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Obviously, this is because of the health care bill.
/republicans
Health Insurance Compe ion Vanishing: Study
Consolidation has not helped patients, says AMA president
THURSDAY, Feb. 25 (HealthDay News) -- Compe ion in the health insurance industry is vanishing, according to an American Medical Association report that looked at data from 43 states and 313 metropolitan markets.
In 24 of the states, the two largest insurers had a combined market share of 70 percent or more. Last year, 18 of 42 states had that type of market situation.
Among the other findings:
- In 54 percent of metropolitan markets, at least one insurer had a market share of 50 percent or more -- up from 40 percent of metropolitan markets the year before.
- In 92 percent of metropolitan markets, at least one insurer had a share of 30 percent or more -- up from 89 percent of metropolitan markets the year before.
- Ninety-nine percent of metropolitan markets are highly concentrated, according to federal merger guidelines, compared with 94 percent the year before.
The report, Compe ion in Health Insurance: A Comprehensive Study of U.S. Markets, was released this week.
"The near total collapse of compe ive and dynamic health insurance markets has not helped patients," AMA President Dr. J. James Rohack said in a new release. "As demonstrated by proposed rate hikes in California and other states, health insurers have not shown greater efficiency and lower health care costs. Instead, patient premiums, deductibles and co-payments have soared without an increase in benefits in these increasingly consolidated markets."
Rohack added that a lack of compe ion in the health insurance industry "is clearly not in the best economic interest of patients," and the AMA wants the U.S. Department of Justice and state agencies "to more aggressively enforce an rust laws that prohibit harmful mergers."
The AMA also wants the Department of Justice to consider the following measures: a retrospective study of health insurance mergers; research to identify the causes and consequences of health insurance market power; and creation of a system for predicting the effects that health insurance company mergers will have on patients and health care providers.
Obviously, this is because of the health care bill.
/republicans
Health insurance reform as passed isn't likely to break the trend and may even help it along.
Why we put all our eggs in the basket of a middleman which is failing in its job as an intermediary (to use its clout to negotiate "regulatory bargains" on our behalf), is more than a little perplexing, if bringing down health care costs was the contemplated end.
In retrospect, I tend to doubt it was.
Last edited by Winehole23; 04-09-2010 at 09:15 AM.
"if bringing down health care costs was the contemplated end"
There is no serious effort of bringing down health care costs, because serious effort on costs would have meant a serious effort on health care industry profits. Harry-and-Louise would have been resurrected to kill the bill.
There are $Bs being made from the inefficiencies, over-treatment, and general insanities of the US health care. Any effort at reducing the $Bs will be met with 100 of $Ms of counter-effort, primarily buying comparatively cheap Congress votes.
I seldom agree with you, b_d, but in a broad sort of way I can go along with that.
Judge may rule by tomorrow on insurance dispute
April 8, 2010 01:10 PM
By Robert Weisman
A Suffolk Superior Court judge today adjourned a two-hour hearing without ruling on a request by six Massachusetts health insurers to reinstate premium rate increases rejected by the state last week.
Judge Stephen E. Neel said he expected to rule by tomorrow or Monday on the insurers' request for a preliminary injunction that would allow them to go ahead with charging higher rates for individuals and small businesses.
Insurance commissioner Joseph G. Murphy's decision to reject the double-digit rate increases was "arbitrary and capricious," said Dean Richlin, an attorney representing the health insurers.
"Insurers are required either to submit to confiscatory rates or to go out of business," he said.
But assistant attorney general David Guberman said the court had no jurisdiction in the case because the insurers had not exhausted the administrative appeals process within the state division of insurance.
Last week, the state Division of Insurance rejected insurers' proposed base rate increases for individuals and small businesses averaging 8 to 32 percent, in what is known as the small group market. The category includes about 800,000 Massachusetts residents.
Prior to the state turning down the higher rates, the insurance companies posted them on the Commonwealth Health Insurance Connector Authority's website, www.mahealthconnector.org. The site was set up under the 2006 Massachusetts health care overhaul to help residents buy insurance. After the state refused to accept the higher rates, it ordered insurers to pull them from the site. The new rates were supposed to take effect April 1.
