I read the opinion piece and many other of your works about the health insurance companies, but you have been writing about their ripoffs for many years, yet these companies still find loopholes, workarounds, employ dirty tricks and game the healthcare system to increase their profits while doing little to enhance patient care. Legislation to address one set of bad practices leads to the healthcare companies finding different schemes to separate money from their customers bank accounts. It seems to be a futile game of whack a mole to end their bad practices. Perhaps that is their intention and have people throw their arms in the air to say nothing can be done.
I think politicians have been captured by the contributions of the healthcare industry and a political solution to change/stop the companies corrosive practices appears difficult to obtain.
Is there a market solution possible where a non-profit company can enter the marketplace and compete with these financial behemoths to end the ripoffs?
I appreciate the information you give of health insurance company ripoffs, but would like to start seeing some writing on solutions. Or some stories on where in the U.S. some entity has found a way to do right by their health care customers.
Very grateful for these insightful article. The Economist has written repeatedly about how American Healthcare insurers are largely responsible for the eye-watering cost of healthcare today. With $8,000 deductibles for a family of 2, and paying monthly premiums, American healthcare insurance is really only there for catastrophic situations (sometimes). To stay healthy, and manage cost, Americans need the old healthcare insurance coverage from the 90's, and the big margin investors need to find another industry - yes, there WILL be other investors to take their place. Then we can start digging into the outrageous costs demanded by hospitals and big pharma. (FYI - my daily inhaler costs $200/month in the US, 9 euros in Germany and 20 British pounds, big pharma earns 50% of their income in the US alone - who is negotiating on behalf of the taxpayers?!)
thank u for saying this sean. i agree. and I'm a health care provider and a patient in the system and, at 63, am frightened with the amount keeps rising each year that I have to pay with retirement/aging looming. Dealing with the system as a health care professional has long ago burned me out. No one told us how expensive even medicare is for the average retiree. we need a 'medicaid' not medicare 'system for all'. there has to be a way given other countries have done it ex: france, uk, england, even cuba for god's sake - have you seen Michael Moore's 'Sicko'?
I'd like to read it to, but not everyone subscribes to NYT. On other listservs, I've seen full-length articles from the Times copied into the body of emails. Please consider this in the future. Thanks.
A few questions, Mr.Potter. Can you cite your source on people having to lay out $18,900 "before" health insurance kicks in? In 2024, H.S.A maximum OOP for a family is $16,100. Still alot of money for sure, but most commercially available H.S.A's limit family deductible to less than $8,000 - and then often followed by a 20% cost share. Secondly, I was likely at that NYC meeting in 2005 with the roll out of H.S.A's. As I was at the roll out of M.S.A's in 1995. This was not as you suggest a scheme developed to shift more costs with policy holders (many - by the way - happen to be Cigna employees) but rather an alternate approach to financing health insurance by exchanging the cost of absolute premium with potential claim liability, all the while gaining a vested interest in smarter healthcare decisions (Ie: an xray vs MRI - or atorvastatin vs lipitor) + a tax favored vehicle for financing significant medical liability at retirement. Also, how does the insurer gain by promoting plans with lower premium? While you're at it - how does an insurer gain by rejecting more claims if ACA limits margins to no more than 20% above paid claims? And why are people scratching their heads over why insurers sought out alternate revenue streams?
Quote: “At Cigna, my P.R. team and I handled dozens of calls from reporters wanting to know why the company refused to pay for a patient’s care. We kept many of those stories out of the press, often by telling reporters that federal privacy laws prohibited us from even acknowledging the patient in question and adding that insurers do not pay for experimental or medically unnecessary care, implying that the treatment wasn’t warranted.”
I read the opinion piece and many other of your works about the health insurance companies, but you have been writing about their ripoffs for many years, yet these companies still find loopholes, workarounds, employ dirty tricks and game the healthcare system to increase their profits while doing little to enhance patient care. Legislation to address one set of bad practices leads to the healthcare companies finding different schemes to separate money from their customers bank accounts. It seems to be a futile game of whack a mole to end their bad practices. Perhaps that is their intention and have people throw their arms in the air to say nothing can be done.
