Health Insurers Skirt New Coverage Requirement For Kids

[RandomGuy]

The requirement to cover kids with pre-existing conditions was one of the dumber parts of health care reform, IMO. It was one of those "sounds good on paper" things, that gets completely fucked when it comes to implementation. The things that the story talks about are happening, and I have some first-hand knowledge of that. I think a better way to have done this was simply to have set up an insurance pool of some sort, with (gasp) some government funding to subsidize any company that wanted to take the kids on.--RG


http://www.npr.org/blogs/health/2010/09/21/130013723/colorado-insurers-skirt-new-coverage-requirement-for-kidsby Julie Rovner

Starting late this week, parents of children with pre-existing health conditions were expecting to breathe easier.

That's when a provision of the federal law overhauling health care takes effect and bans insurance companies from denying individual policies for kids with a history of health problems. But families counting on the change could be in for a shock.

The Denver Post reports, "at least six major companies — including Anthem, Aetna, Cigna, and Humana — have said they will stop writing new policies for individual children" in Colorado. The companies "blamed health reform mandates taking effect Thursday requiring companies that write such policies as of that date to also cover sick children up to age 19," the paper said.


The Washington Post reports that three big insurers — WellPoint, Cigna and CoventryOne — made their decisions because of "uncertainty in the health insurance market."

By dropping all new children-only coverage before the effective day of the new mandate, the companies effectively sidestep the new requirements.

The advocacy group Health Care for America Now was the first to bring the action to widespread attention. "Even for the insurance industry this behavior is surprisingly brazen," HCAN Executive Director Ethan Rome wrote in a blog entry for the Huffington Post. "They don't like the rules, so they're going to take their ball and go home."

But the insurance industry trade group America's Health Insurance Plans rejected HCAN's contention that the companies' refusal to sell to all comers is somehow a violation of a promise made earlier this year by AHIP CEO Karen Ignagni that insurance companies would comply with regulations regarding children and pre-existing conditions.

In an interview, AHIP spokesman Robert Zirkelbach said Ignagni was responding only to promises that children wouldn't be excluded from their parents' plans and that if the kids are covered, the policies would include treatment of their pre-existing condition.

What emerged in the regulations, however, Zirkelbach said, was, in effect, a requirement that insurance companies accept children even if they are already sick. That, he said, would be tantamount to exactly what companies want to avoid with the adult population — letting people wait until they are sick to sign up for insurance. Which is exactly why the insurance industry is so insistent on a coverage mandate: It needs premiums of healthy people to help cover the costs of those who are not.

Thus, he said, the companies in question "are having to make some difficult decisions" to stop offering coverage to all new children rather than take the chance that only the sick would enroll. At least until 2014, when everyone is supposed to be covered under the law.

[TeyshaBlue]

Is anybody really surprised? When the concept of insurance is transmorgrified into a healthcare shopping card, this is what happens.
I saw this one coming a mile away.:depressed

[boutons_deux]

Health insurance MUST be handled exclusively by orgs whose priority is delivering health care, NOT in maximizing profits while minimizing services and payouts.

US health care is fucked up and exorbitantly expensive because of the profit motive, and those $Bs in profits buy Congress to protect and increase those profits.

Let's see if the Repugs even address health care in their campaign announcement Thursday.

[Winehole23]

More lip service on repealing it, maybe.

[101A]

And if insurance companies didn't do this?

A child with Leukemia/diabetes/other cancer is IMMEDIATELY enrolled on their plan (probably by the hospital/doctor that is treating them) - the insurance company is limited in the premium they can receive and is no longer allowed to limit maximum benefit; so the insurance company can collect a couple hundred bucks a month in premium (again probably paid by the provider, not the family), and immediately be saddled with a claim with absolutely no ceiling. 5, 6, 10 million dollars? How much do you think the hospitals/labs/docs/etc... are going to bill now that those bills can be limitless?

It would be irresponsible to all of the carriers other insureds to leave themselves open to that.

Who gets hurt by this?

Healthy children.

Unintended consequences suck.

