher premiums to those in poor health.

Offering the option of a public plan would supercharge the competition, supporters say.

Blumberg envisions a plan that pays medical providers more than Medicare, but less than private insurance. Her study estimated it could grow to 47 million members, leaving 161 million with private insurance. Even so, that would make the new public plan one of the largest insurers in the country, rivaling Medicare, Medicaid and big private companies such as Wellpoint and UnitedHealthcare.

It's a scenario that gives pause even to traditional adversaries of the insurance companies.

"The fear and concern is that the public plan could become the market-dominant plan," said Dr. James Rohack, president of the American Medical Association. "When you've got the federal government involved, it can infuse money into a plan to keep it solvent even if the premiums are lower than its actual costs."

Snowe, among the few Republican senators still trying to come up with a bipartisan compromise, wants to hold back on creating a public plan for now and give insurers one last chance to show if they can keep costs in check.

That's doesn't go far enough for liberals, who are loath to give the insurance industry tens of millions of new customers supported by taxpayer subsidies.

"It would give the industry a windfall without any countervailing force to require them to lower their costs," said Richard Kirsch, national campaign manager for the advocacy group Health Care for America Now. "The insurance companies could continue to jack up premiums while getting a whole new market."

http://news.yahoo.com/s/ap/20090822/ap_on_bi_ge/us_health_care_insurance_competition

I'm for more of the same!

[Yonivore]

I'm for more of the same!
It's hard to compete in a strict regulatory environment.

[SouthernFried]

The attack....continues.

[boutons_deux]

The last things corps want to do is compete. CEO/CFOs' wet dreams are all about monopolies (Microsoft) and cartels and price fixing, milking captive clients.

PussyEater, tell us how guvmint regs prevent price competition among, or even between, health insurers.

And most companies have been "captured" by one insurer and offer/require the employee to "buy" that one plan.

[DMX7]

It's hard to compete in a strict regulatory environment.

lol, what "regulation" is making it hard to compete? :lmao

[Yonivore]

lol, what "regulation" is making it hard to compete? :lmao
Well, the regulation that prohibits insurance companies from selling across state lines is the first major "regulation" that comes to mind. Small insurance companies cannot expand their market and large insurance companies are forced to create redundant corporations with all the associated overhead and administration.

[polysylab1k]

no one can out-compete the government, or even tie the game with government.

[Yonivore]

The last things corps want to do is compete.
I agree...most corporations would like to be monopolies.


CEO/CFOs' wet dreams are all about monopolies (Microsoft) and cartels
Illegal


and price fixing,
Also illegal.


milking captive clients.
With a competitive market, they could "milk" their clients to another provider.


PussyEater, tell us how guvmint regs prevent price competition among, or even between, health insurers.
Anytime the government regulates they restrict commerce.


And most companies have been "captured" by one insurer and offer/require the employee to "buy" that one plan.
The answer to that isn't regulation; it's for employers to be discouraged from providing insurance at all but, instead, paying the premium in wages and allowing the employee to provide for their own insurance.

[SpurNation]

I think that much of what this article says is correct in terms of what is happening regarding private insurance but I also think the discussion is great and will lead to a compromise and not a ram rod approach to passing insurance reform. I particularly like this quote:


The government would offer subsidies to make premiums more affordable.



I have been a proponent of subsidation all along. But it should be across the board regarding the entire health care industry. Especially in the Pharmeceutical industry. Rate regulation should also be a consideration throughout the entire health care industry.

This allows private industry to remain as the main providers and executors of health care along with government intervention as a needed only basis. Private industry will remain independent as long as they follow government regulations.

Items such as standard office visits will be set at a flat rate. If specialized treatment is deemed necessary then charges increase according to the nature of illness/situation to be treated.


Consumers would find it much easier to shop for a plan through the exchange. For one thing, they would be able to readily compare benefits and premiums in different plans. Also, participating insurers would have to take all applicants and not charge higher premiums to those in poor health.


Bravo for this option. I agree except for in the case of existing conditions...this is where government subsidation could be implemented to help the insurance company cover the additional cost of having to except a pre-exisiting condition.

Again...this is just the beginning of a long overdue need to reform health care. But at least it is being investigated and not rammed down our throats by agenda based partisanship.

Props to Obama for at least listening to both sides and not giving in to his constituents. So Far.

[DMX7]

Well, the regulation that prohibits insurance companies from selling across state lines is the first major "regulation" that comes to mind.

Oh please... that's not going to do anything except prevent older people from getting health insurance as the health insurance companies cherry pick only young healthy people (like myself :) ) to insure.

However, I think this problem can be solved with guns. There are few problems that can't be solved with guns.

[Wild Cobra]

There is competition in the health insurance industry. I have a neighbor, who's wife a couple years ago, had a serious issue and operation. The peanut counters for his work's insurance policy tried to stop coverage after some pretty high medical bills were paid. His employer, being one of the largest in the state, told them if they screwed their employees wife, they would go to a policy with the competition. The insurance company paid.

[DMX7]

There is competition in the health insurance industry. I have a neighbor, who's wife a couple years ago, had a serious issue and operation. The peanut counters for his work's insurance policy tried to stop coverage after some pretty high medical bills were paid. His employer, being one of the largest in the state, told them if they screwed their employees wife, they would go to a policy with the competition. The insurance company paid.

