Affordable Care Act Scene 2 - Insurance Premiums

<p>A Blue Collar concierge model. Low monthly fees to see a primary care physician with a catastrophic type insurance policy to cover catastrophic accidents/diseases. The PCPs take more time with the patients and get rid of all the paperwork.</p>

<p><a href=“http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2014/04/01/physicians-abandon-insurance-for-blue-collar-concierge-model”>http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2014/04/01/physicians-abandon-insurance-for-blue-collar-concierge-model&lt;/a&gt;&lt;/p&gt;

<p>The trouble with the Blue Collar Concierge plans is that a person still has to get insurance, because the concierge is only for doctor’s office visits, not hospitalizations and not all drugs or all lab tests. And the patients’ maximum out of pocket is a lot higher: they have to pay the concierge fee as well as the regular high-deductible insurance premium, and then, if they have a health catastrophe, they still have to pay the entire out-of-pocket for the regular insurance.</p>

<p>Families that use a medium amount of health care would end up paying less. But families who use almost no health care would pay more, and families that use a lot of health care involving hospitalization would pay quite a bit more. So it’s a bit of a risk, for a family that doesn’t have a lot of money.</p>

<p>I suspect that the concierge plans are going to lead to doctor groups offering full insurance plans and bypassing the insurance companies entirely. And that would be a good thing.</p>

<p>Sigh, nvm… </p>

<p>One thing I don’t understand about these blue collar concierge practices: how do they avoid adverse selection? Izbicki, the practice that is described in TatinG’s article, charges $750/person/year. If they were able to get a cross-section of customers, then that would be fine, because most people don’t go to the doctor often, which would offset the people who need to go once a week or twice a month to have their chronic conditions monitored.</p>

<p>But people who hardly ever go to the doctor aren’t going to sign up for concierge medicine; it’s just an additional expense on the top of insurance, with no benefit. How do the practices not fill up with people who have chronic diseases and need to go to the doctor frequently? How can the practices make money?</p>

<p>

Thought it was your point to begin with Fang. A numerical one, comparing US outcomes to countries with entirely different demographics.</p>

<p>Like a lot of the fact-based outrage that surfaces here, it doesn’t survive too much examination.</p>

<p>

</p>

<p>Yes it is. Why are we allowing this shame in our country?</p>

<p>Other countries have poor people too. But in other countries, those poor people get universal health care so they don’t die in childbirth. We can’t even beat out Belarus, which has an average annual income of $2400.</p>

<p>Dietz, like you I have never had a day in my life where I wasn’t insured. For the last 25 years I was in the individual market because I was self-employed. </p>

<p>If you add up the premiums I payed in during that period and the benefits I took out, the insurance company made a ton of money off of me. No way I was freeloader or got a great deal because I was healthy. The insurance company loved me as a customer. To say I took advantage of those with pre-existing conditions or anyone else for that matter is hogwash. </p>

<p>PS. I have never taken a penny from the govt or anyone else without working my butt off for it, and I am not ashamed to say it. As a matter of fact, I am proud of it.</p>

<p>There’s a faint line between pointing fingers…and coming off as callous. Also, as the discussion increasingly cites “taxpayer dollars” underwriting others’ costs, it seems fair I can point out your taxpayer dollars pay for many things you may not need, but someone else- or another region- does. How much of this boils down to unpleasant “us versus them?” Especially the comments here about who these “takers” are, who are causing such grief for some of you. </p>

<p>You realize, I hope, that for all the years that, say, Dietz paid in, her own medical attention won’t stop when she exceeds that. Or would you put a cap on her care? After all, the excess has to come from somewhere. And that may be out of others’ pockets, as the insurer pays and premiums rise. Is that what you mean? So Dietz is only good for a certain amount? How much do you think you paid in premiums, for all those years, Dietz? Enough to cover anything that could happen to you or your family? </p>

<p>You know what I mean. It’s not all that complicated.</p>

<p>I see the attitude. You really think you never took a penny? never benefited even if they didn’t hand you a coin? Think about it.<br>
Good night.</p>

<p>There is one thing I am certain of: the entire social welfare system (including Obamacare) would cease to function if people like Dietz or me weren’t there to pay for it. Nothing like being insulted by the people who benefit from my largesse.</p>