Group coverage (where the VAST majority of people get their coverage from) are moving forward with amended plans eliminating pre-x exclusions for children, or just continuing as they have - several carriers did away with any pre-x exclusion years ago, anyway.

[SnakeBoy]

Eh, this is no big deal. People are going to love Obamacare once they get used to it.

[fraga]

You stay classy Health Insurance Companies...

[MannyIsGod]

And if insurance companies didn't do this?

A child with Leukemia/diabetes/other cancer is IMMEDIATELY enrolled on their plan (probably by the hospital/doctor that is treating them) - the insurance company is limited in the premium they can receive and is no longer allowed to limit maximum benefit; so the insurance company can collect a couple hundred bucks a month in premium (again probably paid by the provider, not the family), and immediately be saddled with a claim with absolutely no ceiling. 5, 6, 10 million dollars? How much do you think the hospitals/labs/docs/etc... are going to bill now that those bills can be limitless?

It would be irresponsible to all of the carriers other insureds to leave themselves open to that.

Who gets hurt by this?

Healthy children.

Unintended consequences suck.

Group coverage (where the VAST majority of people get their coverage from) are moving forward with amended plans eliminating pre-x exclusions for children, or just continuing as they have - several carriers did away with any pre-x exclusion years ago, anyway.

It really doesnt matter what providers bill for considering that the insurance company is only going to pay a percentage of that. Simply not having a lifetime maximum isn't going to somehow magically drive up the prices in the medical field.

[ElNono]

And if insurance companies didn't do this?

A child with Leukemia/diabetes/other cancer is IMMEDIATELY enrolled on their plan (probably by the hospital/doctor that is treating them) - the insurance company is limited in the premium they can receive and is no longer allowed to limit maximum benefit; so the insurance company can collect a couple hundred bucks a month in premium (again probably paid by the provider, not the family), and immediately be saddled with a claim with absolutely no ceiling. 5, 6, 10 million dollars? How much do you think the hospitals/labs/docs/etc... are going to bill now that those bills can be limitless?

It would be irresponsible to all of the carriers other insureds to leave themselves open to that.

Who gets hurt by this?

Healthy children.

Unintended consequences suck.

Group coverage (where the VAST majority of people get their coverage from) are moving forward with amended plans eliminating pre-x exclusions for children, or just continuing as they have - several carriers did away with any pre-x exclusion years ago, anyway.

I don't understand what's the difference, risk wise, from a kid with preexisting conditions who just got enrolled on a group coverage plan vs an individual plan.

[Drachen]

the fear (probably justified) is that all of the sick kids w/o insurance will enroll, and none of the healthy kids w/o insurance will enroll, this will cause them to raise premiums on all insured, or lower benefits. If a sick child enrolls in a group program, presumably others in that group are not sick, and this could offset the cost of that child. Additionally, that group would be considered (premiumwise) as a separate entity from their general insured's pool. They could, therefore, raise rates on JUST that group, without affecting all other group and individual policies.

[Latarian Milton]

under the new healthcare system obama advocated kids may be covered under parents healthcare till their 26 birthdays which imho demonstrates how delusional and quixotic the kenyan president is. if a 22yr old is married and has a couple kids, where would his/her kids get the healthcare coverage? from their grandparents?

[Latarian Milton]

the fear (probably justified) is that all of the sick kids w/o insurance will enroll, and none of the healthy kids w/o insurance will enroll, this will cause them to raise premiums on all insured, or lower benefits. If a sick child enrolls in a group program, presumably others in that group are not sick, and this could offset the cost of that child. Additionally, that group would be considered (premiumwise) as a separate entity from their general insured's pool. They could, therefore, raise rates on JUST that group, without affecting all other group and individual policies.

if a kid is sick, 90% of chance is he's suffering some severe obesity & consequent syndromes like diabetes which are all the results of bad lifestyle & laziness. all these lazy asses deserve no cure but a coffin & funeral, and there's no cure for inferior genes you know.

[Wild Cobra]

Ive said it before, and I'll say it again.

Liberal policies do not account for full circle thinking.

Liberals are destroying this nation because they go by "feelings" rather than "thinking."

