Joanna Antongiovanni
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As the Supreme Court of the United States will likely rule on health reform soon, conversations about the bill’s constitutionality are once again resurfacing. Aside from this debate, there are several flaws within the bill that contribute to its inability to best protect consumers from increasing rates and provide them with affordable coverage. Below are five things that supporters of health reform don’t want you to know.

A lack of focus

The bill is more focused on insurance costs and does not adequately address the main reason health care costs go up: the actual cost of care. This is a big problem because it overlooks what could really make a difference and solve some of the health care issues in our country. The Kaiser Family Foundation report predicts that the health care rebates employers can expect to receive is minimal, an average of $127 compared to premiums of $5,400 a year for an individual and $15,100 for a family. If these predictions are close to the actual rebates, it proves the bill’s insurance reforms and current medical loss ratios do not address the true cause of increasing premiums in our country.

One size doesn’t fit all

As health reform stands now, it fails to address the unique needs of each state. One of the mostly unpublicized outcomes of the medical loss ratio (MLR) requirements has been that carriers have opted to exit specific unprofitable markets or exit health group products altogether to concentrate on lines of business not affected by health reform.

In some states this has created an unfair advantage for the one or two carriers that remain.

Other plans have eliminated specific products such as “child only policies” citing the inability to cover the cost of the additional mandates placed on these policies at an affordable cost. In addition, doctors and hospitals in wealthy areas are more likely to pass along those costs to consumers in those areas, increasing health insurance costs in those regions.

What was originally intended to increase coverage to the uninsured and lower health insurance costs has in fact done the opposite. In addition, many states that are struggling to balance their budgets following the burden of Medicaid expansion are seeing red and increasing deficits. These states are looking for alternative ways to save money and state-funded programs like education are at risk for budget cuts.

The current exchanges don’t fit

One major oversight of the bill is that there is no exchange that exists today that would satisfy health reform’s exchange requirements. An exchange is a government manufactured insurance marketplace for individuals not covered for health insurance by their employers to shop for health insurance at competitive rates. None of the current exchanges that exist for health care work under the new bill, the health reform exchange is two parts Massachusetts exchange, one part Utah exchange and one part “other”.

It’s debatable if either the Massachusetts or Utah exchanges accomplishes what they are set out to do, that is, to provide a market for people to purchase affordable insurance.

The creation of the exchange itself did not make health insurance affordable as it never addressed the cost of care. This is an obvious problem as individuals that are not covered by their employer need to have an affordable alternative for health care. Instead of looking to examples of what would work, the exchange dreamed up by health reform is a conglomeration of different ideas hastily combined.

Pennies on the dollar

Did you know that health insurance companies only make 3 cents to 6 cents on the dollar for health insurance premiums?

Health reform’s misplaced blame on insurance companies will only result in more difficulty for employers and individuals to get the specific insurance policies that they need. If the insurance companies continue to be attacked, they will lose more money and have fewer agents who will be able to help consumers find a policy that meets both their financial and health needs. Again, the cost of care resurfaces as the larger influencer on health insurance premiums.

All bark and no bite

There is only one thing worse than a mandate…a mandate without teeth. The bill mandates individuals to purchase health insurance but the consequences for not purchasing insurance is so weak it begs the question about how serious lawmakers were about actually making people purchase insurance. As the law is written now, it will accelerate the destruction of the insurance industry as people, after they have done the math, will opt to pay the penalty rather than pay for coverage.

Only time will tell the Supreme Court’s final decision regarding health reform. Regardless, so long as the legislation fails to address the above issues, the bill will be ineffective in solving the health care conundrum in our country.

Joanna Antongiovanni is the president of the Texas Association of Health Underwriters.

104 Responses

  1. Thinking Producer Says:

    It is my understanding that Texas has the largest percentage of uninsured citizens of any state in the nation. I remember reading that individual health products in the state are notorious for paying out a low percentage of benefits in relation to premiums paid by insureds.
    This is definitely a state that seeks to maintain the status quo regarding health insurance products in the state.
    PPACA is certainly not perfect. However it is an attempt to change the present system which appears to put consumers last.
    Profit is important. However you would think such an important coverage area SHOULD minimize profit for the benefit of USA consumers.

  2. Rick Bryan Says:

    Very nicely written; thank you.
    Without disagreeing with any of your points, what I would ask is what is your alternate solution to ensuring everyone has access to basic and affordable quality health care? I’m not necessarily a ‘pro-Obamacare’ guy, but I do observe that this seems to be the only somewhat realistic plan on the table. The anti-Obamacare crowd makes valid points, but to my ear never seems to offer a detailed alternative way to solve the problem. Yes here and there various people offer good solid ideas as alternatives, but there doesn’t seem to be a solidly detailed alternative plan ready to be implemented. My sense is that for better or worse we should go forward with Obamacare and see how it shakes out after a few years, and make changes along the way. Otherwise, it seems like we do nothing, and how is that going to solve the problem?

  3. Thinking Producer Says:

    I followed the health care congressional debate extensively. I found the notion that 80-85% of every insurance premium dollar collected must be used to pay consumer health benefits refreshing. Our current system generates too much profit; consumer interests are secondary, not primary.
    PPACA uses PRIVATE CARRIERS to compete with products that provide significant benefits.
    The individual mandate is justified & necessary to cover all pre-existing conditions. The mandate gets young, healthy insureds into the pool. Without a broad pool of insureds, elevated premiums will destroy the program. It is estimated that a $1000 per year is added to premiums because of the uninsured who are covered without contributing to their cost.
    If the US Supreme Court in a 5-4 decision destroys this private sector attempt at CHANGE,it will reinforce in my mind, that what counts in the USA is Power and the SIGNIFICANT $$$$$$$ behind such power.
    Just because attacks on change are repeated…over and over in Ads, doesn’t make them correct.
    We might be a highly, industrialized nation but our values as a nation need significant re-evaluation !

  4. GoMavs Says:

    MLR’s are price controls – name me an industy where price controls caused a better product for a lower price, making healthcare more accessible by making it less expensive.
    MLR’s basically say – if you make a profit, give some back, if you lose money – tough. We have too few carrier options now, why would any smart biz person enter the health insurance biz under this scenario? We need more carriers, not barriers to more competitors.
    MLR’s will force Customer Service, for a product people already don’t want to pay for, to move to India, further eroding people’s view of insurance.
    Where are the MLR’s on the Doc’s, Hospitals, and Pharmaceutical companies? That’s where the healthcare costs are.
    Insurance carriers are a ‘convenient’ villian to get PPACA passed, but PPACA doesn’t solve the problem – read Joanna’s article above.

  5. Opposite Says:

    So, I have to call out a few points here “Thinking Producer”. You are diluting your argument by making too many at the same time. In back to back sentances, you point out that Texas has the most uninsrued individuals of any state and that individual products are notorious for paying out a low percentage of benefits. Which point are you trying to argue here?

    Health insurance is a business…period. The job of their management is to turn a profit. However, you should compare profit margins by industry, specifically under the broad umbrella of health care. Health insurance companies are not making the huge profits that you think they are; the numbers happen to be large, but the percentages are not by comparison. Just check the Fortune 500 list of most profitable industries and you will see that Health Insurance companies fall far behind many other industries within health care:

    Ranking-Industry-Profit Margin

    3 Pharmaceuticals 19.3
    4 Medical Products and Equipment 16.3
    22 Insurance: Life, Health (stock) 4.6
    30 Health Care: Pharmacy and Other Services 3.0
    34 Health Care: Medical Facilities 2.4
    35 Health Care: Insurance and Managed Care 2.2
    39 Wholesalers: Health Care 1.3
    47 Insurance: Life, Health (mutual) -3.0

    The profit margins for the insurers are already pretty low (or even negative in the case of mutuals); they aren’t pulling the wool over anyone’s eyes. Suppliers and pharmaceuticals are where the large profit margins lie.

    Oh, lastly, the reason we give Supreme Court justices their seats for life is to avoid exactly what you imply above, that their decisions could be swayed by money.

  6. Thinking Producer Says:

    I am not suggesting that our health care “Mess” is solely the fault of the insurance industry. I definitely feel that ALL providers: hospitals,physicians, drug carriers, insurance producers and Insurance Carriers need to make LESS profit regarding health care. I’m not talking about buying or selling a Used Car here. I’m talking about providing quality health care at a reasonable cost to ALL USA citizens.

    PPACA deals with more than private carriers providing quality coverage. A large expansion of Medicaid is in the legislation to help our citizens with substantial income problems.
    Health care in the USA is extremely expensive as compared to other highly industrialized nations. PPACA also deals with methods to control the health care inflation which continues to flourish in our system.

    I wasn’t suggesting the US Supreme Court is swayed by $$$$$$$, I was suggesting that the average Joe can be swayed by excessive, distorted political Ads paid for by those who can afford to promote their own selfish interest with little or no regard for the welfare of our citizens in general. Hopefully the 5 Supreme Court justices who sanctioned Unlimited Corporate political spending in the “Citizens United” case will NOT kill the opportunity for “SOME” change in our health care system generated by our US Congress in passing PPACA. Conservatives ONLY detest activist justices when it harms their agenda. The Roberts Court appears to be doing more than calling “Balls & Strikes” regarding corporate interests in our society.

  7. Sam Says:

    Nice article. But, an important point needs to be made here. Health insurance is not in the business of health – it is in the business of insurance. And, another alternative does exist.

