Health Insurers Skirt New Coverage Requirement For Kids

[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 bull . 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

[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...0&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 ed 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

[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.

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...l?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 compe ive 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 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 compe ive 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.