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Re: Healthy? Insurers don't buy it
Old 01-01-2007, 08:49 PM   #21
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by mykidslovedogs
This is the one point that I think a lot of people are mistaken on. The system does shuck more and more folks out of the employer-sponsored insurance pool, but the ones that remain are not the healthy, they are the unhealthy. The healthy go off and get their own coverage at cheaper rates or drop out altogether, leaving the unhealthy in guaranteed and employer-sponsored markets, again facilitating a self-perpetuating problem of rising healthcare costs.

See, I believe that the majority of people are heathy (not the minority) and that the majority of people CAN afford coverage (not the minority).
Really?

Here in New Jersey, where they can't turn you down, I'm told comprehensive insurance for me and my wife (ages 35 and in good health) will run around $11K. Not exactly affordable when considering the median family income is somewhere around $42K before taxes.

Elsewhere, insurance is less expensive if you're healthy, but perhaps not available to everyone.

To the larger point, when companies discontinue health care coverage they discontinue it for the healthy and sick alike. The young and healthy are welcomed by the insurance industry as profitable customers. The rest, well, tough luck. Oh, and about those pre-existing conditions, tough luck. That is until we see you in the emergency room.

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Re: Healthy? Insurers don't buy it
Old 01-01-2007, 09:40 PM   #22
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Re: Healthy? Insurers don't buy it

Just to get a feel for the magnitude of the issue....

Google tells me that the total spending on US health care in 2005 was about $2 trillion.

Assuming 100 million families, that's an average of $20,000 per family per year (and rising).

Median household income was $46,000 in 2005 (couldn't find the mean).
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Re: Healthy? Insurers don't buy it
Old 01-01-2007, 10:21 PM   #23
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by 3 Yrs to Go
Really?
Well, I guess this is what I see a lot in my business, because my state is not a guaranteed issue state, and I deal mostly in the small group market vs. large group market where coverage is guaranteed, and insurance carriers cannot turn the small groups down regardless of health. The small group market has gotten killed, pricewise, in our state, in part due to this phenomenon of healthy individuals and/or their dependents foregoing the group plans for cheaper, individual policies.
[/quote]

Quote:
Originally Posted by 3 Yrs to Go
Here in New Jersey, where they can't turn you down, I'm told comprehensive insurance for me and my wife (ages 35 and in good health) will run around $11K. Not exactly affordable when considering the median family income is somewhere around $42K before taxes.
This is a perfect example of why guaranteed-issue and community rating do not work. Even with a large population of people contributing to the pool, insurance carriers cannot accurately assess risk in a guaranteed market, so they just charge everyone, including the majority of people who are healthy, much higher rates, forcing even the healthy to abandon coverage and leave the risk pool.

Quote:
Originally Posted by 3 Yrs to Go
Elsewhere, insurance is less expensive if you're healthy, but perhaps not available to everyone.
Well, this is true, but which is the worse of two evils? ... Having insurance be so expensive that almost noone can afford it, or having the ability to get insurance, albeit at different ratesfor the healthy vs. the unhealthy?

Quote:
Originally Posted by 3 Yrs to Go
To the larger point, when companies discontinue health care coverage they discontinue it for the healthy and sick alike. The young and healthy are welcomed by the insurance industry as profitable customers. The rest, well, tough luck. Oh, and about those pre-existing conditions, tough luck. That is until we see you in the emergency room.
In a scenario like this, in the current system, many of the "uninsurables" will find other jobs to provide coverage for them (thus facilitating the self-perpetuating cycle of higher prices in the group market), some will enter high risk pools, and some will forego coverage or go into the medicare system. I don't know the best solution, but I like to theorize that consumer-driven health plans like HSAs and HRAs are a better way to reduce the inelastic demand and facilitate less inflation in the industry rather than universalizing care and making the quality of the system worse for everyone.

Quote:
Originally Posted by Martha
You want to attack root causes of high cost of healthcare. But too many things are off your table. Insurance companies and their huge profits for one. Ever think that maybe part of the root cause is that insurance companies do not compete on price but instead compete for the most healthy?
What you are saying is not logical to me. Naturally, insurance companies are competing for whatever business will bring them profits. And naturally, the competitors with the lowest premiums will win the business. If we were dealing with a situation where there were no competitors, then I could see how corporate greed could get out of hand and become a root cause of the problem, but that is not generally the case here in the U.S.A, unless you live in an area that forces competitors out of the market with guaranteed-issue and community rating.

