Short Circuit to Universal Health Care

[berni_mccoy]

Are there or have there been any NON-PROFIT Health Insurance organizations?

After dealing with several insurance companies, from auto, home and health insurance, I am convinced that they are the most profitable companies and that the health insurance companies make a bundle. I can go into details if anyone wants... but that's beyond the point I'm trying to make.

If there were a non-profit health insurance company, they could offer a much lower premium and by doing so, attract more subscribers and thus be able to negotiate lower cost health care.

Because the insurance would be a non-profit org, it would qualify for many advantages that existing for-profit companies can not, further reducing costs.

What is stopping this concept from moving forward? Effort, organization, greed? Or is the health care system just that screwed up that there is no place for such a concept?

[evlbstrd]

1. Blue Cross/Blue Shield is non-profit,

and yet very profitable. Good luck.

[ibid]

6. Without National single payer, there are sales costs for "non-profit"

and earnings comes from claims underwriting - meaning deny insurance to those that might be more sick than average, and then fight claims by saying procedures were not followed.

"non-profit" is not enough.

[berni_mccoy]

15. Yep, I'm starting to see that

Why have so many non-profit insurance companies tried to transition to for-profit? The only answer I can see for now is greed. For example, when BCBS of NH went for-profit, it had $83 million in assetts. That was non-profit gained... all Anthem had to do was 'create' a non-profit entity to funnel the $ into and dole out as they see fit to 'worthy' causes under the law.

It seems to me that any potential organization that would do this right would need to be a national (or international) non-profit organization that stood on it's principles and had a checks-and-balance system put into place with some sort of poison-pill that would prevent it from going for-profit.

It would also almost have to be a co-op driven organization divided into 2 parts: one part to determine rates/policies/expenditure budgets and another part to execute (similar to legislative/executive branches of gov't) and where beneficiaries (not necessarily contributors) voted on the seperate groups. A true health care system by the people, for the people.

To get started, the organization could use the left-over non-profit assets of insurance companies that have gone for-profit.

[ibid]

18. left-over non-profit assets have been deemed by the courts as property of

current policyholders

So the state watches as it is paid out to them.

Afterwhich the going concern value allows stock sales and future unlimited pricing/earnings.

greed

access to capital is the excuse

but it is greed.

[BR_Parkway]

2. Here in NC = Blue Cross is actually a Not for Profit and was trying

to convert to a profit corp. They gave up on that one after all the hoops they'd have had to go to, now one of the state legislators has introduced a bill to require them to pay out some of their $8 billion surplus towards medical costs for un-insured - since they've been posting record "profits" and rate increases for the past 5 years.

[berni_mccoy]

10. Info on the BCBS For-Profit Conversion

http://www.consumersunion.org/conv/bluecrossconversions.html

It looks like BCBS is in the process of a conversion of all of its companies.

NH is already converted (to Anthem) and Anthem is trying to merge with Wellpoint to become the nation's largest health insurance company. Not cool.

[prolesunited]

12. Anthem already merged with Wellpoint

and the stock has gone through the roof. I had been with Anthem prior to the conversion. Those with coverage got to vote on the plan for going for-profit and I voted no, but it naturally went through anyway.

They offered plan participants a buyout or stocks based on the years of service. The initial IPO went for about $40 per share. It's now trading around $127-&129 per share. I took the stock option and guiltily have made a nice chunk of money on it (on paper anyway).

The irony is that I got laid off and am now on COBRA. I might have to sell some of my stocks to pay for my $519 a month premiums to that same company until I get a new job.

It's insane. People's lives are NOT a commodity to make a profit from. :mad:

[AllegroRondo]

3. Its like credit unions vs banks

I'm betting there may be some regultions about this, but its definitely worth looking into.

[ihaveaquestion]

4. I believe the first HMO started as a non-profit....

by a group of doctors in Calif. It's probably ancient history though and long since evolved to a for-profit.

[wtbymark]

5. it will be labeled as a socialist agenda

by the right wing and demonized. The insurance industry will financially back the propoganda and lobby against it just like the pharmicutical industry did for drug prices. profits, profits, profits "dont go after my money you socialistic pig" (this would be the national language of 'debate')

[berni_mccoy]

17. They could try to do that

But if successful, the very capitalistic society we live in would dictate it's true perception. That is, if it offered good coverage at a lower price-point, people would start using it. It is evident in our society that lower-cost products/services dominate and it takes a great deal of effort to change that. This is why huge corporations like Wal-mart and Home Depot are so successful. If a good non-profit came along and did the equivalent for the Health Insurance industry.... it'd be pretty hard for the right to demonize it.