[ElNono]

the fear (probably justified) is that all of the sick kids w/o insurance will enroll, and none of the healthy kids w/o insurance will enroll, this will cause them to raise premiums on all insured, or lower benefits.

Why only kids enter the equation though? I would think the insurance pool includes both kids and adults? And sure, after doing risk-assessment, they'll probably conclude that the risk is X and that the premium needs to be Y.
Even if the price of said policy would be astronomical, why would they just flat out not offer it?


If a sick child enrolls in a group program, presumably others in that group are not sick, and this could offset the cost of that child. Additionally, that group would be considered (premiumwise) as a separate entity from their general insured's pool. They could, therefore, raise rates on JUST that group, without affecting all other group and individual policies.

But if they can adjust the premium in a group after assessing the risk, why wouldn't be able to do the same on individual policies, instead of flat out not selling policies (however astronomical the premiums would be on those)?

[ElNono]

if a kid is sick, 90% of chance is he's suffering some severe obesity & consequent syndromes like diabetes which are all the results of bad lifestyle & laziness. all these lazy asses deserve no cure but a coffin & funeral, and there's no cure for inferior genes you know.

A kid could suffer from many different things that have nothing to do with laziness and bad lifestyle. Things like Poliomyelitis, Autoimmune diseases, Congenital disorders, Autism, etc etc etc...

[Wild Cobra]

A kid could suffer from many different things that have nothing to do with laziness and bad lifestyle. Things like Poliomyelitis, Autoimmune diseases, Congenital disorders, Autism, etc etc etc...
Any why is that an insurance companies responsibility, when it's common underwriting practice to use all factors to determine a price?

Liberals are simply dumb when it comes to real work economics.

[ElNono]

Any why is that an insurance companies responsibility, when it's common underwriting practice to use all factors to determine a price?

What are you babbling about? The problem was insurance companies refusing to insure kids with pre-existing conditions. There was no risk assessment or price calculation since no policy was offered, period.


Liberals are simply dumb when it comes to real work economics.

Because conservatives like Reagan really knew how to rein in spending and reduce the country's debt... :jack

[Drachen]

Why only kids enter the equation though? I would think the insurance pool includes both kids and adults? And sure, after doing risk-assessment, they'll probably conclude that the risk is X and that the premium needs to be Y.
Even if the price of said policy would be astronomical, why would they just flat out not offer it?


the insurance pool does include both kids and adults. However the reason why this discussion is focusing on kids is because insurance companies as of a certain date (I think the end of this week) cannot decline a child for pre-existing conditions.

As far as your "risk x, premium y" question, they cannot price a policy individually. You are always a part of some group. If a bunch of sick kids enter the pool, the EVERYONE in the pool suffers a higher premium.




But if they can adjust the premium in a group after assessing the risk, why wouldn't be able to do the same on individual policies, instead of flat out not selling policies (however astronomical the premiums would be on those)?

I explained this above, but want to add that if I remember correctly it is actually illegal to price a policy individually.

[SnakeBoy]

A kid could suffer from many different things that have nothing to do with laziness and bad lifestyle. Things like Poliomyelitis, Autoimmune diseases, Congenital disorders, Autism, etc etc etc...

I think he covered all those with the inferior genes comment.

[101A]

I don't understand what's the difference, risk wise, from a kid with preexisting conditions who just got enrolled on a group coverage plan vs an individual plan.


Insurers didn't say they wouldn't take ANY children; they simply said they wouldn't write policies for ONLY a child in a family; they want at least one parent w/that child; or, presumably, all the children. In group plans; by definition; a child must be included with at least one parent, as well as his/her brothers and sisters.

What the insurance companies are, ostensibly, guarding against is severe selection against them. Say a family or Medicaid has a single (really) sick child; it is VERY likely a provider would pay for that child's coverage on a private plan, because that provider would stand to make much more than he could under Medicaid - hypothetical, but I can imagine that is the kind of abuse the companies are worried about; the family has to have more skin in the game, essentially.

Also, under group policies; the premium difference is exponential vs. what a single child on a single policy would produce (children are, by far, the least expensive people to insure - although inexpensive treatments are common (vaccinations, ear infections, etc...) REALLY expensive stuff is very rare - they haven't had time to screw up their bodies like adults have.