Quite a few years ago, several insurance companies left the state of Colorado because loss ratios were 1.65 to 1. $1.65 was going out in claims for every $1.00 that came in. This happened right after Colorado decided to adopt modified community rating in the small group market and insurance carriers were required to charge flat age-banded rates, regardless of gender or health status of the group. About half of the big players left our market at that time. (Aetna and Pacificare were two of the biggest to leave). Because competition dropped so much, insurance rates went through the roof, inflating at 20-50% per year for several years. As soon as new legislation was passed, allowing carriers to rate small groups up to 25% lower for "healthier" groups and up to 10% higher for "sicker" groups, several new players came into the market, creating new competition which helped hold rates much steadier over the past few years.

I don't think corporate greed is a root cause of the healthcare problems in the U.S. I'm not saying it doesn't exist at all, but I lean more toward 3 yrs' opinions about inelastic demand and consumers having been sheltered from the cost of their care for so many years.

Quote:
Originally Posted by Martha
When I ran our business of 75 employees, we could get only one insurance company to bid on us for a number of years, only because our group tended to be a bit older. All in all we were very healthy.
Hmmm...it's hard for me to believe that the insurance carriers were declining to quote because of the overall age of the group, because I'm fairly certain it is against the law for insurance companies to decline to quote based on the age of the group. I have, however, seen large groups be declined due to being in a high-risk industry (such as nursing home care - yes, people who work in the nursing home business tend to be heavy utilizers of healthcare), and I've also seen large groups be declined because of the overall disclosed health status of the group.

It always kills me when people say, "I really am healthy...the insurance company just doesn't want my business because...." It's simply not true. Whether or not a group or individual is accepted for coverage depends purely on a logical, statistical analysis of the risk of taking them on as customers.
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Re: Healthy? Insurers don't buy it
Old 01-01-2007, 10:51 PM   #24
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by wab
Just to get a feel for the magnitude of the issue....

Google tells me that the total spending on US health care in 2005 was about $2 trillion.

Assuming 100 million families, that's an average of $20,000 per family per year (and rising).

Median household income was $46,000 in 2005 (couldn't find the mean).
But I think that about half of that spending is in the Medicare and Medicaid sectors (public sector), so you can't include that into the pricing for the private sector. Good thought to check into that, though...It's still too high no matter how you look at it!
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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 07:21 AM   #25
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by mykidslovedogs
Well, I guess this is what I see a lot in my business, because my state is not a guaranteed issue state, and I deal mostly in the small group market vs. large group market where coverage is guaranteed, and insurance carriers cannot turn the small groups down regardless of health. The small group market has gotten killed, pricewise, in our state, in part due to this phenomenon of healthy individuals and/or their dependents foregoing the group plans for cheaper, individual policies.
Cherry picking.


Quote:
This is a perfect example of why guaranteed-issue and community rating do not work. Even with a large population of people contributing to the pool, insurance carriers cannot accurately assess risk in a guaranteed market, so they just charge everyone, including the majority of people who are healthy, much higher rates, forcing even the healthy to abandon coverage and leave the risk pool.
Many insurance companies abandoned the guaranteed issue/community rating market of NJ and some other eastern states, for better waters elswhere. If the whole US was guaranteed issue and community rated, the insurance companies would have to compete on price.

Quote:
I don't know the best solution, but I like to theorize that consumer-driven health plans like HSAs and HRAs are a better way to reduce the inelastic demand and facilitate less inflation in the industry rather than universalizing care and making the quality of the system worse for everyone.
You assume reduced quality without facts. You assume that HSAs will effect inflation in the industry with no facts. An HSA would do nothing for me. I still need to take certain drugs for asthma. If I was low income and only could buy an HSA plan, I may forgo getting necessary drugs. End result I would end up in the hospital. If I found a lump in my breast, I am not going to call around and find out who does the cheapest biopsy. I am going to my primary care doc and asking for referal to the best. If the lump is cancer, I am not going to shop around for the cheapest chemo provider. I want the one who gives the best result. Not Budget Chemo at the mall. According to the Kaiser foundation, half of HSAs are not even funded and the average funding is only $500.

