100%. America's healthcare system is a disgrace - it serves the executives and shareholders of the gargantuan health insurers rather than patients, who often turn to substandard "temporary" or "association" plans, or even "ministry" plans, thinking they are getting the same coverage for less cost, only to learn their lesson the hard way.
Yes I’m sure the sponsors understand that Medicare for all will not include part c. Part c is for-profit private health insurance and places people’s health at a disadvantage with corporate welfare being the advantage.
Also Part D will no longer be needed with passage of Medicare for all Act.
There is another cost effective model in the U.S. I have managed a union health plan for 15 years and approaching retirement. The plan covers about 6000 lives with comprehensive low deductible (ranging from $5 to $115) as well as dental and vision. But we are not for profit and self administered (we do not use a contracted third party administrator. Our administrative costs are 4% to 8% of total spend. Our contribution rates (a/k/a premiums) are just under 1/2 the national average per participant cost. Nearly 100% of the contribution is paid by employers and most employers do pay 100%. We have very modest offices, pay modest salaries, and have kept annual increases between 0% and 4% for last ten years. As this article notes, we are not driven by profit - we are driven by pressure from employers and the union to keep costs as low as possible while still offering a comprehensive set of benefits.
All the real math and difficult work has been completed through years.
Please call your senators and ask them to co sponsor senate Bill 1506 introduced by Bernie Sanders. It’s called the Medicare for all Acts. Please call your representative to cosponsor house bill 3069 Introduced by Jayapal & Dingle thank you.
Yes we rent networks for physicians and ancillary - but use reference based pricing for hospitals and surgery centers. We also have implemented higher level bill review on claims. So we do incur network fees and we do pay "shared savings" fees. But we put a cap on the payment of shared savings for larger claims. So we do pay for these but we find that our net is very favorable.
If all unions around the country demanded single payer, we would have it. It would also take healthcare off the table as a bargaining tool. I don't know what they don't get about it.
The arbitrage between payers and providers as the payers have made claims processing and the repeated denial and clarification steps a resistance to defer cash flow out is the main reason Hospital providers are struggling to have positive margins. The game is to constantly change and make more obscure the rules and hurdles so that money stays in the bank as long as possible. It is the ultimate process tax on healthcare spending and sadly deflects directly to patients experience in seeking care.
Cont get me started on the delays that PBM’s (now largely owned directly or indirectly by Insurers) do the same thing with drugs. The friction created is harming patients in a large number of cases.
And the dirty little secret, The insurers pay so much in lobbying and political donations (bribes) to Congress and senate that there is no incentive to make wholesale changes or even investigate the way the game is being rigged against providers and patients.
Mr. T. R. Reid's article leaves out one HUGE difference in American healthcare. The document (a Provider Contract) that defines what we are owed in care and coverage is being deliberately hidden from us to grow the earnings of the so-called health insurance industry. And, it isn't insurance either, so we don't owe what they fail to pay. - - Ignore me if you you choose, but you can't dispute the above because it's clear Contract Law. Frank Lobb & www.killAbill.com
Thank you so much for this explanation of the 20% medical loss ratio our insurance companies are allowed, vs the actual cost of doing business overhead of 4-11% seen in other systems- including our own Medicare/Medicaid.
The whole idea that the INSCOs profit is based on denial of services is explicated right here.
Yes. And laws were changed under Reagan to encourage non-profit mutual companies to convert to for-profit corporations. The industry has been generally re-purposed accordingly.
It is no longer about providing protection against medical expenses or providing preventive care. The purpose of a for-profit corporation is to pay competitive dividends to shareholders while growing in financial value. They compete with other investments. That's their thing now.
There are still some non-profit carriers, but the practices of the industry have been bent. Democrats are the best hope at changing this, but too many are stuck insisting on single-payer. Politically, it is a total mess.
I write with the perspective of fifty years as a retail insurance agency. My thinking is reality-based, not investor driven. I am an independent agent and not an employee of any insurance company. We are the people charged with explaining all this to consumers. Go fish, Jerry.
100%. America's healthcare system is a disgrace - it serves the executives and shareholders of the gargantuan health insurers rather than patients, who often turn to substandard "temporary" or "association" plans, or even "ministry" plans, thinking they are getting the same coverage for less cost, only to learn their lesson the hard way.
