Healthcare Reform

[mclureins]

A touchy subject here! Well as an insurance agent for the last 12 years I have to say that I am ready for something different. My book of business this year has declined almost 34% at one point reaching about $1.2 in premiums sold. Not a whole lot but enough to make a decent profit. Most f not all of my book is group health and the reason why my book of business has declined so much is because most of my clients are out simply out of business. And the ones are hanging by a dandelion on a cliff just can't afford it anymore.

Even though I may see an even bigger decrease in my book, at the end of the day I will have a clear conscience about my integrity of selling health insurance. I have been sick with guilt all these years knowing that health insurance is a greedy money machine that needs to be stopped. Doctors, labs, pharmaceutical companies are infested with greed and its time to clean it up. What happen to this profession being a public service? Many doctors do not deserve the same respect as teachers, police, Fire and Medics, Social Workers and so on. They should be ashamed of themselves. Prescribing medication for EVERYTHING! And prescribing medication for side effects of other medication! Most of this coming from family practice.

Why aren't doctors doing something for people that are preventative? Educate people about nutrition and how to be healthy. No. They want you to keep coming back and coming back. Oh and don't forget to tell the "specialist" your M.D referred you. Wouldn't want to forget that little kickback.

I cringe every time I sell a policy and I feel sorry for my clients who are trying to do the right thing and retain their employees. I try to find them the lowest possible premiums that make as much sense as they can. Yet I know if something happens or someone gets ill, it will cost thousands before they realize whats going on. If they ever do.

Is it wrong for me to think this way?

[Big Dog]

Many health insurance companies have "wellness" programs associated with their group health coverage. The problem is, most employees choose not to participate in these programs. It's not the doctor's fault for not trying to educate the patient (I'd hate to tell you how many times my dad's doctor told him to stop smoking and drinking, and you can guess what the result was), but it comes down to the individual making the choice NOT to use common sense.

Don't blame the doctors - they're not the "cause" or the "problem" in this case. It comes down to the individual choosing not to listen to doctors, nurses, information available on the 'net, etc.

FYI, after working some 25+ years in the insurance industry, I "escaped" and am finally on the "client" side working for a large healthcare provider (hospital). The hospital itself has it's own "wellness" program for its employees, and even farms it out to other employers.

[d's insurance store]

I'm putting my career at risk here by saying this, but you know, I agree with you, and I really hope that for the good of the USA, some kind of reform makes it way out of Congress, even though I'm going to lose a portion of my income that comes from health insurance commissions.

I liken this to a big pot of money and everybody involved feels entitled to a chunk of it. The reality as I see it is that my value as an agent, is to guide someone at the point of purchase and be able to explain a plan either to an individual or very small group so that they really know what they're buying. I dispise those who sell this product over the phone or blindly on the internet without explanations, leaving the consumer with a vague sense that they have health insurance that may or may not fail them if they are unfortunate enough to suffer from a major health event.

But that said, I cannot change the terms of the insurance contract, I cannot make unpaid or denied claims get paid and when rates get too high for a plan, most of my clients either drop out or make their own decisions about downgrading to a cheaper, albeit, lower benefit plan. And that's been happening a lot over the past few years. So, paying an agent a continuing commission of 7-10% for not a lot of work seems to add to the cost of healthcare for everyone.

If it were up to me with a magic wand, I'd make the plan Medicare for all and charge an 8% payroll tax for the program, forcing everybody to be involved. I'd venture to say that 8% is likely to be a whole lot less than what individuals are paying now, and it would get rid of the burden for small and large businesses.

Health carriers have scrambled in recent years to devise plans that cannot be easily explained with convoluted benefit options that are nearly impossible to get people to understand...co pays, deductibles, out of pocket maximums, limited benefits after the first three yearly office visits, misunderstandings about well care visits and the associated tests, blah, blah, blah. My suspecion is that the companies are trying to stay one step ahead of the civilian and legislative outrage by coming up with plans that can be called health insurance, but in fact are inch thick EOB's that only attorneys can figure out.

Oh wel, that's how I feel...let the flaming begin. I'll put on my fireproof jacket. Criticize away.