You can do that when you have a contract or whatever and you're one of the largest companies in the state. The peanut counters are profit motivated people though, so they are going to try and deny as many claims as they can.

[Marcus Bryant]

Yeah, so what we need is a government program which runs at a loss and is subsidized by the income taxpayers (not you mooches who merely pay payroll taxes).

[DMX7]

Yeah, so what we need is a government program which runs at a loss and is subsidized by the income taxpayers (not you mooches who merely pay payroll taxes).

Nah, we had that covered with the Death Panels until you losers made us take it out.

[Spursmania]

I think the government can solve all our problems and they definitely should be providing free healthcare to every American out there. I wonder if I can start sending my water and electricity bill to them too? They should take care of that too.

[SpurNation]

I wonder if I can start sending my water and electricity bill to them too?


Nah. Then we would have to practice water rationing taking baths only once a week and then we would all stink.

[Marcus Bryant]

Nah, we had that covered with the Death Panels until you losers made us take it out.

LOL. Uh yeah, us "losers" who would pay for it for your free riding ass.

[DMX7]

I think the government can solve all our problems and they definitely should be providing free healthcare to every American out there. I wonder if I can start sending my water and electricity bill to them too? They should take care of that too.

Yeah, universal healthcare has never been done before. Next thing you know, the government is putting out fires and locking up criminals. Then, they're providing healthcare for our troops and helping out old people. Next thing you know, we're living in Nazi Germany.

[Marcus Bryant]

Next thing is you can't get the treatment you need when you need it. And dumbfucks like DMX eat this shit up because they can't provide for themselves.

[DMX7]

Next thing is you can't get the treatment you need when you need it. And dumbfucks like DMX eat this shit up because they can't provide for themselves.

I have healthcare (employer provided, UnitedHealth). I'd like people who can't presently afford it to at least have an option even if it meant I had to pitch in some way. How selfish of me.

[Marcus Bryant]

ROFL. You don't have shit. Like many you seek a handout.

[DMX7]

ROFL. You don't have shit. Like many you seek a handout.

I work for AT&T, dumbfuck. ...and not as a receptionist like your dumbass.

Must be why you have like 1,000,000 posts, just sitting there doing shit all day like all receptionists. :lol

[SouthernFried]

Yes...the govt is going to come in, attack insurance companies, and provide their own universal health care instead.

Why, that's exactly how you increase competition.

Think that's what I'll do to my competition. Demand they give me all their records, then have Kens, WOAI and others start looking into all the funny business they have been doing.

Cuz that's how you REALLY solve "competition problems."

and so it goes...

[Marcus Bryant]

at&t wouldn't hire a stupid fucking moron like you. but on the off chance you slipped through the cracks, i'll let them know.

[Marcus Bryant]

Yes...the govt is going to come in, attack insurance companies, and provide their own universal health care instead.

Why, that's exactly how you increase competition.

Think that's what I'll do to my competition. Demand they give me all their records, then have Kens, WOAI and others start looking into all the funny business they have been doing.

Cuz that's how you REALLY solve "competition problems."

and so it goes...

ROFL. Because free market competition is about the government being involved. Goddam this country is fucking stupid.

[SouthernFried]

This health care debate has never been about increasing competition. Although that's what it SHOULD be about.

Right now, it's about making Insurance Companies look worse than the govt.

It's not possible.

[fyatuk]

Could have told you that. So why not create a more competitive marketplace for the private insurers instead of adding undu stress on the government by creating a massive logistical effort of a public option.

[boutons_deux]

Tort reform did nothing but screw over victims, no savings realized by patients, only by doctors (did their premiums really go down? by how much?), but the big winner was health insurers who pay out less on liability policies.

Regulations aren't causing health insurance to rise 5%-7%/year, no regulations won't stop that rise, and certainly not cause any reductions.

Health insurers are a mafia ripping wealth and raises off employees before the employees have any chance to even smell their salary.

Imagine the firestorm if taxes were rising 5-7%/year.

[George Gervin's Afro]

Texas passed tort reform and they (Texas) still have the highest rate of uninsured in the country.

[SouthernFried]

Texas passed tort reform and they (Texas) still have the highest rate of uninsured in the country.

So what?

It's amazing...this country survived close to 200 yrs without having the need for everyone to be "insured."

Now, it's like "the country can't survive if everyone isn't 'insured'."

At the same time people are attacking insurance companies...they are demanding everyone be insured.

Really...I blame Woodstock on all this.

[polysylab1k]

The problematic illegal immigration will only get aggravated to uncontrollable degree if the government continues to give them so much welfare that they actually don't deserve.

[johnsmith]

PussyEater, tell us how guvmint regs prevent price competition among, or even between, health insurers.



:lmao:lmao:lmao


Did you really just call someone 'PussyEater'?

:lmao:lmao

Is that an insult or not?

[johnsmith]

Texas passed tort reform and they (Texas) still have the highest rate of uninsured in the country.

Come on now..........you know as well as I do why Texas has the highest rate of uninsured..........

[boutons_deux]

Illegal immigration is a separate, serious problem. I'm sure the corporate-financed swift-boat mobs will scream down Magic Negro's proposed solution, too.

