Perhaps All The Health Insurance Companies Should Be Asked To Defend Why They.......

[global1]

are important to the system - how they save us money - how much they save us - and justify why they should remain in place.

In my humble opinion - I don't think they can justify their existence. They should be put on the hot seat and tell us why they are better than a government run - single source - universal program.

Somebody should put dollars together to compare both systems - and not made up figures. The insurance companies know how much it costs to administer their programs. They have the numbers as to how much profit they make. They should show us how they help people - if they do. They should provide us with testimonials of people they have benefited. They should be able to provide us with numbers of how many people praise them for their insurance and coverage and how many people file complaints with them.

If they are so important to the future of healthcare - they should be able to justify their existence and tell us why we the American public would save money using them versus a single payer - universal system.

We should demand that of them!!!!!

[mike_c]

1. you're missing an important point....

This debate has NEVER actually been about providing health care to people who need it, or about cost effectiveness, efficiency, or anything else that's thrown up as a smoke screen whenever the topic of health care reform arises.

What this debate is REALLY about is preserving the obscene profits of the insurance industry, big pharma, the for-profit health care industry, and so on. This is America, where profits trump people by default, and corporations call the tune that political leaders dance to. It's just bidness, nothing more. Sick people are a resource to be mined, just like coal and natural gas.

[geckosfeet]

3. Yes. And the insurance companies will tighten their grip on our throats just like AIG, BoA

and the other financial institutions when the time comes to break them up. They will demand tax payer money because they are "too big" to fail - ie: they employ hundreds of high paid execs who must continue their extortion into perpetuity. The little guys get cut loose without so much as a severance check.

[Captain Hilts]

18. They can decide who gets healthcare. If you're unemployed, forget it. nt

[msongs]

2. Blue Shield/Cross are parasites - skim 30% off the top & try to deny services so their profits rise

just total leeches. Our work force is always trying to get our health deductions paid directly to local HMO or service providers but management keeps paying it to BLUE screw you who skims money for itself while providing no services in return. Then Blue screw you denies services left and right so it can make more money. The perfect BLUE screw customer lives 90 years, never gets sick, and dies instantly with no services necessary.

Msongs

[John Q. Citizen]

6. Which Blue?

Broad brushing is counter productive because it undermines your/our argument.

My kids get CHIP, which is run through our state blue and we have never been denied. In fact it has worked seamlessly. Our blue is a private non-profit, which means there are no stock holders profits.

Now that's not to say that your Blue isn't bezel bub herself, but if you were a tad more specific it would be helpful.

[customerserviceguy]

15. Don't kid yourself into thinking

that a single-payer system will not have some pencil pushers sitting at desks denying claims, or pre-reviewing them. At the very least, we will have to have fraud detection, look at all the fraudulent claims that have been submitted to Medicare and Medicaid over the last several decades, and the just plain inaccurate ones. Yes, the vast majority of doctors and hospitals don't abuse these two programs, but there will always be someone who tries to "game" the system, and we will require protection from the scam artists that are always with us.

Insurance companies might make the claim that they've been providing that "service", and I suppose that if we eliminate them, the people who used to deny, challenge, or audit claims will be the most qualfied people to do it for a governmental bureaucracy that will administer single-payer.

[eridani]

25. Global budgeting eliminates those problems

Our current oversight method is equivalent to controlling the movememnts of a herd of cattle by hiring hundreds of cowboys with sets of reins to each individual cow. Global budgeting for capital and operating expenses is the equivalent of putting a fence around the cattle and letting them move freely within. If providers try to cheat the system, they would take money directly out of the pockets of their colleagues, who would tend to notice and strongly object.

[customerserviceguy]

28. Sorry, I don't buy that

Individual providers don't have the means to track what Doctor Feelgood off in some strange city has going on. They're not going to be able to put monitoring devices in his office to see what he really does for the people who come in there and get handed a twenty dollar bill, while he bills a single-payer plan for $100 for their office visit.

We're clearly going to have tracking by individual of health expenses, some government bureaucrat will be able to go to a computer terminal, type in your Social Security number (or other unique identifier) and see every place you've ever sought medical help. Of course, the insurance industry can already do that.

There will always be cheats, and there will always be someone whose job it is to try to catch most of them, or at least the sloppiest of them.

[eridani]

29. Doctors who bill more than their share will be immediately flagged by their colleagues

Otherwise the money comes out of their own pockets.

[customerserviceguy]

30. And what will be the mechanism

that they will know exactly how much their collegues are billing? How will they know that some particular doctor is even performing services for people, if he just bills the single payer system at about the average?

I don't see any possible way how your scenario works.

[eridani]

31. Global budgeting is regional and local

This is much easier to track than national information. All providers and hospitals will know what their yeary budgets are, and who is making charges against them.

[eridani]

32. Works fine in Canada

Given that health care there is a part of the general budget and not in a sequestered fund like Medicare, they have underfunding problems. Fraud is not a problem. The reason is the local scale of the oversight.