As a result of the standoff between the state and insurers, residents and small businesses shopping for insurance, as well as those seeking to buy new policies, have been unable to get quotes for new coverage this week.
Yesterday, Blue Cross Blue Shield of Massachusetts -- the state's largest health insurer -- and Tufts Health Plan said they will, as ordered by the Division of Insurance, resume making new policies available for the small group market -- using last year's base rates, not the requested double-digit increases rejected the state rejected. The companies said they were not sure the new prices will be ready by tomorrow, as the state wants.
Harvard Pilgrim Health Care and Fallon Community Health Plan have not committed to offering new rates by tomorrow -- despite the insurance commissioner's stern warning that the law requires them to do so.
Is everyone looking forward to these problems to go nation wide?
"these problems to go nation wide"
lack of health-insurance compe ion is already nation-wide.
Private equity investors compromise public health and medical practice for profit.
https://www.nakedcapitalism.com/2021...practices.htmlMedPage Today: “Private Equity Is Ruining American Healthcare”
For-profit insurance companies have long been regarded as the ultimate offenders in medical -profiteering. However they distract from the goal of providing healthcare, it is the unscrupulous involvement of private equity (PE) in medicine, a similarly culpable and even more insidious economic an.
In May 2021, an American An rust Ins ute white paper found private equity investment accelerates consolidation and “is fundamentally incompatible with a stable, compe ive healthcare system serving patients and promoting the well-being of the population.”
The rise of private equity in medicine has resulted in a proxy war against insurance companies exclusively for the benefit of clandestine shareholders and investment fund managers rather than patients or clinicians.
PE is a unique and unregulated investment platform with the objective of aggressively generating short-term revenue for the firm and its investors without regard for long-term value to society, including public health much less the people of the organization.
PE firms typically operate on a 3 to 7-year cycle for the acquired company by an investment manager with funds from “limited partners” who can be ins utional investors also. The company can be acquired in a leveraged buyout from which the resulting transaction saddles the company with high-interest debt needing to be paid back. The company bears the full risk of failure to become more profitable. A typical and ruthless tactic to insure profits is cost-cutting and personnel layoffs which cuts into the capabilities of the company.
In any case and regardless of outcome, the PE firm and manager become significantly wealthier due to exorbitant fees on such as assets under management.
If billing transparency would tend to expose ER docs to fraud charges, the clear implication is that the companies in charge of ER billing are routinely adding phony charges.
https://www.dailyposter.com/er-organ...rivate-equity/Private equity firms have spent hundreds of millions of dollars convincing emergency room doctors and patients that they are all on the same team, fighting the greed of evil insurance companies. But in a remarkable “saying the quiet part out loud” moment, the major professional organization representing emergency physicians just admitted that private equity greed may be leaving the ER doctors vulnerable to criminal fraud charges.
The admission came in a do ent the board of the American College of Emergency Physicians (ACEP) circulated to its roughly 400-member council in advance of its annual conference, which began earlier this week in Boston. Robert McNamara, a Temple University medical school professor who has been working for decades to galvanize ER doctors in opposition to the “corporate practice of medicine,” had proposed a resolution that would essentially force all ER staffing companies seeking to do business with ACEP to periodically furnish their physicians with data on the services and procedures the company had billed for under their license numbers.
Buried in the middle of the otherwise mundane memo on past resolutions, the board addressed McNamara’s proposal. Unsurprisingly, the Board expressed extreme reluctance to adopting the proposal, noting that four separate attorneys it had consulted believed there was “substantial risk to implementing the resolution as written.” The ACEP brass had previously cited the (dubious) threat that forcing transparency could somehow invite an an rust lawsuit, but this time they provided a new and eyebrow-raising concern.
“ACEP engaged outside counsel to advise on whether securing regular reporting of billing in a physician's name could inadvertently subject that physician to potential liability under the False Claims Act [emphasis added], since provision of this information could now leave them considered to be ‘knowing,’” they wrote.
In other words: emergency room doctors are better off not knowing what their private equity overlords are billing under their license numbers, because they are less likely to go to jail for Medicare fraud if they didn’t actually know they were committing it.
