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Here They Go Again!

Stanley Feld M.D.,FACP,MACE

The healthcare insurance industry is blaming physicians for the industry’s need to raise insurance premiums. Aetna has been assigned to replace Wellpoint as the bad guy this week.

All of the stakeholders are to be blamed for our dysfunctional healthcare system. However, the healthcare insurance industry is the biggest villain.

Why is Aetna attacking physicians?

Physicians are easy to attack. They are the least organized and least effectively represented. They are also primary stakeholders along with patients. If secondary stakeholders can successfully attack primary stakeholders they think they enhance their value to the healthcare system. They are really decreasing the effectiveness of the patient physician relationship thereby decreasing the quality of care. The result is an increase in the cost of care.

“How much do you think doctors charge for a routine colonoscopy in the San Francisco Bay Area? Anywhere from $1,250 to $7,300, a range of more than $6,000, according to Mark Bertolini, president of health-insurance giant Aetna.”

This is a bogus. Aetna’s President knows it does not matter what physicians charge. Physicians only receive the allowable fee. Aetna’s CEO is setting up the public to defend the healthcare insurance industry’s unjustified premium increases. He is also developing the case for healthcare insurance mandates.

It is clear that the healthcare insurance industry a has well coordinated strategy.

“Most people don’t know how variable health-care costs are across the country and how that plays into the problems plaguing the system”, he said in a wide-ranging interview Monday, the same day President Obama turned up the heat on insurers in a bid to push his year-long quest for comprehensive health reform across the finish line.”

Physicians behave like indentured servants. They are treated as they behave. Some physicians believe the behavior is in their vested interest.

Where is the physicians’ or consumers’ leadership? Who is pointing out the game the healthcare insurance industry is playing with the healthcare system in order to increase its profit?

No one is challenging the healthcare industry’s return on investment of over 20% a year. President Obama is accepting the published profit of 2% per year and permits the industry to raise premiums.

Who is challenging the healthcare industry’s faulty accounting regulations that permit these premium increases? No one! Neither President Obama, Congress, nor state insurance regulators.

The healthcare insurance industry does not allow consumers to purchase healthcare insurance across state lines for two reasons.

In many states one or two companies have control of 90% of the market. In some states the healthcare insurance industry has complete control of the State Insurance Boards. They raise healthcare insurance premiums at will. The healthcare insurance industry dominates State Insurance Boards.

I am not in favor of federal control over the healthcare insurance industry. Lobbyist control the federal government’s regulations and decision making. Consumers have a better chance of putting pressure on the State Insurance Boards than a Federal Insurance Board.

I am also opposed to abrogation of states’ rights in favor of federal control.

President Obama must change accounting regulations to reflect the true medical loss ratio. If this was done the healthcare insurance industry would be required to lower premiums immediately.

Instead the administration makes this weak appeal to healthcare insurance executives.

At the March 10, 2010 Health and Human Services Secretary Kathleen Sebelius, at a health insurance industry meeting on Wednesday, pressed insurers to "give up some short-term profits" for the good of the country and assist congressional Democrats struggling to move toward votes on a health care overhaul measure.”

Can you believe that? Remember the good cop, bad cop routine I have outlined. President Obama and the healthcare insurance industry are playing a trick on us. Rather than getting to the root of the healthcare’s system problems the changes will increase costs and decrease access to care.

“Sebelius, President Obama and other administration officials seeking to build public support for the overhaul have repeatedly attacked the health insurance industry for proposed double-digit premium increases in the individual market, such as a 39 percent hike proposed by Anthem Blue Cross Blue Shield for its California customers.”

This is the ploy.

Insurers defend the premium increases as the product of skyrocketing medical costs they can’t control, and they’ve strongly objected to what they contend is a vilification of their business. “

The healthcare insurance industry wants a mandate. President Obama wants a mandate. This is the goal.

“I think the individual mandate as currently structured is incredibly weak,” Bertolini said. “The result is it’s going to exacerbate the current problems in the individual and micro-group markets,” he said, referring to coverage for groups with fewer than 10 people in them.

Much is riding on how much latitude the federal government gives states to enforce such a mandate, he said. “That could put this whole bill in the balance as to whether it will be successful.”

Kathleen Sebelius pleaded with the healthcare insurance industry executives at their March 10th meeting.

"So there’s a choice on the table. You continue the opposition to reform," said Sebelius. "If you do and reform fails . . . by next March, when you’re meeting again, premiums will take even a bigger bite out of Americans’ wages, your market will shrink even further, more Americans will lose their employer-sponsored insurance and we will have a situation where the market is unsustainable."

The people do not want a mandate. They want fair healthcare coverage. They want leadership that makes sense.

Effective healthcare reform would be instituting an ideal medical savings account. Consumers must own their healthcare dollar in order to decrease the cost of healthcare. The result would be lower healthcare costs and a simple self regulating system.


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

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