    There is a new movement, Direct Primary Care, and it is gaining speed rapidly. Individuals and employers contract for health care directly with primary care specialists, without going through the insurance middleman, and for amazingly low cost. These practices charge as little as $59 per month, take care of all primary care needs, and make their profit in volume. For care outside general medicine, insurance with a high deductible is paired, sometimes linked via an HSA/HRA.

    There are states that have passed legislation for these practices, and Congress has also passed laws in support, as these Direct Primary Care practices reduce health care costs. The fastest growing DPC company is MedLion out of California, and they are going nationwide.

    Insurance was always meant for the surgery, not for the sinus infection.

  8. Silence Dogood Says:

    I feel like we need to look at the bigger picture with all of this. “Thinking Producer”, you speak of wanting to allow this reform to occur to have an opportunity for “some” change. There will be some change, but neither result is particularly appealing.

    This reform, as of 2014, will not allow an insurance company to deny a person from receiving health insurance at an ‘affordable price’. This in itself is enough to kill the bill because it isn’t fiscally possible. An insurance company is essentially legalized gambling. It plays the odds that it will take in more money than it pays out in order to continue operating and it makes these determinations based on the risk of its’ clientel. If it can not discriminate, it will not be able to take in the necessary capitol to cover the pay-outs. Thus the result:

    1) The company will go bankrupt.
    2) As stated above, the comopany will have to leave certain markets to avoid catastrophic loss. This would result in people having to “a-la-carte” purchase their health insurance and leave potential gaps in coverage if there are no companies catering to specific venues.

    Either of these options would spell disaster for the health insurance industry. So yes, we do need reform, but the option on the table is absolutely NOT what this country needs. The “some” change you seek for americans in need will not come from this bill as it is currently written. I agree that americans need help with affordability, but the approach to the problem is not correct.

  9. michael duncan Says:

    Tag days for insurers, the fourth largest insurer in the US, HCSC of Illinois, posted profits foir the last two years of 1.1 and 1.2 billion dollars for 2010 and 2011 respectively ( BC BS of Illionois ). Dominant players in a given region are the problem since competition goes away, by the way BC BS of Illinois owns Texas, New Mexico and Oklahoma BC BS plans.

    Insurers such as HCSC hold providers hostage with PPO discounting whils not passing all of the savings back to the buyer. Simply put companies such as BC BS of Illinois hold back between 6% and 10% of our health care dollar.

    Disagree, look at their bottom line created on the backs of local individual and group consumers.

  10. michael duncan Says:

    Tag days for insurers, the fourth largest insurer in the US, HCSC of Illinois, posted profits for the last two years of 1.1 and 1.2 billion dollars for 2010 and 2011 respectively ( BC BS of Illinois ). Dominant players in a given region are the problem since competition goes away, by the way BC BS of Illinois owns Texas, New Mexico and Oklahoma BC BS plans.

    Insurers such as HCSC hold providers hostage with PPO discounting while not passing all of the savings back to the buyer. Simply put companies such as BC BS of Illinois hold back between 6% and 10% of our health care dollar.

    Disagree, look at their bottom line created on the backs of local individual and group consumers.

  11. Thinking Producer Says:

    Dear Silence Dogood~

    It is my understanding that PPACA does permit different age bracket rates in the legislation. The oldest age bracket may not have rates higher than 3 times the lowest bracket.

    Insurers would be able to change bracket rates. States would strictly review rates proposed. Federal software has been developed to make sure insurer rates are justified. Rates for women and men may not vary do to sex or health status. Exchange competition would be helpful. 80-85% pay out of benefits in relation to premiums collected is essential.

    Individual mandate would keep the pool efficient, not only packed with older, sicker insureds.
    Certainly heading in a better direction for the consumer….WHO should matter !

  12. GoMavs Says:

    Checkthe financials of stock companies – public records – normally between 3 and 6% profit – significant money, but a whole lot less profit than Apple’s 18%. Apple made $11 bil last quarter, and funnell a lot of profits overseas to avoid nearly $3 bil in U S taxes.
    So who is ripping off the public?

    Insurers generally have 6 age brackets for healthcare – lowest cost to youngest, and increasing as you age. Obamacare really socks it to the yournsters – doubling their rates due to the 3 to 1 max age bracket differential. They’ll be mandated to buy better coverage than they want, and pay 200% of the old rates. The penalty will be so much more appealing that we’ll still have a huge uninsured problem.

  13. Thinking Producer Says:

    Michael Duncan~
    I understand where you are coming from, however a well supervised insurance exchange could help control the problems you mention. Your point does show why a totally “Free unregulated health insurance market” helps corporate profit levels at the expense of USA insurance consumers.

  14. Brian Says:

    The real question is why do Americans in general and the healthcare industry continue to fight over private healthcare? If the system was made public (run by the government) as it is in most other countries, the problems would disappear. But that’s the other side the healthcare providers don’t want you to know either, they will go out of business if the government runs the medical system. 3-6 cents per dollar of premium is better than 0 cents per dollar I suppose… People complain over the ever-increasing costs, yet don’t want to go the extra step and just have a safe public system. So this is what you get, one side complains about costs, the industry complains about how unfair the law is. The government already educates your children, picks up garbage, delivers drinking water, takes care of roads etc etc etc, what is the debate over public healthcare? You get sick, you go to a doctor and don’t pay. End of story. Don’t complain that the lion keeps attacking you if you won’t put him in the cage.

  15. Silence Dogood Says:

    ~Thinking Producer~

    Your arguments are compelling, but not very realistic.

    You say that adding these restrictions on the insurance companies will benefit the consumer and yes I suppose they would, but they inhibit the company’s ability to charge what they would need to in order to cover what they pay out. With the cost of health care, the premiums needed would fall into the “unjustified” category. Companies can NOT continue to operate if they can’t discriminate, it’s part of the business. As Sam said above, this is a business of insurance, not health. Insurance companies aren’t designed to subsidize the costs of health care for all americans, they are there to help people when catastrophic things occur.

    Secondly, you say that the individual mandate will keep things balanced. I can’t tell if you haven’t thought it through or just don’t understand the concept. The PPACA currently has a penalty in place for the individual mandate of $900 per person and $1,900 per family. Average statistics place health insurance at $6,000/year for individuals and $15,000/year for families. How many families are really going to pay $15,000 over $1,900? That’s right, they won’t. Which means that millions of people are going to continue to go without coverage and drown the system in unpaid medical bills. This in turn forces hospitals to raise their prices to offset costs, this in turn raises insurance premiums and causes more people to have to drop their coverage because they can’t afford this. This is the spiraling catch-22 that we are currently in and mandating people to buy insurance or face a trivial penalty is NOT going to fix anything!

  16. Shaun McCarron Says:

    Nice article Joanna, although I’m not sure the folks out there would feel very bad that the insurance companies making a 3-6% profit, especially in this economy. The state of healthcare access in the United States is indeed troubling. Some 50 million folks remain uninsured, and we find ourselves playing partisan politics with an issue that is far too important to continue to ignore, instead of fixing a problem that could crush our economy and our way of life. The average cost to insure a family of 4 is over $14,000. If a person makes $15/hour, works full-time, they take home less than $24,000, and that’s before paying for health insurance. Do the math. The status quo no longer works.
    For me, this issue is a personal one.

    In 1994 I was diagnosed with cancer, stage 3b. Over the next 18 months I endured aggressive chemo and radiation treatments, and in spite of everything I was told, I beat the odds and survived. My group insurance policy paid for everything, less my out-of-pocket expenses. I was very thankful that I had insurance, and very thankful that my doctors were in-network! I have accomplished things in my life, but conquering the cancer ranks up at the top.

    After surviving cancer I decided that my life needed to be lived, not just walked through. I started doing things I only talked about before cancer, things like going back to school, things like becoming a winning crew chief in NASCAR. A year ago I also started my own insurance consulting firm, specializing in small employer groups, individuals, etc. We are indeed in the thick of things when it comes to access to healthcare and insurance. Because my company is a start-up and we are not drawing a normal salary yet, and because we only have a handful of employees (only 2 full-time), we like so many of those companies that ask for our help, slip through the cracks of tricky legislation and carrier underwriting rules that keep us from qualifying for group insurance. I have also been declined by every carrier for an individual policy. While I can always apply for the high risk pool insurance, the premiums are extremely high and the coverage is minimal at best. This is the reality of the current state of healthcare access.

    So, while partisan politics takes the stage, and lost becomes this very important issue, I like so many others, wait to see what happens. And while I wait, my reality when I wake up each morning is hoping that I don’t get sick again. That is all we can do at this point. We hope that Washington figures it out and does something productive about it. We hope that partisanship gives way to concern, ownership and practicality. We hope someday that folks like me, folks that are willing to pay a reasonable premium for reasonable coverage, will have access to healthcare and health insurance.

    TODAY so many just like me, and those even less fortunate, cannot get insured. TODAY so many like me are losing everything they own in an effort to spend down assets and qualify for Medicaid. TODAY so many like me felt a lump or other symptom and aren’t doing anything about it, simply because they can’t afford it. TODAY millions ignore acute conditions that most likely will become chronic and more costly, so that they can pay the mortgage or feed their families. Yes, this is personal, not just for me, but for all of us. TODAY we need a solution, not more partisan politics.

  17. Practical Solution Says:

    explain to me why if the gov’t wants to do something, they don’t just help with Research and Development? Companies cry poor because of, and prescriptions and MRI machines are outrageously priced, resulting in an MRI for a guy with a hang nail to pay for the things. I’m afraid to say that our country is too large to have an efficient solution to health care. Sad but true. The Medical Loss Ratio is such a far cry from what is needed, it cuts out people that sell the product! Let’s just sign everyone up online!