[customerserviceguy]

35. No fraud in Canada?

It didn't take me more than ten seconds to find a website directly related to the subject:

http://www.chcaa.org

You're fooling yourself if you think that the US record would even be ten times what Canada's is. Every time there's a pot of money out there, there will always be someone looking to loot it. And we will need people to ask questions about even legitimate uses of that pot of money.

[eridani]

36. The only mention of a provider involves US Medicare!

Students peddling unauthorized pills don't count.

[customerserviceguy]

37. That's just the front page

on other parts of the site, there are various stories of fraud.

Live in a perfect dreamworld if you want to, but it will KILL single-payer if we do not have a fraud detection method, however imperfect, in place. And it should kill it, we have scoundrels in the US who are far less honest than the average doctor in either Canada or Europe.

[eridani]

38. I'm not seeing that fraud is a huge issue in Canada or Europe

That isn't because they have a better type of person there. It is because global budgeting forces providers to divide a specified and limited amount of cash among themeselves. Controlling the movement of a herd of cows by surrounding them with a fence would of course imply that someone has to be put in charge of fence maintenance; otherwise, the system would break down. That still is a far cry from hiring a bunch of cowboys with sets of reins to each cow.

[John Q. Citizen]

4. Better yet, we need some Senators and Reps to write and introduce single payer versions

of any bills introduced. Then we can compare the costs and benefits.

Single Payer is a Pubic-Private Hybrid. In fact it's the original and only time tested public private hybrid. The public self insures, and the private sector delivers the health care.

It works very well.

We need the Insurance industry and their bought and paid for Democrats and Repos to put up or shut up.

We need a fair debate where their plans can be inspected dissected and questioned, and where a Single Payer Fee for Service taz supported system can be inspected, dissected, and questioned as well. And where competing ideas can be tested.

[WyLoochka]

5. They can't justify themselves

They add no value whatsoever. They siphon value off. That's all they do. Pure parasites.

I keep asking my Senator - Enzi - What makes it the "American way" (as he puts it) to make a "deal" with business partners who add no value and, in the case of health insurance, actually drain value?

He won't answer because the truth of the matter is, it is the Republican way to divert other peoples' money to wasteful, totally unnecessary "middle men" big businesses.

Single payer just means one huge risk pool - which gives the pool the "economy of scale" so that there is enough premium to pay claims.

Single payer would take off the layers and layers and layers of admin costs for doctors, hospitals and clinics involved in having to submit claims to so many different places and submit paperwork to try to get into so many different "networks", vastly improving efficiencies. Not to mention vaporize the the admin costs of the health insurers which is, of course, built into the exorbitant premiums we currently have to pay.

[Ewellian]

7. They do provide

transaction processing services. Many large employers self -fund their health benefits...the insurance companies just administer the plan for a fee. The insurance company has no financial interest in denying claims..their goal is to pay claims as accurately as possible according to the terms of the plan. In an audit, an underpayment is just as bad as an overpayment.

Even Medicare services are administered by private companies under contract to the government (always have been).

[annabanana]

14. "The insurance company has no financial interest in denying claims"

And what percentage of employees nationwide are on the payroll of those "large employers who self-fund their health benefits?"

The largest employer in the Country (the federal government) doesn't.

[Ewellian]

17. From a 2008 Kaiser Foundation study:

Here are some interesting statistics offered in the 2008 survey results:

* 44% of all workers were covered by self-funding in 1999, increasing to 55% in 2008
* 62% of workers with employers having 5,000+ employees self-funded in 1999, increasing to 89% in 2008
* 62% of workers with employers having 1,000 to 4,999 employees self-funded in 1999 compared to 76% in 2008
* Firms under 1,000 employees didn’t increase levels of self-funding (for 2008: 12% of workers for firms with less than 200 employees, and 47% of workers for firms with 200 to 999 employees,) as the nature of self-funding is more conducive to larger employers

http://community.changenow4health.com/blogs/simplify/bl...

link for the Kaiser report: http://ehbs.kff.org /

[annabanana]

20. "Kaiser" as in "Kaiser Permanente"?

oh brother

[Ewellian]

22. wow, what a "knee-jerk" reaction.

You asked what percentage of employees had self-funded medical plans, I found some numbers for you.
Did you even read the information.

And to answer your question...no.

Who We Are

A leader in health policy and communications, the Kaiser Family Foundation is a non-profit, private operating foundation focusing on the major health care issues facing the U.S., with a growing role in global health. Unlike grant-making foundations, Kaiser develops and runs its own research and communications programs, sometimes in partnership with other non-profit research organizations or major media companies.

We serve as a non-partisan source of facts, information, and analysis for policymakers, the media, the health care community, and the public. Our product is information, always provided free of charge – from the most sophisticated policy research, to basic facts and numbers, to information young people can use to improve their health or elderly people can use to understand their Medicare benefits.

The Kaiser Family Foundation is not associated with Kaiser Permanente or Kaiser Industries.