[jimmyr1978]

Okay, I can finally come out of the health care reform closet. My large, regional agency receives significant income from health benefits commissions, and we could potentially lose a lot if effective reform is implemented. That said, after delivering 10-30% increases to business owners and managers year after year, or telling a small group that they are incurring a 25% increase because one employee has a very sick child, I strongly believe the system is broken. Every year, all of our group benefit clients face the decision of downgrading their plan, eating the increased cost, or even laying off workers to help cover cost increases. Even for young, healthy groups, renewal pricing comes in way ahead of inflation. When will it all end?

The fact of the matter is—we have universal healthcare, it just isn’t called that. When an uninsured person receives treatment, that cost is spread to the insured. We need a system where as many people as possible are put into the risk pool, from the young “immortals” to the infirm.

We are the only modern, Western nation to not provide national healthcare. I’ve lived in Sweden, Spain and England in my life—no one worries about rationing there. The only real issue that arises (like in Germany) is a shortage of doctors, which we would need to address early in the process. The elderly are not left to die, and the terminally ill don’t face some so-called “death panel.” People just go to the doctor when they get sick and don’t worry about losing their life savings when it happens. Spouses don’t have to make the decision to either stay home with the kids, losing the family’s benefits, or returning to work. Business owners don’t spend countless hours and dollars to manage employee benefits, and they don’t have the skyrocketing increase in pricing every single year.

I’m fiscally conservative, and as a business owner, I hate writing that quarterly check to the IRS as much as anyone. But what I hate more is telling my 5 direct employees that they are now on an $2500 deductible HSA plan because we got hit with a 20% increase on the traditional plan. I hate that I can’t hire high quality new producers because they can’t afford to lose the rich benefits at their current Fortune 500 company.

It’s time for agents to stand up and help in the process, not fight it. Perhaps Obama’s plan isn’t the final answer, but let’s at least be part of the solution and not a hindrance to progress.

[kevinraz]

All of you are equating health insurance with health care. You have fallen into the same mindset that most of the country has - that you must have health insurance to obtain health care.

Think of the word insurance. You buy auto liability to provide coverage in case of an accident, right? Odds of a claim are small.

But health insurance? We use that for checkups and visits to the ER for stiches when little Jane gets hurt. That would be like asking your auto policy to cover oil changes, windshield wipers and tires.

What would the cost be for auto coverage if it covered anything from minor repairs to major accidents? And then for a 1972 Dodge Dart as well as a new Honda? We've got to lump all these together into a group and come up with a premium. Think it's going to be high or low? Check out auto premiums in Michigan for an idea of what comprehensive no-fault coverage costs.

And then add in the fact that everyone wants everything taken care of by a doctor. Little Johnny has a sniffle? Doctor. I get sick often because I'm fat, smoke like a chimney and eat crap? Medications. Can't get it up any more because you drink like a fish, never exercise and have lots of stress? More meds.

Just finished a week at Disney. The vast majority of people I saw in wheelchairs were not ill or injured but were obese. How much do we pay for their care because they will not take care of themselves? Go ahead, call me heartless, but let's get those people up and moving and then they can enjoy life.

We would never even consider this with auto, property, GL, etc. But for health insurance it must be 100% comprehensive and cover it to the fullest.

A report I heard a few months ago said that something like 12% of health care expenditures in the US are for end of life care and showed how those who went into hospice frequently lived weeks longer than those who engaged expensive regimens to preserve life in terminal situations. We spend billions slowing death and that money has to come from somewhere (and I am NOT a proponent of assisted suicide, eugenics or whatever you want to call it).

Some reform is needed alright. Reform in the way we life our lives. Reform in what we eat. If health insurance was modeled more along the lines of other types of insurance that would make sense too - have it cover that major stuff and anything small we pay for ourselves. They make all the drugs because we buy them and there is profit to be made.

Finally - even though our system does have problems it still produces more healthcare innovations than any other country. I've not heard of much in the way of new treatments coming out of Canada. Have you?

[IndyMischief]

I'm with you, Kevin!