  18. Scratching My Head Says:

    I, like most people feel health care reform is necessary. However, not the way it’s being done. A lot of the blame lies in the medical field. I had a 10 minute laser eye surgery and the doctor charged my insurance co. $7600. More people could afford insurance if the companies could charge lower premiums from not being over billed. Doctors could charge less if malpractice insurance wasn’t so high. Health reform as it stands is designed for a minority in which the majority is going to have to help foot the bill for them. Many of the uninsured are uninsured by choice. They simply opt not to buy it even if it’s available to them. Either because they feel they can’t afford it or are healthy and wouldn’t use it.

  19. Daniel Says:

    This whole thing seems to me to be manufactured. We need to get over the fact that health insurance is a right. It is a business, and should be profitable. The way it is profitable is to provide services at a price that a segment of people will buy because it meets their needs. That’s it. If another segment can afford, or chooses to purchase something that meets those needs. There is a premium for this service, known as profit. All should aspire to cover their families, based on needs, not wants. So go get what you need. Take control of that need. You would see costs fall into line. If your doctor or whatever prescribes something understand it before you buy it. You decide the need. An example, chiropractors routinely have you get a set of x-rays before they touch you. Why? I tell mine I don’t do that, I save hundreds a year just on that.

  20. Thinking Producer Says:

    I appreciate YOUR comments. You may help some of our readers realize that in the USA if you are not fortunate enough to work for a large employer with a quality health plan, in most cases the individual market product is not only very expensive but in most cases provides inferior benefits.

    As for Daniel~ You may feel its fine for millions of our citizens to have inferior or no health coverage, I think your attitude contributes to the “I’m OK , you’re on your own infection” that too many Americans have caught. I feel our country should be better than that!

    The Status quo seems to be what many insurance producers cherish to protect their profit margins.

    I have faith that change must and will occur. PPACA deserves a better fate than a 5-4 destruction by the Roberts court.

  21. jon Says:

    I found your article to be most [word deleted] as your article is opinionated and non supporting facts everything from 3-6 cents to whether the states of Utah and Mass didn’t accomplish. By your style of writing it is the reason why so many people are so confused and the purpose of writing your article for carriers or lobbyists or whatever other bureaucratic reasons are weak.

    As an agent I am supposed to be against it for compensation purposes as much as the carriers, but even I know that it is better to have major medical availability than by way of your article to believe its a weekened watered down version. You should be ashamed or at least do the job right and get your facts not opinions.

  22. Chuck Says:

    Brian says that the government already educates our children, picks up garbage, delivers drinking water, and takes care of our roads. True. But they do so very inefficiently and very expensively. The same thing would happen with single payer.

  23. GoMavs Says:

    Please do some research before you waste peoples time listening or reading your uneducated opinions. It appears you have simply replied with emotion and no logical facts.

    I’ve also found that people that are losing arguments turn to personal attacks since they have realized they can’t win the debate – as Jon has shown.

    I question whether he’s actually an insurance agent with so little knowledge of the biz.

  24. mike kehler Says:

    I’m a Canadian, with a Canadian perspective of health care. Our health care system is flawed, wait times are long, you have to be your own advocate in the system to get the services you require, however; after your 6 hour wait in the emergency room, the service you recieve is free. Man, Woman, AND child get their medical needs taken care of. After you are born, the cost of coming into this world will not hang over your parrents heads for 10 years while they attempt to pay off the hospital bill. It isn’t the best system, and it is understood there are better treatments for some instances available elsewhere (specifically in the states).

    What people in this debate seem to forget, the insurance companies mandate is to make a profit, the mandate of the government is to uphold the constitution and protect the people under it’s domain from powers desiring to take those rights and freedoms away. The intention of universal healthcare was hijacked by the republican controled congress who desire that everyone fend for themselves, unless you are wealthy or are a corporation, then there is billions in aid and bail out and corporate socializm available, all you have to do is ask.

    In Canada, we understand the right of life includes a healthy one, thus mandating the universal health care. Again, not perfect, but i’ve never paid health insurance and i’ve always had a doctor.

    1. right of religious freedoms: there are individuals in north America, such as Amish, Hutterite, some Mennonite sects and others who feel insurance premium itself is against their practices. What happens in these situations.
    2.Amendment 13 of the constitution: “involuntary servitude” is exactly what this law would do. Americans would be involuntarily serving a master who desires profit and not our well being. I thought slavery was abolished???

  25. SSSilberstein Says:

    Chuck, I believe that Medicare and the VA health care systems are being run more efficiently and less costly per patient care than is private industry. You should check on that. If I’m right, how would then think?

  26. John Spek Says:

    As always with these conversations, the idea of government run or single payer gets floated

    We already have that

    VA is government run, government managed and government paid
    Equipment is old and not as accurate as new equipment, processes and proceedures are out of date, and 6,000 people were infected by one sitiation last year
    Current Drugs are not available
    Staffing and consistancy are short supply because wages are sub par

    Medicare is another
    cost is almost 15,000 per insured, for a limited benefit package – details how limited
    HHS 2012 budget shows the numbers,

    Medicaid is at over 12,000 per person

    100 million are on one or both of those programs

    but there are costs for medicare and medicaid that are off budget – like the worker salary, benefits and retirement costs, as well as the GSA costs for the facility and services

    so add 15 – 20% to the costs listed above

    here is the problem –
    100 million are on Medicare and Medicaid – they contribute 0.00 to that cost

    230 million more men, women and children live in the country, and they need to pay for their health care costs AND the costs for the 100 million

    but average household income is below 50K
    (so average adult income is under 25K each)

    how can you fund the 100 million people on the backs of 230 million?

    so where does the money for a great social program run by a large government entity come from?

  27. GoMavs Says:

    I suggest we go to a single payor ‘HIGHLY RATIONED’ healthcare system for all, paid for by the taxpayers.

    Those that feel the need and can afford, will buy supplements to get better more timely healthcare.

    You’ll have Federal Facilities and you’ll have Private Facilities and you’ll be able to tell a marked difference just by looking at them.

    We already have 60 MILLION people on Medicaid, then add Medicare, VA, Chips, etc, and you pretty much have a single payor system now, without the RATIONING.

    Seniors have a GREAT deal – they paid in @ pennies on the dollar and are now getting 300% of the healthcare their parents did, all on the backs of their working kids and grandkids. Seniors only pay 25% of their cost of care, about $2900 of an average $13,000/year EACH. The rest is subsidized by the taxpayors and the COST SHIFTING of UNDERPAYMENTS to providers, who in turn OVERCHARGE private pay and insurance companies.

    It’s a terrible system the Seniors pretty much don’t know about and would scream if they knew they were placing such a burden on their kids/grandkids.

  28. Captive Says:

    I have read most of the above comments and the John is right on. Some of you feel that the VA or Medicare systems are being run efficiently and less expensive??? where are you living. I have had relatives in the VA and if you ever walked into the typical VA hospital and then walked into a hopsital that is privately run, come back and tell me that they are one in the same. I just don’t see why so many people feel that there is this huge problem. Yes there are uninsured people, there will always be uninsured people, this is a country that made up of people that can’t and can afford health care. Healthcare reform is making the cost of health insurance more epensive not less. Joanna is right, attempting to make this a better system via Insurance Premiums is treating the symptoms not the disease which is the COST OF THE CARE ITSELF! I think she is right on track and this is going to be another large waste of tax payer dollars which we can’t spend at the moment. Why does everyone want a world where we are all treated the same I don’t get it.

  29. GoMavs Says:

    The Federal Gov’t has spent nearly $1 TRILLION dollars so far on Obamacare and the Supreme Court may declare it unconstitutional in the next 3 work days.
    Not to mention the jobs it has delayed as biz want some answers as to what the rules will be going forward before they hire people they can’t afford to compensate due to the increased cost of mandatory health insurance or NON-deductible penalties.

  30. dan Says:

    wow, some of the ignorance, from what i assume to be other benefits professionals is outstanding. for those who believe health insurer profit margins are low, how do you explain the huge bonuses? how do you explain those gaudy broker events with live bands and a feast of the finest food and wine laid out for you? sure health insurance is a business, but that does not mean the business model in it’s current form is correct. name another industry that shuns their customer when it’s time to use the product that they have paid for? let me remind you that fire fighting was a business as well. the current firefighting model is much better than the previous one, where if your house was burning, a medallion at the door determined whether or not the firefighters responded. several catastrophic fires (and dead americans) later, people determined it was unfair and a more equal business model was needed, enter public firefighters. for those bashing on medicare and medicaid, you do know that the reason for those costs being higher is the actual health condition don’t you? veterans, the elderly and the disabled all have higher utilization of services for obvious reasons, despite this, the pepy cost of care is still less than that of private insurers. it is important to point out that improvement is a science and that every system is PERFECTLY designed to achieve exactly the results it gets. can we all agree that the system’s results were not adequate? it’s not as if people use health care recreationally. will there be abuse, yes, but there is abuse now. in fact the ACA has already identified and prosecuted “providers” who were bilking the tax payer of billions of dollars. lastly, where is american exceptional-ism in this debate? it’s a moral issue, and the fact that we ware the only western industrialized nation without adequate health care coverage for all its citizens is shameful. at the end of the day, those who rail against ACA because of the costs, should look at the costs of inaction. nearly all wage increases over the past decade have been gobbled up by the rise in health insurance costs. and if you think the ACA is expensive, perhaps you should take a look at the defense spending and the fraud and abuse on that side of the ledger. stop being such greedy and scared little fucks who don’t want to help your neighbor, but expect that same neighbor to lay it on the front line for you.