IIRC, what he said during the campaign was that illegals could become legal residents (not citizens) if they paid a penalty for breaking the law and got in line, and waited, behind legal applicants for work permits.

It's completely Magic Negro's fault the the Repugs did nothing about illegal immigration for 8 years.

[johnsmith]

That Magic Negro sounds like a real PussyEater!

[George Gervin's Afro]

Come on now..........you know as well as I do why Texas has the highest rate of uninsured..........

ok, show me whatever documentation that supports whatever your point is.

[fyatuk]

Texas passed tort reform and they (Texas) still have the highest rate of uninsured in the country.

Okay...

Tort reform was supposed to influence Medical Malpractice premiums (haven't seen whether it did or not, but I'd bet the best reaction would have been to just slow down increases).

That means for it to actually affect health insurance policies, you'd need the MedMal insururs (a completely different set, no one does both medmal and health policies) to lower their premiums, then doctors to lower their prices (not likely as they'd just reinvest the savings somewhere else), and then health insurors could lower their premiums (again, more likely just to slow the rate of increase).

There's too many steps for one to make a direct connection there.

Texas also has one of the highest rates of medical liability cases that get filed.

Personally, I think limiting punitive damages in medical liability cases (except where permanent disability or death is involved) to a ratio of actual damages is a good thing, because it's FAIR.

[johnsmith]

According to a summary of national data by the Congressional Budget Office (CBO), groups with a high likelihood of lacking health insurance include:

People in families with income below 200 percent of the poverty level;
Hispanics;
Young adults, age 19 to 34;
People in families in which the adults worked either part-time or only part of the year; or
Individuals in fair or poor health status who are significantly more likely than others to be uninsured for longer periods.

Break the ones in bold down a bit. Poor people - Been to the south, east, or west side of SA lately? How about East Austin? Or South Dallas? We have a lot of fucking poor people here.

Hispanics- Figure that out yourself.

Poor Health Status - Which state always ranks in top 2 for fatties like yourself?


And don't forget the more then 1,000,000 illegals currently living of your tit.

[johnsmith]

Now GGA, quit being such a PussyEater...........wait, I'm still not sure if that is an insult or not.

[George Gervin's Afro]

Break the ones in bold down a bit. Poor people - Been to the south, east, or west side of SA lately? How about East Austin? Or South Dallas? We have a lot of fucking poor people here.

Hispanics- Figure that out yourself.

Poor Health Status - Which state always ranks in top 2 for fatties like yourself?


And don't forget the more then 1,000,000 illegals currently living of your tit.

so the poorest of texas' ctizens still lack insurance.. that's shocking. SO insurance companies still haven't reduced premuims..so why did we need tort refom again? If I remember corretly tort reform was supoosed to bring malpractice insurance down and costs wer suposed to follow...nice job conservatives.

[johnsmith]

so the poorest of texas' ctizens still lack insurance.. that's shocking. SO insurance companies still haven't reduced premuims..so why did we need tort refom again? If I remember corretly tort reform was supoosed to bring malpractice insurance down and costs wer suposed to follow...nice job conservatives.

Hey, you brought up that Texas still has a high uninsured rate and I told you why........nothing more and nothing less.......Texas is full of poor, fat, and hispanic folk, therefore, the uninsured rate is high.

And I'll see your tort reform and raise you a 'stimulus package was supposed to stimulate the economy' not just do awesome things like establishing an actual border through the gulf of Mexico seperating the US and Mexico.

[George Gervin's Afro]

Hey, you brought up that Texas still has a high uninsured rate and I told you why........nothing more and nothing less.......Texas is full of poor, fat, and hispanic folk, therefore, the uninsured rate is high.

And I'll see your tort reform and raise you a 'stimulus package was supposed to stimulate the economy' not just do awesome things like establishing an actual border through the gulf of Mexico seperating the US and Mexico.

so since tort reform happened 5 or 6 yrs ago I guess to be fair (which I know your not) you should give the stimulus package the same amount of time to be effective. You criticize Texas yet that is the standard by which all conservatives use to show how conservatism works at the state level..

[polysylab1k]

Hey, you brought up that Texas still has a high uninsured rate and I told you why........nothing more and nothing less.......Texas is full of poor, fat, and hispanic folk, therefore, the uninsured rate is high.


Exactly that's why I blame the immigrants on all the messes, both legal and those illegal. But I don't think that can be only be solved by strengthening the fence along the Mexico border, as the flights have been carrying much bigger numbers of immigrants inboard than those penetrated through the border. Texans speak relatively slower English which is more understandable to dumbass immigrants, that's the reason why Texas is always the destination for immigrants and therefore there're more livings uninsured in Texas. Sincerely the federal government should tighten the filter to immigrants, for the perpetual prosperity of America.

[boutons_deux]

"why did we need tort refom again?"

TX Congresscritters, as corrupt as any in the country, passed tort reform to protect the heavy-lobbying liability insurers and wealthy doctors, while fucking over victims of malpractice, slamming the court house door in their faces.

[johnsmith]

so since tort reform happened 5 or 6 yrs ago I guess to be fair (which I know your not) you should give the stimulus package the same amount of time to be effective. You criticize Texas yet that is the standard by which all conservatives use to show how conservatism works at the state level..

