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Posted at 10:34 AM ET, 11/18/2010

Think government is bureaucratic and rationing-happy? Try dealing with insurers.

By Ezra Klein

Here's what we know about government: It's inefficient, and working with it requires endless paperwork and arguments about bureaucrats. And here's what we know about government-run health care: It rations, and is constantly rejecting claims. At least, that's what we think we know.

The Commonwealth Foundation decided to test this knowledge, surveying residents of 11 high-income countries about their insurance-related experiences. Some of the questions asked whether respondents had "spent a lot of time on paperwork or disputes" or found their insurer denied payment or both. In all three categories, America leads the world:

rationingintheus.jpg

That's not the sort of exceptionalism we should be proud of. Of course, perhaps those questions are cleverly designed to make the United States look bad. So the researchers also included more general questions testing confidence in health-care system. We didn't do well there, either:

healthsystemconfidence.jpg

And remember, we pay quite a bit more for this health-care system that we enjoy and trust quite a bit less.

By Ezra Klein  | November 18, 2010; 10:34 AM ET
Categories:  Charts and Graphs, Health of Nations  
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Comments

Small correction: This is a study from the Commonwealth FUND, not the Commonwealth FOUNDATION. Two different organizations.

The data is not surprising to me though.

Posted by: vvf2 | November 18, 2010 10:42 AM | Report abuse

Can I have my Public Option, please?

Posted by: leoklein | November 18, 2010 10:51 AM | Report abuse

"According to AMA’s National Health Insurance Report Card, Medicare denies 6.85 percent of its claims, higher than any private insurer (Aetna was second, denying 6.80 percent of its claims), and more than double any private insurer’s average."

http://blog.heritage.org/2009/10/06/medicare-largest-denier-of-health-care-claims/

Posted by: msoja | November 18, 2010 10:55 AM | Report abuse

And remember, government accounts for *at least* fifty percent of health care spending in the U.S., with its nose stuck solidly as far up the rest of it as can be. What Klein has offered here, in his usual propagandist fashion, is not a look at socialist vs private, but a mash of variously socialized vs variously socialized. He's playing the fools game for all his little fools.

Posted by: msoja | November 18, 2010 10:59 AM | Report abuse

Ezra wondered: "Think government is bureaucratic?"
----------------------------------------
Okay Ez, since you have ZERO business experience and no experience ACTUALLY dealing with gov I answer you. Gov is FAR more bureaucratic than business? Why? Because with a business there is chance you will drive customers to a competitor. Gov has NO such worry.

I hope that clears up your confusion caused by having no real world experience.

Posted by: illogicbuster | November 18, 2010 11:03 AM | Report abuse

I have had health insurance provided by several private employers ranging in size from a dozen people to tens of thousands, and I have never had a choice of insurers. I have been forced to change insurance companies and doctors, but as far as insurance providers go, my choice has never included anything but "take it" or "leave it". I can, of course, choose whatever pharmacy I want, provided I am willing to pay an extra couple of hundred dollars per year in deductibles. If I don't want to pay extra, I have exactly one mail order pharmacy to choose from. It is inconvenient and does not save me a dime, and would not be my choice if the insurance company did not charge me substantially more to use my neighborhood pharmacy.

I wonder how the weather is in illogicbuster's real world?

Posted by: tl_houston | November 18, 2010 11:15 AM | Report abuse

These graphs have no meaning without uncertainty intervals. It looks to me like the second one, and arguably the first as well, show no significant difference.

Posted by: pj_camp | November 18, 2010 11:18 AM | Report abuse

Yes, Medicare was worst in Denials in the AMA Health Insurance Report Card - in 2008, that is. In 2009 & 2010 the worst was Anthem BCBS.

Posted by: PattyP1 | November 18, 2010 11:21 AM | Report abuse

Remarkably, Ezra did not reproduce the entire report in his blog entry. There is additional information in the report he linked.

"US adults under age sixty-five were significantly more likely to report insurance paperwork, disputes, or insurance surprises than were those sixty-five and older and covered by Medicare (35 percent compared to 16 percent). The high rates of insurance concerns among younger adults may stem from unstable coverage as well as complex benefit designs. One-third said that they had changed plans in the past three years, often more than once (see the Technical Appendix for contrasts between groups under age sixty-five and age sixty-five and older)."

Posted by: tl_houston | November 18, 2010 11:27 AM | Report abuse

While my experience with private insurers has been difficult and bureaucratic, I'm not sure how a "public option" would improve things. Is there some secret sauce the government would use to be less bureaucratic, and ration less, while doing the same sorts of things in the same sorts of situations?

