Insurance exchanges may limit health care options
By Chad Terhune, Los Angeles Times
The doctor can’t see you now.
Consumers may hear that a lot more often after getting health insurance under President Obama’s Affordable Care Act.
To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state’s new health insurance market opening Oct. 1.
New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law.
These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation’s biggest healthcare expansion in half a century.
Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.
Duh.
The media that was proclaiming how obamacare would save the world is suddenly waking up to the reality of the market.
The major problem with “Obamacare” is no different than what would have been the problem with Romneycare McCaincare or anything else that could have been introduced. That problem is that they are still all dependent on “FOR PROFIT” insurance companies. Until we get the special interest lobbyists out of Washington nothing will be done to move us towards the single payer concept that works well throughout the world. Until that happens, the insurance companies will still be dictating what type of health care you will get and now they have a captive market that is required by law to pay them for it. And the fat cats will keep getting richer while our health care system will continue to become more substandard than it is already.
Worldcycle—- Forget the insurance companies, the Federal Government is already doing this through Medicare. If your Doctor accepts Medicare as payment (fewer and fewer now do this) the Medicare system decides how much a procedure is worth and pays the Doctor 80% of their value then you pay the other 20% (possibly through another insurance plan).
Say the Doctor charges $100 for an office visit including some tests, Medicare might say it’s only worth $50 and they pay the Doctor $40. You pay the remaining $10. But if the Doctor doesn’t accept Medicare, like Mayo Clinic, Medicare would pay $40 and you’d be responsible to pay $60.
This isn’t an insurance company it’s our Federal Government and it isn’t making any insurance company rich.
The newest revelation about Obamacare is found in today’s New York Paper at
http://nypost.com/2013/09/15/obamacare-will-question-your-sex-life/
Sexual history was supposed to be asked for at least the last 20 years, the only reason it wasn’t, is because medical personnel was too embarrassed to ask.
Advocate, what you say is not news. The insurance companies do the same thing. Each company contracts for a certain amount that they will pay per procedure with each care provider. This is why you have the PPO’s, HMO’s and numerous other type of plans which determine who and who is not in your network of care providers. If your insurance company is not contracted with them you will pay more or all of the bill if you see them. A large number of people here are sent down the hill for their care from the local hospitals if they are non-emergent because they have Kaiser and Kaiser will not pay.
The situation is even worse for those of us who do not qualify for Medicare yet. Lets say you go to the hospital and receive a $10,000 bill. Etna may have contracted that procedure is only worth $6000, Health Net perhaps $4,500 and Blue Shield $7,000. Medicare may only pay $4,000. Just because they have contracted for these amounts does not necessarily mean that you are responsible for the balance. Yet if you were uninsured you would be responsible for the entire $10,000. There should be one price for everybody regardless of how or who is paying the bill. Thus in all probability the uninsured is not going to pay their bill. I know plenty of doctors that would rather provide care for a Medicare patient than an uninsured one because as “bad” as Medicare pays, at least they know they will get paid.
Both are equally guilty in that respect, yet why must we all suffer and pay over inflated premiums to support an industry that continually posts higher quarterly earnings. At the same time our premiums are conventionally raised to pay for what the statements claim to be increased healthcare costs while at the same time the policy coverages decrease.
How about if we got the government out of the insurance business completely? Instead of government favoring certain insurance companies over others, maybe they could let the market actually work.
Let the insurance companies work across state lines. Let people purchase policies for things THEY want covered instead of everything the State says must be covered. Let the companies compete for your business, without government interference. How about tort reform to get rid of the ridiculous malpractice lawsuits where people think a mistake entitles them to win the lottery?
Back in the day, you could buy catastrophic coverage for the big stuff, and an everyday visit to your family doctor wasn’t so expensive that it would break the family budget.
You can thank lawyers and government for all of this. Expecting the people who created the problem to fix it now is lunacy.
Dogula, insurance companies competing over state lines is not going to make a difference. Already the biggie such as BCBS, Met and others do this. They just tweak their names slightly. In reality, a company is not going to give high cost states such as our own the same rates as s lower cost state. This already holds true even for the same company insuring you in California. Live in El Dorado County? One rate. Move to Orange County, your rate will change. The insurance companies have been doing this for decades. I own rental property here, Nevada and Utah. Guess what? For the same property value and coverage, Utah is the least expensive. Maybe they do not have as many lawsuits there. I can show you my premiums to prove it.
Everybody blames the government. Maybe true in the past because the past is why it is the way it is today. Now the insurance companies hold the upper hand and spend billions in lobbying to make sure that they still remain in control and the ones holding the cards when it comes to you and me getting our health care needs met in the future.