Where did I criticize Texas? I pointed out that we have more Fat, Hispanic, and poor people then most states.......that's not criticizing. You should let chumpdumper put words in everyone's mouth because he's at least funny and much better at it then you.

[SpurNation]

Illegal immigration is a separate, serious problem.

Agreed. It is a separate serious problem. But it is a problem that directly affects health care costs since these people do get sick , injured and need medical assistance.

Who do you think pays for that medical care when they are being admitted to clinics and hospitals to care for themselves and their children?

And if the government truly would want to crack down on illegal immigration all they would have to do is set up shop at any work force location or "Santa Whatever" Catholic sponsored charity hall and have bus loads of illegals to process and deport.

It won't happen that way though since many small businesses compile much of their day labor work force from these locations. Paid in cash. No paper trail. Cheap labor.

And the hypocrosy is that most of the people (from democrats to republicans) receiving the services of these people know they are illegal.

Democrats and Republicans talk the talk...point the fingers...but in reality knowingly contribute to the problems. It's ALWAYS somebody else's fault.

PFFFT.

[Wild Cobra]

:lmao:lmao:lmao


Did you really just call someone 'PussyEater'?

:lmao:lmao

Is that an insult or not?

No kidding.

[boutons_deux]

Yonivore parroting conservative talking points get trashed:

"High on the list of recommendations in Romney’s health care platform is an idea frequently touted as a silver bullet by conservatives: allow insurance companies to sell policies across state lines. Doing so, they say, will increase competition and, consequently, bring down the cost of coverage.The problem is that no one had done a study to determine definitively whether the across-state-lines idea would work—until now. And the conclusion of that study, conducted by the Georgetown University Health Policy Institute, is that allowing coverage to be purchased across state lines is much more of a blank than a bullet.

The study also finds that no new federal law is even needed to allow insurance companies to sell policies across state lines.

“With or without changes to federal law, states already have full authority to decide whether or not to allow sales across state lines and, if so, under what circumstances,” the study noted.

Of course, you wouldn’t know that from listening to Romney and other politicians who seem to believe than an act of Congress is needed. It isn’t. State legislatures can make it happen whenever they want, but, so far, only six have decided to try it. Georgia, Maine and Wyoming have enacted legislation in recent years to allow out-of-state insurers to sell policies within their borders. Lawmakers in Kentucky, Rhode Island and Washington passed bills requiring their insurance departments to research the idea and determine interest from out-of-state insurers.

The lawmakers who championed the legislation expected their states would be inundated with applications from insurers far and wide eager to sell their policies. But it hasn’t happened. In fact, not a single insurance company has expressed the slightest interest in doing business in any of those six states. "

http://www.publicintegrity.org/2012/10/08/11205/opinion-romneys-phony-answers-tough-health-care-questions?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+publici_rss+%28The+Center+for +Public+Integrity+Latest+Stories%29&utm_content=Google+Reader

the old free market and competition pixie dust, just sprinkle some around, kill ALL regulations, and all will be wonderful

[vy65]

The study also finds that no new federal law is even needed to allow insurance companies to sell policies across state lines.

“With or without changes to federal law, states already have full authority to decide whether or not to allow sales across state lines and, if so, under what circumstances,” the study noted.

This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding.

[boutons_deux]

This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding.

you're saying insurance companies are forbidden by FEDERAL LAW from selling across state lines, so states cannot allow it? If so, which Federal law is that?

[vy65]

What I'm saying is that the claim that state's having full authority to decide whether to allow cross-state sales would be irrelevant in the face of a federal law requiring them to allow such sales.

[boutons_deux]

What I'm saying is that the claim that state's having full authority to decide whether to allow cross-state sales would be irrelevant in the face of a federal law requiring them to allow such sales.

ok, nothing but an obvious hypothetical

the Repug point that "insurance across state lines" is restricted, horribly "regulated", when 6 states have OKed it, and not one insurance company has responded. So the Repug talking point is disproven, a lie.

[vy65]

lol 6 states
Is there a problem with cross-state selling other than it being a repug talking point?

[boutons_deux]

lol 6 states
Is there a problem with cross-state selling other than it being a repug talking point?

If the Repugs are for it, then the companies would gain, and clients would be screwed. Apart from that certitude, it's just non-stop Repug anti-govt bullshit.

[vy65]

How would companies gain? Why would clients be screwed?

Seems to me like its a good idea.

[RandomGuy]

What I'm saying is that the claim that state's having full authority to decide whether to allow cross-state sales would be irrelevant in the face of a federal law requiring them to allow such sales.

That is correct.

This is a case where almost all statutory authority for insurance regulation resides with the states. Any change to that would have a LOT of state governments very upset.

Call it a "truce" between layers of government.

[RandomGuy]

you're saying insurance companies are forbidden by FEDERAL LAW from selling across state lines, so states cannot allow it? If so, which Federal law is that?

They aren't. State law governs in all cases of who sells what insurance and how within any given state, as the article in the OP notes.

[vy65]

That is correct.

This is a case where almost all statutory authority for insurance regulation resides with the states. Any change to that would have a LOT of state governments very upset.

Call it a "truce" between layers of government.