Quote:
What you are saying is not logical to me. Naturally, insurance companies are competing for whatever business will bring them profits. And naturally, the competitors with the lowest premiums will win the business.
Lowest price for the healthy, no coverage or outrageous price for the unhealthy. They are cherry picking, not competing.



Quote:
I don't think corporate greed is a root cause of the healthcare problems in the U.S. I'm not saying it doesn't exist at all, but I lean more toward 3 yrs' opinions about inelastic demand and consumers having been sheltered from the cost of their care for so many years.
I think you are reading more into what 3 Yrs said that what he really said. I think insurance companies are a big reason why are costs are so high in the US, along with a number of other reasons.

Quote:
Hmmm...it's hard for me to believe that the insurance carriers were declining to quote because of the overall age of the group, because I'm fairly certain it is against the law for insurance companies to decline to quote based on the age of the group. I have, however, seen large groups be declined due to being in a high-risk industry (such as nursing home care - yes, people who work in the nursing home business tend to be heavy utilizers of healthcare), and I've also seen large groups be declined because of the overall disclosed health status of the group.
This is a state law issue. Actually, we did get one company say it would quote but the quote would be so much higher than our current provider that we probably would not want to bother. This was before they obtained any health info from our group and only had age info.

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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 07:51 AM   #26
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Re: Healthy? Insurers don't buy it

My throw-ins on this topic: Too many people are on too many drugs. I have an aunt and uncle, both with type II diabetes and now, consquently, cardiac issues who are each on over a dozen drugs. I cannot imagine that their docs know the interactive effects of all of these. Type II diabetes is a preventable epidemic that is driving up the cost of care. Smoking: I have lost a parent and a brother to lung cancer, the end stage. What proportion of cost are we non-smokers bearing to pay for preventable maladies tracable to smoking? Our government is complicit in both epidemics. The standard American diet recommendations don't do enough to warn people away from an overemphasis on refined grains and sugars and arise from intense lobbying by interest groups. You know about tobacco subsidies. Talk about government interference in health. While not insignificant, I do not think that malpractice suit costs are in any way a major factor across the board. One aspect that is not often mentioned is that the fact of malpractice also burdens the system. Brain damaged babies requiring lifetime care would be an example. This thread is raising some great points. In the meantime, I am bracing myself for the mess to get worse. The lobbying forces that conspire against rational treatment are entrenched and wealthy.

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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 08:59 AM   #27
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Re: Healthy? Insurers don't buy it

they only increased premiums because i work out at the gym which throws off apparent bmi. i fully disclosed both allergies and arthritis on application and was accepted without riders or increased premiums on those.

when i went to the doctor for pain in my shoulder which i thought might be a torn rotor-cuff, he diagnosed the arthritis. i asked him what i can do about that. he said "blame your mother." i asked "is that your professional opinion?"
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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 09:07 AM   #28
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by Martha
This is a state law issue. Actually, we did get one company say it would quote but the quote would be so much higher than our current provider that we probably would not want to bother. This was before they obtained any health info from our group and only had age info.
Large group markets (50 + eligible to be insured) are presided over by Federal ERISA regulation, not State, and Federal law prohibits insurance carriers from declining to quote based on age, so the only thing I can think of here is that your group was declined due to the nature of business or industry. Otherwise, the carriers that declined to quote were breaking the law.

Quote:
Originally Posted by Martha
Many insurance companies abandoned the guaranteed issue/community rating market of NJ and some other eastern states, for better waters elswhere. If the whole US was guaranteed issue and community rated, the insurance companies would have to compete on price.
NY and NJ have large enough populations to test market the concept, and we have seen the results there. IMO, if we went nationwide with the concept of guaranteed issue and community rating, small carriers that can't get a good handle on risk assessment will be driven out of business, leaving us with an oligopoly of only large carriers like United HealthCare. These carriers, especially at first, will charge exhorbitant rates, until they can get a better handle on the risks associated with guaranteed issue of coverage. Lower income families will forego coverage which will result in further inflation.