You contradict yourself. You say if USED to be government to blame, then you say the insurance companies hold the upper hand because of lobbyists. Who do lobbyists lobby??? Government officials. Who have the power over the insurance companies. They give or take away. And 90% of those government officials are lawyers these days. THEY are the ones who make the rules. And WE are the ones who pay.
Corporatism can’t exist without government favor.
Letting insurance companies work across state lines is a stupid ‘market’ idea-thats just what happened with the credit card companies during Reagan-offer some conservative state such as So. Dakota in this case some tax income and jobs in exchange for allowing the company to write all the laws and regulations-thats why the card cos. get away with consumer theft and insurance cos. would do the same thing with the same disasterous results-take the money out of gov’t elections with campaign finance laws eliminating ‘corps are people, money is speech’-improve gov’t don’t eliminate it in favor of the predators of privatization that have only one goal-profit at any cost
Teatotal, it is obvious that you dont know how things work, just because a company is domiciled in a state does not mean that is can use those state laws to run over another states citizens, they still have to go by the state that the business was transacted in laws. This is esp. true where insurance is concerned as each state has its own department of insurance and if a company is an admitted carrier it has to submit its rates to the department and those rates have to be approved. Non admitted carriers dont have to do this but their rates tend to be much higher than admitted carriers.
Heres what I see-The conservative plan from gop.gov. would allow people in any state to buy insurance in any other state-therefore if say Alabama offers some cheap plan with basically no coverage and rules and regs completely in favor of the insurers-anybody in any state can buy it-its obvious that you haven’t kept up with the latest teabagger controlled GOP ideas
Teatotal, are you saying people are too stupid to read their own policies and must have government to take care of them?
I’m saying that many low info-low income people will be easily duped into buying ripoff insurance plans with miles of small print offered by unregulated insurance cos.-look what they pay in annual cred. card rates-and yes gov’t should have regulations and help them avoid being scammed by the kind of sick predatory capitalism you propose.
You’re probably right, teatotal. So much better to be scammed by the sick, predatory government cronyism that you favor.
By the way, everyone; Happy Constitution Day to you. This would be a great day to read it. Might learn some stuff.
well on the left and on the right…..some good points and I leave it to others that can decide who makes better use of fact and logic….
My two cents….just try making an appointment at the Barton clinic – that mostly services the uninsured – to see that rationing of medical services has been going on way before anything called “Obamacare”. The issue is that the “issue” isnt that we just need insurance reform, it’s the cost of medical care, and in reality government regulated insurance plans barely put a dent in it. Why do doctors not participate in certain plans and refuse medicare patients (actually, despite the previous comment, few do not take medicare) – its not because they dont pay a fair amount, it’s because there are still enough folks out there with either plans or deep pockets that are willing to pay more, and enough of them to fill the appointment calender.
So until we have some sort of single payer system, costs will continue to rise as medical providers seek maximum revenue streams – what we really have missing from the old days is any sense that the majority of medical professionals (certainly not all, but the majority) are in the business to help sick people – they are in the profession to make money! Just talk to aspiring med students to see what they expect from their educational choice? That individuals can make informed medical/financial decisions as though they were shopping for a car is a little absurd – #1, evaluating the quality of the medical care you are going to “buy” is extremely difficult, and #2, when one is faced with an acute medical crisis, it’s not like you have the time to shop. These two things by themselves strongly suggest that a market controlled system doesn’t have all the required feedback loops to function to the benefit of patients as some suggest.
Until we join the rest of the civilized world and offer some kind of single-payer health care system we will continue to be at the mercy of “profit before people” healthcare.
I agree that the teabagger invisible hand of the market idea is not only predatory capitalism, it’s downright inhuman in it’s “Me the People” survival of the haves and who cares about anybody else philosophy.
As stated in the preamble to the Constitution(emphasis is mine):
“WE the people of the United States, in order to form a more perfect union, insure domestic tranquility, provide for the common defense, PROMOTE the GENERAL WELFARE, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”
Our country was founded on ideas that were for the benefit of ALL not the few.
I’ve been to the rest of the civilized world, and let me tell you straight up Bill, you wouldn’t want their health care system.
The great thing about the United States is that if you’re not happy here, you can leave.
I understand that North Korea, Cuba, and Venezuela have single payer health care programs. Probably time you consider moving there.
“Our country was founded on ideas that were for the benefit of ALL not the few.”
Wrong again, BB. Read the whole document, including the Bill of Rights.
Our Constitutional Republic was designed to protect the individual from the majority. And to protect the states from an overbearing Federal government.
Really. Read it. It’s about the individual, NOT the collective. Socialism has utterly failed everywhere it’s been tried.