I might or might not have answered your actual question. Let me know.

[TeyshaBlue]

Classically, insurance has been nothing more than a hedge against a future problem(s). Insurance companies still operate and underwrite somewhat as if this were the actual practice today. Unfortunately, the role of insurance has become distorted as a result of being forced into a facilitator/mediator role. Alot of the slop in contemporary healthcare is the result of trying to pound this square peg into a round hole. The Fed's approach? Pound harder, of course.
IMO, there are two roles for contemporary healthcare provision.
1. Routine and common health maintenence, much like the HMO model.
2. Catastrophic and serious health coverage, which used to be the purview of insurance companies.

We keep trying to force these two roles on an industry that was built to work successfully with only one. I think this dysfunction is what drives alot of the pricing opacity that is part of the foundation of our healthcare crisis. It's a pricing crisis, essentially. The quality of healthcare is not the main issue...it's simply the cost. Until we stop trying to force insurance companies into becoming healthcare facilitators, we will never address the underlying cost issue...indeed, as is likely to be the case with mandatory coverage of pre-existing illnesses, costs are likely to rise for all of us. Simply putting money in the hands of those who can't afford health insurance is not addressing the root causes. Instead, it's a weak bandage on a symptom...one that will be inadequate and will cause more damage in the long run.

[101A]

Now I am, literally, going to join our (weekly) meeting with my senior staff, TWO new employees, and a secretary to record it all to determine where we stand on keeping ourselves AND our clients in compliance with the Healthcare Reform act.

The topic of this weeks meeting? Establishing a worksheet for each client with the fourteen criteria necessary to determine whether or not their plans qualify as "grandfathered" - AND setting up the model notices that need to be sent to each employee telling them that (the notice will be at least two pages, and must be included with ALL correspondence). Also on deck is reports of our claims processing, as well as claim's appeals practices which MUST be filed with the Director of HHS for each plan we administer. That's THIS week.

Sure, this is gonna save a TON of money.

[TeyshaBlue]

Now I am, literally, going to join our (weekly) meeting with my senior staff, TWO new employees, and a secretary to record it all to determine where we stand on keeping ourselves AND our clients in compliance with the Healthcare Reform act.

The topic of this weeks meeting? Establishing a worksheet for each client with the fourteen criteria necessary to determine whether or not their plans qualify as "grandfathered" - AND setting up the model notices that need to be sent to each employee telling them that (the notice will be at least two pages, and must be included with ALL correspondence). Also on deck is reports of our claims processing, as well as claim's appeals practices which MUST be filed with the Director of HHS for each plan we administer. That's THIS week.

Sure, this is gonna save a TON of money.

Start. Drinking. Nao.

[101A]

Classically, insurance has been nothing more than a hedge against a future problem(s). Insurance companies still operate and underwrite somewhat as if this were the actual practice today. Unfortunately, the role of insurance has become distorted as a result of being forced into a facilitator/mediator role. Alot of the slop in contemporary healthcare is the result of trying to pound this square peg into a round hole. The Fed's approach? Pound harder, of course.
IMO, there are two roles for contemporary healthcare provision.
1. Routine and common health maintenence, much like the HMO model.
2. Catastrophic and serious health coverage, which used to be the purview of insurance companies.

We keep trying to force these two roles on an industry that was built to work successfully with only one. I think this dysfunction is what drives alot of the pricing opacity that is part of the foundation of our healthcare crisis. It's a pricing crisis, essentially. The quality of healthcare is not the main issue...it's simply the cost. Until we stop trying to force insurance companies into becoming healthcare facilitators, we will never address the underlying cost issue...indeed, as is likely to be the case with mandatory coverage of pre-existing illnesses, costs are likely to rise for all of us. Simply putting money in the hands of those who can't afford health insurance is not addressing the root causes. Instead, it's a weak bandage on a symptom...one that will be inadequate and will cause more damage in the long run.

VP (Marketing) is running late; while waiting I read this post - great one.

[MannyIsGod]

Addressing the cost issue inevitably comes back to some form of price control such as you see with Medicare. Good luck having anyone in this country listen to that once you go there.