<p>The United States Treasury and the State of California have been my silent partner for 25 years. They take somewhere from a third to one half of my profits year in and year out.</p>

<p>One other thing: Besides not being fond of being lectured to by the recipients of my hard earned dollars, I really dislike it when people who have benefited because of inherited wealth or by virtue of marrying into a wealthy family decide to chastise me because I am somehow not sufficiently sensitized to the suffering of the less fortunate.</p>

<p>Without naming anyone, I suspect we may have a poster who fits that description.</p>

<p>Arrogance. More mockery. What you are doing, GP, is trying to suggest you are, in some way, more special, more deserving, more alert, better able to spot the true victims (from cancer patients in media stories to yourself,) and clairvoyant re: the future. I think all of us on this thread pay taxes and hope for the best and keep going, when there are challenges. </p>

<p>I suggested you complain where it counts, take that energy and put it to work- and you suggested that is useless. Someone recently said take it to Jones- you dismissed him. So, what’s it gonna be? Just griping on CC? Why this soapbox, when you could work toward the changes you think are needed? If the problems are that real and vital to you. Don’t answer to me, think about it for yourself. Methinks you protest a lot. And then some more. Show, not tell.</p>

<p>ps. I honestly thought it was the poor and needy (and the sick) you resented. Now it’s the wealthy, too? How many targets?</p>

<p>

</p>

<p>The insurance company loved my family too. My DH’s high blood pressure and high cholesterol – the reasons his premium was pushed up by 50% – actually cost Anthem almost nothing. A few blood tests and some generic meds. So guess what. They made even more money off him than they made off you. And my D’s condition – the reason she was declared uninsurable – cost them less than $1000. In fact, there was never a year in which my family got more in benefits than we paid in premiums. So do not lecture me about your “largesse.” </p>

<p>BTW, this business about “I’ve been covered every day of my life” is not a badge of honor if you’re healthy. Where it gets tough is if you get sick. But I’m guessing that you’re in the camp which believes that illness is a symptom of moral laxity or lack of proper planning, and that it could therefore never happen to you. But believe it or not, it could. Someday you could get sick. Expensively sick. So expensively sick that your claims exceed all the premiums you’ve ever paid. And then I suspect you will be rather grateful for the “largesse” of other premium-payers. </p>

<p>

</p>

<p>No, that’s not how it works. If you’re going to toss out stuff like that, you need to have the guts to name names.</p>

<p>GP- what type of business do you own?</p>

<p>Looking at this from time to time, it’s clear this needs to be permanently shut down.</p>

<p>…………….</p>

<p>The interesting thing about the Ble Collar concierge model is that a small but growing number of PCPs are fed up with the paperwork of insurance and with the low reimbursement of government programs and are finding a way to practice to avoid both.</p>

<p>One of the problems with health insurance as a whole is that few people really understand how it works. For example, I have heard people griping who get individual plans on how much it costs them and then they see what a group plan from an employer costs, get all upset that it is cheaper. What they are missing is that the reason employer plans are cheaper isn’t the government subsidizes them or collusion, it is that when you are in a group plan the risk is spread over a large pool of people, so for example, the relatively young and healthy participants mean that their premiums offset costs of those who use more. It is why Obama care forces people to get insurance, because the larger the pool, the less risk, and the less the premiums will be for everyone. It is why in theory a national health plan would be cheaper to run, a pool of that size would have a lot less risk (I am talking national insurance, not a true national health plan here). Every group plan works on that model, and yes, those who are healthier subsidize those who are in poorer health, but guess what, those in poorer health once subsidized those that weren’t. In theory, the insurance company could simply make their entire company one pool and call it a group plan, so whether you come in individually or through an employer, you would share the savings, but they obviously aren’t going to do that, by nailing individual policy holders they jack up their profits (and if one more person tries singing the blues about health insurers, please, the head of UMR/United Health care makes close to 100 million dollars a year in compensation)</p>