  31. dan Says:

    one last point, and my only beef with the ACA. it only addresses half of the problem. it addresses cost and access, but does not adequately address the health of our citizens. WE NEED TO BE A HEALTHIER SOCIETY. with better health, utilization of health services decreases. with lower utilization costs come down as well. so drop that doughnut and go for a run and drag that chubby kid of yours with you, make it a value, not a talking point.

  32. civisisus Says:

    GoMavs, pulling big fake Fox #s out of your ass will produce a health condition called hemorrhoids. While you’re making stuff up, why not make it THREE trillion? You can’t look any stupider.

    There’s plenty that can and will be made better in health reform. Making dumb stuff up (like the 5 things reform advocates don’t want you to know) is all about retreat, and zip about tackling the challenge.

  33. Thinking Producer Says:

    Go Mavs~
    It is my understanding that Employers of less than 50 employees under Obamacare are NOT penalized for not offering health insurance coverage to employees. Such employees would be able to use the Insurance exchange to select their own coverage & get financial help with premiums depending on their income.
    Its amazing how 250 Million Dollars in Negative Ads TELLS SO LITTLE regarding the ACTUAL law… or “Throw enough [word deleted] up against the wall and some of the [word deleted] sticks.” This is legislation with over 2000 pages.

  34. stan kays Says:

    No one is talking about what has really pushed the high cost of healthcare, and will continue to do so unless significant changes are made; and that is the fact that doctors/hospitals, etc. are recommending unnecessary tests, treatments, proceedures daily, etc, just to avoid lawsuites. Most doctors today go to work with the goal in mind of not being sued.

  35. Don Says:

    Pennies on the dollar you say. I guess your preference would be dimes on the dollar. Unfortunately in the world of P&C insurance, 3 to 6 cents is right where peoples profits are supposed to be. I guess health care insurers deserve more. Really Joanna. Your article may be well intentioned, but when you fling silly red herrings like that out there, you lose credibility.
    Focus on what can be done to fix the problem instead of being just another nattering nabob of negativism. Thanks Spiro.

  36. Ross Schriftman Says:

    If the Supreme Court declares President Obama’s Health Care Law unconstitutional will he simply ignore the decision and continue to implement Obamacare? After all, he has required insurance companies to pay for contraceptives for certain employer groups without any provision in statute and he has decided to change immigration rules without a new law. If he ignores laws passed by Congress or creates his own why would he not ignore a ruling from the Supreme Court?

  37. John Spek Says:

    @ Thinking

    there is a penalty

    if the employer offers coverage, and the worker buys on the exchange – the employer is fined based on the number of workers, not the number of workers who went on the exchange
    does not matter if they want another company, or a differant network, or they made the switch for out of state coverage needs

    Since Small business is the major employer –

    what does that do for small business group coverage?

    estimates are that up to 62% of working families could qualify for federal funding on health care

    add that to the 100 million already costing taxpayers

    Who has that money?

  38. John Spek Says:

    No one has yet to come up with a good response to

    Where will the money come from?

    since the government already funds health care for 100 million, at over 15K per person
    30 million more will be added to medicaid by this law

    1/3 of the U S are getting a taxpayer funded healthcare ride

    plus another 30 million will age onto medicare

    and up to 62% out of 170 million households of working families will also get full or partial taxpayer funding to buy insurance

    while 47% of working households pay no taxes other than FICA, and many get funds back in EIC

    Where will the funds come from?

    Average household income is under 50K per year

  39. Thinking Producer Says:

    I enjoyed your comments. When the 3-6 cents per dollar profit for Health insurance carriers is mentioned…that MUST be after all expenses are deducted. Executive salaries & Bonuses come out BEFORE the net profit.
    I’ll bet when the payout in benefits to policyholders is lower than 80-85% that additional gross profit pays for excessive commissions to producers. Could it be the 3-6% left after ALL expenses come out go to the stockholders? 3-6% doesn’t sound like much when the calculation of how such net profit is determined isn’t disclosed !

  40. GoMavs Says:

    Once again, if you don’t have facts to add to the conversation, spare us your unsubstantiated emotional outbursts.

    Cost of Obamacare: Bloomberg News of Congressional Hearings:
    Coverage continues today of Medicare trustee Charles Blahous’ report charging that the Affordable Care Act will increase the deficit substantially and that CBO’s methods do not show this because its accounting rules count some savings twice and because it must assume that Congress actually will follow through on the cost-saving measures in the law. Most of the coverage is devoted to Blahous’ argument although nearly all of it gives some coverage to the Administration argument that Blahous is violating standard government accounting rules and specifically to a blog post by Jeanne Lambrew, deputy assistant to the president for health policy. Bloomberg News (4/11, Faler) reports that Balhous argues that the Affordable Care Act “will add as much as $530 billion to the US budget deficit over the next decade,” and that “Blahous rejected estimates by the Congressional Budget Office that the 2010 law will improve the government’s finances,” because “lawmakers are unlikely to enforce many of its cost-saving provisions,” and “are double-counting savings used to finance expanded coverage to the uninsured that would be needed to shore up Medicare even without the” ACA.

  41. Thinking Producer Says:

    John asks, “Where will the additional $$$$$$ come to fund Obamacare?” One source is a new 3.8% percent tax on investment income for individuals making $200,000 a year or couples making $250,000 a year. The 3.8% tax is applied to unearned income ABOVE the levels of earned income I mentioned.
    Medical device manufacturers have a 2.9% tax on medical devices with exemptions for eyeg;lasses,contact lenses & hearing aids.
    In 2013 individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax …2.35% rather than current 1.45 %
    This is NOT the total source for new revenue for Obamacare. However, those who have substantial incomes would definitely be paying more in taxes.

  42. Ross Schriftman Says:

    “Thinking producer” mentions excess commissions being paid out. Does he/seh know something I don’t. My commissions have gone down per case over the years. Not sure why “Thinking producer” doesn’t use his/her real name.

  43. Ross Schriftman Says:

    After last night’s last minute letter by President Obama to invoke Executive Privelege concerning Attorney General Eri Holder not turning over documents to the House Oversight Committee concerning “Fast & Furious” I am even more concerned that the President will ignore the Supreme Court ruling on the health care law.

  44. Bbassham Says:

    Let’s give the same Government that runs the Post Office, Medicare, Medicaid, and Social Security total controll of health care. Do you really believe they will do this any better than any of the other programs they are running? When has government ever been able to do better then private enterprise. The biggest problem with health care now is the part the government already managing. Check out the cost of malpractice insurance that covers health care providers. Whatever happens if the government controls it, you can bet it will be complicated, broke and corrupt.

  45. Susan Says:

    Companies only make .03 to .06 on the dollar? Really? Then how do they manage to pay the CEO’s so much? They earn salaries in the millions of dollars each year. Peoples health should not be a for profit enterprise. I say Public health care is the answer.

  46. Thinking Producer Says:

    Dear Ross~

    I seem to remember “George W” revoking executive privilege a number of times during his “Great” tenure as President.

    Whatever the Roberts Court does with Obamacare, Obama will follow the law.

    I gather you don’t appreciate MLR requirements.

    If my memory is correct, Texas is one of those states where an 80% MLR requirement is too high for Health carriers in that state.

    My other name is “Parity Fanatic”. I fought for equal Health insurance coverage for both mental & physical illness in our country. After MANY years, THAT equality in coverage is heading in the right direction.

    We as insurance producers deserve reasonable compensation. Consumers deserve first rate coverage at a reasonable price.

    Not EVERY insurance producer will support Romney in 2012.

    Many insurance producers don’t forget the Bush Years of 2001-2008!

  47. Dr. Bernard Says:

    As one has said earlier, Obamacare pretends to address health care cost yet it fails miserably at that. It does not reduce any cost, it only takes over the insurance side of the equation, ignoring the source. Health care is too expensive in the USA.

    Hospitals are 5 star luxury hotels. Good equipment, perfectly adequate, gets replaced by the newest and more costly new gadget, an unnecessary expense. But you could get sued for not having the newest gadget.

    A large portion of the costs generated are for legal protection against a litigation-hungry horde of attorneys and patients. Tort reform would reduce malpractice exhorbitant premiums (billed in doctors’ fees) and eliminate a large part of the testing & procedures that are preformed exclusively for legal protection purposes.

    Drug patents could cover classes of drugs and avoid the “new” drugs that are the same as old ones except for one minimal twist and sell for 5-6 times the price of the old one with NO health benefit. But you can get sued if you don’t use the newest drug.

    Barak Obama and his wife are attorneys, like most of their friends and presidential appointees. Will they push for tort reform and irate their peers? Of course not. The President has avoided this topic like the plague. This would be like attacking your own species. Leave the wolves alone and blame the shepherds for the cost of building fences..

  48. Kent McAbee Says:

    Self-serving propaganda.

    The fact remains that health care costs are the highest and health care delivery the most unequal in the US compared to other wealthy nations.

    Our market-driven health care system creates too many losers to be morally justifiable. Millions with no insurance. Millions who lose all they own when a family member gets a catastrophic condition. Not to mention the other hidden costs to our nation when people cannot get treatment for lesser medical problems.