Healing solution …
Get Republicans on board with Medicare for All Acts currently reintroduced into this 119th Congress
Yes I’m sure the sponsors understand that Medicare for all will not include part c. Part c is for-profit private health insurance and places people’s health at a disadvantage with corporate welfare being the advantage.
Also Part D will no longer be needed with passage of Medicare for all Act.
TR Ried's reporting on health care is impeccable!
There is another cost effective model in the U.S. I have managed a union health plan for 15 years and approaching retirement. The plan covers about 6000 lives with comprehensive low deductible (ranging from $5 to $115) as well as dental and vision. But we are not for profit and self administered (we do not use a contracted third party administrator. Our administrative costs are 4% to 8% of total spend. Our contribution rates (a/k/a premiums) are just under 1/2 the national average per participant cost. Nearly 100% of the contribution is paid by employers and most employers do pay 100%. We have very modest offices, pay modest salaries, and have kept annual increases between 0% and 4% for last ten years. As this article notes, we are not driven by profit - we are driven by pressure from employers and the union to keep costs as low as possible while still offering a comprehensive set of benefits.
I’m out because I support Medicare for all act.
All the real math and difficult work has been completed through years.
Please call your senators and ask them to co sponsor senate Bill 1506 introduced by Bernie Sanders. It’s called the Medicare for all Acts. Please call your representative to cosponsor house bill 3069 Introduced by Jayapal & Dingle thank you.
Does this plan use networks?
Yes we rent networks for physicians and ancillary - but use reference based pricing for hospitals and surgery centers. We also have implemented higher level bill review on claims. So we do incur network fees and we do pay "shared savings" fees. But we put a cap on the payment of shared savings for larger claims. So we do pay for these but we find that our net is very favorable.
I’m out
If all unions around the country demanded single payer, we would have it. It would also take healthcare off the table as a bargaining tool. I don't know what they don't get about it.
I’ll make it even simpler. It doesn’t work because it’s not real insurance.
The arbitrage between payers and providers as the payers have made claims processing and the repeated denial and clarification steps a resistance to defer cash flow out is the main reason Hospital providers are struggling to have positive margins. The game is to constantly change and make more obscure the rules and hurdles so that money stays in the bank as long as possible. It is the ultimate process tax on healthcare spending and sadly deflects directly to patients experience in seeking care.
Cont get me started on the delays that PBM’s (now largely owned directly or indirectly by Insurers) do the same thing with drugs. The friction created is harming patients in a large number of cases.
And the dirty little secret, The insurers pay so much in lobbying and political donations (bribes) to Congress and senate that there is no incentive to make wholesale changes or even investigate the way the game is being rigged against providers and patients.
Mr. T. R. Reid's article leaves out one HUGE difference in American healthcare. The document (a Provider Contract) that defines what we are owed in care and coverage is being deliberately hidden from us to grow the earnings of the so-called health insurance industry. And, it isn't insurance either, so we don't owe what they fail to pay. - - Ignore me if you you choose, but you can't dispute the above because it's clear Contract Law. Frank Lobb & www.killAbill.com
Thank you so much for this explanation of the 20% medical loss ratio our insurance companies are allowed, vs the actual cost of doing business overhead of 4-11% seen in other systems- including our own Medicare/Medicaid.
The whole idea that the INSCOs profit is based on denial of services is explicated right here.
Love this essay👊🏼
Your mansplaining just supports the article’s premise.
Incel
Yes. And laws were changed under Reagan to encourage non-profit mutual companies to convert to for-profit corporations. The industry has been generally re-purposed accordingly.
It is no longer about providing protection against medical expenses or providing preventive care. The purpose of a for-profit corporation is to pay competitive dividends to shareholders while growing in financial value. They compete with other investments. That's their thing now.
There are still some non-profit carriers, but the practices of the industry have been bent. Democrats are the best hope at changing this, but too many are stuck insisting on single-payer. Politically, it is a total mess.
Greg -Jerry Myers is big into moronsplaining, so just ignore him.
Might work to get employers, unions, retirement systems and etc. out of our healthcare.
I write with the perspective of fifty years as a retail insurance agency. My thinking is reality-based, not investor driven. I am an independent agent and not an employee of any insurance company. We are the people charged with explaining all this to consumers. Go fish, Jerry.
It’s the cost, Jerry. GFY.
CA Insurance License 0488272
White supremacist ideology is why the US doesn't have universal healthcare but pays for Israel's. Oh, that includes free abortive care.
So the only thing determining tax rate is health policy? With your intelligence, you must be a Trump fan...