The irony of a so-called republican calling on the federal government to regulate the states is duly noted btw

[vy65]

as well as the fact that, when left to their own devices, the states balk and prevent a free market from coming about

[RandomGuy]

Okay...

Tort reform was supposed to influence Medical Malpractice premiums (haven't seen whether it did or not, but I'd bet the best reaction would have been to just slow down increases).

That means for it to actually affect health insurance policies, you'd need the MedMal insururs (a completely different set, no one does both medmal and health policies) to lower their premiums, then doctors to lower their prices (not likely as they'd just reinvest the savings somewhere else), and then health insurors could lower their premiums (again, more likely just to slow the rate of increase).

There's too many steps for one to make a direct connection there.

Texas also has one of the highest rates of medical liability cases that get filed.

Personally, I think limiting punitive damages in medical liability cases (except where permanent disability or death is involved) to a ratio of actual damages is a good thing, because it's FAIR.

Tort reform has brought down malpractice insurance premiums in Texas.

What it has not done, is limit the increases in the costs of health care. The reason for this is that malpractice premiums for most specialties, aren't all that significant.

"Texas also has one of the highest rates of medical liability cases that get filed."

Link?

[RandomGuy]

as well as the fact that, when left to their own devices, the states balk and prevent a free market from coming about

Texas has a ueber conservative governor, and an ueber conservative Republican super majority in its legislature. If it were a priority, it would have happened.

That private insurers are somehow more efficient at providing health insurance than governments is a myth, in my opinion.

I have yet to see anyone show that (cost+profits) < (cost+government inefficiency)

Insurance is risk pooling.

Hordes of smaller insurers = exceedingly inefficient + poor risk pooling

More risks pooled = more predictability

The only thing that a private insurer has over governmental insurer is returns from invested reserves to offset some amount of premiums, which government programs doesn't do. These days though, the returns on the kinds of investments insurance companies are allowed to make is low, and will continue to be low for the forseeable future.

[TeyshaBlue]

Tort reform has brought down malpractice insurance premiums in Texas.

What it has not done, is limit the increases in the costs of health care. The reason for this is that malpractice premiums for most specialties, aren't all that significant.

"Texas also has one of the highest rates of medical liability cases that get filed."

Link?

I haven't found much per capita, or by a rate. But I did find this...http://www.statehealthfacts.org/comparemaptable.jsp?ind=436&cat=8

Texas is #5 in paid claims for 2011. Not exactly earthshaking numbers either. New York has about 3x as many and in the overall scheme of things, a pretty insignificant number.

[RandomGuy]

How would companies gain? Why would clients be screwed?

Seems to me like its a good idea.

Information asymmetry.

Shopping for health insurance is mind-numbingly complex, and the market is opaque to most people.

In such an environment, advantage naturally accrues to the negotiating side with the best information. That isn't your average joe, who can barely sift through a cell phone contract, let alone the byzantine complexity of a health insurance policy. Fuck, I'm an insurance expert, and I have problems figuring out my health plan sometimes.

Oddly enough though, I have access to some first-hand data about medmal insurance in Texas. I will talk to the actuary I am working with and get the skinny.

[vy65]

Information asymmetry.

Shopping for health insurance is mind-numbingly complex, and the market is opaque to most people.

In such an environment, advantage naturally accrues to the negotiating side with the best information. That isn't your average joe, who can barely sift through a cell phone contract, let alone the byzantine complexity of a health insurance policy. Fuck, I'm an insurance expert, and I have problems figuring out my health plan sometimes.

Oddly enough though, I have access to some first-hand data about medmal insurance in Texas. I will talk to the actuary I am working with and get the skinny.

That all may well be true (I have some issues with it, namely, a large amount of employers shop and purchase policies using insurance specialists, but whatevs), I still don't see how increasing the number of insurance companies competing within any given state increases a policy's complexity. There's a gap in between an increase in providers and an increase in a policy's complexity.

[RandomGuy]

I haven't found much per capita, or by a rate. But I did find this...http://www.statehealthfacts.org/comparemaptable.jsp?ind=436&cat=8

Texas is #5 in paid claims for 2011. Not exactly earthshaking numbers either. New York has about 3x as many and in the overall scheme of things, a pretty insignificant number.

(downloads state populations to excel, uses your link for the paid claims, sorts, filters, does a quick claims/population formula)

Sorted by ratio, smallest to largest. Texas is #11 on a per capita basis.

Minnesota 0.000916768%
Alabama 0.000978608%
Wisconsin 0.000980432%
Hawaii 0.001382009%
Alaska 0.001383666%
North Carolina 0.001470527%
Wyoming 0.001584066%
North Dakota 0.001608347%
Iowa 0.001698065%
Idaho 0.001703486%
Texas 0.001733225%
Ohio 0.001827639%
Virginia 0.001914383%
Colorado 0.001954358%
Arkansas 0.001974146%
Washington 0.001976563%
Oregon 0.002066191%
Georgia 0.002078407%
Delaware 0.002094506%
Vermont 0.002234883%
South Dakota 0.002305596%
Nevada 0.002350071%
California 0.002358596%
Maine 0.002409297%
South Carolina 0.002436298%
Nebraska 0.002442147%
Illinois 0.002447694%
Mississippi 0.002484462%
Kentucky 0.002517533%
Tennessee 0.002561158%
Indiana 0.002562559%
Missouri 0.002645288%
Arizona 0.002792131%
Massachusetts 0.003218199%
Michigan 0.003310994%
Oklahoma 0.003323216%
Connecticut 0.003658493%
Utah 0.003691580%
New Hampshire 0.003793068%
Florida 0.003977428%
New Mexico 0.004034148%
Maryland 0.004272266%
Rhode Island 0.004280407%
Kansas 0.004423179%
Montana 0.004608300%
New Jersey 0.004863309%
Pennsylvania 0.006019045%
Louisiana 0.006710623%
New York 0.007084439%
West Virginia 0.008461951%

