Posts Tagged ‘Health Insurance’

Rhetoric versus Reality in Reform

Tuesday, September 22nd, 2009

By Evan Falchuk

Joe Biden unveiled a White House study on the rise of health insurance premiums.  He pressed for consumer protections the President wants to see in any reform legislation.  Among these are a pledge to pass a law that “ends exorbitant out-of-pocket expenses, deductibles or co-pays.”  Presumably this is meant to address worries many feel over the growth of high-deductible health plans.

The St. Petersburg Times looked into it to find out what this pledge means, in practical terms.  David Axelrod at the White House pointed them to the proposed House legislation, which would create limits on out-of-pocket expenses, deductibles and co-pays of $5,000 a year for an individual, and $10,000 a year for a family.

It sounds like they’re drawing a line in the sand.  But how does it compare to existing law?

Well, for a plan to qualify as a “high deductible health plan” for federal tax law purposes, it has to have a maximum limit on annual deductible and out-of-pocket medical expenses.  For 2009, that amount is $5,800 for an individual, and $11,600 for a family.

I guess the line between “exorbitant” and “not exorbitant” is somewhere between $5,000 and $5,800.

But it raises another question:

How does the strident rhetoric against insurance companies measure up against what’s actually being proposed?

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Reform Federalism?

Tuesday, September 8th, 2009

By Evan Falchuk

In America, insurance is regulated by the states, not the federal government.

Each of the 50 states decides who can sell insurance, mandates coverages, and sometimes even premiums. For some products, like auto insurance, states have made it mandatory for everyone to buy coverage. Massachusetts has taken this a step further and applied this kind of a mandate to health insurance.

The nearly complete authority of state governments over these issues is clear.

Which makes the press release issued earlier today by Pennsylvania Insurance Commissioner Joel Ario rather curious, and revealing.

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How Government Insurers are a Little Different

Thursday, August 20th, 2009

By Evan Falchuk

There has been a lot of talk about the way in which a public health insurer would compete against private ones.  As the President put it recently:

People say, well, how can a private company compete against the government?  And my answer is that if the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining — meaning taxpayers aren’t subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do — then I think private insurers should be able to compete.  They do it all the time.

He makes a good point.  But we don’t have to talk about this in theory – we can look at existing state insurance programs to see how they operate.

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A Piece of the Action

Friday, August 7th, 2009

By Evan Falchuk

The effort to find scheming enemies of progress continues.

Harry Reid announced yesterday that people protesting at town hall meetings were there at the behest of the “insurance rackets.”

Rackets?

2008-07-15-Piece_Action

There’s a lot to criticize in the health insurance industry.  But any fair discussion has to recognize the important role government has played in the creation of the health insurance industry as it exists today.

Health insurance is one of the most heavily regulated industries in America.  State governments limit competition in their markets by mandating what insurers must cover and how much they can charge.  It’s a combination that leads to high prices, anti-competitive practices, and a market that looks like this:

  • The median market share of the largest insurer in each U.S. state is about 47%
  • The five largest insurers in each state control 75% or more of the market
  • In 23 states, the five largest insurers control 90% of the market

And so if the government is so involved in the creation of the health insurance market as it exists today, why isn’t it also to blame for its woes?

Senator Reid ought to know better.

If the health insurance companies are a “racket” – well, their partner in this racket is the government itself.

Don’t Mess with My Health Care

Thursday, July 30th, 2009

By Evan Falchuk

The news is full of stories about the President’s declining poll numbers.

Analysts struggle to explain the politics of what is wrong.  But anyone in the business of employee benefits shouldn’t be surprised at all.

You don’t mess with people’s health care.

Benefits professionals could tell you all about situations where companies have tried to make important — or even minor — changes to their employees’ health plans, only to run into strong resistance.  It’s one of the reasons they work so hard to communicate and engage with employees on this subject.  Smart companies don’t change health benefits without spending a lot of time explaining things to their employees and incorporating their views.  It’s hard work, and it takes time.  But it’s necessary if you want to make effective change.

