Looks like one of the parties that sang kumbaya with Obama at the White House in May is going to break ranks. What people forget, especially Obama, is that they agreed to work together to reduce health costs. That does not necessarily equate to supporting Obama's plan.
The AMA is a weasel. They supported universal health when it looked like more volume for their doctors. Now they see that they were set up to become "health care workers" who see more patients for fewer dollars. Wise up chowderheads! What did you think that socialized medicine looked like.
If someone slaps them hard enough, maybe AHIP will smarten up soon. Their little lovefest with Obama isnt going to lead to mandated coverage and a gold rush. They are leading the industry down a rathole all while Obama is able to say he has their support. Wise up chowderheads!
Now the AMA will team up with Olympia and her band of moderates who are looking for recruits then we will have a decent dog fight around the issues rather than the backroom deals where both the government and the industry are trying to carve out turf.
I kinda figured these folks would figure it out sooner or later. Everybody's always been fine with the "other" guy taking it in the shorts for healthcare, but when you're the "other" guy???
The easiest way to lower premiums will be to lower payments to doctors and hospitals as they do consume the largest part of the healthcare pie.
This is also why no plan has really surfaced because when it does... 4th of July! All these groups are going to s hit themselves when they see what they're supposed to give up.
I'm still betting that we end up nationally with what we have in WA state. Guaranteed issue, subsidized high risk pool and subsidized low income plan.
The reason? It's the easiest way to save face for OBama. He can "give" healthcare to all that way with the least amount of effort. Everything else is going to cost far more than we can afford and is going to take more than two terms to phase in with doctors and hospitals kicking and scratching all the way in.
I'm still betting that we end up nationally with what we have in WA state. Guaranteed issue, subsidized high risk pool and subsidized low income plan.
The reason? It's the easiest way to save face for OBama. He can "give" healthcare to all that way with the least amount of effort. Everything else is going to cost far more than we can afford and is going to take more than two terms to phase in with doctors and hospitals kicking and scratching all the way in.
Indeed and it has always been thus. But it is also the easiest way for the Republicans to save face too because it keeps it in the private sector. When Olympia Snowe talks about wanting to keep it in the private sector but to make changes there you can be sure that guaranteed issue is part of the equation and if there is a high risk pool to take the high users out of the picture, all the more palatable.
Guaranteed issue is coming. All the rest of the stuff like mandate and "public options" and the like can be beaten back unless the Republicans continue to go in circles as they have. Olympia will fix that even though she was a complete and total redcoat on the stimulus bill. She may have joined Arlen by cross the aisle on the stimulus bill but she is not going to be sent to Siberia like Arlen.
Yep, I know the argument that is continually made here. AHIP wont go for guaranteed issue unless there is a mandate. I just dont think they are holding enough cards and never were to play brinksmanship on that point. Of course, that will cause them to break and run and side with AMA and then one more of the kumbaya crowd will have broken ranks. Good.
As more reports and documents come out, such as the whitehouse report the other day, it becomes more obvious that the problem isn't so much the insurance companies (where AMA wants to put the blame) but the cost of actually providing care.
The whitehouse report basically said the only way to fix this is to decrease what we pay to hospitals and doctors. At that point, you can scratch the support of hospitals and doctors off the list.
Obama is great at pointing to a group who backs a concept and implying that they support his plan. He is careful with his words though.... In this, he truly is a master.
Dan
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Originally Posted by moonlightandmargaritas
How dare anyone question a physician, or make him work within any sort of financial responsibility.
Don't you realize that in the pecking order they are second only to God - and should never be questioned?
When did physicians get demoted?
Last edited by djs : 06-05-2009 at 09:23 PM.
Reason: Posts merged
The whitehouse report basically said the only way to fix this is to decrease what we pay to hospitals and doctors. At that point, you can scratch the support of hospitals and doctors off the list.
They would also get uneasy if Congress announced that it was going to reduce costs in Medicare/Medicaid 20% without reducing reimbursements by cutting fraud committed by physicians, bogus clinics and lab owners etc.
Isn't it amazing when attention finally turns to what is really driving the cost of healthcare. Everyone can whine and complain all they want about drug and insurance companies, but we all seem to forget about the hospitals, lab companies, and doctors. Unless we change the rates these providers charge and are paid, we are just rearranging deck chairs. However, many claim that to regulate the fees paid to these providers will invite the socialized medicine that is common to Europe. To be honest, they are probably right about the consequences of further government regulation in this area.
The reality is, nothing is really going to change until all parties honestly agree to work together on a solution. And let's not forget one of the real problems with the current system, the millions of Americans that CAN afford and qualify for health insurance that choose not to purchase it. Eventually these people will need the system, but since they have free-loaded for so long, they are yet another drain on the system.
The sad truth is, I do not see any leader that is strong enough to convince all the involved parties to work towards a real solution.
"Can you elaborate on WA State Guaranteed Issue? What kind of plans are these? Thanks"
It might be better to visit the OIC in Washington state and review all the details because of the variables but...
Pretty much if you want health insurance you can get it. We still have pre-ex rules to hinder the jump on jump off people. We have a 327 question health screen for those applying that can determine regular coverage or the high risk pool. The HRP runs about 40% more than a normal premium, but even that cost is subisdized by a premium tax on everybody else. So the high risk get covered and get a little help on cost.
It's been in effect for about 7-8 years maybe longer but seems to work. The only people who really complain about it are the ones who only want to pay $20 a month max for healthcare.
[quote=LGilmore;163311pretty much if you want health insurance you can get it. .[/quote]
Washington state has the type of system that I support, or at least, a base from which I think improvements can be made. I could change my mind.