The problem with adding all of these costs, that are "expected" and "likely", under an insurance policy will lead to the product being less affordable. If anyone should understand that concept, you would think it would be insurance agents and company employees that primarily surf in these waters. There are always costs of doing business under an insurance policy and it helps add to the unaffordability for medical insurance. Commissions, clerks, forms, clerks to check the forms and other clerks, not to mention another layer of lawyers waiting for the inevitable mistakes ...it's just ludicrous.

Let me pay for my doctor visits and my own prescriptions. Let me pay for my well-man care and well-woman visits. Let me pay for my trip to an Emergency Room, and then let insurance pay for the things that are unexpected. Yes, that name-brand drug might cost a few hundred dollars. Let me decide if the problem merits the solution. Maybe I won't need that Prozac if I have to pony up the Benjamins. If we did this, I think life will be a lot better for a lot of people. Drug manufacturers would know that the drug would need to be affordable. Maybe if people read all those possible, and sometimes probable, side effects then they might decide that all those risks are worth more consideration than the $10 co-pay it previously cost to fill their order.

By cutting out many of the ordinary benefits, w would take costs for employees (and wings to house them) out of the equation that's caused by the need to hassle with 50 different insurance carriers' paperwork and procedures.

Next, make medical records electronic and portable. Why do I need to fill out a book every time I go see a different doctor. Or, why does the hospital need to take the time, while I'm bleeding to death mind you, to manually get my medical history in order to be able to treat me? This would speed up the time, and probably help with a lot of fraud and duplicity. Not to menion, it could stop my bleeding faster.

Finally, educate Americans on what it means to be an American. This is the land of the free ...not the land of the taken care of from cradle to grave. Life has opportunities and it also has risks. We WILL die some day. When something bad happens, it doesn't require automatic legislation. Sometimes, things just happen.

O, so it seems to me.

[Mainemiss]

Excellent logic from Kevin and the following commentator. I never really thought about the relation between car tuneups and wellness visits to the doctor. If the former were incorporated into the car insurance that would certainly hike the premium.

We also have the requirement in many states for class rating which includes all regardless of health. That is not really fair is it when many of us could be significantly healthier if we paid attention to the health information which is all around us. Why should the excerciser who doesn't smoke and eats carefully pay as much as the overeater couch potato?

It always seems when govt gets involved though that there must be a broad brush approach where the strong support the weak and the weak take it as their due. That is the mentality piece of this puzzle...then you have fiscal management which is a whole other problem...solutions??...I'd say good ones will be hard to come by....

[mica.cooper]

Kevin is right....

Don't forget, Healthcare is a privilege and the Constitution of the United States provides that we all have fair and undiscriminatory access. Healthcare is NOT a right nor is a coverage allowed to be provided by the Federal government under our Constitution, this is a states right and is clearly so.

That said, there is no reason for the government to provide healthcare as we have plenty of examples of how to reform the system to provide coverage for most people without a single payer system. As we all know, a single payer system would be a huge mistake and increase cost and reduce coverage.

The plan is simple. Bust coverage up into small groups and get rid of billing where possible. Let the government define a standard set of coverage policy forms and then loan money to fund competitive medical mutuals to compete and provide these coverages. GM got $68 billion... Imagine if that money had been used to start new medical mutuals at $25 million each, we would have 2720 NEW health insurance companies. Now imagine that each of these companies join a medical mutual non-profit services corp for providing the software to these companies. This would provide a low cost platform for these companies to operate and give them a $$$ operating advantage over the behemoth monster insurers.

The coverages:
MED Coverage A: Basic Care - This is provided directly by clinics for basic services like seeing a family doctor. This is billed directly to the clinic and no health insurance companies are involved. As a pre-pay service, this is NOT insurance. This will reduce costs because there is NO billing to third parties and clinics get their money up front.

MED Coverage B: Hospital Care - This is a coverage provided by local hospitals and coverages ER, extended stays, surgeries, and other basic services provided by hospitals. Again this is NOT insurance as it is a pre-pay service. It saves money because there are no third party billers.

MED Coverage C: Prescription - This is an insurance coverage provided by places like Walgreens, Walmart, and local pharmacies. This saves money because the pharmacy is not billing an insurance company but providing coverage directly. We see this type of coverage already in effect with the Walmart and Walgreens $4 generic plans which are working great.

