Why Private Health insurance fails.....

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In the current system, insurance companies add negative value -- which is to say, they make healthcare worse, not better. And here's why: It is actually against their interest for insurers to compete on giving us the best care. It's not simply that they're not doing it, but given the structure of the marketplace, they shouldn't do it.

) Universality: Insurers cannot compete effectively unless everyone is in the pool.

2) An end to cherry-picking: Insurers cannot be allowed, before offering insurance, to use demographic sub-slicing to cherry-pick the market. .... Insurers should have to offer insurance to anyone who wants it for the same price. No exceptions.

3) Risk adjustment: .... So on top of the universal system and the community rating, you need risk adjustment, which means either that insurers are reimbursed more for taking on sicker patients, or (my preferred method, and the one used in Germany) insurers with particularly healthy pools pay into a central fund that redistributes to insurers with less healthy pools. At the end of the day, it has to be as profitable for an insurer to insure a sick person as a healthy one.

4) Benefit floors: There has to be a minimum level of comprehensiveness below which insurance plans cannot dip. Otherwise, they'll just sell the healthy on plans that don't cover anything and so are very cheap. That's just another way of pulling in the healthy and keeping out the sick. Creating a floor ends their ability to segment the market by offering less value.

5) Information transparency: ...And within that space, it needs to be easy for individuals to compare insurers on plan comprehensiveness, price, outcomes, etc.

http://prospect.org/cs/articles?article=why_health_insurance_doesnt_work

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the thing is until you have worked for a private insurance company and a public one which i have worked for both you think things must be equal. well in this world things are not equal and not everyone is nessacarily entitled to the samethings. and as for your sources, i am supposed to believe them lock stock and barel because they are from a liberal site, yet if we post sources from a conservative site we are called neo cons and the info is automatically dismissed as biased. so i take your posts with a large grain of salt and all those graphs that you love to put in that show really nothing as numbers can be twisted to show anything you want them to. so in the end your universal health that you so adamantly cry for probably and hopefully will never be passed for it it does it really will spell the end of the fast and quaility yes i sqid quality healthcare that we get here n the us. i know of the european quality and let me tell you it is nowhere near where ours is.

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the thing is until you have worked for a private insurance company and a public one which i have worked for both you think things must be equal.

it sounds like you dispute the assertion that "private health insurance fails." it also sounds like you have some experience with health insurance that might shed light on a different perspective. i'd be interested to hear your experience as well how private health insurance is working just fine (if that is in fact how you feel).

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I didn't link to this story as "factual." Very clearly this is an op-ed. Mr. Klein's analysis of how free markets are not doing the job is a fair criticism. As to the complaint about equity I find it difficult from either a moral or intellectual standpoint to argue against a consistent benefit package for all americans. Costs (IMO) cannot be contained without administrative simplification. Regardless of your opinions about the quality of European health care the data does show better outcomes for their populations.

4) Benefit floors: There has to be a minimum level of comprehensiveness below which insurance plans cannot dip. Otherwise, they'll just sell the healthy on plans that don't cover anything and so are very cheap. That's just another way of pulling in the healthy and keeping out the sick. Creating a floor ends their ability to segment the market by offering less value.

I freely source my data because I happen to believe in the intelligence of readers. Agree or disagree the data is available that I used to formulate my policy suggestons. You are also quite free to source academic studies and data that proves that CDHP or HDHP will deliver better results as a reform strategy. That has been my standing challenge to opponents of effective reform.

Rgds...

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I did case management for a private health insurance company and it was stressed to no end that prevenative health was the best way to go. If a member was seen in the ER more than 3 times for any reason (other than injuries from a car or sports) we would contact and offer case management to them. We would stress the importance of seeing thier doctor regularly and following the advice of their doctors. We would assist even at times getting the patient to the doctors for our chronic illness members. It was more cost effective to catch and treat the illness or condition in the begining than in the later stages. In the public health ( medicaid) costs were really not contained and the members would not follow advice, they would use the ER like a doctors office instead of going to a doctor. Money flowed thru like a river. It ws unreal.

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In the public health ( medicaid) costs were really not contained and the members would not follow advice, they would use the ER like a doctors office instead of going to a doctor. Money flowed thru like a river. It ws unreal.

What would the private insurers do if patients didn't follow their advice? I suppose if an insured patient tries going to the ER for an unapproved reason, they'll be stuck with a bill, while issuing a bill to a Medicaid patient is just an exercise in futility (like squeezing water from a rock). Do similar case management strategies not work for Medicaid patients? Is there not enough funding for such services? Is the Medicaid patient population resistant to such strategies? I can only speculate.