A survey by the National Business Group on Health in a couple of years ago is still one of the best on this problem.  Helen Darling, President of the NBGH said at the time: “Overall, no aspect of a job is more important to workers of large companies than having good benefits, and our survey results clearly show that the benefit most important for most workers is the health plan.”

Here’s what she is talking about.  The NBGH survey of American workers found that:

  • 75% said they would forgo a pay raise if it meant they had to buy health insurance on their own
  • 60% would not trade a drop in health benefits for a better retirement plan
  • 83% said that if their company had to cut total compensation costs, they would rather have their pay or retirement plans cut than give up any of their benefits

And yet here is the President, proposing national insurance exchanges where it sounds like employees may be encouraged to buy their own coverage.  Saying that we need to control health care costs because the government won’t be able to afford retirement plans like Social Security and Medicare.  Telling us that the government needs to save money and so has to think of ways to cut spending on health care — and raise their taxes.

It’s the perfect combination of the worst buttons to push on health care.

Imagine a CEO who told his workers, good news, we need to save money for our retirees, so I’m going to cut your health benefits in ways that are very complicated and hard to explain.  Also, I’m going to cut your pay.  And, by the way, I don’t want to talk about this for very long, we need to do this right now.

He’d be awfully unpopular.  And that’s pretty much what we’re seeing now.

Of course there’s plenty of polling data that show that, in theory, most Americans support all kinds of changes to health care.  But when you are talking about their health care, well, it’s pretty simple.  Don’t mess with it.

Why is Health Insurance So Expensive?

Friday, July 24th, 2009

By Evan Falchuk

Gary Schwitzer links to a Business Week article that says health insurance is a very uncompetitive market.  Schwitzer notes this hasn’t gotten much attention, and wonders if it is a reason why health insurance premiums keep going up.

It is – and it isn’t.  As with most things in health care, there’s more to it than it seems.

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Limited Benefits: Is the Government Really Here to Help?

Monday, July 13th, 2009

By Evan Falchuk

The American health care system is so bad, even people who have health insurance go bankrupt.

Is it true?  It may be.

The New York Times, searching for a poster child for this problem, uncovered other, more interesting questions.

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Ezra Loses It

Thursday, June 25th, 2009

By Evan Falchuk

Ezra Klein is back with another post showing what happens when you form strong opinions without knowing very much about your subject matter.

Today, he’s here to tell us the “truth” about the insurance industry.   He succeeds – but only in making himself look very silly.

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What in the World Is Steven Pearlstein Talking About?

Wednesday, June 10th, 2009

By Evan Falchuk

Did you know that doctors are paid too much, wrongly complain about medical school debt, and falsely believe there is a medical malpractice crisis?

Did you know that doctors are hopelessly conflicted sellers of medical care, motivated by the search for extra income?

Well, then you haven’t read the Washington Post’s Steven Pearlstein’s work on health care reform.

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Revealed: Why Health Insurance is So Expensive

Monday, May 11th, 2009

By Evan Falchuk

It’s a secret, hiding in plain sight.

A recently-released GAO study of the health insurance market (.pdf) found:

  • The median market share of the largest insurer in each state was about 47%
  • The five largest insurers in each state control 75% or more of the market
  • In 23 states, the five largest insurers control 90% of the market

Health insurers look like — and some might say, act like — your cable company.  They’re pretty much regulated that way.

But it’s not just insurers.  In the last two decades, there has been an equivalent consolidation of hospitals.

It shouldn’t be a surprise, then, to find hospitals and insurers cutting highly questionable deals that make each other lots of money at the expense of everyone else.

We know what to do about this.  In America, we try to introduce competition to fix problems like these.  Maybe this is one of the motivations behind the idea of a government-sponsored health insurer.  But wouldn’t it be much simpler to open up these markets to real competition?

  • "Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first."
    - Sir William Osler, MD
    The Father of Modern Medicine
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