I don't disagree with what you're saying Teysha, but you can't act like the insurance companies don't have a hand in this situation either. They fought tooth and nail against any form of the public option and even the high risk pools because of how it would affect their business model so I have very little sympathy for them.

[TeyshaBlue]

Addressing the cost issue inevitably comes back to some form of price control such as you see with Medicare. Good luck having anyone in this country listen to that once you go there.

I don't disagree with what you're saying Teysha, but you can't act like the insurance companies don't have a hand in this situation either. They fought tooth and nail against any form of the public option and even the high risk pools because of how it would affect their business model so I have very little sympathy for them.

Oh, I agree, Manny. They are reacting against the public option because they cannot function in a mediator/facilitator role with any level of success when faced with a public option. But again, their fears are just another symptom of the underlying problem...the opacity of cost and the inablity to assess cost/benefit among providers. Insurance companies are chained to GPOs that administers contract pricing to Hospital and clinics. GPOs are chained to the collusion/rebate sytem of Drug Companies who are chained to their P&L.

I've always thought a decent solution would be a tiered approach.

Public Option for routine healthcare and clinic visits/tests/prescriptions.

Insurance for the larger, more serious issues as was their original mission.

I think the insurance companies, freed of the considerable expense of the routine clinic visit, could then offer a catastrophic or surgical care policy at a reduced premium...even with a no exclusion clause.

If the PO was administered effectively, you would see the pricing of services and pharmaceuticals begin to:

a. Standardize
b. Shrink
c. Compete for business

In spite of the conventional wisdom that says the Gov can't do anything efficiently, I say bullshit. I've seen the DOD ruthlessly negotiate and then aggressively police their pharmaceutical pricing contracts. I administered those contracts for years.
Besides that, pricing should not be the ultimate metric of success. I think that the often proposed cost savings of a Public Option creating a healthier citizenry fail to look at the back end of those "savings". When you screen every woman for breast cancer with a mammogram, you undoubtably will save lives and save the huge expense of battling cancer. But on the other hand, mammograms aint free and the folks that have to administer them don't work for free either. The net cost is probably higher, but the effectiveness is exponentially improved. I've said before, if we could reform healthcare via this system or any other, and reduce costs even a little, would be awesome. But even if the costs were the same, but the effectiveness increased, that's a serious win too.

[MannyIsGod]

I agree with pretty much everything you've said. I've not done much reading into a tiered approach like that, but when I sold health insurance many years ago I focused on selling hospitalization insurance for major problems. I completely avoided major medical and anything that covered dr visits mainly due to the type of people I was selling too but also because I felt this was a better form of insuring people and more cost effective for my clients so what you say strikes a chord.

Also, people who say the government can't do anything more efficiently simply need to look at Medicare costs compared to health care costs for everyone else.

[ElNono]

the insurance pool does include both kids and adults. However the reason why this discussion is focusing on kids is because insurance companies as of a certain date (I think the end of this week) cannot decline a child for pre-existing conditions.

As far as your "risk x, premium y" question, they cannot price a policy individually. You are always a part of some group. If a bunch of sick kids enter the pool, the EVERYONE in the pool suffers a higher premium.

I explained this above, but want to add that if I remember correctly it is actually illegal to price a policy individually.

I don't believe this is the case at all with individual policies.
I even remember this article from early this year that indicated otherwise: link (http://articles.latimes.com/2010/feb/04/business/la-fi-insure-anthem5-2010feb05)

[ElNono]

Insurers didn't say they wouldn't take ANY children; they simply said they wouldn't write policies for ONLY a child in a family; they want at least one parent w/that child; or, presumably, all the children. In group plans; by definition; a child must be included with at least one parent, as well as his/her brothers and sisters.

What the insurance companies are, ostensibly, guarding against is severe selection against them. Say a family or Medicaid has a single (really) sick child; it is VERY likely a provider would pay for that child's coverage on a private plan, because that provider would stand to make much more than he could under Medicaid - hypothetical, but I can imagine that is the kind of abuse the companies are worried about; the family has to have more skin in the game, essentially.

