How do these guys even compete? Wheres the miracle of the free market, driving down prices? Actuarial tables are just math, everybody’s math is the same, Blue Cross does not have different actuarial facts than HealthPartners. Risk compared to benefit plus profit and admin. equals premium. So how do they make enough money to attract the very best and most talented CEOs, and build office complexes with massive, stupid sculptures in a plaza?
Well, they screwed folks, didn’t they? We watched them do it, for years, and they got clean away with it. Remember hearing about that new law how they have to return 80% of their premiums as benefits? Was anybody else surprised to hear that was even necessary? They get a twenty percent margin guaranteed, and they bitched about it! The Invisible Finger of the Free Market (blessings and peace be upon it) doesn’t seem to be all that great…
Remember that 80% paid out in benefits does not equal 20% profits. The 20% left still has to cover the cost of doing business - the actuaries, the claims processors, the accountants, the people running the nurse line so you can decide if you need to go to the emergency room for your splinter or dismemberment. I could be wrong, but my guess is that that isn’t part of the “paid out in benefits” equation.
Then there are the other less necessary parts of the business- lobbyists, marketers.
Health insurance is an expensive business (I used to work in IT for one of the big ones) - even once you get rid of the sculptures, fancy offices and executive salaries. One of the reasons that UHC/Single Payer makes so much sense is that there is so much repeated overhead from company to company - a lot of which wouldn’t exist in a single payer model because you wouldn’t need to analyze and market for profit.
Health care is also an expensive business - not in its simplest clinical “I go to the nurse practitioner and get a pap smear and a checkup every year” (though they don’t do a pap every year any longer) or “I bring my toddler in because of an earache” - that is relatively cheap - but emergency rooms and operations and every changing pharmaceuticals (that really are improving the quality and quantity of life) and expensive equipment for MRIs and mammograms - that’s expensive.
(My brother in law died of cancer. It was two years from diagnosis to his death. He almost hit the still in existance lifetime cap of $3M.)
We self insure and use the health exchange and qualify for a subsidy. This year the marketplace was the easiest to navigate and compare plans and see what doctors participate. I kept my plan from 2014.
In Michigan costs seem to have gone down. My healthy family of four saw our premium drop $200/month this year! I chose a bronze high deductible plan with an HSA,that covers “maintenance” visits at 100%. ALl of our doctors participate, seems most doctors in Michigan are in a group practice and participate in most insurance plans. I do not have vision in this plan. I pay for a separate dental plan thru delta dental and that premium also dropped by $40 this year.
W/O the subsidy we’d be paying 15K a year rather than 5-6K!
actually at 15k could not afford to pay those premiums, would be cheaper to skip it altogether, until disaster strikes, eh
So because your insurer didn’t violate the law, you think that means the law doesn’t exist? Some great logic there. You aren’t the center of the universe and your experience isn’t everyone’s.
You seem to be minimizing the role of actuaries - it’s just math right? Actuarial analysis is quite complex, and as an effort to predict future outcomes, it’s not “just math”. Can you cite where there is a guarantee of 20% margin? Do you even know what the margin rate for A/H insurance companies are?
What difference does it make if taxpayers pay for someone’s insurance or taxpayers pay for someone’s hospital bills? Why is one a problem and the other is the solution? It seems like it would be cheaper for taxpayers to pay hospital bills directly than to pay an insurance company with all their overhead.
The difference is that insurance is much cheaper for the taxpayers to buy than paying for hospital bills is. As long as the total cost of premiums is less than the total of hospital bills, of course.
And it’s not just the taxpayers who pay for the uninsured. We pay a great deal of that through our own insurance premiums, since the hospitals simply shift unpaid costs to us.
The idea is that if somebody has insurance, they can afford to go to the doctor at least semi-regularly and get the little problems treated before they become big problems.
Cancer discovered and treated at stage 1 or 2 has a much lower bill and much better prognosis than at stage 4. Diabetes properly treated and monitored is much cheaper than the uncontrolled diabetic who ends up admitted to the hospital on a monthly basis. Early-stage interventions in coronary disease tend not to cost anywhere near as much as waiting until the patient has a massive heart attack.