[RandomGuy]

That all may well be true (I have some issues with it, namely, a large amount of employers shop and purchase policies using insurance specialists, but whatevs), I still don't see how increasing the number of insurance companies competing within any given state increases a policy's complexity. There's a gap in between an increase in providers and an increase in a policy's complexity.

It does not increase a policy's complexity. It simply increases the amounts of options available. Which is good for an efficient market. (economic "efficient", meaning information is equally known to all concerned)

The problem is that health insurance by its complexity does not lend itself to "efficient" markets. Individuals rarely have the desire and/or capacity to do enough research to be able to adequately evaluate the products they are offered. (edit) The insurance company, however, does, and has every motivation to maximize profits This is not always compatible with inexpensive coverage, to put it mildly.(/edit)

What complexity does, is drive up costs, by removing the negative feedback of free markets that forces companies to offer products cheaply.

Not all free markets are created equal.

[RandomGuy]

That all may well be true (I have some issues with it, namely, a large amount of employers shop and purchase policies using insurance specialists, but whatevs)

"insurance specialists" = agents, paid commissions by... insurance companies?

Conflict of interest. Insurance agents have a profit motive to steer people to whatever makes them the most commission, that assumes that they are appointed by more than one type of health insurer. (agents are limited to selling only for companies that have appointed them, if any given company has not appointed any given agent, you will not be able to shop from that insurer if you go to that agent)

One can get professional actuaries and other sorts though, if you have the resources to do so, which large companies do. Small insurers aren't going to pay hundreds of dollars an hour for such advice, and individuals certainly won't.

[TeyshaBlue]

(downloads state populations to excel, uses your link for the paid claims, sorts, filters, does a quick claims/population formula)

Sorted by ratio, smallest to largest. Texas is #11 on a per capita basis.

Minnesota 0.000916768%
Alabama 0.000978608%
Wisconsin 0.000980432%
Hawaii 0.001382009%
Alaska 0.001383666%
North Carolina 0.001470527%
Wyoming 0.001584066%
North Dakota 0.001608347%
Iowa 0.001698065%
Idaho 0.001703486%
Texas 0.001733225%
Ohio 0.001827639%
Virginia 0.001914383%
Colorado 0.001954358%
Arkansas 0.001974146%
Washington 0.001976563%
Oregon 0.002066191%
Georgia 0.002078407%
Delaware 0.002094506%
Vermont 0.002234883%
South Dakota 0.002305596%
Nevada 0.002350071%
California 0.002358596%
Maine 0.002409297%
South Carolina 0.002436298%
Nebraska 0.002442147%
Illinois 0.002447694%
Mississippi 0.002484462%
Kentucky 0.002517533%
Tennessee 0.002561158%
Indiana 0.002562559%
Missouri 0.002645288%
Arizona 0.002792131%
Massachusetts 0.003218199%
Michigan 0.003310994%
Oklahoma 0.003323216%
Connecticut 0.003658493%
Utah 0.003691580%
New Hampshire 0.003793068%
Florida 0.003977428%
New Mexico 0.004034148%
Maryland 0.004272266%
Rhode Island 0.004280407%
Kansas 0.004423179%
Montana 0.004608300%
New Jersey 0.004863309%
Pennsylvania 0.006019045%
Louisiana 0.006710623%
New York 0.007084439%
West Virginia 0.008461951%


Nice.:toast

...and vanishingly small. Lends credence to the "Tort Reform aint all that" school.

[FuzzyLumpkins]

If the Repugs are for it, then the companies would gain, and clients would be screwed. Apart from that certitude, it's just non-stop Repug anti-govt bullshit.

Typical ideologue stupidity. It's not like we are talking about Euclidean identities here.

[FuzzyLumpkins]

Texas has a ueber conservative governor, and an ueber conservative Republican super majority in its legislature. If it were a priority, it would have happened.

That private insurers are somehow more efficient at providing health insurance than governments is a myth, in my opinion.

I have yet to see anyone show that (cost+profits) < (cost+government inefficiency)

Insurance is risk pooling.

Hordes of smaller insurers = exceedingly inefficient + poor risk pooling

More risks pooled = more predictability

The only thing that a private insurer has over governmental insurer is returns from invested reserves to offset some amount of premiums, which government programs doesn't do. These days though, the returns on the kinds of investments insurance companies are allowed to make is low, and will continue to be low for the forseeable future.

Texas also has one of the strictest insurance commissions in the country. It's an interesting juxtaposition. I have said before that one thing that I hope to see is similar oversight of underwriting as you see for P&C gets implemented for health insurers.