“If emergency physicians saw what was being billed in their name they would be shocked,” McNamara says. “We know that these companies are regularly charging nine times the Medicare reimbursement rate, and we know we aren’t making that kind of money, but we don’t know what’s actually being charged in our names,.”
“What we should really be getting angry about is the fact that those same insurance companies we demonize are actually subsidizing the expansion of private equity controlled medicine, by giving companies like Team Health and Envision far higher reimbursement rates than independent practices,” says McNamara.
Indeed, a seminal research paperon surprise ER billing found that hospitals that outsourced ERs services to Envision saw their charges for the same procedures immediately double, and that private insurers pay ER doctors a far higher average multiple of Medicare rates than their counterparts in virtually every other medical specialty.
“Physicians have no idea the insurance companies are paying them so much,” explains McNamara, “because they don’t see any of that money.”
The profit motive screws patients and delivers substandard care.
https://www.nbcnews.com/health/healt...-back-rcna9152The email to the health care workers was like something out of “The Wolf of Wall Street.” “We are in the last few days of the month and are only 217 appointments away from meeting our budget,” the August 2020 memo stated. “Don’t forget the August bonus incentive for all patients scheduled in August! That’s the easiest money you can make. Get that money!!”
The “Get that money!!” entreaty wasn’t addressed to a bunch of hard-charging, coke-snorting stockbrokers. It went to Michigan-based employees of Pinnacle Dermatology, a private equity-owned group of 90 dermatology practices across America.
The memo was shared with NBC News by a former Pinnacle employee, Dr. Allison Brown, a board-certified dermatologist and dermatopathologist. Brown says Pinnacle terminated her shortly after she advised management of questionable practices that she contends were hurting patients.
Among the practices Brown alleges: overlooked diagnoses, lost patient biopsies, questionable quality control in the company-owned lab and overbooking of patients without sufficient support staff.
Focus back on insurers: employer based plans mean lost wages for employees
https://www.statnews.com/2021/12/29/...-immiseration/The... excessive cost of health care is largely absorbed by employer-based plans that insure approximately 160 million Americans. That these health plans are funded by employees’ lost wages (“lost” because this money would otherwise be paid to workers), Case and Deaton argue, substantially explains decades of lost jobs and stagnant wages particularly hard felt among lower-wage workers. Beyond the negative effect excessive costs have on care, the burden on low-wage workers cons utes a reverse Robin Hood effect that exacerbates already substantial economic inequality. As Case and Deaton conclude, “the industry that is supposed to improve our health is undermining it” and “our government is complicit.”
Corporate medicine sucks for the pt and the Dr.
The solution is booming tho
https://www.yahoo.com/lifestyle/bigg...232327341.html
ST Left: Employer provided HC coverage doesn't work!
also
ST Left: ICUs are overrun with patients! Hospitals at their breaking points!
Conclusion: If we just had socialized medicine where everyone could go to the hospital without concern for cost, there'd be so much more available ICU space and hospitals wouldn't be stuffed to the breaking points.
ST Left
Not really. You would just be able to go to the doctor regularly and discover/fix problems before they get so bad that you have to hit the ER. This is not theoretical either, see:ST Left: Employer provided HC coverage doesn't work!
also
ST Left: ICUs are overrun with patients! Hospitals at their breaking points!
Conclusion: If we just had socialized medicine where everyone could go to the hospital without concern for cost, there'd be so much more available ICU space and hospitals wouldn't be stuffed to the breaking points.
While the discussion about the health of citizens in the US and EU is a topic for another time, we can compare stats about how emergency medicine is handled across borders using several notable studies[*].
To begin with a big issue, the US has the highest rate of deaths which could be avoided by routine healthcare interventions compared to those in the EU.
https://www.duvasawko.com/us-healthc...her-countries/
DMC: HURR-DURR THE LEFT
The Left: lol
If COVID is the cause of overcrowding and "elective" care is denied due to it, how would these people be better off? In fact, the people in the ICUs are there largely due to COVID (so the narrative goes) so how would catching it earlier have prevented that (never mind the insane wait times for medical care in other countries).