LGilmore you state that it is guaranteed issue and I agree with that and think that that is where we will end out. It is however guaranteed issue at the system level in the sense that everyone who wants coverage can get it and the system guarantees that they will be issued coverage if you can afford it.
However, it is important to note that that is a very, very different kind of guaranteed issue than what many of us in guaranteed-issue states currently have. In the State of Maine for example, if you are in poor health and apply for coverage with Anthem or Aetna, they must take you - period. (although they can apply pre-x limitations for 6 months). I could be wrong but my understanding is that the situation in Washington state is very different. There, a carrier can decline an applicant but it is still a guaranteed issue system in the sense that the applicant is still guaranteed to get coverage somewhere (if they can afford it) although they may have to go to the high risk pool. This is not true "guaranteed-issue" at the carrier level as we have come to know and hate in some states.
Let me know if I am going wrong here because I would like to understand this better. If I apply with a specific carrier in Washington state and have serious health issues they can deny me, right?
This is very interesting as I am noticing in California a newer trend towards Kaiser Permanente. I have several groups right now and lots of individuals who are currently covered by a health insurance company (versus Kaiser, which is really a health care delivery product) and are wanting to switch either their individual coverage or go with a new small group plan.
The number one reason for the trend: PEOPLE ARE COMPLAINING THAT THEIR PREMIUMS KEEP GOING UP AND WHEN THEY SEE THE EOBs, THEY ARE GETTING FRUSTRATED WITH WHAT THE PROVIDERS ARE BILLING THE INSURER.
Everyone I have talked to on this has the complaint that they are tired of paying ever-increasing insurance premiums for doctors and providers who are overbilling the carriers. And they feel that the carriers are letting them get away with it.
They feel that Kaiser has much better cost controls in place given that they have employee-doctors and hospitals.
I know often when I see my own EOB, I think "wow, I don't remember the doctor being in there more than 2 minutes, how did he bill 12 different services."
"There, a carrier can decline an applicant but it is still a guaranteed issue system in the sense that the applicant is still guaranteed to get coverage somewhere (if they can afford it) although they may have to go to the high risk pool"
As the local Blue Shield rep told me "you are guaranteed coverage in Washington, you just aren't guaranteed that it is with us."
So yea, if you fail the health screen, you can be told "no" by the carriers and your "yes" is going to be the HRP. That said, the only way they can put you there is the health screen and in many cases, the person does not have to take the screen. It will depend on their situation. You can "wing walk" successfully (w/o the screen) if you've been a good trooper and had coverage and used your options up. There are about 6-8 different situations where you have to be taken by the carrier and they can't screen. While not perfect, I think it works well. Ya don't make alot in commissions here, compared elsewhere, but it's pretty cut and dried. There's not alot of choices as most individual carriers left when we adopted the Clinton plan back then. The current situation came about because for about a 5 year period, no one sold individual health as the Clinton plan was so screwed up. What we're doing now is a compromise between government and insurance that does appear to work for people who really want coverage.
As I said before, for those who expect it to be $20, well they are our uninsureds. You can't have a $5 latte every day and expect to pay premiums too...
Riding on LGilmore's comment . . . had a guy call at 6:20AM a few days back. Normally I don't answer that early but went ahead any way.
He had been up since 2AM looking for health insurance on the web. That's a bad sign right there. Found my site, ran some quotes, called.
Out of work car salesman who moved back to GA from FL. 25 years old. Doesn't need much coverage since he is never sick and very careful.
I am only half way through my first cup of coffee so not firing on all cylinders. I got his particulars, ht, wt, etc then I asked if he was taking any meds.
Not now was the response.
OK . . .
He lost his job and health insurance a year ago. Been off anxiety meds for a year and needs to get back on. Just looking for insurance to cover the doc visit to recertify his Rx and cover his meds.
Zoloft, Ambien, LExapro.
I don't have to pull up my Rx calculator to know that is $300+ in monthly Rx costs.
He can only afford $80.
I spent another 10 minutes before finally cutting him off. He was incredulous that carriers would not swap $80 in premium for $300+ in monthly Rx costs.
And Dave has a good point. One that I make whenever I suggest KP.
Here in Atlanta KP is middle of the road on premiums. They have excellent coverage especially on maternity but that is about to change.
The thing I tell folks is when a big claim rolls around you will have significantly less OOP with KP than any PPO plan.
But my doctor is not in their network . . .
That usually ends the discussion right there. I learned long ago not to push that one.
Just wait until Mr. Fixit takes away all their choices. They will wish they had a KP option.
I spent another 10 minutes before finally cutting him off. He was incredulous that carriers would not swap $80 in premium for $300+ in monthly Rx costs.
It's amazing how many times I hear this. Well that and I need insurance to go see the doctor.... hmmm, just go, they take cash.
Now, because the insurance company is not willing to lose $220 a month on him, they are profit hungry, capitalistic companies that don't care about anything.
Since he was not receptive to buying cat cover for everything else ("I am a very careful guy and never get sick") I offered him a non-insurance discount card for $30 per month.
Still waiting to see if he applies . . . but not holding my breath.
Ya don't make alot in commissions here, compared elsewhere, but it's pretty cut and dried. There's not alot of choices as most individual carriers left when we adopted the Clinton plan back then. The current situation came about because for about a 5 year period, no one sold individual health as the Clinton plan was so screwed up. What we're doing now is a compromise between government and insurance that does appear to work for people who really want coverage.
Reform: AMA Resisting
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