MED Coverage D: Specialists - Coverage for seeing specialist and is insurance and provided by insurance companies

MED Coverage E: Travel Coverage - Coverage for A,B,C,D while traveling and may be purchased from an agent for only the days needed traveling.

MED Coverage F: Long Term Care - Insurance for long term care for diseases like cancer, leukemia, etc. This coverage should be discounted if A,B,C, and D coverages are purchased.

Providing coverage ala carte should allow consumers and companies to make better and cheaper purchasing decisions. It would also cheapen coverage for government subsidized care.

My 2 cents,
Mica

[gregcw]

After reading the posts on this I think that I may be the Odd man out here but maybe not because I'm addressing some of the same things but from a slightly different perspective.

All of you are equating health insurance with health care. You have fallen into the same mindset that most of the country has - that you must have health insurance to obtain health care. .......

Think of the word insurance. You buy auto liability to provide coverage in case of an accident. right? Odds of a claim are small. .....
But health insurance? We use that for checkups and visits to the ER for stiches when little Jane gets hurt. That would be like asking your auto policy to cover oil changes, windshield wipers and tires. ....

Some reform is needed alright. Reform in the way we life our lives. Reform in what we eat. If health insurance was modeled more along the lines of other types of insurance that would make sense too - have it cover that major stuff and anything small we pay for ourselves. They make all the drugs because we buy them and there is profit to be made.

Finally - even though our system does have problems it still produces more healthcare innovations than any other country. I've not heard of much in the way of new treatments coming out of Canada. Have you?

Most of the rhetoric appears to be blaming the insurers for the cost of health care. This is shooting the messenger. They just pay the bills they don't create the costs.

The entities that create the costs are the providers. Not just the doctors and hospitals but the; drug manufacturers; the equipment manufacturers; equipment suppliers; emergency services; etc. Additionally the patient by overusing the system.

I have no problem with the developer of a pharmacuetical recovering the expense of developing it. But, they do not have to recapture all of it by direct sales and locking out their competitors from production. They could receive a Royalty from other manufacturers based on that manufacturers sale price. That way they would recover the cost of development without the expense of production. Their competitors could have a lower cost of production. Other equipment and supply costs are inflated because of the term Medical in the name. Admittedly some of that is due to the cost of Malpractice and Product Liability insurance. The government could reduce those costs by establishing reasonable restrictions on that type of suit.

I had one insured that said that it had to be the insurance companies because they only had to pay Usual and coustomary not realizing that that is not the same as REASONABLE and customary like it is in a casualty policy.

The list could go on and on and it is not a simple solution. But it is not going to be fixed by shooting the messenger.

[Island Girl Agent]

I loved the analogy with auto maintenance, Kevin!

Here in Hawaii, we have a mandatory health care plan for employees working over 20 hrs/week. I've heard a lot of discussion in the news about how Hawaii already has a solution. But what they don't talk about is how that really hits the small businessowner in the pocketbook. At a time when the economy is poor and our small businesses are struggling just to stay open, their mandatory health insurance premiums continue to increase over here to the point where it's unaffordable for many.

I find it interesting to note the cost of heath care services have increased so much over the years, way out of proportion to inflation. Here's an example...my son was very sick back in the 70's and was hospitalized for 30 days. We did not have insurance then and had to take a bank loan out to pay off the hospital and surgery bills. They were astronomical, as you might assume, for surgery and an entire month in the hospital. How much? $5,000. Now compare that to what a surgery and 30 day stay would cost today...the numbers just don't match up. What happened? I think some of the previous posters have addressed it...I just hope we can come up with solutions.

[Joatmon]

What everyone seems to be talking about is INSURANCE reform - not HEALTH CARE reform. Big Difference.
Insurance is not now - nor has it EVER been the problem.

Insurance is competitive by nature and directly tied to the market it serves and the claims it must pay. Health care insurance pays for health care costs. If you want health care insurance to be more affordable, the proper vehicle to accomplish that end would be to limit health care costs - NOT the cost of health care insurance. Apples and oranges friends.

The industry "health care plans" ranks 86th in profit margin at 3.3%, last time I checked. Outrageous! 3.3% profit margin you say? The nerve of those guys. String 'em up! (Can you detect a little sarcasm here?)