Quote:
Originally Posted by Martha

You assume reduced quality without facts. You assume that HSAs will effect inflation in the industry with no facts. An HSA would do nothing for me. I still need to take certain drugs for asthma. If I was low income and only could buy an HSA plan, I may forgo getting necessary drugs. End result I would end up in the hospital. If I found a lump in my breast, I am not going to call around and find out who does the cheapest biopsy. I am going to my primary care doc and asking for referal to the best. If the lump is cancer, I am not going to shop around for the cheapest chemo provider. I want the one who gives the best result. Not Budget Chemo at the mall. According to the Kaiser foundation, half of HSAs are not even funded and the average funding is only $500.
Martha, I have a lot of confidence that HSA usage will continue to rise over the next several years. I don't think that their effects will be immediate. Of course, it will take some time before employers as well as individuals learn how to use them and understand how to use them to their advantage.

If you had an HSA under an employer-sponsored plan, your asthma drugs would be covered subject to the plan deductible, and you would be able to purchase them on a tax-deductible basis with your HSA dollars, so how can you say an HSA will do nothing for you? Oftentimes, the cost of a prescription is not much more than the copay itself. My kids take Zyrtec. If I were on a copay plan, I would pay $45 for the prescription. The retail price of the drug is $80.00. On my HSA, I pay $60.00 on a tax-deductible basis with my network discount, AND, the cost of the prescription reduces my deductible which would NOT happen on a copay plan. Many people do not take that benefit into consideration.

I had a client who owned her own business. Before she purchased her HSA through employment, she was paying about 4000/yr. in copays for prescription drugs alone. After she purchased her HSA she was receiving 100% coverage for all services including prescriptions after her 2000 deductible was met. The additional cost to the insurance carrier was offset by the number of other healthy people in the group who now have an HSA. Before the client purchased the HSA, she used only brand name drugs. After, she started purchasing the generic equivalents for some of the drugs she was taking....a HUGE savings to the insurance carrier. This is a perfect example of how consumer-driven plans can influence our buying decisions in the healthcare market. For the chronically ill and the consumers with the highest expenses, HSAs under an employer-sponsored plan are often the best solution, because the premiums are much lower, and coverage kicks in oftentimes at 100% after deductible. There are no un-ending copays or high co-insurance maximums to meet. For this particular client, the savings to her in premiums plus copays and coinsurance splits ended up being about $10,000/yr.

We have many groups that are now either offering HSAs solely to their members or offering HSAs as part of their benefit mix. As this trend continues, I truely believe that HSAs will begin to have a positive impact on consumer spending. Some employers are saving so much on their premiums, that they are able to fund almost the entire deductible into their employees HSA accounts as a BENEFIT! I think that's fantastic.

There are many ways to save on costs within the medical industry. For example...last year, my daughter needed an ultrasound. It would have cost $1000.00 at the local hospital, or $200.00 at her Drs office in Denver. Since I have an HSA, where do you suppose I decided to take her? If I had been on a copay plan, I never would have had any incentive to shop around.

Here are some facts regarding the adoption of HSAs since they began. We need to give this concept more time. So far, 31% of people who have adopted HSAs were previously uninsured and 42% were families with incomes below $50,000.

http://www.treas.gov/offices/public-...tic-growth.pdf

Martha, if asthma is your only illness, Assurant Health will take you on their HSA plan and even cover your asthma under a separate, condition-specific deductible. Humana one is also much more lenient with contolled asthma on their high-deductible healthplans. You might want to check into it. If the premium savings is enough to justify the OOP cost of your meds, it might be worthwhile for you to look into the possibility of an individual plan for yourself.
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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 01:17 PM   #29
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Re: Healthy? Insurers don't buy it

http://lefarkins.blogspot.com/2007/0...universal.html

I and others have gone into the points made above on other threads, but I thought I would highlight these two comments:

"As someone who works in the field, I can tell you that insurers' administrative costs run about 30% of premium. That's for advertising, broker fees (paying to have new customers brought in), underwriting (ie screening out really sick people), claims handling (ie trying not to pay claims due to prior existing conditions, etc), reinsurance (laying risk off onto other insurers, typically overseas). The great majority of these costs are entirely unnecessary for the delivery of health care. And this is the insurers' costs only- the costs imposed on employers, doctors and hospitals in dealing with this system are additional."

