Stanley Feld M.D., FACP, MACE Menu


Health Insurers Will Accept Universal Coverage! On Condition!

Stanley Feld M.D.,FACP,MACE

A few weeks ago in a speech in Detroit the CEO
of Aetna Healthcare Urged Mandatory Health Care Coverage

said it would lower costs
healthcare insurance

Of course the CEO of Aetna would want mandatory healthcare coverage with the
government providing a subsidy to consumers who could not afford to buy
healthcare insurance. The
more lives insured the more profit his healthcare insurance company would
Aetna CEO’s statement is clearly self serving.

The cost of healthcare insurance could decrease or stay the same.

If the government subsidizes the premiums of all Americans the price of the
premium might also go up. The
Massachusetts mandate has experienced cost overruns
for a very simple reason
Premiums have gone up in Massachusetts and the government has paid the
difference. Premiums are put out for bids and the healthcare industry is in
control of determining the bid.

health insurance industry said Wednesday that it would support a health care
overhaul requiring insurers to accept all customers, regardless of illness or
disability. But in return, the industry said, Congress should require all
Americans to have coverage.”

Consumers should have freedom of choice of physicians. If they want
healthcare insurance they should be able to buy it. If they qualify for
government assistance they should be able to buy it under the same conditions a
consumer not qualifying for government assistance buys insurance. The government
should not mandate consumers to buy healthcare insurance.

The healthcare insurance industry claims “In the absence of such a
mandate, insurers said, many people will wait until they become sick before they
buy insurance.”

If the consumer got sick and did not have healthcare insurance the financial
penalty for buying insurance after they got sick would be higher than before
they got sick. This would be a deterrent to consumers’ gaming the system and not
becoming covered by insurance. Healthcare insurance at an affordable price
should be available to all.

“The proposals, put forward by the insurers’ two main trade associations,
have the potential to reshape and advance the debate over universal health
insurance just as President-elect
prepares to take office.

The problem is there is no transparency in the pricing of healthcare
insurance nor is there an effective system of competitive pricing. There is also
no deterrent to overuse of the healthcare system by consumers. Consumers have no
incentive to keep the price down for their care. There is no price transparency
or pricing competition among hospital systems. Hospital systems have inflated
fees. Their actual costs of services are not transparent to the government or
the healthcare insurance industry.

Physicians can be patient advocates. The public must be empowered to make
physicians competitive.

Finally, pharmaceutical prices are random and in most causes not justified.
There are at least five different prices for pharmaceuticals. The prices vary
from a retail price, an average wholesale price and a wholesale price.

The temptation by healthcare policy wonks is to regulate the pharmaceutical
industry by imposing price controls. Price controls never work. They only make
things worse. Real price transparency and competitive pricing of drugs is
essential. It is also essential to make physicians aware of the prices of drugs
they prescribe. If the brand name drug is ten times the price of a generic drug
both the patients and physicians should know it and be aware of the difference.
If physicians feel the drug effect of the brand does not justify the price
difference. Physicians will order the generic drugs.

“Research suggests that some insurers turn down 10 percent or more of
applicants for individual coverage because of their pre-existing medical

55-65 year old male with mild obesity (BMI=28), mild hypertension and an LDL of
105 (normal is less than 100) would be rejected by a healthcare insurance
company. If he was in a group insurance plan he would be accepted.
to his employer the premium the employer pays for all his employees would be
increased. Medicare will automatically accept this person at age 65.

“Mr. Obama said he wanted to be certain that insurance was affordable and
available to all before considering such a broad requirement”

This is very wise on Mr. Obama’s part because the insurance industry is going
to control the premium. He needs to guarantee affordability.

“In the individual market, people can choose whether or not to apply for
coverage,” Mr. Hamm said in an interview. “If they know they can obtain coverage
at any time, many will wait until they get sick to apply for it. That increases
the price for everyone.”

The insurance industry wants to be assured that the market is expanded. They
are killing the goose that laid their golden egg because they can be cut out of
the picture entirely.

“The new policy statements are silent on two important issues: how to enforce
an individual mandate and how to regulate insurance prices, or premiums. While
insurers would be required to sell insurance to any applicant, nothing would
guarantee that consumers could afford it. Rate regulation promises to be a
highly contentious issue, since it pits the financial interests of insurers
against those of consumers.”

Medicare has guaranteed rates and insurability regardless of the severity of
the illness. The government subsides the shortfall. The insurance industry’s
only interest is net profit without price transparency.

Alissa Fox, a vice president of the Blue Cross and Blue Shield Association,
said the individual mandate was an indispensable corollary of any approach
forbidding insurers to reject applicants because of health status.

If the healthcare insurance industry continues to make demands that guarantee
excess profits the government will impose universal coverage with a single party
payer (socialized medicine) and all
the problems that will bring


opinions expressed in the blog “Repairing The Healthcare System” are, mine and
mine alone.


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