    I agree with one argument of Health Reform bashers: being required to purchase health insurance is unfair. But I blame that on the fact that the government option in the plan was dropped so that the bill will pass the corporate controlled right-wing congress.

    Your article was self-serving propaganda.

  49. GoMavs Says:

    Susan, Read the public companies accounting reports – required by the Securities and Exchange Commission. The big dollars you’re questioning being paid to top health insurance company employee’s are mostly stock and stock options – it’s investors money – not insurance premiums. The stockholders should scream about the high stock options paid CEO’s because it dillutes the value of their stock, but insured are NOT paying it.

    Don’t feel bad – even the President doesn’t have a clue as to how business works.

  50. Mark Miller Says:

    Your 5 items were 100% on the mark. Nice job. Out of the entire Bill, there is probably less than 5% that are worthy items to keep but still have no definition on how it will be carried out. For example, transparency of costs for all care.

    A lot of discussion in the bill discusses preventive care but all of the “Preventive” items in the insurance plan descriptions are “detective” and none are preventive. The service detect that you have diabetes but don’t cover preventive measures to loose weight for example.

    One problem is that very few will pay for true preventive services, like health coaches to keep you from being over weight, as an example. No solid preventive measures have been touched on in the new law.

    One comment was “then what would you do different”? I would say pick one problem from a list that relates the the cost of care (not capping the finance of health care), fix the problem very well, then move on to the next top priority item. Don’t try to eat this elephant whole (fix the whole problem at once as attempted with Obama Care), as it will likely never be done – especially with the school yard kid-like antics going on in congress now by both sides.

  51. Dave McCarty Says:

    I write in support of comments by BRIAN, DAN AND SUSAN. Government run healthcare costs are mostly driven by patient’s serious health issues disproportionate to the general population. I am a classic example of a vet utilizing the VA healthcare system with a chronic condition that makes me uninsurable. The system is not perfect, as the Canadian referenced, it can be frustrating at times and it is not as pretty an environment as most profit based facilities but it’s dependable healthcare delivered by caring staff.

    The business sales model necessary for profit based facilities demand big bucks for PR/marketing, beautiful remodeling initiatives and expansion only for the sake of expansion. The same is true of insurance companies when Healthcare Reform immediately caused rising premiums in reaction to initial admin costs(form changes,communications & staff training)and continue in anticipation of PPACA roll out.

    Negative backlash is already evident in willingness to accept a penalty instead of mandatory health plans, cuts in Medicare-Medicaid provider reimbursement rates causing providers to only accept private pay sources and less competition as insurance companies withdraw from specific markets. My outlook is dismal in regard to the general public being capable of seeing the truth in these matters.
    The middle class are quickly disappearing in the face of healthcare cost being the #1 reason for new bankruptcy. The take away from my frequent public speaking events about this subject is that communism and socialism do not have a middle class and are not stable governments as a result. Our government is heading down the same path and the ‘powers that be’ are perfectly content if the middle class embrace their propaganda campaigns and do nothing but bitch to each other while the rich get richer.

  52. Every Aspect Says:

    I am a person who has every aspect, I work in insurance, I have worked in the health care industry, I am a healthy individual who carries health insurance, I have a mother who is uninsurable, in-laws who are on medicare. So to say the least I have put a lot of thought into health care reform.

    Fact is insurance companies are in business to make money, they are starting to cut agent commissions, some completely out, for selling health insurance. This will eventually cause agents to get out of health insurance business completely, making it harder for the individual to find an agent to help determine what is best for them.

    In Arkansas they have a program called Chips, Overall it is not the best because premiums and deductibles are very high. This is a program put in place to insure the uninsurable. I think instead of forcing insurance companies to take everyone reguardless of heath, maybe do an open enrollment period 1 month a year that individuals can get insurance no matter their health. The rest of the year if they are not insured they must join a program like Chips and be required to stay on it or pay the cost out of their own pocket. The fact is if we say that you can get insurance at any time no matter your health. Why would a healthy person ever buy insurance. Why not wait until you need it then the insurance company has to take you. Maybe the goverment could give tax break for insurance premiums making it benifical for the healthy to get insurance.

    Health care cost are going up, fact is when you go to hospital you will pay $8 for 1 Asprin. They do this to help cover the cost of all those who come into emergency rooms and or don’t ever pay for thier hospital bills, maybe hospitals should require payment plans based on what the individual can afford even if it is just $5 a week instead of just writing it off and putting the cost on the rest of us. If law stands and they say everyone is required to have health insurance, are we going to refuse care to those without? What if they make to much for things premium assistance but not enough to afford insurance that is mandated?

    They say require employers to cover all employees fact is this puts a huge strain on small businesses. If the fine for not covering employees is not more than cost to cover them they will opt for the fine. And in some cases either way may put them out of business.

    I think healthcare reform was and is needed. I would love to see something in place where everyone could be insured and they could afford it. My Mom is on Chips she pays over 500 a month with a 10,000 deductible. Once you are on Chips if you ever go off you can never get it again, Why don’t goverment put something like that in place for the uninsurable with lower deductibles and premiums. Why not have where all screenings and wellness checkups are free. Maybe we could catch health issues sooner. Maybe require people on Food Stamps to purchase healthy foods instead of sodas, potato chips, candy Etc. I don’t have all the answers but I think the current program was rushed and had stuff added that should never have been added and did not address many issues that it should have. This is just my opinion.

  53. Ross Schriftman Says:


    The health care law was passed by a liberal Democratic Congress; not a right wing Congress. It narrowly passed the House with a vote of 219-215 with many Democrats voting against it and virtually no support from any Republicans.

  54. Ross Schriftman Says:

    Dear Parity Phanitic/Thinking Producer,

    Just for the record a support AND campaigned for Barack Obama. I opposed George Bush and ran for State Rep. as a Democratic in 2004. I have served as Leg Chair for the PA Assoc. of Health Underwriters from 1993 to 2003 and have worked on real reforms to try to make health insurance affordable. Congress and Presidents have ignored NAHU’s proposals. Instead they try and micromanage the markets which have driven up rates. MLR raises costs. The $1 billion in refunds equate to 3/10th of 1% of annual premiums and have caused a tremendous amount of time and expense. At the same time our Federal government spends $4 billion each day. That is our tax dollars much of it is wasted such as the estimated $60 billion of Medicare funds. This is where the focus must be.

  55. Thinking Producer Says:

    I enjoyed your comments. However Corporate interests control BOTH political parties since Corporate $$$$$$$ make it possible for our “Representatives” to WIN their periodic elections. The Roberts Court with its 5-4 Citizens United Case decision shows how important Corporations are to SOME justices on the current court.
    When the Dems controlled Congess in the early part of Obama’s first term, the “public option” died when SOME Dems in the Senate sold their vote to corporate interests…A good Example…Independent Joe Lieberman.
    Some other REAL Dems in the Senate also forgot they were DEMS when it really counted.
    So Obamacare….without a public option…became what was the only viable alternative. I might add PPACA (Obamacare) is still better than WHAT WE HAVE NOW….

    Ross- Happy to learn you are not a 100% Republican. I disagree 100% regarding Medicare. Traditional Medicare was and is the most viable approach to providing health care for our senior citizens. Time will tell whether the insurance industry (Medicare Advantage) without additional supplementary $$$$$$ from the federal government can compete with traditional Medicare.
    Some people believe that Health Insurance is a SPECIAL CATEGORY of coverage for our citizens which REQUIRES less profit in the entire health care system. I support THAT view.

  56. Striving for Wealth- My American Right Says:

    I am so saddened to see the comments from “Thinking Producer” and “Don Says” and “Susan”. If you were that CEO you would know how hard you worked to get there and guess what you DESERVE it! Thinking you say: “I definitely feel that ALL providers: hospitals,physicians, drug carriers, insurance producers and Insurance Carriers need to make LESS profit regarding health care”

    Are you serious? Do you know how many years of school and dedication a doctor must put in? And in America, where we have the right to pursue untapped wealth, you want to say anyone DESERVES to make LESS PROFIT!?
    What do you do for a living? Do you not want whatever business it is you are in to grow and be profitable? Oh… I know.. because your business is not in the spotlight, it’s easy to say make LESS. What if this was pointed at your business- I’m sure you’d be excited at being told to make LESS profit. That is what we call socialism and guess what IT DOES NOT WORK- PROVEN! Then you boast that the funds will come from those earning greater than $200k a year. Wonderful- penalize those who worked hard and made it, that will get this country going. Hey do me a favor and google North Korea and see how well they are doing.

    I’m shocked by how some of you folks view this. THIS IS AMERICA PEOPLE! Where you work hard to earn whatever you want, and NOBODY should tell you otherwise. If Apple can charge me $300 bucs for a phone, then guess what an Insurance Company is allowed to make some money too. Educate young people to enroll VOLUNTARILY because were not communist. PERIOD.

    Did you know that in the business insurance world, like liability and workers comp, those carriers also have their agents and execs go on wonderful trips to Europe, and they also have great expensive events. Just because that field of business is not in the spotligh- nobody says anything. Again with Apple, I’m sure their Christmas parties are pretty good- but they don’t deserve to be able to achieve that right “thinking producer” “don says” and Susan. Your nuts, and need to move to a communist country. I’m here in the greatest country on earth because I’m FREE to do and make whatever amount of $$ I want. Not wealthy yet, but I’m striving to become.

    Thank goodness for Go Mav and Bbassham…those are AMERICANS.