[boutons_deux]

when was the last the the Repugs did anything for Human-Americans and the environment?

Repugs' priority is enriching, protecting the 1% and corps, and fucking everything and everybody else. Try to prove otherwise, for our entertainment.

[vy65]

when was the last the the Repugs did anything for Human-Americans and the environment?

Repugs' priority is enriching, protecting the 1% and corps, and fucking everything and everybody else. Try to prove otherwise, for our entertainment.

If spurstalk could contract STDs, you'd be AIDS

[rascal]

LOL. Uh yeah, us "losers" who would pay for it for your free riding ass.

It works in Europe

[RandomGuy]

Texas also has one of the strictest insurance commissions in the country. It's an interesting juxtaposition. I have said before that one thing that I hope to see is similar oversight of underwriting as you see for P&C gets implemented for health insurers.

How does Texas have one of the strictest insurance commissions? (not sure what that means)

[boutons_deux]

"Originally Posted by Marcus Bryant (http://www.spurstalk.com/forums/showthread.php?p=3648701#post3648701)
LOL. Uh yeah, us "losers" who would pay for it for your free riding ass."

taxpayers pay for the uninsured health care already.

and "free riding assholes" are those employees who get tax-free benefit (aka income) from employers (tax deductible) health insurance.

If employees had to pay their full after-tax health insurance (as do self-employed people), we would have had, by popular pressure, a hardcore public insurance option decades ago.

[FuzzyLumpkins]

How does Texas have one of the strictest insurance commissions? (not sure what that means)

In terms of requirements to get the underwriting to justify policy rates. I am not sure if it's annual or if it's biannual but all P&C rate tables of any company wanting to do business in Texas have to be approved on the basis of the actuarial data.

The medical insurance industry doesn't have to show anything as a matter of course like P&C does.

For example BlueShield doesn't have to get their actuarial work justified to insure Jon Doe age 26 nonsmoker with a 10% copay blah blah blah in the state of Texas.

OTOH if All State wants to sell Mr. Doe a minimum policy 50/100/25 they have to go to the TIC and get approval for charging a 26 yo male living in location A, with record B and driving a C class car.

The TIC has been telling insurers for years now to take their HO rates and try again. It's why you heard a bunch of shit about how they could no longer insure homes in Texas and tried to nonrenew a bunch of policies. TIC would not allow them to use short term risk assessment.

It's also why the insurance industry is freaking out becaues the long term risk outlooks are changing due to climate change.

[FuzzyLumpkins]

"Originally Posted by Marcus Bryant (http://www.spurstalk.com/forums/showthread.php?p=3648701#post3648701)
LOL. Uh yeah, us "losers" who would pay for it for your free riding ass."

taxpayers pay for the uninsured health care already.

and "free riding assholes" are those employees who get tax-free benefit (aka income) from employers (tax deductible) health insurance.

If employees had to pay their full after-tax health insurance (as do self-employed people), we would have had, by popular pressure, a hardcore public insurance option decades ago.





I can agree with this. I really do not understand the resistance to it like we see.

Tying health insurance to payroll is bad juju yet the party that claims to be 'business friendly' doesn't see it that way.

[RandomGuy]

In terms of requirements to get the underwriting to justify policy rates. I am not sure if it's annual or if it's biannual but all P&C rate tables of any company wanting to do business in Texas have to be approved on the basis of the actuarial data.

The medical insurance industry doesn't have to show anything as a matter of course like P&C does.

For example BlueShield doesn't have to get their actuarial work justified to insure Jon Doe age 26 nonsmoker with a 10% copay blah blah blah in the state of Texas.

OTOH if All State wants to sell Mr. Doe a minimum policy 50/100/25 they have to go to the TIC and get approval for charging a 26 yo male living in location A, with record B and driving a C class car.

The TIC has been telling insurers for years now to take their HO rates and try again. It's why you heard a bunch of shit about how they could no longer insure homes in Texas and tried to nonrenew a bunch of policies. TIC would not allow them to use short term risk assessment.

It's also why the insurance industry is freaking out becaues the long term risk outlooks are changing due to climate change.

(nods) Understood. (FWIW: Texas does not have a "Commission", it has a "Department", although the Department does have a Commissioner)

All HMO's have their actuarial assumptions examined periodically. Their rates are looked at, just not approved or micromanaged for every minor variance. It would not be really feasible to do so for health insurance, simply because it is far more complex than simple liability for cars.

This is kind of interesting to me, so if you have any links to the background info, let me know. I like to keep up.

It is worth noting that part of Obamacare limits profits at HMO's to a certain percentage of profits relative to the benefits offered/paid. That is something that is regularly monitored.

[RandomGuy]

"Originally Posted by Marcus Bryant (http://www.spurstalk.com/forums/showthread.php?p=3648701#post3648701)
LOL. Uh yeah, us "losers" who would pay for it for your free riding ass."

taxpayers pay for the uninsured health care already.

and "free riding assholes" are those employees who get tax-free benefit (aka income) from employers (tax deductible) health insurance.

If employees had to pay their full after-tax health insurance (as do self-employed people), we would have had, by popular pressure, a hardcore public insurance option decades ago.


Don't forget the other subsidy we all pay:

Higher interest rates on loans.