I think politicians have been captured by the contributions of the healthcare industry and a political solution to change/stop the companies corrosive practices appears difficult to obtain.
Is there a market solution possible where a non-profit company can enter the marketplace and compete with these financial behemoths to end the ripoffs?
I appreciate the information you give of health insurance company ripoffs, but would like to start seeing some writing on solutions. Or some stories on where in the U.S. some entity has found a way to do right by their health care customers.
I was a doctor working for a health insurance company until I found out they were doing something illegal and they canned me. The lawsuit is ongoing
I would love to read the article but it’s paywalled. And I refuse to give money to the NYT.
Can you please post a gift link?
Here’s an archived copy (free to read):
https://archive.is/c0Oc2
Thank you 🙏🏼
Tge NYT paywall won't let me in. I canceled my subscription because of their horrible election coverage and clear rightward slant.
Sorry I can't read you piece, but I don't want to resubscribe.
Archived copy;
https://archive.is/c0Oc2
Very grateful for these insightful article. The Economist has written repeatedly about how American Healthcare insurers are largely responsible for the eye-watering cost of healthcare today. With $8,000 deductibles for a family of 2, and paying monthly premiums, American healthcare insurance is really only there for catastrophic situations (sometimes). To stay healthy, and manage cost, Americans need the old healthcare insurance coverage from the 90's, and the big margin investors need to find another industry - yes, there WILL be other investors to take their place. Then we can start digging into the outrageous costs demanded by hospitals and big pharma. (FYI - my daily inhaler costs $200/month in the US, 9 euros in Germany and 20 British pounds, big pharma earns 50% of their income in the US alone - who is negotiating on behalf of the taxpayers?!)
thank u for saying this sean. i agree. and I'm a health care provider and a patient in the system and, at 63, am frightened with the amount keeps rising each year that I have to pay with retirement/aging looming. Dealing with the system as a health care professional has long ago burned me out. No one told us how expensive even medicare is for the average retiree. we need a 'medicaid' not medicare 'system for all'. there has to be a way given other countries have done it ex: france, uk, england, even cuba for god's sake - have you seen Michael Moore's 'Sicko'?
Thank you for speaking out. You are doing something so important...giving us hope.
https://www.msn.com/en-us/health/diseases-and-conditions/i-was-a-health-insurance-executive-what-i-saw-made-me-quit/ar-AA1w4N8L
I'd like to read it to, but not everyone subscribes to NYT. On other listservs, I've seen full-length articles from the Times copied into the body of emails. Please consider this in the future. Thanks.
In a nearby comment I posted a link to an archived copy (free to read).
A few questions, Mr.Potter. Can you cite your source on people having to lay out $18,900 "before" health insurance kicks in? In 2024, H.S.A maximum OOP for a family is $16,100. Still alot of money for sure, but most commercially available H.S.A's limit family deductible to less than $8,000 - and then often followed by a 20% cost share. Secondly, I was likely at that NYC meeting in 2005 with the roll out of H.S.A's. As I was at the roll out of M.S.A's in 1995. This was not as you suggest a scheme developed to shift more costs with policy holders (many - by the way - happen to be Cigna employees) but rather an alternate approach to financing health insurance by exchanging the cost of absolute premium with potential claim liability, all the while gaining a vested interest in smarter healthcare decisions (Ie: an xray vs MRI - or atorvastatin vs lipitor) + a tax favored vehicle for financing significant medical liability at retirement. Also, how does the insurer gain by promoting plans with lower premium? While you're at it - how does an insurer gain by rejecting more claims if ACA limits margins to no more than 20% above paid claims? And why are people scratching their heads over why insurers sought out alternate revenue streams?
Quote: “At Cigna, my P.R. team and I handled dozens of calls from reporters wanting to know why the company refused to pay for a patient’s care. We kept many of those stories out of the press, often by telling reporters that federal privacy laws prohibited us from even acknowledging the patient in question and adding that insurers do not pay for experimental or medically unnecessary care, implying that the treatment wasn’t warranted.”
Isn’t that just typical!
Read more about Nataline Sarkisyan here:
https://en.m.wikipedia.org/wiki/Death_of_Nataline_Sarkisyan