Posted by: Kevin_Willis | November 18, 2010 11:33 AM | Report abuse

What's interesting is that the countries with the most bureaucratic problems -- the US, France, the Netherlands, and Germany -- are the same countries that have the most privatized system of insurance and health care. The most socialistic system -- the UK -- has the fewest.

The only outlier is Switzerland, which manages to have both a privatized universal-health care system and few bureaucratic delays.

Posted by: constans | November 18, 2010 11:42 AM | Report abuse

OK, illogicbuster, there are a few problems with your assertions. First, health insurance companies are not the same as, say, potato chip manufacturers or car companies. They're more like cable companies, in that they often have localized monopolies (a cable company often has an exclusive contract with an apartment complex, for example, and a health insurance company oftentimes has an exclusive contract with an employer) and the consumer has ZERO opportunity to shop for services with a competitor. This type of imperfect competition, or utter lack of competition, encourages bureaucratic wrangling, denial of service, and consumer gouging.

Second, it's a ridiculous notion that people must have business experience in order to comment on the way businesses operate. Consumers who have experienced the run-around from any type of business, whether it be a health insurance company, a cable company, or a phone company, can easily comment from their experience as to whether a particular business is bureaucratic and inefficient or not. From my experience as a consumer, I can list the three most maddening and inefficient entities that I've ever had to deal with. Number one on the list is a cable company. Number two is a phone company. And number three is a health insurance company.

Posted by: brimadison | November 18, 2010 11:42 AM | Report abuse

I'd like the single payer with a side of socialism, please.

Posted by: Candressuhmoose | November 18, 2010 11:44 AM | Report abuse

People would simply like the CHOICE of a Public Option , just as I now have the choice to mail my package with Fed Ex , or UPS , or the Post Office ( Public Option ) . As regards cost , the answer is Single Payer, too bad the Single Payer advocates were not allowed a seat at the table. I knew the fix was in when I saw American doctors and nurses taken away in handcuffs from Capitol Hill .
The paperwork in Health Care is copious and growing every year , computers will not diminish it much as regards for example nursing entries , it still has to be entered ( typed ) and updated.

Posted by: sligowoman | November 18, 2010 11:47 AM | Report abuse

--*I saw American doctors and nurses taken away in handcuffs from Capitol Hill.*--

And yet you would "like the CHOICE of a Public Option".

Yeah, I see the police state in action, and my first inclination is: I want to do business with these people.

Posted by: msoja | November 18, 2010 11:52 AM | Report abuse

Oh look, somehow the NHS has no bureaucracy. Then again, if you measure bureaucracy as time spent on paperwork and denied claims, socialized systems will appear efficient. When I worry about bureaucracy, I worry about bad top down decisions like this one:

http://www.dailymail.co.uk/health/article-446388/Thousands-denied-sight-saving-drugs-em-save-em-NHS-money.html

At least in the U.S. you tend to have options if one insurer doesn't cover a particular treatment.

Who cares about confidence and trust in the system? U.S. students are quite confident in their math skills relative to students in other nations, but when you compare by actual ability U.S. students rank poorly.

Likewise, Brits might have a lot of confidence that they will receive the best treatments from the NHS, but that has no bearing on whether or not that belief is true.

Let's take a look at cancer incidence and cancer mortality in the U.S.

Age standardardized incidence here is 335 per 100,000 (men), and age standardized mortality (again men) is 121.4. In a rough sense, about 36.2% of cancer cases end up dying.

In the UK, incidence is 280.8, and mortality is 133.3, for a 47.5% ratio. One might argue that the UK doesn't detect as many cancers as the U.S., but also keep in mind the overall death rate is higher and I find it unlikely that the UK actually has greater incidence than the US given the poor general health of the typical American.

I looked at the mortality to incidence ratios for men for in US, UK, Germany, France, Japan, Norway, Sweden and Finland. The US has the lowest ratio, barely edging out Norway which came in at 36.6%.

For women, the U.S. ties for second at 33.0% with Finland, and just above France with 30.4%. The U.K. has the worst ratio for women, at 41.2%, and overall mortality in the UK for women due to cancer is the highest, at 102.8 vs. 90.6 for Americans.

http://globocan.iarc.fr/

So the U.S. does a decent job at keeping mortality low despite high cancer incidence and roughly 1/6 of the population uninsured at any given time.

Posted by: justin84 | November 18, 2010 11:53 AM | Report abuse

An observation: The more government controlled an insurance program, the fewer complaints there apparently are.

I wonder why.

Posted by: AMviennaVA | November 18, 2010 12:08 PM | Report abuse

I have a lot of business experience, including managing benefits for a mid-sized company. Our usual yearly increase in premiums was 30-50% and of the 10-15 insurers we would ask to quote on our business, we were lucky to get two. The rest wouldn't even bother. I don't mind having a legitimate discussion about the pros and cons of insurance company vs. gov't run, but let's not fool ourselves into thinking that what we have is an efficient health delivery system.

