Judge Karen Scott dismisses federal claims against HaloMD, signaling that insurers can’t use RICO and ERISA suits to bypass the law’s dispute resolution process.
The piece most plan sponsors miss in this litigation pattern: when a fully insured plan loses an IDR arbitration, the insurer pays the award. When a self-funded plan loses, the employer does. Anthem is pursuing ERISA theories in federal court nominally on behalf of plans whose sponsors often do not know the strategy exists, let alone whether it is being pursued in their interest.
The Fifth Circuit QPA case deserves the same employer lens. If the calculation has been systematically depressed, self-funded plans have been underpaying out-of-network claims for years, and the correction will land on plan reserves. The carrier does not carry that risk. The plan sponsor does.
USAmerican Healthcare is some of the best in the world.
However, the funding for USAmerican Medical Care is the most complex and complicated and intentionally obtuse in the world.
There can be only one explanation for this--the insane GREED of the Health Insurance Corporations. The Physicians--most of them--are just along for the ride. The physicians like the big paychecks but most would accept much less without complaining.
It's the Medical Insurers and the Hospitals that are driving the ridiculous Profit-Taking in American Medical Care!
THERE ARE CURRENTLY 72 COUNTRIES THAT PROVIDE UNIVERSALLY FREE HEALTHCARE!
The USA is NOT one of them!
It could be but the USAmerican Insurance Industry won't give up this CASH COW!
Since this substack is devoted to the health insurance system, some may find interesting a recent interview of Republican healthcare policy person Lanhee Chen, on Firing Line. (This is not an endorsement of what Chen advocates. I am on the other, Democratic side on healthcare. I think many of the readers here are also on that side, but we all want to understand all sides of an issue in order to be good participants in a democracy.)
Having gotten the impression that some of the Republican advisers on healthcare might be fully incompetent, or no more than pure propagandists (e.g. when I researched a bit here:
Mr. Chen calls for small changes only to improve the current system, and was not specific in the interview. I get the feeling he is not uncomfortable with the idea of throwing say 15% of the people under the bus on healthcare and the bills from healthcare services, though I think he is genuinely trying to get a bit of improvement in the system.
He seems oriented very highly to have the market fix most of our healthcare problems, and I could see potential refutations of some of his proposed general ways of doing things quickly. (Though, really, I need more details on his exact policy recommendations.)
He did criticize Republican politicians for trying to wreck the ACA simply because it came from the Democrats. O.K. He’s in a political world, and in fact is a politician as well, since we learn from the interview that he ran for office somewhere in California. Really, such behavior as trying to wreck the ACA simply because it came from the Democrats is such a low and incompetent thing, very bad for a democracy, and is evidence of a class of political leaders who are not suited to lead in a democracy that we want to function. He didn’t say that!
Actually, Margaret Hoover, who does the Firing Line interviews, and who I like, is not in the current dominant hooligan class of Republicans, and does actually call out the current comtemptible Republican behavior. She doesn’t condemn it with with angry words, but still points it out, and makes it apparent that she opposes to that stuff. (Not so on this episode, though.)
As well, notable, unfortunately not clear enough in the minds of many reporters that it was a lie, at the end-of-last-year, the more base Republicans were outright lying about the shutdown going on at the time, saying it was so that the Democrats could provide healthcare to undocumented immigrants.
Neither Mr. Chen, nor Ms. Hoover, made mention of that extreme lying. (I take that lying to be beyond prior political norms on deception levels.)
I was encouraged by that Mr. Chen used terminology for people on the other side of him on the issue, which were something like “my Democratic friends” or “my liberal colleagues”, rather than talking about, say, “toxic Paul Krugman”, which I noted Treasury Secretary Scott Bessant did at least once😊.
Shame on these insurance company litigants
The piece most plan sponsors miss in this litigation pattern: when a fully insured plan loses an IDR arbitration, the insurer pays the award. When a self-funded plan loses, the employer does. Anthem is pursuing ERISA theories in federal court nominally on behalf of plans whose sponsors often do not know the strategy exists, let alone whether it is being pursued in their interest.