[annabanana]

24. For those interested in the origins of HMOs

Perhaps the best introduction to the Kaiser HMO and Kaiser Permanente Medical Care Plan is the summary by Mr. Edgar Kaiser that the less Kaiser does for patients the more money it makes. To get the full context one can go to the University of Virginia and review the presentation Mr. Edgar Kaiser (then Kaiser CEO) made to President Nixon through Mr. Erlichman – the less we do the more we earn. This convinced President Nixon to go forward with the HMO Act of 1973 with Kaiser as the template. The conversation is recorded below within the Nixon Whitehouse Tapes.



John D. Ehrlichman: "On the … on the health business …"

President Nixon: "Yeah."

Ehrlichman: "… we have now narrowed down the vice president's problems on this thing to one issue and that is whether we should include these health maintenance organizations like Edgar Kaiser's Permanente thing. The vice president just cannot see it. We tried 15 ways from Friday to explain it to him and then help him to understand it. He finally says, ‘Well, I don't think they'll work, but if the President thinks it's a good idea, I'll support him a hundred percent.’"

President Nixon: "Well, what's … what's the judgment?"

Ehrlichman: "Well, everybody else's judgment very strongly is that we go with it."
President Nixon: "All right."

Ehrlichman: "And, uh, uh, he's the one holdout that we have in the whole office."

President Nixon: "Say that I … I … I'd tell him I have doubts about it, but I think that it's, uh, now let me ask you, now you give me your judgment. You know I'm not to keen on any of these damn medical programs."

Ehrlichman: "This, uh, let me, let me tell you how I am …"

President Nixon:

Ehrlichman: "This … this is a …"

President Nixon: "I don't …"

Ehrlichman: "… private enterprise one."

President Nixon: "Well, that appeals to me."

Ehrlichman: "Edgar Kaiser is running his Permanente deal for profit. And the reason that he can … the reason he can do it … I had Edgar Kaiser come in … talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because …"

President Nixon:

Ehrlichman: "… the less care they give them, the more money they make."

President Nixon: "Fine."

Ehrlichman: "… and the incentives run the right way."

President Nixon: "Not bad."


The preceding transcription (http://www.whitehousetapes.org/pages/listen_tapes_rmn.h... ) is from the University of Virginia for the clearest possible presentation (pathway discovered by Vickie Travis). Check - February 17, 1971, 5:26 pm - 5:53 pm, Oval Office Conversation 450-23. Look for: tape rmn_e450c.

[WillowTree]

21. It's not just "large employers" who self-insure.

I've seen groups as small as automobile dealerships with self-funded coverage.

[eridani]

26. Agreed. What a bunch of horseshit

I'd like to hear an explanation of why insurance companies hire reams of people to investigate a woman wanting reimbursement for chemo to find out that she had neglected to mention a yeast infection on her application.

[Hepburn]

8. I had a discussion with my neighbor on Thursday about "socialized medicine."

My question to him was: So what is the difference if the Insurance Companies or the Federal Government runs the health care system? At least we consumers have a chance with the government, right?

Light bulb came on and suddenly this "socialized" bullshit was no longer of importance.

[moondust]

9. Okay, here's one.

They provide valuable investment choices for investors who have too few choices as it is. You don't really expect all those "financial experts" and their wealthy clients to go out and get real jobs, do you?

[leftstreet]

10. Hey, is Obama capping their CEO pay at $500,000?

Oh wait. That won't happen until they come groveling to DC for taxpayer bailouts.

[Catshrink]

11. You nailed it.

Insurance companies add a cost to the system that doesn't provide value.

[onethatcares]

12. you guys forget one thing

"deregulation of the healthcare industry will engender competition thereby lowering costs for everyone"

[SharonAnn]

23. That's why we pay a bonus to private companies that provide Medicare coverage?

Because competition has made the private plans more expensive so that they can not compete with Medicare?

Honestly, I don't get it.

[Cleita]

13. As long as the insurance enablers are letting them sit at the table you won't

hear those hard questions asked.

[Kansas Wyatt]

33. Death Merchants need to be tossed out in the street on their fat asses.

Who in their right mind sits these Death Merchants at the table?

After Obama told the story about what his mother went through with them, how could he sit them in the same room, let alone the table?

[Faryn Balyncd]

16. Why are Americans who are DENIED INSURANCE charged 250-600% more than insurance companies pay?

((Without insurance companies we some Americans (insured) couldn't escape from the perverse pricing system of fantasy "regular" hospital/medical prices that only came into existence because of insurance negotiations.))

http://www.democratsunderground.org/discuss/duboard.php...

[Juche]

19. They are too rich to need to do that

They can just use their pocket change to create psychologically persuasive but highly misleading ads they can run in the media.


I don't think they can justify their existence. My understanding is people who have medicare like it better than people with private insurance. Plus medicare (aka single payer) is cheaper. Unless there are other issues that need to be looked at the cheaper program that people like more is the better one.

[Festivito]

27. That's easy: They're a protection racket for the 'good ole boys club.'

Sons and daughters of once-upon-a-time good people, long dead, leaving inheritances to their addled offspring, who only know how to protect close-by butts. Their own too, as long as they can find it.

[hunter]

34. Why ask them?

People get laid off from work every day. Why not the same for giant corporations?

"Sorry. We the People of the United States of America no longer require your services. Pack your things and security will escort you to the door."