Also, under group policies; the premium difference is exponential vs. what a single child on a single policy would produce (children are, by far, the least expensive people to insure - although inexpensive treatments are common (vaccinations, ear infections, etc...) REALLY expensive stuff is very rare - they haven't had time to screw up their bodies like adults have.

I might or might not have answered your actual question. Let me know.

You did. At least, you gave me a plausible reason why they would not want to issue individual policies. Even at an astronomical rate, it wouldn't preclude providers from enrolling patients there. Thanks.

[ElNono]

Classically, insurance has been nothing more than a hedge against a future problem(s). Insurance companies still operate and underwrite somewhat as if this were the actual practice today. Unfortunately, the role of insurance has become distorted as a result of being forced into a facilitator/mediator role. Alot of the slop in contemporary healthcare is the result of trying to pound this square peg into a round hole. The Fed's approach? Pound harder, of course.
IMO, there are two roles for contemporary healthcare provision.
1. Routine and common health maintenence, much like the HMO model.
2. Catastrophic and serious health coverage, which used to be the purview of insurance companies.

We keep trying to force these two roles on an industry that was built to work successfully with only one. I think this dysfunction is what drives alot of the pricing opacity that is part of the foundation of our healthcare crisis. It's a pricing crisis, essentially. The quality of healthcare is not the main issue...it's simply the cost. Until we stop trying to force insurance companies into becoming healthcare facilitators, we will never address the underlying cost issue...indeed, as is likely to be the case with mandatory coverage of pre-existing illnesses, costs are likely to rise for all of us. Simply putting money in the hands of those who can't afford health insurance is not addressing the root causes. Instead, it's a weak bandage on a symptom...one that will be inadequate and will cause more damage in the long run.

Completely agree and that's exactly what's backwards with the legislation that passed.

[ElNono]

I think he covered all those with the inferior genes comment.

Polio is a viral disease, not genetic. Certain autoimmune diseases are also not genetic.

[Wild Cobra]

Also, people who say the government can't do anything more efficiently simply need to look at Medicare costs compared to health care costs for everyone else.
So you want all insurance companies to be a bad as medicare is?

[TeyshaBlue]

Nice, unsupported declaration, WC. Thanks for adding to the discussion.

[Cane]

WC's an idiot.

[boutons_deux]

As if they were houses, let's burn down all the sick people so we don't have to pay for their treatments.

--- Mike Huckaby, a "Christian" man.

[DarrinS]

Also, people who say the government can't do anything more efficiently simply need to look at Medicare costs compared to health care costs for everyone else.



Gee Einstein, why would Medicare costs are lower? Perhaps because they make the doctors eat the difference?

[MannyIsGod]

Gee Einstein, why would Medicare costs are lower? Perhaps because they make the doctors eat the difference?

Darrinbot, your thread scanning script needs work.


http://spurstalk.com/forums/showpost.php?p=4638220&postcount=25

Also, the difference between insurance company price control and Medicare? Nothing. Doctors are neither required to take insurance nor are they required to take Medicare.

Krugman youtube on the way!

[ElNono]

Gee Einstein, why would Medicare costs are lower? Perhaps because they make the doctors eat the difference?

How is that different from private insurance?

Why would doctors accept Medicare at all if it's such a drag to their practice?

[Yonivore]

Thousands of pages and billions of dollars and they fucked it up? Who would have thunk it?

But, goddammit, you're going to have to submit 1099's for every $600 purchase made from your small business.

It's for the children.

[Yonivore]

How is that different from private insurance?

Why would doctors accept Medicare at all if it's such a drag to their practice?
Many of them no longer do, ElNono.

[ElNono]

Many of them no longer do, ElNono.

How many? Plenty of them do, AFAIK. You would think none of them would if it's that bad...

[Yonivore]

How many? Plenty of them do, AFAIK. You would think none of them would if it's that bad...
As it gets worse the doctors continue peel away from Medicaid and Medicare.

Here's a story.

Baby Boomer Bust: Doctors Refusing Medicare Patients (http://www.theroot.com/buzz/babyboomer-bust-doctors-refusing-medicare-patients)

[MannyIsGod]

Many of them no longer do, ElNono.