[I don't think MKLD is a shill, but while she has given us some valuable info here, she'd be crazy to support something that would give her less business.]

and, this.. eye-opening!!
"I don't even go to the doctor anymore, it's a two month wait for an appointment, makes no sense to me. I just go to the ER, pay the $50 deductible, and at least get some kind of medical record going as to the condition I am reporting."
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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 03:58 PM   #30
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by ladelfina
http://lefarkins.blogspot.com/2007/0...universal.html

I and others have gone into the points made above on other threads, but I thought I would highlight these two comments:

"As someone who works in the field, I can tell you that insurers' administrative costs run about 30% of premium. That's for advertising, broker fees (paying to have new customers brought in), underwriting (ie screening out really sick people), claims handling (ie trying not to pay claims due to prior existing conditions, etc), reinsurance (laying risk off onto other insurers, typically overseas). The great majority of these costs are entirely unnecessary for the delivery of health care. And this is the insurers' costs only- the costs imposed on employers, doctors and hospitals in dealing with this system are additional."

[I don't think MKLD is a shill, but while she has given us some valuable info here, she'd be crazy to support something that would give her less business.]
I have serious concerns about the effects of nationalized health insurance, regardless of what happens to my business. Administrative costs are a fact of life. If insurance companies and brokers didn't exist, the government would do the administrating, and I'd be willing to bet the level of service you demand right now wouldn't be there when you needed it (Ever try getting answers from the IRS?) ... Imagine trying to appeal a claim problem with a government entity! I realize the general consensus here is that insurance companies try their darndest not to pay claims, but being in the business, I can assure you the opposite is true! We have several hundred clients and only a few claim problems here and there. 9 times out of ten, the problem is that the doctor did not bill correctly, or the client did not interpret the explanation of benefits correctly. I have seen the insurance carriers pay out thousands, even millions in claims, saving people from financial ruin.

Here is one staggering statistic. Hmmmm.....who will innovate all of the new breakthrough prescriptions without the U.S.A leading the race?

I'm sure France is using plenty of drugs that were developed in America and reaping the benefits of all of the R&D that we insurance payers and tax payers in America have had to pay for: See below:

U.S. Leads in Development of Global Drugs
Source: Pharmaceutical Research and Manufacturers of America.
USA: 45%
France: 3%
Sweden: 4%
Belgium: 5%
Others: 6%
Japan: 7%
Germany: 7%
Switzerland: 9%
UK: 14%

How about this statistic which came straight from information published by Medicaid....Over 70% of Medicaid claims stem from illnessess related to obesity and alcoholism. I've heard others on this board comment that lifestyle issues are a drop in the bucket compared to the other problems in our healthcare industry. Seems to me that lifestyle is a very important consideration when comparing the cost of care in our country to other countries.

Quote:
Originally Posted by ladelfina
and, this.. eye-opening!!
"I don't even go to the doctor anymore, it's a two month wait for an appointment, makes no sense to me. I just go to the ER, pay the $50 deductible, and at least get some kind of medical record going as to the condition I am reporting."
I am curious where this quote came from. I too have had to schedule preventive exams in advance (big deal), but here in America, I have NEVER had to wait more than an hour for urgent care nor have I ever been put on the back burner for important diagnostic tests or surgery (I'll bet the same is not true in other nationalized systems). This person who is taking advantage of the ER in that way is abusing the system and is contributing to the problem of the high cost of care in our country.
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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 04:22 PM   #31
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Re: Healthy? Insurers don't buy it

The way I see it there are only three was national health care can be done. 1) The government accepts bids form independent insurers, 2) The government provides the insurance, similar to Medicare, or 3) the government provides the service, similar to the military or VA.

The problems as I see it from 1 are. Right now there are numerous insurers to provide benefits and competition, but as soon as the government issues the contract, even if they are bid regionally, the number of insurers will drastically decrease. The end result is lower competition. This will result in one of two things. The insurer naming their price or the government taking over the game. If the insurer names their price it will be more expensive than what we already have. Then comes the second problem since the insurance companies are mandated by the federal government and are private companies they would basically be able to tell the providers what they will receive for their services. You can guess it will be rather low after all the insurers are in the business of making money. That leaves the insurer dictating the salary of the health care provider. If the doctors don't like the pay the can simply not accept the insurance and close their doors.

The problems with number two are essentially the same as with number one. I haven't heard too many people who are pleased with Medicare, I'm sure they are out there I just haven't heard of many.