<p>One of the things that Obama care is supposed to help is the worse subsidy of all, what is known as cost shifting, and it is the 500 pound gorilla in the room. Our hodgepodge of insurance systems,the hybrid of government programs, private insurance and charity care, has gaps in it large enough to drive a fleet of Titanics through it, and it also has some ‘cost savings’ that are not. I have heard touted, for example, how medicare is so efficient and its cost of services is relatively cheap, but the reality of it is that medicare cut back how much they pay for stuff, and because of regulations and the sheer size of medicare and the fear of being seen as callous of not treating older people, doctor’s and hospitals have to take it. When medicare underpays compared to what other plans pay, the doctors and hospital make up the difference by cost shifting, they jack up the fees for services. I went to the emergency room with a gash in my hand from a utility knife, and the total charge to put 10 stitches in it and bandage it was over 1 thousand dollars, when the total treatment time was about 15 minutes. </p>

<p>Then, too, when people come into the hospital without insurance, it is the same thing (despite what Rick Santorum claimed on the campaign trail last time, going to the ER when you don’t have insurance is neither full coverage, nor is it cost efficiency). My local hospital sent out a mailing recently, and they said in a typical year they had about 25 million dollars in treating the uninsured, of which about 3 million dollars was covered by government pools for the uninsured, and that 22 million comes from somewhere. </p>

<p>It is like everything else, a lot of claims of “I paid my own way”, “I pay and get nothing back”, are often more the result of myopia and ignorance than reality. For example, a lot of the places that claim to be anti government, don’t want government ‘running our lives’ and so forth, are also places that often get a lot of services from the government. States that are proudly anti tax receive a lot of money from the feds to pay for education (on whole, it averages 9% of all spending from the feds; but some states get close to 25% of their ed funding from the feds). A whole array of block grant programs, subsidies, transfers and the like benefit states, but yet anti government fever is often strong in those places. The reality is that almost everyone does get benefits from the government, whether they realize it or not. Banks love to whine about government regulation, yet if it wasn’t for those regulations, and specifically FDIC, no one would put money in a bank. Government corporations like the TVA have allowed for industry to bloom in certain quarters, and federal power plants (mostly hydro), have subsizided businesses and homeowners in places for many, many years (hint: federal power production is charged at the cost of producing it, typically 10c/KWH; utility companies charge twice that in most places)…</p>

<p>As far as ‘largesse’ goes, all I can say is people who feel that what they pay in taxes or premiums is largesse, are ignoring that it is likely that in their lives, they have been the recipient of the same ‘largesse’ they give others. As David McCollough the historian said, show me a ‘self made man’ and I’ll show you at least 10 people who have helped that person, subsidized them or otherwise help make them.</p>

<p>It is the same with health care, there is a lot of obfuscation, a lot of claims that aren’t true about it, because it is such a hidden and confusing maze.Among other things, one of the reasons rates have gone up isn’t lawsuits, it isn’t pain and suffering, it isn’t CYA, it is that health insurance companies have changed how they make money. Up until about 20 years ago, health insurers like most insurance companies pretty much broke even on premiums, the way they made money was they invested the premiums they got and made money of those investments (don’t believe me? At one point, the large insurance companies had huge financial units, long before they merged with investment firms; Travellers, Aetna, et al, were some of the largest buy side or institutional investors out there). When the markets became shaky, they changed their model, and basically started raising rates even high than before, to make money off the premiums. At one point, companies figured on a 5% ‘float’ about costs in terms of premiums, today last thing I read it was 20-25%. It wasn’t lawsuits, it wasn’t the cost of any one thing, it was in grinding out maximum profits out of premiums, which are a lot more controllable than a fluctuating stock market. On top of that, it also pleases stock analysts, which is huge to the CEO’s and executives of those firms, not to mention well heeled investors, to make money off the premiums. Health insurance executives were not generally in the higher ranks of CEO pay in the past,they made good money, but not crazy money. Thanks to stock grants being a large part of compensation, health care insurance CEO’s do very, very well, like I said, the head of UMR typically makes in the range of upper 8-9 figures, for example.</p>

<p>One other little side note, never believe when they talk about the tax burden on businesses. There is a slight of hand here, one that is thrown around and is a lie. It is true that the US has some of the highest nominal business tax rates in the world, but what that leaves out is unlike other countries, the plethora of deductions and incentives means that in terms of real rates (what the firms actually pay), the US is not even mid tier.</p>