[NewJeffCT]

7. I think Kaiser Permanente is (or was) non-profit

I haven't heard their name in years, but I believe they were one of the first. I don't even know if they're still around or if they are still non-profit if they are around. I know when HMOs first started making their debut in the mid to late 80s & growing in the early 90s, they were one of the big ones early on...

The problem with a non-profit is that they have to raise capital to grow the business and it's harder to do that if you're a non-profit in any business. And, if the business is small or mid-sized to start with, they won't be able to offer the lower premiums because they won't have the economy of scale that a national insurer like Anthem Blue Cross, United Health, Aetna, Cigna, or Wellpoint can offer. So, while a mid-sized may be able to compete locally, it will be hard for them to grow.

[evlbstrd]

8. Kaiser Permanente is gone.

I'm typing this from their former offices.

[ibid]

19. they raise capital so as to grow the "reserves" - a single payer

national health plan would not need such capital.

[sui generis]

9. There are a couple of things

Any form of social insurance has to build cash reserves for high casualty years during low casualty years so that demand on the cash pool can be leveled. That's where "for profit" investors come in - they build this cash pool up front.

Pricing has to be controlled -- i.e., pharmacy can't charge insured people $3/pill and uninsured people $15/pill for the same pill like they do today.

Medical procedures have to be standardized on cost.

The issues are that different doctors charge way over "reasonable and customary", and different purchasing groups in pharmacy distribution purchase discounted drugs in advance that become translated into your pricing at your local pharmacy and supermarket, the gummint has traditionally set "reasonable and customary" price structures to be too low and HMO's pay based on expected padding from doctors and laboratory corporations are publicly traded, the cost of repaying doctors for their risk and education is inflated, and and and - you see an entire interconnected industry would have to be taken apart and put back together again. There is even a collections industry that is vested in your inability to pay your medical bills so they can take a cut while you're already bleeding.

So clearly there are at least half a dozen giant lobbies out there right now keeping anything like this from ever surfacing in any serious legislative form and relying upon our ignorance and innate distrust of change to keep Universal Healthcare from happening. Thank the AMA, and medical schools and Big Pharma, and For Profit HMO's, hospitals, and national laboratories, not to mention medical labor unions and ultra "free economy" conservatives and even professional / medical risk and malpractice insurance and the credit card companies.

It's not hopeless, but it requires a re-orientation of priorities that will have to border on a national obsession or else it will fail as an initiative.

[Sir Jeffrey]

11. Insurance by its very nature is a profitable venture...

as such it considers, out of necessity, the risk of insuring the patient and the patient's ability to pay. It has to, since it needs to cover expenditures.

The reason single payer works so well is that the national government becomes the sole insurer of the patient. Private for profit or (theoretically) nonprofit insurers would not have the power to tax that the national gvoernment has. The national government under single payer would also have the power to control costs to some extent.

Why hasn't this change happened? Primarily, the greed of those interested in maintaining an inefficient and bloated system stifles any attempt to change the system. I know of few (changed from "little" on edit) defenders of the current system in academia. We spend, per capita, over $2000 more per person on health care than every other industrialized country in the world, yet we still have 45 million uninsured. That extra money goes into infrastructure, salaries, and corporate profits. As simple as that, I'm afraid :)

[berni_mccoy]

13. I believe you are correct

Greed is the main issue.

http://www.census.gov/epcd/ec97/industry/E524114.HTM

From this gov't study based on 2002 census data, Health Insurance companies received a whopping 203 BILLION dollars in revenue in 1997 while paying only 12 billion in salaries. This leaves quite a bit for operational costs and payouts for coverage. The one thing that I'd like to know that's not in this study is what *were* the payouts that were made...?

[Spike from MN]

14. I'm in a non-profit HMO and I must say they provide excellent

care. They were rated best in state in the fall of 2004 and, IMHO, they should be used as a model for a national health care system.

Then again, Minnesota has long been known for the quality of care provided by its HMOs and the state currently has 7 HMOs/PPOs that received an "excellent" rating from the National Committee for Quality Assurance. Not all health plans elect to persue NCQA accreditation as it isn't a legal requirement and according to the NCQA website, accreditation is quite a rigorous process. Here's a link if you want to check to see how NCQA-accredited providers in your area (if there are any) stack up.

http://hprc.ncqa.org/frameset.asp

So yes, non-profit HMOs do exist and in my experience, they provide excellent care at a very reasonable cost. If everyone in this country had the same health care plan as mine I think that we would all be better off. I really feel terrible for those that have little or no health care coverage. That just shouldn't be happening in this day and age.

[hiley]

16. greed

i do think that Americans have had about enough of it and are going to stay focused and fight for health care for all !
:applause: