AMA opposes health insurance mergers

[explanade]

AMA says insurance mergers will raise premiums and hurt quality of care - Sep. 8, 2015

So fewer big health insurance companies.

Doctors and hospitals (hospitals also oppose these mergers) would have fewer insurers with which they can negotiate rates.

We know that some plans offered by a given insurance company has a smaller network of providers, especially the ACA exchange plans.

So the insurance company gains leverage and then what? Some doctors and hospitals which command higher rates and thus are not on the cheapest plans' networks would either have to reduce their fees or not have any arrangements with insurance?

Guess it could be more like Medicare, where a lot of providers supposedly stop taking Medicare but they're so huge that providers can't ignore it.

But if they don't take any insurance, then what, it's not like a lot of people can afford to pay out of pocket.

 

[samclem]

They are reaping what they sowed. Couldn't happen to a nicer cartel.

 

[Greencheese]

So the medical profession opposes stronger insurance companies and the insurance companies oppose stronger medical professions, shocking!

 

[travelover]

So the medical profession opposes stronger insurance companies and the insurance companies oppose stronger medical professions, shocking!

It is hard to love insurance companies, but it is hard to imagine what we would be charged by medical providers if they were given carte blanche to set rates. We have a hint from the rates for the uninsured or, God forbid, out of network.

 

[photoguy]

It is hard to love insurance companies, but it is hard to imagine what we would be charged by medical providers if they were given carte blanche to set rates.

In California, we have a pretty dramatic difference between Norcal and Socal where the north sees a 7% rate increase vs 2% for the south. Covered CA attributes this to a lack of competition in providers:

Provider competition (or area provider monopolies) is a primary driver of the difference in premiums between northern and southern California. Close to 70 percent of the 25 largest general acute care hospitals are in the southern region of the state compared to the north. When a region has fewer hospitals and is dominated by a few large integrated hospital systems and medical groups, there is much less negotiating leverage for the health insurance companies to secure lower contracted rates for health services. In California, this regional variation in cost is apparent between the northern and southern California counties where premiums can be up to 30 percent higher, for example, comparing the San Francisco region to the Los Angeles region.

from http://www.coveredca.com/PDFs/7-27-CoveredCA-2016PlanRates-prelim.pdf

 

[Car-Guy]

I may start a new poll. Who claims they really care about you and will offer the best service available but actually provides terrible service to their "base", once they are selected?

Options, Medical insurance companies or Washington Politicians.

I'd probably add a third option, they are equally as bad.

 

[Senator]

Medical professionals are some of the most overpaid professionals out there. Ever look at a 10 minute appointment invoice? A bit of pain on their end doesn't hurt me.

They limit entry into the medical field, then complain about too many hours. We should let more people attend medical school.

Soon all insurance will be merged into a single payer, like medicare. Then it will not matter as much.

 

[longranger]

Single payer is the best solution, but only if we eliminate the insurance, legal and pharmaceutical lobbies from the equation. Everyone loves throwing stones at the health care providers but DRs now collect less than 10% of "medical dollars". No boo hoos for physicians but the real savings are in that other 90%.

 

[Walt34]

Medical professionals are some of the most overpaid professionals out there. Ever look at a 10 minute appointment invoice? A bit of pain on their end doesn't hurt me.

I wouldn't be too harsh on them for that. Consider their expenses - the office I go to there are three doctors, three administrative people who I'm sure spend much/most of their time dealing with insurance companies, three or four nurses/techs, plus the rent for the office space that I'm sure isn't cheap. We haven't even discussed malpractice insurance...

Their cost of doing business is high, I'm sure.

 

[samclem]

Single payer is the best solution, .

Because having no choice is better than having choice, and because competition is bad.

 

[neihn]

I have no respect what so ever for medical professionals who first priority is make big bucks. Yes, I know it is how capitalism works, but if you are in the business of saving life, why it is not the first priority.

 

[samclem]

I have no respect what so ever for medical professionals who first priority is make big bucks. Yes, I know it is how capitalism works, but if you are in the business of saving life, why it is not the first priority.

The first priority can't be the only priority . . .ever. It's true in every decision we make. And since resources aren't infinite, those in the medical field, and the insurance biz, have to make decisions about where they are used.

 

[Gotadimple]

Soon all insurance will be merged into a single payer, like medicare. Then it will not matter as much.

Yes, it will matter just as much as it matters today. You do realize that Medicare does not contract with doctors and hospitals - health plans that process the claims do - on behalf of Medicare.

Medicare collects the money and the health plans claim it to pay for medical services. Medicare makes the rules and health plans (and providers) follow them. AMA speaks up and Medicare changes the rules - after long and thoughtful deliberation.

Health plans get paid an administrative fee for maintaining systems and hiring people to do the work.

Rita

 

[explanade]

Single payer is the best solution, but only if we eliminate the insurance, legal and pharmaceutical lobbies from the equation. Everyone loves throwing stones at the health care providers but DRs now collect less than 10% of "medical dollars". No boo hoos for physicians but the real savings are in that other 90%.

Here is a breakdown of where health care spending goes, for 2013.

Out of $2.9 trillion total, 20% went to doctors and 32% went to hospitals.

Insurance was only 7%, though it paid 72% of the dollars (includes Medicare, Medicaid, VA as well as private insurance).

https://www.cms.gov/Research-Statis...Downloads/PieChartSourcesExpenditures2013.pdf

 

[Mulligan]

I wouldn't be too harsh on them for that. Consider their expenses - the office I go to there are three doctors, three administrative people who I'm sure spend much/most of their time dealing with insurance companies, three or four nurses/techs, plus the rent for the office space that I'm sure isn't cheap. We haven't even discussed malpractice insurance...

Their cost of doing business is high, I'm sure.

Plus it is easy to forget the first phase.... Most have hit 30 before they even can get started. Throw in student debt load in the hundreds of thousands of dollars. Assign Doctors a mandatory capped salary of $100k and lets see how many enter the profession. If I was promised a million dollars a year as a doctor, that couldn't have motivated me to survive 10 plus years of schooling. Well at least going to school and actually focusing on learning anyway...


Sent from my iPad using Tapatalk

 

[AllDone]

Here is a breakdown of where health care spending goes, for 2013.

Out of $2.9 trillion total, 20% went to doctors and 32% went to hospitals.

Insurance was only 7%, though it paid 72% of the dollars (includes Medicare, Medicaid, VA as well as private insurance).

https://www.cms.gov/Research-Statis...Downloads/PieChartSourcesExpenditures2013.pdf

20% goes to physician services (i.e. gross income), 8-10% (i.e. net income) actually goes home with the physician.

 

[explanade]

But they're still getting $600 billion and then half of that net would be $300 billion.

 

[longranger]

The numbers we are discussing include only dollars coming from the federal government. "The real numbers", which include private insurance and patients that pay out of pocket is much higher. It is easy to point a finger at any of the major cost centers and call them the problem. That is not productive unless we first target cost centers that do little or nothing to improve the delivery and quality of healthcare. These cost centers are well known and represented by strong political lobbies. Think pharma, malpractice litigators, insurance companies etc.. Then there is the cost of regulatory oversight at the federal, state and local levels. I cannot even find an estimate of what % of the medical dollar goes to that demographic.

It is very frustrating. We all know for a fact that we pay the highest per capita for healthcare in the world. For what we pay everyone in this country should be getting Cadillac coverage.

So how does this all relate the the issue that started this thread? Consolidation of companies eliminates competition and is counter the principles of capitalism. Consolidation creates a more powerful healthcare insurance lobby. Sure it is more complicated than that but these are the primary drivers for consolidation.

Lastly beware of statistics. The numbers tossed around may be gross or net. They are usually skewed by limiting the data to "subsets of data" that are favorable whatever argument an organization or individual is trying to make.

 

[explanade]

No it isn't, that chart shows all dollars, including private insurance.

And insurers account for only single digit percentage of health care spending.

Why is it controversial to say the providers get bigger pieces of the pie? We've heard about $900 charges for a bottle of aspirin at the hospital. Is the insurer getting most of that $900?

 

[Gotadimple]

No it isn't, that chart shows all dollars, including private insurance.

And insurers account for only single digit percentage of health care spending.

Why is it controversial to say the providers get bigger pieces of the pie? We've heard about $900 charges for a bottle of aspirin at the hospital. Is the insurer getting most of that $900?

No, and neither is the hospital. The figure is inflated to cover the costs of uncompensated care (those without insurance) + costs to maintain their facility + a sinking fund for new buildings equipment (Medicare lets them do this math).

Insurers and hospitals are generally diametrically opposed business partners.

All the insurer gets is the 'chance' to keep a profit if the cost of care + their administrative costs stay under the premiums collected. All the provider (hospital/lab/doctor) gets is the 'chance' to use the large stream of patients to cover the cost of care + administrative costs (building funds, salaries, benefits, etc.).

So one wants to keep costs low (insurers) while the other wants to increase the compensation they receive (providers). This is true in private insurance and in single-payer plans, like Medicare and Medicaid.

The cost of a bottle of aspirin, as billed, is no different than Boeing charging $10,000 for a screwdriver used to build a jet airplane. It's a negotiating point.

Rita

 

[longranger]

"No it isn't, that chart shows all dollars, including private insurance.

And insurers account for only single digit percentage of health care spending.

Why is it controversial to say the providers get bigger pieces of the pie? We've heard about $900 charges for a bottle of aspirin at the hospital. Is the insurer getting most of that $900?"

Found that chart, I think. Yes it does list total medical including private insurance at a little over 17% of GNP or 2.7 trillion. Looks like data for 2012 so it may be a different chart. I was using a 2016 estimate of 3.8 trillion. Sorry for my initial misinformation.

As far as concern for ridiculous prices for medical care I suspect we are in agreement. I am a practitioner so I see it every day. It is so frustrating.