Id like some data on the shrinking pool of doctors. This is something that would be easily quantifiable so please feel free to do so.

[MannyIsGod]

According to your figures, Yonivore 87% of doctors responded that they currently accept medicare.

Would you like to provide me with any other form of insurance that is accepted by 87% of doctors?

[Yonivore]

According to your figures, Yonivore 87% of doctors responded that they currently accept medicare.

Would you like to provide me with any other form of insurance that is accepted by 87% of doctors?
Not my data and your argument is straw man...

13% is up from 8% a year before and 6% three years before that. cuts Who's insuring those 13%?

What will it be next year when the Medicare cuts take effect and the government pays even less and even slower?

[Yonivore]

Id like some data on the shrinking pool of doctors. This is something that would be easily quantifiable so please feel free to do so.
Fuck you, I don't do your research. Go find what you'd like somewhere else.

[MannyIsGod]

Oh I can provide data but the difference is none of my data backs up your stance. Should you choose not to back up your claims that is your prerogative but I don't blindly accept statements as fact.

My argument is that Medicare is more efficient than private insures are price control and in general as an insurance service. The article you posted yourself certainly backs this up because there is no private insurance out there that is accepted by anywhere near 87% of all doctors.

Who insures those people? Medicare. If they attend a physician who no longer takes it then they can go to one of the 87% of doctors who do. Are you saying this is not an issue with private insurers? I sure hope not because insurance networks change on a regular basis and they lose and gain physician all the time.

[MannyIsGod]

Here's an article that shows that doctors are refusing Medicare.

http://www.nytimes.com/1992/04/12/us/physicians-refuse-medicare-patients.html?pagewanted=2

Of course its from 18 years ago. Nearly two decades later 87% of doctors are still accepting Medicare yet how many insurance companies have become insolvent over the past 18 years?

[Yonivore]

Oh I can provide data but the difference is none of my data backs up your stance. Should you choose not to back up your claims that is your prerogative but I don't blindly accept statements as fact.
I don't care what you accept.


My argument is that Medicare is more efficient than private insures are price control and in general as an insurance service.
I'm sorry, that sentence makes no sense. But, to what I think is your point, the Government has never implemented a program that is more efficient than a profit-based private company. It's just not inherent in government programs.


The article you posted yourself certainly backs this up because there is no private insurance out there that is accepted by anywhere near 87% of all doctors.
Government is able to offer Medicare nationwide. Not so for private insurers. In areas where they are able to operate, I'd be willing to bet there are a number of private insurers that are accepted at more than 87% of the physicians' offices.


Who insures those people? Medicare. If they attend a physician who no longer takes it then they can go to one of the 87% of doctors who do.
Maybe in an urban setting but, try that in towns where the next doctor is in the next town.


Are you saying this is not an issue with private insurers? I sure hope not because insurance networks change on a regular basis and they lose and gain physician all the time.
Name a doctor that doesn't accept private insurance. It's a competitive market, and I'm willing to bet nearly 100% of doctor's accept private insurance.

[MannyIsGod]

I don't care what you accept.

I'm sorry, that sentence makes no sense. But, to what I think is your point, the Government has never implemented a program that is more efficient than a profit-based private company. It's just not inherent in government programs.


Your right, my sentence sucked. Medicare is absolutely more efficient in many ways than private insurance. It's medical prices are cheaper, its far more accepted than any private insurance



Government is able to offer Medicare nationwide. Not so for private insurers. In areas where they are able to operate, I'd be willing to bet there are a number of private insurers that are accepted at more than 87% of the physicians' offices.


You're welcome to prove it.



Maybe in an urban setting but, try that in towns where the next doctor is in the next town.


Oh, small town doctors that are rejecting patients? Sounds like a rampant problem. What do you want to do about people in those towns who have insurance but no in network providers?

This is almost as lame as your mosque reasons and is one hell of a reach.

I'll openly acknowledge Medicare is not a perfect system. That was never my contention. This problem is one that affects private insurers just as much if not more so I don't see how it makes Medicare look worse in comparison.