Let's pose a few simple questions, shall we?
So if your health care plan costs $10,000, the profit on that is $330. Hmmm...
So if you eliminated the insurance companies profit, your insurance would cost $9,660 instead of the original $10,000. Double Hmmm...
So if we figure in how much it would cost to implement the gigantic government bureaucracy needed to compete with the insurance companies health care plans - just how much do you think we could save? Triple, Hmmm...

Look at this graphic below. Examine some of the other, much more profitable industries, with an eye towards how they might affect health care costs. With breweries, cigarette manufacturers, major pharmaceutical companies (the sponsors of most med schools), agricultural chemicals and wineries & distilleries being in the top 20, it should give you pause for thought. I don't think the carriers are the problem here folks. Industry profits are not the market force driving the cost of health care upwards.

[marydavis]

As far as I'm concerned, I don't want the government in anymore business than it has to be. Too much of it is called socialism. This country was built on capitalism and I don't want to lose my freedom to choose what's in my healthplan, or the freedom to be rewarded for healthy living or the freedom to choose high deductible coverages or the freedom to keep my existing plan or to choose my own doctors.

How about making it mandatory for everyone to have an HSA, that way you can pay for your minor medical services and keep a high deductible for major medical services and save on premium. I would want to have my preventive care reimbursed but pay all other rountine doctor visits and tests with my own money from my HSA.

Besides all this, the long lines to doctors offices, who will take the government run health care plan, would be a nightmare!

[FFA]

I am more then a little surprised - not a word about Tort Reform on these posts.
How about reforming our legal system so that if you sue me and lose, you pay every penny of my expense.
Government Intrusion into business is not part of our economic model.
Do away with HIPPA, let the carriers set their own underwriting guidlines. The strong will survive.

How is you GM & Chrysler stock doing? Why can I not sell mine?

This debt that will rack up as a result will ruin our country.

[d's insurance store]

All these arguments about 'choice' and losing it in the current outline proposals for reform in healthcare plans is in my opinion poppycock. This co called 'choice' only exists for individuals with their own plans so long as their health records have no history...otherwise switching from one plan to another or from one health insurance carrier to another is turned down at the underwriting level. And for those who have healthcare as part of an employer paid benefit package, the 'choice' is made by the employer as to what carrier and what plans within a carrier are available. As costs have skyrocketed for employers, they make 'choices' based on business survival and not necessarily what's best for employees.

As to the argument of encouraging 'health lifestyles' with financial incentives or penalties, that's a very slippery slope for institutional intrusion into the individual lives of citizens. How do you feel about smokers? The overweight? The 'thrill seekers' living dangerously? The drinkers? The parents of kids on behaviorial modification meds? The high chlesterol people? The people who feel a need for psych counseling? Can your lifestyle attributes be imposed on your neighbors and fellow citizens? I can certainly make the case that the individual overeating at the fast food emporium who spends days and nights in front of an entertainment device rather than excercising is going to put financial strain on the health system, as opposed to my holyer than thou, clean living, low fat, active life, but how do I confront that abuser for the sake of my healthcare rates?

Malpractice tort reform? Good idea, and certainly popular with the people wanting that to be in front of any other system reform, but the statistics I see indicate that to be a relatively minor part of the healthcare money pit. Excessive tests and use of the system and the practice of 'defensive' medicine are also fair issues to discuss, but to the sick person who begins to feel they're not being treated with the maximum options, that's not going to fly.

For better or worse, citizens used to employer paid health care in an HMO environment have been acclimated to feel that healthcare only costs the $10 fee at the doctor's office and Rx really only costs $5 generic and $15 brand name. Users within the current system have no idea just how much financial burden is placed on employers to offer what has become 'usual and customary' in the workplace. For any kind of reform to work, it will take much more than congressional action...citizens of this country are going to have to have to accept major attitude adjustment in how lives are led, are care is paid for. But I don't think HSA's and high deductible plans with $10K deductibles are the entire answer fo a system that is now out of control and profit oriented.

Flame on...
D.

[FFA]

All good points.
All this profit bashing going on. If you can not turn a profit, then why be in business?
Think back to Community College business classes, the mission statement of a business is to turn a profit.