  57. ClaudieBoy Says:

    Right on Striving for Wealth- My American Right

    You are a real American and I am with you 100%. Socialism has failed all over the world in the past. However, some dreamers still have not “got it”! They would rather have others pay for their comfort. They should move to a socialist country if this is what they want. Or they are just jealous of other peoples’ success and blame them for reaping the fruits of their hard work. Parasite mentality. Sad that we have those in the BEST country in the world. Just do not let them win.

  58. Glenn Says:

    Why are costs going up elsewise?

    1. America is growing older, older means more cancers, joint replacements, heart surgeries that financially outstrip broken childhood bones.
    2. America is fat and getting fatter. More costs include diabetes, heart conditions, cancer, and joint replacements.
    3. America still subsidizes and then taxes tabacco, another major cancer contributor.

    But who wants to discuss personal responsibility? Healthcare should be weight and tabacco product priced. These are human choices and elections. Nobody forced anyone to be fat, and no one forced anyone to use tabacco.

    And how much would a healthy U.S. save in healthcare costs per year?

  59. Thinking Producer Says:

    Dear Striving for $$$$$$$$~
    Your comments remind me of the Conservative who thinks its fine for those without good Healthcare in the USA to rely on Hospital Emergency rooms for THEIR health care….THEY didn’t earn the right to quality healthcare under your thinking.

    I certainly am NOT against profit! The issue is…. our Health Care system is the most expensive in the industrialized world. Our citizens spend the highest amount of GDP toward health care of any industrialized country.

    Somehow I don’t compare Apple selling YOU a $300 smartphone made OUTSIDE the USA at a great profit margin for Apple with millions of USA citizens unable to afford quality Healthcare in the USA.

    I am an insurance producer selling all lines of coverage. You reject the concept that Health insurance is a SPECIAL INSURANCE CATEGORY that needs to be as inexpensive as possible. I don’t believe it is a Socialist plot to seek lower profit margins for ALL sectors involved in USA Healthcare system.

    Many of my clients are professional health care providers. I do believe that wanting our citizens to have affordable healthcare doesn’t preclude these providers from earning substantial incomes.

    I am reminded of the concept…the ETHICAL insurance producer should provide that service to his clients that he would recommend to himself if he was in that client’s IDENTICAL position.

    We work to earn $$$$$$$$$$. Making $$$$$$$$ doesn’t preclude the professional producer from wanting his product to be quality for his clients.
    My wish for “Striving for $$$$$$$”… Be concerned about more than making $$$$$$$$ for yourself !

  60. GoMavs Says:

    I’m surprised @ Thinking Producer’s comments on Medicare as it’s bankrupting our country. It needs to go the way of the defined benefit pension plans because that is what it is. Seniors paid in to subsidize their parents retirement healthcare at a reasonable price. If you compare todays Medicare benefits (all the healthcare you want, only the best, and RIGHT NOW) to a 401k plan (defined contribution) then an example would be that todays Seniors paid in around $400k, and it grew with earnings to $700k, but they are getting nearly $2 mil in healthcare benefits because the COST of healthcare has increased so much in the last 20 years.

    And guess what – the Seniors kids and grandkids can’t afford to subsize 75% of their care at these prices, in addition to the COST SHIFTING from the Federal Gov’t to the private sector.

    Medicare needs to change to a definded contribution – we give you money and you buy the right health insurance for you – have some skin in the game and be a better consumer.

    We also need to ration it – let the family decide if spending $250k in the last 6 months of life, trying every possible futile life saving treatment, at the cost of the families own future standard of living, for a 98% fatal prognosis and a miserable quality of life for the remaining months, is the wisest course of action.

    Harsh words? Necessary discussion – you bet. And our Politicians don’t have the stomach/courage to even bring it up as it bankrupts us.

  61. Shermdog in Wisconsin Says:

    Healthcare reform needs to be addressed but at the cost and competion level. This bill does not create competition or allow for cooperation to find solutions. Health insurance premiums are a direct reflection of the underlying costs. Published hospital and physician prices, published quality data, reimbursement based on costs, not savings or fee for service will do more in the long run. An educated consumer and a truly competitive market place for these services will help reduce costs in the long run, rather than stifle imagination and ingenuity by having a heavy handed government presence.

  62. qualified-to-comment Says:

    My wife and I have combined 80 years employment in doctor’s offices, ambulance services, hospitals, and insurance companies at various positions and levels. We have health insurance coverage – some paid by employers – some purchased privately – AND we have family members who we aid financially who have NO coverage – we know BOTH sides and views.

    Here is what is needed to fix the system –

    PROVIDE PATIENT/PROVIDER LEGAL REFORM (tort reform and others)
    A> limit damages to realistic amounts (similar to Workman’s Comp – you DONT get 6 million for a minor burn from the company coffee – you should get millions if an MD didn’t cure your cold – and prevent frivolous court cases and provide punishment for those who abuse the system)
    B> create a “contract for reasonable services” so that the person with the hangnail can’t be charged for an MRI that they don’t need – and the medical provider can’t be sued for not providing the unneeded services (unnecessary testing is one of the BIGGEST parts of the increased cost)

    A> eliminate tax breaks for investment in unnecessary equipment and facilities (tax code “benefits” can be the driving factor in unneeded expansion for a doctor or hospital – and once “expanded” the facility/equipment will be used and YOU will be billed for it
    B> forcing anyone to do anything by government decree usually just leads to resistance (and sometimes more) – don’t do it.
    C> make sure laws do not create de-facto service monopolies
    D> monopolistic government providers COST MORE than competing private providers (this is a FACT – they cost more because there is no reason to keep cost down)

    A> make “open” contracts between patient and provider and patient and insurer required – so that the patient can pick the level of service and insurance coverage without being forced into “packages” and restrictions by either the provider or the insurer.
    B> insure that legitimate (non-slanderous) documented statements about price and service can be made by all parties (patient/provider/insurer) in forums like “Craig’s List” or “Angie’s List”, etc.
    C> make sure that there are no limitations to providers/insurers ability to advertise services and pricing.
    D> Insurers – create a new “existing condition” limited term premium/rebate coverage that charges heavily up front based on risk but returns “unused” premiums when the risk does not becomes reality.

    IF all the above were in place NOW we would all benefit from the forces of a free an open economy on health care services – better and lower cost.

    Lastly – the uninsured – no hospital should refuse to treat immediate life threatening medical conditions in a patient – even if they can’t pay (this “cost of the public’s conscious” gets spread across all bills as a surcharge) – but providing on demand prevention services or immediate services for minor medical conditions that do not pose immediate threats to life is not a “public’s conscious” issue.

    Anyone unwilling to participate should not be forced.
    Anyone wanting to participate should be able to compare services and select them by any criteria they chose.
    Anyone who wants/needs participation but cannot afford it can get assistance, both financial and services, through local government and recognized charity sources.

  63. qualified-to-comment Says:

    Correcting my TYPO >>>>> I left out the word “NOT” regarding compensation awarded for an MD not curing a cold >>>> it should have read:

    A> limit damages to realistic amounts (similar to Workman’s Comp – you DONT get 6 million for a minor burn from the company coffee – you should NOT get millions if an MD didn’t cure your cold – and prevent frivolous court cases and provide punishment for those who abuse the system)

  64. Health care worker Says:

    Thanks Glen for pointing out that poor health in this country, is largely, our own doing. We are fat, lazy, eat poorly and then when we are diagnosed with a chronic conditions, we are non-compliant with medical advice. Just take a look at the 10 most costly diseases in this country – the list will shock you. We need to assume more personal responsibility for our health and stop simply taking a pill and charging it to insurance.

  65. Mike V Says:

    Just have a look at this

    You in the USA are paying for the bureaucracies of the Insurance companies. I am sure that in the USA if you can afford it you can get better care than anywhere else in the world but if you can’t…..

  66. Peter Ball Says:

    We do need to have skin in the game to be responsible consumers in healthcare. Transparency should be a requirement for all basic health proceedures. I differ from most in what insurance should cover. Regular services would be much less expensive if they were paid out of pocket. Just look at the relative cost for Lasik eye surgery and what those costs are compared with simple imagery costs. We can help consumers be valued healthcare purchasers by separating diagnostic medicine from procedural medicine for the significant and costly problems. Consumers could then look for centers of excellence for the proceedures needed and shop the total costs for those services. We would eliminate some unnecessary surgeries and the overall cost and efficiencies would be enhanced. Many other good ideas have been expressed but there is no doubt we have to get preventive care to those who can’t afford it and there is a societal benefit of doing so. I feel that county health clinics providing services or contracted private providers like Walmart would be more cost effective than an expensive insurance system for first dollar benefit. This PPACA is like buying oil changes and wiper blades for everyone but without the benefit of strong market forces. Let the consumers have skin in the game and we can actually do something to lower our healthcare costs.

  67. Patrick Kelliher Says:

    Thank God for the NHS and socialist medicine – it may not be as good as the best US health policies in terms of quality and extent of care, but the UK spends 9% of GDP on health compared to the US’s 16% while covering 100% as opposed to 90% of the population. What a drag US health care costs must be on living standards and its competitive position.

  68. Dr. L. Says:

    OK, but at what cost to the people of the UK who have sub-par medical care from all that I have heard of long delays and insufficient investigation & treatment. I have directly witnessed that in Canada because I am a doctor who graduated and worked in Canada for 33 years. I had to pay for my daughter to get an MRI in Buffalo, NY because she could not get one in Ontario for 6 months… yes, 6 months, while her neurologist suspected a brain tumor!!! Please do not glorify the lower cost of rationed care.