Do these avoidable death people choose to not be seen? It's like pulling teeth to get older people to do routine checkups. It's not because of the cost, but because of the fear of what will be found coupled with the inconvenience of going and the fact that the PCP is a pusher who just wants to fill their night stand with copious amounts of scripts they don't actually need.
But you weren’t talking about COVID, you were talking about employee sponsored healthcare.
And I disagree, cost plays a significant role. Even for a good chunk insured people, high deductibles means paying out of pocket for initial visits and followups. Another factor is actually requesting and getting the time off. And yet another factor is some insurances demanding that you visit an in-network doctor or foot a chunk of the bill. Then there’s copays… and all that is if you’re insured at all.
COVID is a health emergency, and everybody understand it as such. That’s why you don’t get charged for vaccines, for example. Though if you do end up hospitalized and you don’t have solid insurance, good luck.
Since people with health insurance fill up the available spaces already, how does free HC for all even make sense? There wouldn't magically be open ICUs suddenly. Hospital waiting rooms wouldn't suddenly be empty. They'd be even more full of kids with runny noses and every other person dragging the entire family in for testing weekly.
Not sure you remember but there was a time when there was no copay for emergency room visits (but there was a copay for PCP visits). People would simply not go to their doctors for small , they'd go to the emergency room because it was free. Then insurance companies wised up a bit and set a copay for ER visits, even a modest one like 25 dollars at the time (more now). That stopped most of it right away. Where you'd see whole families in waiting rooms during any visit, you now saw only people who had emergencies (for the most part).
You cannot convince me that 25 dollars made the difference between needing emergency care and being able to wait. Socialized medicine is that free ER especially if the PCP has a waiting list.
I'm all for free for everyone but it's not really free. It's just free to them.
I walked into a hospital in Australia just like that, stuffed with people with runny noses and sore fingers and . The attending told me it was like that every day because it was free to them. They'd often see the same family a couple times a week.
I’ve been in 4 different countries with government-covered HC (Buenos Aires, São Paulo, Paris, Alberta) where I made visits to doctors and/or hospitals for different reasons, and it works. I suspect the NIH in the UK is not much different as well. I’m pretty sure they all have different models and different standards of care, but right now the US actually spends more money in healthcare per capita than they do, while they provide very close to full coverage.
Now if your argument is that a change like that would also require a cultural shift in the US, I agree, and it probably wouldn’t be overnight as well. In January 1st, a new law here in the US kicks in that prevents ‘surprise’ billing from out of network providers, which apparently are so common that we need a law to stop that. It’s another band-aid that comes too late to a system that’s uniquely expensive and broken.
We discussed this topic over the years a million times, and at some point when we go down the rabbit hole we all end up on the same spot: the reason we have Medicaid, or Reagan’s law that hospitals can’t turn away patients, is that the profit motive sometimes simply doesn’t align with what’s best for patients. Before the law, hospitals would load up sick people into busses or actual chopper and ship them out of town. That’s actually what triggered that law.
At some point we have to face the fact that for some things, there’s more than just the profit motive (we already recognize that it the military, for example, where NatSec prevails over making a buck). Healthcare is not different, you’re either ok with poor people dying on the street (political suicide) or just stop with the pretense that the free market will suddenly have a solution to this specific problem when it never has.
Per capita
Why do I care about per capita? That's just saying person A pays for person B and the per capita is they paid the same amount.
About medicaid
Payer Trends
Previous analyses have shown that utilization of the ED is also related to insurance coverage (for
instance, Sun et al. 2018 and National Center for Health Statistics 2019 are two examples). Adults under
the age of 65 with Medicaid were approximately twice as likely to report having gone to the ED in the
past year compared to those who are privately insured (National Center for Health Statistics 2019).
Previous work has shown that between 2006 and 2015, the share of ED visits for children was highest
among those with Medicaid and increased substantially, while the share covered by private insurance
declined. Similarly, among adults 18-64, the share of ED visits covered by private insurance decreased
and the share covered by Medicaid increased for most years between 2006 and 2015 (Sun et al. 2018;
Moore et al. 2017).
No, per capita means dividing the entire price tag over your country’s population. That’s how you compare costs between countries with disimilar amount of population. How else would you compare it?
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