The Fifth Circuit QPA case deserves the same employer lens. If the calculation has been systematically depressed, self-funded plans have been underpaying out-of-network claims for years, and the correction will land on plan reserves. The carrier does not carry that risk. The plan sponsor does.
Grateful for the coverage.
Once again this greedy industry fails the most basic test of economics.
USAmerican Healthcare is some of the best in the world.
However, the funding for USAmerican Medical Care is the most complex and complicated and intentionally obtuse in the world.
There can be only one explanation for this--the insane GREED of the Health Insurance Corporations. The Physicians--most of them--are just along for the ride. The physicians like the big paychecks but most would accept much less without complaining.
It's the Medical Insurers and the Hospitals that are driving the ridiculous Profit-Taking in American Medical Care!
THERE ARE CURRENTLY 72 COUNTRIES THAT PROVIDE UNIVERSALLY FREE HEALTHCARE!
The USA is NOT one of them!
It could be but the USAmerican Insurance Industry won't give up this CASH COW!
The US Healthcare system has produced substandard results, moreover if you look at its poor cost effectiveness.
US healthcare is the best for some but the worst for most.
Since this substack is devoted to the health insurance system, some may find interesting a recent interview of Republican healthcare policy person Lanhee Chen, on Firing Line. (This is not an endorsement of what Chen advocates. I am on the other, Democratic side on healthcare. I think many of the readers here are also on that side, but we all want to understand all sides of an issue in order to be good participants in a democracy.)
The interview is here.
https://www.youtube.com/watch?v=KybHzgxBdJI
My reaction to it, for those interested:
Having gotten the impression that some of the Republican advisers on healthcare might be fully incompetent, or no more than pure propagandists (e.g. when I researched a bit here:
https://normspier828307.substack.com/p/a-little-exploring-around-some-of ), I am pleased that Chen shows himself to be not in one of those categories.
Mr. Chen calls for small changes only to improve the current system, and was not specific in the interview. I get the feeling he is not uncomfortable with the idea of throwing say 15% of the people under the bus on healthcare and the bills from healthcare services, though I think he is genuinely trying to get a bit of improvement in the system.
He seems oriented very highly to have the market fix most of our healthcare problems, and I could see potential refutations of some of his proposed general ways of doing things quickly. (Though, really, I need more details on his exact policy recommendations.)
He did criticize Republican politicians for trying to wreck the ACA simply because it came from the Democrats. O.K. He’s in a political world, and in fact is a politician as well, since we learn from the interview that he ran for office somewhere in California. Really, such behavior as trying to wreck the ACA simply because it came from the Democrats is such a low and incompetent thing, very bad for a democracy, and is evidence of a class of political leaders who are not suited to lead in a democracy that we want to function. He didn’t say that!
Actually, Margaret Hoover, who does the Firing Line interviews, and who I like, is not in the current dominant hooligan class of Republicans, and does actually call out the current comtemptible Republican behavior. She doesn’t condemn it with with angry words, but still points it out, and makes it apparent that she opposes to that stuff. (Not so on this episode, though.)
As well, notable, unfortunately not clear enough in the minds of many reporters that it was a lie, at the end-of-last-year, the more base Republicans were outright lying about the shutdown going on at the time, saying it was so that the Democrats could provide healthcare to undocumented immigrants.
(For examples of that lying, from both the administration and members of Congress, see https://normspier828307.substack.com/p/exploring-the-mass-deception-and).
Neither Mr. Chen, nor Ms. Hoover, made mention of that extreme lying. (I take that lying to be beyond prior political norms on deception levels.)
I was encouraged by that Mr. Chen used terminology for people on the other side of him on the issue, which were something like “my Democratic friends” or “my liberal colleagues”, rather than talking about, say, “toxic Paul Krugman”, which I noted Treasury Secretary Scott Bessant did at least once😊.
His main "new" idea appears to be another health savings account. Thanks but No Thanks.
Agree, he loves HSA’s