  69. Ross Schriftman Says:

    Dear Patrick,

    I am not sure what your experience has been with the British Health Care system, but you should take a look at the Beth Ashmore story about what happened to her Mom who died under their system:

    And this from the British Newspaper, The Telegraph:

    In nations that have global budgets there is a long wait for diagnostics and doctor appointments.

    Simply comparing overall healthcare spending to GDP does not tell the whole story. Our health care spending includes treatment for people from other countries including Canadians who don’t want to wait, leaders of foreign nations and undocument residents of the U.S. It also includes all the research, development and legal liability of our health care manufactures like the drug companies and medical device companies.

    We also have many problems that other nations don’t have as much of such as gun violence. What is the cost to treat young men shot in drug gang fights when they DON’T die at the scene?

    Furthermore, in our nation we almost have health services on demand. The doctors and hospitals will order what we need. At end of life many families wish to try every kind of treatment necessary to keep their loved ones alive. In Britain they have NICE which is the National Institute for Clinical Excellence. This governing body decides what treatments their citizenry receive or do not receive.

    Finally, here we have wonderful teaching hospitals and centers of excellence like Johns Hopkins, The Mayo Clinic and The Cleveland Clinic. I can’t think of a well known British hospital where people go to for a special treatment.

    We certainly have our problems here but many of them have been caused by massive government regulation on the state and federal level. Those rules primarily determine how insurance companies must operate, what they must pay for, how their consumer documents must read, what reports they must send to the government and how their agents can talk with their own clients. Our administrative costs are high because of all the rules. For example, there are 500 pages of regulations for the 9 pages in Obamacare that deals with Accountable Care Organizations. The State Exchanges will cost $30 to $50 million per year to operate on top of the cost of setting them up.

    Simplifying the rules and making them more workable is a start. However, where are efforts should most be focused is on the cost drivers in our health care system which include poor nutrition, lack of exercise, stress, alchohol, drug and domestic abuse, violent crime and a lack of health care literacy. All of us as Americans need to take charge of our own health care.

  70. Ross Schriftman Says:

    Dear Thinking Producer,

    I’m not sure why you disagree with my point about Medicare. What I said is that we need to focus on the waste and fraud in the program. Are you saying you are comfortable with the fact that an estimate $60 billion per year of our tax dollars are being wasted in this $500 billion per year program that helps millions of beneficiaries? My point was that so much time is focused on the MLR which so far has “saved” $1 billion which few workers will ever see and has caused massive amounts of extra work, expense and agrevation for our small busineses. This amount represents 1/3 of 1% of premiums collected. Medicare waste and fraud steels over 10% of that programs money.

    As far as supporting Obama that is past tense. One main reason I campaigned for him was that he was against the individual mandate and Clinton was for it. I thought (wrongly) at the time that he understood the economy, the consitutional and the nature of Americans to make their own financial decisions. Fool me once Mr. President. This year I will be voting for Romney.

  71. GoMavs Says:

    Ross, I just saw Beth about an hour ago and have forwarded her video to many many people. My point is you have a global budget for RATIONED helathcare for the masses, so this country can remain competitive with countires like teh UK, who only spend 9% of GDP on healthcare while we spend 16%.
    Beth’s mom would have had a supplemental policy that would have paid for and avoided the problems of Englands NIH rationing.

  72. Thinking Producer Says:

    Dear Ross~
    Regarding Medicare waste, I remember reading successful recovery efforts by the Obama administration regarding Medicare fraud. This is an area that definitely should be pursued…..fraud and waste.

    I find the individual mandate issue fascinating. For many years the Individual mandate was supported by the Republican party. After Obamacare became law in 2010, these same Republicans switched their position. They couldn’t win in Congress, so they decided to try to win in the courts. Chief Justice John Roberts during his Supreme Court hearings spoke of the court as an umpire merely calling Balls & strikes and relying heavily on past court precedents. If the court acts to destroy Obamacare with a MERE 5-4 decision, many astute observers will look at such action as a purely “political act” by a conservative majority that has put their political agenda ahead of the welfare of our nation.

    I find any comparison of the federal government requiring the purchase of Health coverage or penalty for not buying Health care as equal to the federal government ordering all citizens to buy broccoli, the purest distortion of when the Federal government SHOULD have the power to regulate interstate commerce.

    The individual mandate is a tool merely to get young, healthy insureds into the insurance pool. In order to cover pre-existing conditions immediately for all insureds, you need the healthy & the sick to both be insured.

    When some health carriers say they will adopt many of the PPACA reforms even if the law is declared unconstitutional by the US Supreme court…THEY never promise to cover the pre-existing conditions of all insureds from inception!

    It will take time and effort to improve our health care system. Real change will occur, you can count on that !

  73. Ross Schriftman Says:

    I’m not sure that simply having a supplement policy (I think you mean a travel medical policy which usually only covers emergencies) would have made a difference. The hospital still needs NSH to approve the treatment.

  74. Jeffrey G Kaplan Says:

    I’ll be brief. In my opinion, the PPACA is flawed but necessary, and not only to restore equity to access in the marketplace, community (not experience) rating, but also for patient protection. I’d like to see health care insurers move away from what is essentially money laundering to taking care of patients, their warts (preexisting conditions) and all.

    You want an example where insurers are making a positive contribution to health care – consider the prevention of readmission for congestive heart failure.

    The opportunity, as amply expressed above, is to simultaneously improve the quality, cost-benefit and access to care. This can only be accomplished if health care is less fractionated, the incentives are aligned and someone is measuring and managing.

    You want this to be done privately? That has about a snowball’s chance in he_l of succeeding. (No I am not advocating cookbook medicine or big brother, just patient-centricity, a longitudinal perspective, care coordination, prevention, illness care and follow-through where there are no barriers to appropriate access, tests and treatments.

  75. Dr. Claude Says:

    Then, Obamacare is NOT the solution, unless you agree with rationing of care like what exists in Canada and the UK. Do we need sanity brought into healthcare in the US? You bet we do! Do we want a socialist elitist clique of non-medically trained thinkers to control our healthcare, hell NO. Allow the health professionals to plan healthcare, not politicians and lawyers please. Would you allow landscapers and plumbers to plan and administer food safety or air transport safety?

    A group of doctors, nurses, hospital administrators and private business people could put together, with CONSULTATION, a much more intelligent, efficient and safe plan. Obamacare armtwists the health insurance side but does not address the core issue: excessive litigation, consequent excessive malpractice premiums, protective prescribing of tests and treatments by doctors who fear litigation and the greed of the healthcare supply producers and distributors.

  76. GoMavs Says:

    Ross, I had dinner with Beth and 15 brokers from Dallas last night.

    No I do not mean a cheap medical travel or tourism policy. I mean a substantial and not cheap supplemental policy that would pay over an above what the national rationed plan pays for approved services, pay for better quicker services. The plan would also pay for medically neccesary services that the federal plan does not cover when their global budget runs out of money. It may cost $300-$500/family/m.

  77. Ross Schriftman Says:

    You would have to ask Beth, but I don’t believe the issue was who would pay for the treatment. The issue was whether NHS would approve the service to be performed. In government run health services you can’t just simply go around their rules.

  78. TH Says:

    I think myself that we have more machinery of government than is necessary, too many parasites living on the labor of the industrious. – Thomas Jefferson

    Yet another program for the government to charge too much, hire too many and become too inefficient and too ineffective. I am glad I am old and will not be around too much longer. I do hope I am around long enough to see the revolution to take our country back.

    My reading of history convinces me that most bad government results from too much government – Thomas Jefferson

  79. Thinking Producer Says:

    I don’t blame government for our health care problems. Hopefully Obamacare will not only get more Americans quality health care insurance but work to reduce the excessive greed demonstrated by SOME of the providers in the current system.
    Without the recent Supreme court decision, Americans would have been stuck with the STATUS QUO…..which is NOT where THINKING CITIZENS want to be!

  80. GoMavs Says:

    What a sucker punch from John Roberts! Nowhere in 2700 pages is the word ‘TAX’. But Roberts decided to write the law for Obama, after Obama/Pelosi/Reid lied over and over and over that it was not a tax, but a penalty. More political BS when you can say one word and mean another – they certainly understand how gullible most of America is. I wonder who threatened/paid Roberts for this one – unbelievable!!!

  81. Thinking Producer Says:

    Justice Roberts in his decision, Page 44 states: “The requirement that certain individuals pay a financial penalty for NOT obtaining health insurance may reasonably be characterized as a tax. It is NOT our role to forbid it or to pass upon its wisdom or fairness.”

    It should be noted that only those who fail to get health insurance will suffer the tax. PPACA provides for financial help for certain individuals based upon their income. Individuals covered by Employer group coverage, Medicare or Medicaid would not be subject to this tax.

    Lookout for Republican Campaign adds that SUGGEST that everyone will be paying THIS tax.

  82. Ross Schriftman Says:

    If your health insurance is not good enough according to PPACA rules it will fail the test and the penalty (oops tax) will apply. Let’s see what happens to all those union Mini-Med plans. Maybe they will get extensions of their waivers.

  83. GoMavs Says:

    How do you collect a ‘tax’ from 10 million+ people that do not file tax returns? Illegals?
    It’s just more of the same – you need to pay for me – the Dem’s mantra. I’m not even going to get out of the wagon to lighten the load and help pull. As a matter of fact, I’m not even going to eat better or excercise to lighten the load – you just need to pull harder.
    What a country!