The problem with number three, as I have seen it, is the government is not a very good provider of health care. I suffered through 29 years of government health care. I wouldn't wish that on anybody. My experience has been very poor service and many incompetent doctors. It is interesting that I only receive VA disability for items supposedly fixed by military doctors. A couple items I had to have removed from the VA rating because after consulting a private sector doctor they were correctly fixed.

With no profit motive to encourage the development of new medicines or procedures most of the research would be paid for by the federal government, further increasing the costs. If you think the federal government can do anything without involving large administrative overhead then you need to seriously take a look at how this government works.
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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 05:07 PM   #32
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by mykidslovedogs
Large group markets (50 + eligible to be insured) are presided over by Federal ERISA regulation, not State, and Federal law prohibits insurance carriers from declining to quote based on age, so the only thing I can think of here is that your group was declined due to the nature of business or industry. Otherwise, the carriers that declined to quote were breaking the law.
My firm's experience was pre-HIPAA changes to ERISA. Nevertheless, I don't recall a provision requiring insurance companies to provide quotes to large groups. Yes for small, but no to large.
Do you have a cite to the contrary? State law also governs to extent not inconsistent with ERISA/HIPAA.

By the way, I couldn't help but bold your statement about my office being declined due to the nature of its business or industry. Kinda funny given that we are a bunch of lawyers.
Quote:
NY and NJ have large enough populations to test market the concept, and we have seen the results there. IMO, if we went nationwide with the concept of guaranteed issue and community rating, small carriers that can't get a good handle on risk assessment will be driven out of business, leaving us with an oligopoly of only large carriers like United HealthCare. These carriers, especially at first, will charge exhorbitant rates, until they can get a better handle on the risks associated with guaranteed issue of coverage. Lower income families will forego coverage which will result in further inflation.


Martha, I have a lot of confidence that HSA usage will continue to rise over the next several years. I don't think that their effects will be immediate. Of course, it will take some time before employers as well as individuals learn how to use them and understand how to use them to their advantage.

If you had an HSA under an employer-sponsored plan, your asthma drugs would be covered subject to the plan deductible, and you would be able to purchase them on a tax-deductible basis with your HSA dollars, so how can you say an HSA will do nothing for you? Oftentimes, the cost of a prescription is not much more than the copay itself. My kids take Zyrtec. If I were on a copay plan, I would pay $45 for the prescription. The retail price of the drug is $80.00. On my HSA, I pay $60.00 on a tax-deductible basis with my network discount, AND, the cost of the prescription reduces my deductible which would NOT happen on a copay plan. Many people do not take that benefit into consideration.

I had a client who owned her own business. Before she purchased her HSA through employment, she was paying about 4000/yr. in copays for prescription drugs alone. After she purchased her HSA she was receiving 100% coverage for all services including prescriptions after her 2000 deductible was met. The additional cost to the insurance carrier was offset by the number of other healthy people in the group who now have an HSA. Before the client purchased the HSA, she used only brand name drugs. After, she started purchasing the generic equivalents for some of the drugs she was taking....a HUGE savings to the insurance carrier. This is a perfect example of how consumer-driven plans can influence our buying decisions in the healthcare market. For the chronically ill and the consumers with the highest expenses, HSAs under an employer-sponsored plan are often the best solution, because the premiums are much lower, and coverage kicks in oftentimes at 100% after deductible. There are no un-ending copays or high co-insurance maximums to meet. For this particular client, the savings to her in premiums plus copays and coinsurance splits ended up being about $10,000/yr.

We have many groups that are now either offering HSAs solely to their members or offering HSAs as part of their benefit mix. As this trend continues, I truely believe that HSAs will begin to have a positive impact on consumer spending. Some employers are saving so much on their premiums, that they are able to fund almost the entire deductible into their employees HSA accounts as a BENEFIT! I think that's fantastic.

There are many ways to save on costs within the medical industry. For example...last year, my daughter needed an ultrasound. It would have cost $1000.00 at the local hospital, or $200.00 at her Drs office in Denver. Since I have an HSA, where do you suppose I decided to take her? If I had been on a copay plan, I never would have had any incentive to shop around.