Name a doctor that doesn't accept private insurance. It's a competitive market, and I'm willing to bet nearly 100% of doctor's accept private insurance.

You'd be wrong. Doctors who don't have to take private insurance don't take private insurance. I'm not sure of the exact figures but I work for a doctor and the number of insurance companies we accept is extremely limited (we do however accept Medicare which pays better than many of the private insurance companies.)

However, once again you're welcome to prove your assertion. I'm not going to hold my breath.

[Yonivore]

Your right, my sentence sucked. Medicare is absolutely more efficient in many ways than private insurance. It's medical prices are cheaper, its far more accepted than any private insurance
cheaper prices for the same medical care? What doesn't add up, Manny? Doctors say they're no longer getting fairly compensated for their services under Medicare.

That's why it's dropped from 92% to 87% in 2 years.

Cheating the providers isn't efficient.


You're welcome to prove it.
You're saying there are doctor's that accept Medicare but not any other private insurance?



Oh, small town doctors that are rejecting patients? Sounds like a rampant problem. What do you want to do about people in those towns who have insurance but no in network providers?

This is almost as lame as your mosque reasons and is one hell of a reach.

I'll openly acknowledge Medicare is not a perfect system. That was never my contention. This problem is one that affects private insurers just as much if not more so I don't see how it makes Medicare look worse in comparison.
It is a problem for those who experience it.


You'd be wrong. Doctors who don't have to take private insurance don't take private insurance. I'm not sure of the exact figures but I work for a doctor and the number of insurance companies we accept is extremely limited (we do however accept Medicare which pays better than many of the private insurance companies.)

However, once again you're welcome to prove your assertion. I'm not going to hold my breath.
Does the doctor for whom you work have to take the extremely limited number of private providers you claim?

[MannyIsGod]

cheaper prices for the same medical care? What doesn't add up, Manny? Doctors say they're no longer getting fairly compensated for their services under Medicare.

That's why it's dropped from 92% to 87% in 2 years.

Cheating the providers isn't efficient.



Proving a price for a service that 87% of providers accept isn't efficent?

:lol

Thats pretty fucking laughable.

Also, there are private insurers that pay less than Medicaid and get away with it.





You're saying there are doctor's that accept Medicare but not any other private insurance?


No. I'm saying that doctors pick Medicare over other forms of insurance, however. I'm not sure if the scenario you painted above exists but it certainly does not need to exist for my point to be true.



It is a problem for those who experience it.


Yes. Its a problem when private insurer holders run into the same problem. In other words, its far from a Medicare specific problem so how does it make Medicare worse than private insurers?



Does the doctor for whom you work have to take the extremely limited number of private providers you claim?

No. He can take as many as he wants. He also doesn't have to take Medicare. So what exactly is the point?

[ElNono]

As it gets worse the doctors continue peel away from Medicaid and Medicare.

Here's a story.

Baby Boomer Bust: Doctors Refusing Medicare Patients (http://www.theroot.com/buzz/babyboomer-bust-doctors-refusing-medicare-patients)

So the overwhelming majority of doctors accept medicare willingly... Maybe they don't see the problem that you guys do...

[MannyIsGod]

Man, it takes some serious myopia to call 87% inefficient. Call it socialist, call it whatever you want, but that shit is efficiency.

[ElNono]

So 87% of doctors 'eat the difference' willingly... that a lot of masochist doctors...

[boutons_deux]

"Doctors say they're no longer getting fairly compensated for their services under Medicare."

Doctors are greedy, gouging, overpaid, a major reason US per capita medical costs are twice other industrial countries. Health care is just another way US citizens are getting screwed and gamed.

[boutons_deux]

"Thousands of pages and billions of dollars and they fucked it up"

No country gets national health care right the first try, and they didn't have $1T of vested interests/for-profit corps buying exceptions and regulations to protect their profits.

Medicare and Medicaid, 40 years old, are continually revised and improved, just like for-gouging health insurers tweak their operations, procedures, policies every year to fuck over their clients better.

But Yoni and other VRWC shills expect the US health care reform to be perfect first try.

GFY, Yoni and friends.