  84. Jeff Kaplan Says:

    Pls see “Insurers, Change! ACA/Mg’d Care In”

  85. Thinking Producer Says:

    (1) Illegals are not eligible for Obamacare.
    (2) It is estimated that only 1% of the population will have to pay the penalty which is a TAX on these 1%. Republicans love the word tax since GROVER forbids taxes !
    This is the same mandate that Romney supported to eliminate the “Free-loaders” in his Mass. Romneycare which now insures 98% of Mass Citizens with a 60%+ Approval rating of “HIS” Mass. Plan.
    Regarding the waivers issue, I thought waivers were only granted until 2014 when quality products with essential coverages are mandatory for ALL americans whether a Union member or not a Union member !

  86. fitdoc Says:

    The end of the referenced article — — is what “upholding the ACA means” More to this discussion, tax or not health care is a right, not a privilege (or better, it is both). That means there’s need for Universal coverage, there’s a need for equity in the marketplace, there’s a need for community rating (not experience rating) of health care insurance, the roll of insurers must change as they get involved in improving the value of health care for pateints and thier families – what their investors get is secondary!! ETC, ETC, ETC. Single Payer? Either that or this new role for insurers should allow us to measure and manage a full episode of care – IE, all care over time, regardless of setting.

    However don’t be fooled about pseudo measurement of outcomes and / or biased or predjudiced studies or self serving research ‘conclusions.’

    Please look up a really great book: “Why Nobody Believes the Numbers; Distinguising Fact form Fiction.” Pub. John Wiley & Sons, Inc. © 2012 ISBN 978-1-118-31318-3 (hardback); ISBN 978-1-118-33536-9 (ebk); ISBN 978-1-118-33420-1

  87. Ross Schriftman Says:

    Dear Thinking Producer,

    I hope you realize that when the IRS comes calling to make sure you have the right kind of health insurance you are going to have to give them your real name.

  88. Thinking Producer Says:

    Dear Ross~
    Unfortunately many of your comments sound like Republican talking points. It appears a number of people on this site use Pseudo names…FitDoc, GoMavs, Dr. L for examples. I like the name- “Thinking Producer”…it sounds like someone who thinks about more than the commission rate on a producer commission check.

    The IRS won’t be questioning me regarding my health insurance; my coverage will satisfy Obamacare essential coverages. It is my understanding that PPACA provides for atleast 3 levels of coverage provided by PRIVATE carriers.

    It is great to know that millions of Americans will have quality health insurance coverage who didn’t PRIOR to Obamacare(PPACA) !

  89. GoMavs Says:

    Illegals aren’t eligible for Obamacare, but they get free care at the most expensive place on earth – the emergency room. So they extreme bills, don’t pay them, don’t contribute to the risk sharing, file tax forms, don’t pan the penalty tax.

    And SillyProducer uses illegals as a reason for his Single Payor argument.

    Why don’t you take some illegals to an expensive dinner, then pay back the discount the get for college tuition – then ask me to subsidize their healthcare.

  90. DrClaude Says:

    Who decided and when that health care was a RIGHT?

  91. GoMavs Says:

    TP: Thinking Producer – sure everyone can get one of 3 mandated dictated health insurance policies by big brother, but wait until you see the premiums!!! That’s why they made the law effective after the election. 20 to 40 year olds premium will double as the 3/1 community rating tiers are half of current 6/1.
    If you’re all for a Single Payor RATIONED healthcare system, why are you even an agent? Go work for Uncle Sam now.
    Dr. Claude – agree – shouldn’t water and food be more of a ‘RIGHT’ than healthcare? Yet we require people to pay for it and don’t dictate they get it.
    Thomas Jefferson said ‘A gov’t big enough to give you everthing you need is big enought to take everything you have’. That is certainly where we’re headed.

  92. Ross Schriftman Says:

    Dear Thinking Producer

    It always puzzles me why people like yourself passionately express a viewpoint and yet are afraid to give your real names. What are you afraid of? I strongly believe in free speech but will never hide behind a pseudo name to express my opinion. I am not sure how that has anything to do with party affiliation.

    Regardless of whether you have appropriate health insurance or not, you will still have to prove it to the government or pay a penalty. They can audit records as well to determine if you have coverage for each and every month throughout the year. Your insurance company will have to report your information to the IRS to determine if you will avoide the penalty and, if not, determine your total income for the year to decide on the amount of the penalty

  93. Thinking Producer Says:

    I think you are making a big deal out of NOTHING! Every carrier will provide an insured an annual certificate of coverage.
    In PA, when you renew your auto registration, you attest to the fact that you have valid auto liability coverage in effect. The State of PA doesn’t send a “Big-Bad” inspector down to your house to check. Legal penalties apply when it is discovered that you lied regarding your inforce coverage down the road !
    On your Federal tax form people will be required to mark whether they have health coverage that satisfys PPACA requirements.
    I think you should spend more of your time THINKING about the MILLIONS of Americans who will NOW have quality health care. It appears too many insurance producers haven’t been “thinking” about those individuals for a LONG time.
    Maybe we need more “thinking Producers.”?
    PS… if you had used RS as your name…it would not have bothered me one Ioata !

  94. TH Says:

    That Jefferson was one smart man. He could see things back then that half the country can’t see today. Which half? You decide.

  95. Jeff Kaplan Says:

    To paraphrase Drucker, you cannot manage what you don’t measure and you cannot measure what you don’t manage. The private sector is not the best positioned to control the quality, cost and aceess of health care. The mandate gets most of us into the risk pool. For those who don’t need vouchers, there’s a tax for not being a player. Thus, we are moving to Universal care – health care as a “right.” Today’s iteration of the MCO, the ACO encompases and integrates all the patient care settings: hospital, PCP/ medical home, specialty and ancillary care where the focus is on the patient, where their abd their famiily’s health care needs can best be met, and where the incentives can be properly aligned–Done right, I as a practitioner can make more if I help patients, practice within a resonable standard, efficiently and effectively. The obverse is that if I churn, overutilize, over refer, fractionate the care, have a high preventable hospilization rate, etc., I make less. When the incentives are properly aligned, “for profit health care” becomes an oxymoron; medical loss ratios simply guarantee ‘patient before profit,’ and the gross dispariety of earnings, PCP to specialist diminishes allowing the rebirth of primary care as we once knew it.

    Now the point of this mini-diatribe – you need a central authority where the disparate data can be acuity-adjusted, grouped into episodes and where the processes and outcomes of care can be measured. – The role of management defined this way calls for Single Payer, or large penetration, stable patient population ACO, or a matrix organization. I still feel insurance companies are best suited to be the latter type of player.

  96. GoMavs Says:

    Jeff, You can’t have national single payor healthcare without RATIONING – I agree that’s what we need, but you have to define the rationing and how you tell me my daughter can’t have services because the nation can’t affort it. Congress set’s a national budget – say 11% of GDP, then has to apportion who get’s what? Does my daughter get services or the 88 year old smoker?
    No country has ever has single payor without rationing somehow – wait lists, delaying new technology, delaying use of new drugs, etc.
    Explain rationing or give up the single payor argument – you are just changing one problem for another, you just won’t admit it.

  97. Jeffrey G Kaplan Says:

    “You can’t have national single payor healthcare without RATIONING?” I don’t trust the gov’t either, however single payer will allow us to evaluate structure, precess and outcome (Donabedian), reduce variation Improve quality, cost-effectiveness and access within and between communities of interest. Nevertheless, I still advocate for the Insurance company’s oversight. That is, if they change their M.O. (which is already happening) e.g., monitor, facilitate, fund ACOs? Don’t ask me what that new effort will be called–perhaps managed care.

  98. Jeffrey G Kaplan Says:

    The efficiencies of centralized authority within the self-directing ‘medical home’ concept will allow rational care over rationing. That is what we accomplished with multi-center group practice or IPA model health care in Syracuse/Utica/Binghamton

  99. GoMavs Says:

    Rational Care over Rationing? Please explain how much money your redirect from wellness/immunizations, etc to a 50 year smoker with 90 days left to live? Medicare spent over $100k for my mother in the 100 days from diagnosis to death (she quit smoking 15 years prior to diagnosis). They could have kept her as comfortable as possible for $25k. That’s $75k the working stiff’s paid in taxes that could have been much more efficiently spent elsewhere.
    Until you can man up and publicize/sell the public on those decisions, you can’t have Single Payor – it’s killing our economic competitiveness in a more and more competitive world economy.

  100. Jeff Kaplan Says:

    “Man up”? What does that mean? Anyway, the point of having a central authority is to republicans, to “impose” government medicine with all ofits implied waste and duplication; for democrats it is an opportunity to have equity in access, and to derive and use normative and comparative population statistics esp about process and outcome to pay for what works and to stop paying for inefficient and/or ineffective care.

  101. Sam Says:

    Something has to be done to balance the playing field. A company that self-insures pays about %500 per employee for group insurance. But if that employees at age 55 goes out to buy his own insurance he’ll be paying twice that much. A large company has healthy and unhealthy people and yet the permium per employee is lower than a comparable indiidual policy. Thus to say that people with pre-existing conditions are going to raise premises does not make sense. The current system is so fragmented tha something has to be done. Currently states prohibit individuals from forming groups. As everyone knows, large groups spread the risk. The group ideally will consist of very helathy, healthy, not so healthy, and people in poor health. With eveyone in the pool the pool will be larger and the risk smaller making it easier to set premiums that are affordable and easier to predict and manage

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