Here are some facts regarding the adoption of HSAs since they began. We need to give this concept more time. So far, 31% of people who have adopted HSAs were previously uninsured and 42% were families with incomes below $50,000.

http://www.treas.gov/offices/public-...tic-growth.pdf

Martha, if asthma is your only illness, Assurant Health will take you on their HSA plan and even cover your asthma under a separate, condition-specific deductible. Humana one is also much more lenient with contolled asthma on their high-deductible healthplans. You might want to check into it. If the premium savings is enough to justify the OOP cost of your meds, it might be worthwhile for you to look into the possibility of an individual plan for yourself.
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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 05:11 PM   #33
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Re: Healthy? Insurers don't buy it

Hmm.. I know a lot of people have violent feelings towards lawyers, so...?

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Re: Healthy? Insurers don't buy it
Old 01-02-2007, 10:36 PM   #34
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by Martha
My firm's experience was pre-HIPAA changes to ERISA. Nevertheless, I don't recall a provision requiring insurance companies to provide quotes to large groups. Yes for small, but no to large.
Do you have a cite to the contrary? State law also governs to extent not inconsistent with ERISA/HIPAA.

By the way, I couldn't help but bold your statement about my office being declined due to the nature of its business or industry. Kinda funny given that we are a bunch of lawyers.
I've got a question into NAHU on this. I know they can decline to quote based on nature of business (not sure if lawyers fall into the category of "high risk" or not...I've never run into that before, but then again, we don't do a lot of larger sized groups, either......hee hee) and based on claims history, but I'm fairly certain they can't just decline to quote based on age. I could be wrong on that. I'll get back to you and let you know what I find out on this.
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Re: Healthy? Insurers don't buy it
Old 01-03-2007, 12:26 AM   #35
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by mykidslovedogs
Here is one staggering statistic. Hmmmm.....who will innovate all of the new breakthrough prescriptions without the U.S.A leading the race?

I'm sure France is using plenty of drugs that were developed in America and reaping the benefits of all of the R&D that we insurance payers and tax payers in America have had to pay for: See below:

U.S. Leads in Development of Global Drugs
Source: Pharmaceutical Research and Manufacturers of America.
USA: 45%
France: 3%
Sweden: 4%
Belgium: 5%
Others: 6%
Japan: 7%
Germany: 7%
Switzerland: 9%
UK: 14%

So the US develops 45% of the drugs and the EU develops at least 42%? Why is this staggering?
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Re: Healthy? Insurers don't buy it
Old 01-03-2007, 06:25 AM   #36
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by califdreamer

So the US develops 45% of the drugs and the EU develops at least 42%? Why is this staggering?
The EU is not a single country. If you look at it that way then you could say, "At least 87% of all new medicine is developed by western nations. So Americans aren't tht important to the development of new medicines." The staggering part is that the US with it's incredibley flawed medical system developesalmost half of all new medicines.
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Re: Healthy? Insurers don't buy it
Old 01-03-2007, 07:08 AM   #37
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by lets-retire
The staggering part is that the US with it's incredibley flawed medical system developesalmost half of all new medicines.
When adjusted for gdp, the US and the EU produce about the same amount of new medicines.

That means that the EU, with mostly socialized medical care, developes about the same amount of new medicine as the US.

This doesn't even get into the discussion about the fact that R&D budgets are around the same as sales and marketing budgets for most of big pharma.

Jim
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Re: Healthy? Insurers don't buy it
Old 01-03-2007, 07:48 AM   #38
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by magellan
When adjusted for gdp, the US and the EU produce about the same amount of new medicines.
Plus, many so-called "new drug" development is largely, of late, variations on old drugs which allow remarketing prior to the original patent expiration date. Generally speaking, Enalapril=Lisinoopril=captopril; omopeprazole-pantoprasole=esomeprazole; etc.

No doubt the American pharmaceutical manufacturing capability is impressive and I am proud of it. The irony is that all this fails to improve our health outcomes relative to many other countries.