That’s not even counting the bills that aren’t strictly medical: the diabetic who ends up on disability, or the heart attack victim whose family collects survivors benefits for several decades, e.g. Then there are the opportunity costs of lost wages, lost productivity, and so forth. There are now some treatments that can delay the onset of Alzheimers, at least some of the time; the patient who has to skip those because they have no prescription coverage isn’t saving any money for society given the costs for even an extra year or two of long-term care for dementia.
Nope. Not sure who I could rely upon for the truth. On the one hand, a collection of wild-eyed radical lefties like Sanders and Obama, or well-kept white men in tailored suits. Now, my people are people, with the standard set of human weaknesses. So they cannot necessarily be trusted to deliver the whole truth and nothing but.
And the other hand, they aren’t in it for the money.
So no cite on guaranteed 20% margin claim - where’d you come up with that?
This isn’t about deciding who is telling the truth or not - it’s about simple definitions. You seem to think that an 80% medical loss ratio translates into a 20% profit margin. That’s not true. It’s not even close to true. It’s such a misunderstanding of basic concepts it’s astonishing. And at the same time, you trivialize actuarial analysis saying “it’s just math”.
Wait, you’re saying that there is absolutely no difference between insurance companies? And therefore the only way some could succeed more than others is to screw people? Wow, that’s naive.
You didn’t answer my question either, but at least I didn’t insinuate that you weren’t very smart.
As far as the “80%” thing goes, there are literally oodles of returns if you Google. “80/20 rule” seems to give the most thorough data dump. I assumed you already knew about it. I won’t cite any one in particular, I’m not about to pretend to be non-partisan.
Keep in mind that the record will show the health insurance industry fought this rule tooth and nail. Might we reasonably conclude that the rule will affect their bottom line, or should we conclude that its all an exercise in civic virtue? And might we not further conclude that they are harvesting a benefit in excess of that division? Otherwise, why would they object?
As far as being complex, sure. Fine. But how complicated is it to screw over some poor schmuck over a technicality? Why was it done, if not greed? Or would you like to say it never really happened? Seems fairly clear to me, a boor of little brain, but maybe you can muddy it up a bit. No doubt somebody already has, and got paid for it.
I did answer it - it doesn’t matter who I trust because words have meaning. Your claim has nothing to do with who is speaking.
This is a lot of words for a paragraph with no substance. You claimed that "They get a twenty percent margin guaranteed, " with no citation. You are wrong.
Of course it affects the bottom line. If that was your claim you’d be on solid footing. Since that was not your original claim, you continue to be wrong. Maybe you could try and distract with something less transparent?
Do you even know what you are saying? I mean, there are a lot of words written here that don’t make sense so maybe you can clarify? Do you retract your claim that actuarial tables “are just math” and “everyone’s math is the same”?
Yes - I am saying exactly what I mean. Your paragraph made no sense. Readers of what you wrote will have no idea what you are trying to say. It was nonsense. The opposite of making sense. It’s a simple concept - speaking clearly and plainly.
Still no cite for your claim that, “They get a twenty percent margin guaranteed,”? Any cite will do. I suggest you start with the definition of Medical Loss Ratio. It’s easy enough to concede you were confused or you misspoke, no need for all the dodging and weaving.
On some level yes, but I don’t see it happening on the federal level anytime soon. The aca made health care a bigger responsibility if the federal government and it gave states the option to opt out and create their own plans. I think the odds that at least one state will create a single payer system by 2030 are extremely high. Probably a northeast or west coast state.
But America is a nation divided by race and class, and any health reform will have millions of middle class whites who oppose it tooth and nail, not to mention business interests.
And most people who want to repeal the aca do not have any replacement plans in place, because they do not care about medical costs or coverage.
Also obamacare is not hated by everyone. Republicans hate it but they hate everything Obama does. Millions have been helped by the law.