A lot of debt gets either canceled or restructured in bankruptcy. One of the leading causes of personal bankruptcies, if not *the* leading cause, are medical bills.

The medical bills that don't get paid, get passed on to those who do pay, AND the other debts, like car notes, personal credit, etc. that also get restructured get passed on to those who do make their debt payments.

This represents a subsidy buried in EVERYTHING. All the services you buy, all the goods, no matter what country they are made in.

These costs are hidden from us, but they exist in a very real sense. Single payor systems would bring all these hidden costs out into the open, total them up, and let us deal with a concrete knowable problem, instead of letting them fester in the dark, like we do now.

[RandomGuy]

The TIC has been telling insurers for years now to take their HO rates and try again. It's why you heard a bunch of shit about how they could no longer insure homes in Texas and tried to nonrenew a bunch of policies. TIC would not allow them to use short term risk assessment.

The problem, to my understanding, was that they realized their risk modeling was woefully inadequate, and a lot of them had geographic concentrations that they didn't know about. They erred far on the side of setting their rates a bit high.

Some of the better ones, like USAA, have started getting VERY granular in their modeling processes, meaning they can set rates according to very local conditions, so this should help.

One has to remember, that the brewhaha with Texas Windstorm IA (TWIA vis a vis the Isaac claims), and the ability of insurers to get reinsurance plays no small part in whether or not these types of policies get offered.

[FuzzyLumpkins]

The state only has to review the rates if they are hiked by more than 10%. i understand there are more risk factors but even then that ain't shit.

[rascal]

LOL. Uh yeah, us "losers" who would pay for it for your free riding ass.

I don't have health insurance and I am in my 50's. I have the option not to carry insurance now and that is what I choose. If I have a huge medical cost I am not paying . The bill will indirectly go on you with higher insurance costs for you.

[RandomGuy]

The state only has to review the rates if they are hiked by more than 10%. i understand there are more risk factors but even then that ain't shit.

Well, there is a balance between rate setting and allowing companies the flexibility to operate in changing conditions.

It is not in anyone's interest to put a straightjacket on rates, then force companies to either exit the market, or accept losses if your rates don't keep up with what the market is doing.

States that micromanage insurance rates tend to have ill-served markets, in my experience.

I am pretty sure TDI keeps an eye on health insurers to keep them from acting in a predatory manner.

[FuzzyLumpkins]

Well, there is a balance between rate setting and allowing companies the flexibility to operate in changing conditions.

It is not in anyone's interest to put a straightjacket on rates, then force companies to either exit the market, or accept losses if your rates don't keep up with what the market is doing.

States that micromanage insurance rates tend to have ill-served markets, in my experience.

I am pretty sure TDI keeps an eye on health insurers to keep them from acting in a predatory manner.

But they don't. The only time they even look is if the hike is over 10%. As you can probably guess that has happened quite a lot. I am sure you are familiar with how much the rates have skyrocketed in the last decade especially in the last 3 years due to the excuse that is the ACA. There is no empirical data there.

Here's the rub: for the last three years, of the cases they have reviewed in the last three years have had no action taken. State law does not give them the teeth to do so anyway and a state governemtn that allows itself to get led by the nose by Perry has done nothing at all. this is a very serious issue.

http://www.npr.org/blogs/health/2012/07/20/157117573/texas-slow-to-review-health-insurance-rate-hikes

And I am sorry but spare me 'flexibility' argument. All I see is an upward trend and a market trend that just screams collusion. Insurers dictate the demand and hospitals the supply and there is no oversight whatsoever. All the while rates quadruple.

[RandomGuy]

But they don't. The only time they even look is if the hike is over 10%. As you can probably guess that has happened quite a lot. I am sure you are familiar with how much the rates have skyrocketed in the last decade especially in the last 3 years due to the excuse that is the ACA. There is no empirical data there.

Here's the rub: for the last three years, of the cases they have reviewed in the last three years have had no action taken. State law does not give them the teeth to do so anyway and a state governemtn that allows itself to get led by the nose by Perry has done nothing at all. this is a very serious issue.

http://www.npr.org/blogs/health/2012/07/20/157117573/texas-slow-to-review-health-insurance-rate-hikes

And I am sorry but spare me 'flexibility' argument. All I see is an upward trend and a market trend that just screams collusion. Insurers dictate the demand and hospitals the supply and there is no oversight whatsoever. All the while rates quadruple.

Correlation is not cause.

I will do a bit of digging.

[boutons_deux]

9% or 1o% revenue increase, every year, compounded, no objection? I, and every PE predator, will take it.

hmm, looks like I'm a little late

HCA: The Unsustainble Private Equity Bubble in US Health Care

http://www.forbes.com/sites/stevedenning/2012/08/15/private-equity-wont-fix-health-care-either/ (http://www.forbes.com/sites/stevedenning/2012/08/15/private-equity-wont-fix-health-care-either/)


Health Care REIT to Buy Sunrise Senior Living

http://dealbook.nytimes.com/2012/08/22/health-care-reit-to-buy-sunrise-senior-living/ (http://dealbook.nytimes.com/2012/08/22/health-care-reit-to-buy-sunrise-senior-living/)


I think Carlisle, etc are already owners of senior homes.