AB, you have been to the rest of the civilized world? And you wouldn’t want their healthcare? Oh yea, you consider North Korea and Cuba civilized. Might as well throw in Somalia and Pakistan while your at it. As a matter of fact, I have traveled through a considerable portion of the world and have received excellent medical care in Thailand, India and Kenya at very reasonable cost. I have many friends and family from New Zealand, Canada, England and throughout Europe. They all receive first rate medical care and most importantly preventative care. They are all single payer systems. Sure, you hear stories of people waiting in line for “elective procedures” in these countries. Perhaps you will not get that knee surgery done in time for ski season. If you are ambulatory and can still perform activities of daily living there is no reason to have to get it tomorrow. If something happens and you need emergent care today, you receive care today. That only makes sense. If you do want the elective procedure done today, you can buy supplemental insurance to go with your single payer insurance.
Bijou is right about the constitution, government is obligated to promote (support) the general welfare of its population. Without a healthy well cared for populace, what kind of county have you got? Least you forget, your citizens are your greatest resource. Particularly the younger population who is the most productive. We should make sure that they get the majority of the health care dollars rather than squander it on end of life care as we do today.
I just wonder how many of the individuals out there who are so vehemently opposed to health care reform or single payer are going to be the first to jump on the Medicare (not to mention Social Security) train so that they can now sap out of the system far more dollars than they have ever contributed to it during their lives.
Until the lawmakers have the same health insurance as us commoners it’s not going to be good or cheap.
Dogula,
I consider your interpretation of the Constitution as being all about the individual as opposed to the general welfare of all to be wrong. Then again I consider your interpretation of the bible regarding the earth being 6,000 yrs. old to be nonsense too. I give both of those opinions equal chances at being connected to reality.
Ah. I was unaware that you were both a Constitutional AND a Biblical scholar, BB.
But then, Obama claims to be a Constitutional scholar too.
P.S. When did you ever hear me say the earth was 6K years old? Or are you just parroting the Fish again?
Ok Dogula,
I’ll bite, just how many thousands of years does your creationist BS opinion deem to be the age of the “young earth”? Is fossil evidence or scientific testing really the work of satan to test the faithful?
I support Medicare Part E(everyone) as the only reasonable use of our healthcare dollars because it has been proven to be the most cost and outcome effective and is accepted by the rest of the industrialized world as exponetially better than the for-profit status quo.
I support reality.
My goodness. Check out this logic:
“How about if we got the government out of the insurance business completely? ”
Our private system is a failure compared to government run systems.
So lets do more of what we do now.
We pay more. We get less. You can’t argue that. So you want us to… pay even more and get even less?
Well I guess you could be more wrong
…20k, 6k, you’re still wrong by a few billion years.
While we are throwing around insane ideas.
Creationists shouldn’t be allowed anywhere near government. That includes the ballot box.
Teabager, it is obvious that you have dont realise just because the federal goverment may allow something doesnt mean the state would have to. I dont know if you realize this but if there are two laws on the books for the sams thing, one fed and one state the stricter law will apply. Also the rabbid tea partiers are losing ground every day in the party. Each Party has their own rabid extremeist(yes including your own democratic party) and we can all point to them and say oh look what the entire Republican Party wants to do(or democratic party for that matter) but in truth most of both parties are more toward the middle of the road as America is.
There is no way that the states would completely give up their oversight of insurance companies that operate in their states. Just like they never gave up oversite of securities. But there has been evidence that in certain instances the health insurance rates in one state are lower than rates in another state with the same cost of health care. This is one of the reasons that people are trying to get cross stateline coverages. Also it seems that you did not read or did not understand the minuim healthcare requirements that Obamacare required, because you argued that that a policy issued in Alabama(please leave poor Alabama alone, what has it done to you?) isnt worth the paper it was written on, well if it meets Obamacare requirements it really isnt a bad policy and if it doesnt then it is federally illegal.
Peoples’ health should not be about a company’s profits. It is just wrong that insurance companies make large profits off the backs of hardworking families and individuals. We need to take profit out of the equation and allow everyone the security of having quality medical care.
It’s interesting, or maybe just peculiar that people use “free market” and insurance in the same sentence. By definition insurance shields consumers from the full cost of a good or service and thereby thwarts market forces. Insurance is communism. Doctor shortages, rising costs; all of the problems in news about health care all disappear if we outlaw insurance. Now that would also mean that poor people would probably be priced out of anything but the most rudimentary of care, but hey, that’s how markets work. Yeah Bijou, I know, you hate the concept of scarcity, but health care is a scarce resource just like BMW’s are a scarce resource. Access to both must be limited.
The real conversation is how to limit access.
