Stanley Feld M.D., FACP, MACE Menu


Here Come Harry and Louise Part 2

Stanley Feld M.D.,FACP,MACE
The insurance industry is attempting to sound sympathetic to the plight of the uninsured. I think the attempt is an effort to diffuse their role as villain in our healthcare system.

“America’s Health Plans an association representing the healthcare insurance industry is saying their suggested steps are a way in which states and private insurers can work together to provide coverage in which insurers try to address shortcomings of the individual market.”

I would suggest the states proceed with caution. The states should carefully examine the details of the proposals and the motivation of the healthcare insurance industry.

The goal of the healthcare insurance industry is to increase its insurance roles with the state subsidizing the insurance policies. The defect is that it would be following the rules of the present healthcare insurance premium structure. It would not be creating incentives for the patients, physicians, or hospital systems.
Massachusetts recently reported a doubling of the insurance premium under the state Romney plan of universal coverage.

A self employed person between 50 and 65 years old can not buy affordable healthcare insurance with after tax dollars using the present actuarial rules for determining premiums.

“Currently, about 11 percent of all individuals who apply for coverage are not offered a policy after the insurers review their medical conditions, according to a new survey of the trade group’s members. And nearly 30 percent of individuals who are in their 60s but too young for Medicare are denied coverage.”

“To extend coverage to high-risk people with expensive medical problems, or likely to incur them, would cost money, and states might not go along. In states that already have programs for high-risk individuals, significant numbers of people still do not obtain coverage because the premiums are high.”
“Few states are willing to come up with the money to subsidize them so they can cover enough people,” Mr. Ginsburg said.

The states high risk pools have failed because of the premium structure and actuarial rules. The healthcare insurance industry refuses to adopted a community rating system. It would be unfavorable to its bottom line.

“In fact, only about 180,000 people around the country were covered by existing high-risk pools, said Katherine Swartz, a Harvard professor who studies health insurance issues. “

“The new proposals call for states to provide affordable coverage to anyone whose medical costs are expected to be at least twice the average. For other higher-risk patients who do not meet those criteria, the insurers would agree to cap the premiums at 150 percent of the market rate.”

There you go. The devil is in the details. The goal of the healthcare insurance industry is revealed.

“I have optimism that the states and the country will step up to the issue,” said Ronald A. Williams, the chief executive of Aetna, a large insurer in Hartford.”

I believe everyone is fed up with the healthcare systems’ structure. However, no one seems to be willing to relinquish his agenda in favor of the patients. The patients have to be responsible for their care and in control of their healthcare dollar.

“The trade association declined to provide any estimates for the cost of its proposals.”

“The insurance industry has backed health care change before. Insurers were at first supportive of the initiatives of President Bill Clinton in the mid-1990s, until they felt threatened and unleashed the memorable “Harry and Louise” advertising campaign that helped derail the effort.”

But Ms. Ignagni said her group was ready to push for change. “What’s different than in 1992 is we as an industry did not have a proposal of our own,”

I believe the healthcare insurance industry wants to sound as if it are going to help solve the problem of the uninsured. Patients’ ability to become insured might improve slightly. The healthcare insurance industry’s proposal will lead the states and federal government to create an entitlement with a single party payer system. This is exactly what the Democratic Party wants to accomplish.

I think the healthcare insurance industry is acting for short term maintenance of control over the healthcare system. When it realized the error in its ways in 1994 it introduced Harry and Louise to the healthcare system. I have a feeling we are going to be seeing Harry and Louise soon.

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

  • denise

    Ban for-profit health insurance companies. Eventually medical prices will go down because there will have to be competition. Doctors will have to compete for our business. Heck it could force doctors to participate in customer service; like returning calls, answering questions, lowering prices, etc.
    I’m sorry but most doctors are not part of the solution, and if your not part of the solution…well you know how it goes.

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