I find the "staggering" claim to be unsupported by any reasonable interpretation of the situation, and unrelated to the health care delivery system. What's "staggering" is that the richest, most dynamic economy in the world has failed to provide basic health care access and support for over 40 million of its citizens.
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Re: Healthy? Insurers don't buy it
Old 01-03-2007, 10:08 AM   #39
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by Rich_in_Tampa
Plus, many so-called "new drug" development is largely, of late, variations on old drugs which allow remarketing prior to the original patent expiration date. Generally speaking, Enalapril=Lisinoopril=captopril; omopeprazole-pantoprasole=esomeprazole; etc.
I agree with you on this point and have mentioned it earlier in one of my earlier posts as a wasteful use of our healthcare dollars. However, Americans demand these choices, and the only way to change it is to divorce people from "rich benefits" that they are so used to, and perhaps make people more accountable for their choices ... perhaps by having health plans like HSAs, which make people think twice before using Nexium instead of Prilosec OTC, or perhaps having plans with very high copays for what I call "convenience" drugs and very low copays for "lifesaving" drugs such as anti-biotics.


Quote:
Originally Posted by Rich_in_Tampa
No doubt the American pharmaceutical manufacturing capability is impressive and I am proud of it. The irony is that all this fails to improve our health outcomes relative to many other countries.
I keep seeing this point mentioned in earlier posts by other members of the forum. It seems that the comparison of lifestyles between the US and other countries has been minimized. I don't think we can compare apples to apples on health outcomes when we compare the lifestyles of Americans to other countries. In America, over 65% of our people are overweight. Even Medicaid has published data that over 70% of claims paid out are related to illness stemming from obesity and alcoholism. We take almost as many antidepressents as we do anti-biotics.

Quote:
Originally Posted by Rich_in_Tampa
I
find the "staggering" claim to be unsupported by any reasonable interpretation of the situation, and unrelated to the health care delivery system. What's "staggering" is that the richest, most dynamic economy in the world has failed to provide basic health care access and support for over 40 million of its citizens.
I don't see how you can say that innovation and quality of any sort is "unrelated" to the healthcare delivery system. Yesterday, I spent some time talking to a friend of mine who is from Britain. He shared with me that the hospitals and rooms available to the general public are "dirty" and "lack privacy". Only the very rich are able to get the kind of care and quality that even the poorest American is used to here in the USA. He told me that the primary reason the medical system "survives" out there is through the investments of venture capitalists. He said if it weren't for them, the public system would fail.

If doctors had to survive only on the salaries paid to them by the Medicaid and Medicare systems, would their careers be worth the investment in the education required to become a doctor? Do we really believe that the government would fairly compensate our medical community to a point where there would be no concerns about shortages of care? How many of our young people will choose healthcare careers in a purely socialized system? Would we lose good hospitals to bankruptcy? Is it possible that a lack of good doctors and hospitals could lead to "rationing" of another sort here in America? Perhaps extreme wait times for transplants? - heart/lung surgeries? - oncology care? brain surgeries? due to lack of specialists available to handle the additional 40 million patients? Would the USA continue to be a leader in technology and innovation in pharmaceuticals, medical equipment, diagnostics, hospital facilities, etc..? These are some of the questions that really bother me.
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Re: Healthy? Insurers don't buy it
Old 01-03-2007, 11:19 AM   #40
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Re: Healthy? Insurers don't buy it

Quote:
Originally Posted by mykidslovedogs

I don't see how you can say that innovation and quality of any sort is "unrelated" to the healthcare delivery system. Yesterday, I spent some time talking to a friend of mine who is from Britain. He shared with me that the hospitals and rooms available to the general public are "dirty" and "lack privacy". Only the very rich are able to get the kind of care and quality that even the poorest American is used to here in the USA. He told me that the primary reason the medical system "survives" out there is through the investments of venture capitalists. He said if it weren't for them, the public system would fail.
Complete BS. On your own data the UK system produces proportionately more innovation than the US. Some hospitals in the UK may be old and poorly maintained but everyone in the UK (including visitors) has access to excellent urgent care - the bottom 15% are not excluded. Yes, a lot of new funding is via Private Finance Initiatives so that Gordon Brown (UK Chancellor of the Exchequer) can meet his public finance targets but this is only an alternative form of capital funding, the NHS services the debt.

Stop throwing around ill informed anecdotes to support your case, instead research some facts. The UK system is one to consider but it has many faults, look at other nations and try to develop an answer that combines the better aspects of each. The German and Dutch systems are nationalised medicine combined with private insurance for the better off, both systems are far superior to the current mess in the US. You cannot get away from the simple facts that the US system is incredibly wasteful, is a failure for a large percentage of the population, and is the most inefficient on cost per head basis. This nation is heading for a health crisis.
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