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Specializes in Home Care, Hospice, OB.
futility do similar case management strategies not work for medicaid patients? is there not enough funding for such services? is the medicaid patient population resistant to such strategies? i can only speculate.

yes, yes, and yes.....

during a public health rotation, found that, with one or two notable expections, pts preferred going to the er at their convenience over coming into the clinic for preventative care. most couldn't be bothered unless they were symptomatic or out of medcine.:angryfire

the clinic visit cost them $2 [yes two, not twenty or two hundred..], the er was free..

don't even think about saying they couldn't manage the two bucks--they also smoked, had cell phones, fake nails, and hair weaves (in some combination).:smokin::smokin:

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I can't defend those who use the ER rather than go to clinic. I think the way to fix these issues is to expand the hours of urgent care to 0600-2200 and then put an urgent care center right next to the ER. Patients could be triaged and sent right over to urgent care and told to wait if need be for opening hours.

As to the other complaints: If we want people to work and hold jobs:

1. They need a phone just as much as anyone else.

2. Employees (in any job) are expected to look nice when they report for work.

3. Is it our place to judge them as people for smoking? I am not sure that being judgemental opens the doors for communication to influence positive behavioral changes....

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yes, yes, and yes.....

during a public health rotation, found that, with one or two notable expections, pts preferred going to the er at their convenience over coming into the clinic for preventative care.

when abuse of a system becomes widespread (there will always be a few and it's not always worth the cost to try to stop every last cheater), then that system needs to be adjusted. discouraging this type of abuse, though, is a separate issue from how we might be able to keep health care costs affordable to the majority of people.

so, yes, something needs to be done to discourage the abuse of ers. but what can we do about the fact that if a person loses their job, they lose their company subsidized health insurance and now are facing premiums of $500-$1500 per month for their insurance? if your take home pay is less than $2000/month, that's a pretty penny.

maybe they can shop around for a policy with lower rates, but that policy won't cover much and will still cost a couple hundred dollars a month.

what can we do about the fact that when those who have been responsible and had a job and health insurance get very sick, can't work, lose their insurance and now are faced with astronomical health care costs?

what can we do about the fact that more and more companies are cutting health insurance benefits to their retirees making more and more seniors dependent upon medicare?

these are some of the questions about the current system of private health insurance. private health insurance in the past has been sufficient for a good percentage of the population, but things have been changing.

some other questions to consider regarding how health care is paid for....

are we okay with the fact that a major illness could easily send a family into bankruptcy? this problem isn't just about protecting a family's financial security. astronomical costs mean more default on payments and health care services and we are seeing too many services not being paid for. it's one thing to pay down a $10,000 bill over time. it's another thing to be on the line for $400,000 and on-going costs. i guess one could've just said no to their life-saving surgery. i don't see any easy answers but it does seem like something we need to address as a nation. touting uhc as the answer just because it's "free" certainly doesn't address the real concerns of how to pay for modern (expensive) health care. hsas don't really address these problems either. there do seem to be some major issues with how private health insurance is currently run and the question is what can we do about it?

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Specializes in Home Care, Hospice, OB.

[quote=hm2viking;

as to the other complaints: if we want people to work and hold jobs:

these people were not employed; most had never been.

1. they need a phone just as much as anyone else. one with music and a camera, plus internet access???

2. employees (in any job) are expected to look nice when they report for work. with 3 inch fake nails and hair that never grew on a human..don't think so! we're not talking soap and clean clothes here....

3. is it our place to judge them as people for smoking? i am not sure that being judgemental opens the doors for communication to influence positive behavioral changes....if someone is telling me they can't afford baby formula or the $2 clinic "fee" while they are smoking $12.00 worth of cigarettes, you are damn straight it my place to judge the value system they are choosing to operate under. kid's hungry, but they have their cigerettes and air-brushed nails oh--and the hungry kid is the governments fault..please:angryfire:angryfirequote]

have you ever personally administered an entitlement distribution program run by the government? (i also work at a free clinic, which is a totally different ball of wax) if not, please hear what is being said by those of us who have. :typing

some clients are doing the best they can with rotten circumstances...most create their own problems with bad, bad choices.

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Specializes in Home Care, Hospice, OB.

what can we do about the fact that more and more companies are cutting health insurance benefits to their retirees making more and more seniors dependent upon medicare?

do you mean medicaide?

all seniors already must use medicare, the only other policies allowed are supplements...

quote]

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Thats actually not quite true...There have been companies who offered supplemental insurance for their retirees over and above medicare....

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