I wonder what it was like at the dawn of the human race when communities of people approached their very survival by trying to “insure” that the whole group survived equally, because if they didn’t it meant NONE survived.
Of course that’s long before man INVENTED religion and politics!
“Our private system is a failure compared to government run systems.”
We haven’t HAD a truly private system in 40 years. So how would you know?
“Peoples’ health should not be about a company’s profits”
Doctors go through 8 years of grueling medical training, and continuing education after that. They shouldn’t make a better living than some guy who went to trade school for 6 months to learn how to fix an air conditioner? Please.
” Insurance is communism”
Where to even start with this off the wall statement? Insurance has been around for hundreds of years, primarily as a backup for capitalist enterprises. It’s meant to cover catastrophic events, not pay for every day occurrences. You are supposed to budget for those.
Communists don’t need insurance. They don’t own anything. It all belongs to the collective.
Dog, you ignored the important part of the statement. Insurance shields consumers from the full cost of goods and services and thwarts market influences. Yeah, you got me, its socialism.
Jeeze – I think I woke up on the wrong planet! But in response to BiggerPicture’s last post – makes you wonder how we ever evolved past the “cave man” stage – oops, maybe I shouldn’t use the word “evolved”! :)
Really Dog, Insurance companies are being over regulated? Let’s see, give me some of that regulation as their profits are unprecedented and truly obscene. Let’s see how did they get there, dropping people off the roles when they got sick, not taking on people with pre-existing conditions, not covering preventive care, and having double digit increases on premiums every year for the last decade. Oh and guess what, the last year is the lowest increase in health care cost over the last 50 plus years, and Obamacare has been identified as being partially responsible for that decrease – and the main features have not even taken effect yet.
The non-profit and non-partisian Kaiser Foundation found that of the 21 states that have set up health care exchanges that the premiums are very competitive and in many cases cheaper then what currently occurs.
Walgreen’s has found (like all businesses have over the last few decades) that health care is greatly outpacing inflation, and they have decided to provide their employees a set amount and will have them shop from the 25 plus options from health care exchanges then the 4 the company has. This helps Walgreen’s control health care cost, while giving the employee more power in their health care choices – wow, that must be a bad thing.
There is not such thing as the free market, never has been and never will be. Very wealthy individuals and corporations always game the system – they did in Rockefeller’s day and do so today. It is why Teddy Roosevelt famously went after the “free-marketers” in his own party. Roosevelt believed in capitalism with government oversight as he saw the corruption that came with greed. Look at the collapse of Wall Street, driven by huge greed of the Wall Street bankers where the crappiest Hedge Fund Manager was making in the neighborhood of $20 to 30 million a year investing other peoples money, but paying only capital gains rate on their income, while their maid paid much higher tax rate on their income.
Rick
John, you may have got it alittle bit wrong, what you are purchasing with insurance is risk aversion. All good capitialist purchase something to cover their assets incase something should happen. That is what dirivatives are. With communisim or socialism you are taxed for this insurance and you have no opportunity to chose how much risk you wish to put upon yourself. Admittedly we do have a form of socialism in this county and it is call Medicare, are you are required to purchase this product(through taxes) and have no choice to shop around for a better product that fits your needs or finances.
Also most companies never make any money directly off of underwriting but rather off of investing of the float(which is the premuim that is taken in before it is paid off) it is rare that an insurance company makes more than a 2% underwriting gain. In the Obamacare law insurance companies are required to payout 85% of premuim for medical expenses. The other 15% has to cover sales expense, claims processing expenses and general overhead, employee costs, and what little is left over would be profit. T
Really Dogula, since when did doctors become companies? Please.
The insurance companies, not doctors, make record earnings every quarter.
I have a few friends that have gone through the years of medical school and all of them have told me their main reason for doing the work was to help sick people.
Of course, if you spend eight plus years in school you should make more than someone who went to a trade school for a few months. Duh!
My point was that the insurance companies bank (make profit) off of the sick. That is WRONG!!!
Reloman, I had thought about using the concept of asset protection and derivatives in that post. But really the motivation of a person purchasing health insurance is different. I have an HSA and limit my families exposure to risk to $12k. That’s also what I have to pay. My motivation for purchasing the insurance is so that I can secure access to more expensive health care while preserving my assets. This makes us both right I think.
I do disagree pretty strenuously about your objection to requiring people to purchase insurance. We offer emergency health care to all. That is extremely valuable. If people are not in the system then they are receiving that service to the detriment of people who do purchase insurance. The only alternative is to deny treatment to people without insurance.
I get your point about the payout part. I have no idea how a business can operate on 15% and obtain capital in the financial markets. Heck a money market would have a better return.
Snoheather, think about the last paragraph.