Posted by: phbella61 | November 18, 2010 12:08 PM | Report abuse

illogicbuster @ November 18, 2010 11:03 AM: You should try working for a company, as I did once, that is 'self-insured' (that is, the employer handles the claims). Obviously the employee has no choice, and of course you can imagine the consequences of pressing a claim too hard.

The only logic you can bust is yours. Or rather, you are only logically proving that you have no logic.

Posted by: AMviennaVA | November 18, 2010 12:29 PM | Report abuse

Funny how polling data is useful sometimes but not others.

For instance when I laid out 5 specific examples, from left or center sources, including election night exit polling of how HCR was NOT considered a big issue by the American people in the 2008 election, that didn't mean anything.

Somehow though what the people of New Zealand think about their health care system is very, very important!

Posted by: 54465446 | November 18, 2010 12:59 PM | Report abuse

"I see the police state in action"

mslogan has apparently seen a lot of things that don't exist in his two decades of hamming it up as an internet k00k.

Moving to matters of substance: the numbers for France raise interesting questions about cost control, and touch upon standard conservative arguments that are usually channeled into support for HSAs and other methods of implicit deterrence from seeking care.

One of the standard lines about the French system is that it serves a nation of hypochondriacs, and people have the freedom to seek out practitioners and medical services that charge above the Sécu's reimbursement tariff.

That puts them in the hands of their supplemental insurer to make up the difference, which is likely where most disputes and denials arise, but in that framework, a certain proportion of denials and partial reimbursements is necessary to keep the system honest: you have the freedom to pay above the odds, but out of your own pocket.

(The situation is flipped somewhat in Germany, where more complain about the paperwork than being stung with the cost.)

Posted by: pseudonymousinnc | November 18, 2010 12:59 PM | Report abuse

--*[L]et's not fool ourselves into thinking that what we have is an efficient health delivery system.*--

Of course not. What the U.S. has now is half private, but in name only. Creeping socialism has slowly constrained and strangled insurance company activity over the last half century. There is no free market in health insurance, anymore.

Do you understand that? Do you not see that *that* is the problem?

Posted by: msoja | November 18, 2010 1:00 PM | Report abuse

Oh, it probably goes without saying, but that would not be me, that if you ever want to be able to save anything in ANY future health care format, you HAVE to deny claims sometimes. But that of course is heartless and cruel and not in keeping with the spirit of HCR. It's only money.

Posted by: 54465446 | November 18, 2010 1:02 PM | Report abuse

Either illogicbuster and justin84 are well off enough to shop around for health insurance or they do not live in the reality that the rest of us do.

Or they have just been lucky, so far, in the health care they have received and the insurance their employers provide.

Posted by: vintagejulie | November 18, 2010 1:14 PM | Report abuse

Regulators are not supposed to be for sale or influenced by favours. Insurance is not necessarily a for profit business or a source for venture capital for corporations. Insurance salespeople can earn commissions on the sale of policies but attempting to manipulate government for the purpose of insurance fraud is a felony. Buying protection in order to avoid prosecution is racketeering. It is high time the government got diligent itself.

Posted by: mullarkeymichael | November 18, 2010 1:40 PM | Report abuse

Regulators are not supposed to be for sale or influenced by favours. Insurance is not necessarily a for profit business or a source for venture capital for corporations. Insurance salespeople can earn commissions on the sale of policies but attempting to manipulate government for the purpose of insurance fraud is a felony. Buying protection in order to avoid prosecution is racketeering. It is high time the government got diligent itself.

Posted by: mullarkeymichael | November 18, 2010 1:41 PM | Report abuse

@Kevin_Willis: With regards to how the government can do better:

- Lack of profit motive. Currently Medicare's admin overhead is 3%. Private insurers are fighting tooth and nail to keep theirs (which includes profit) from getting capped at 15%.
- Transparency. Private insurers tend to treat the rules as to what's covered (and not covered) under what circumstances like state secrets. A public plan would have these rules publically available. If doctors know the rules up front, after-the-fact denials (and the ensuing battles between the patient/doctor and the insurer) go down.

A public plan could ration less by applying some of that 12% savings to paying for care. A big enough public plan could use collective bargaining (as the biggest private insurers do) to drive down costs. As for being less bureaucratic, it probably won't; large organizations (public or private) have no choice but to be bureaucratic.

Posted by: mutterc | November 18, 2010 1:56 PM | Report abuse

If you are happy with your private health insurance, I would bet that you've never had to use it for anything significant. As long as our healthcare decisions are in the hands of profit-making companies, we lose.

What people like "54465446" don't seem to get is that some day, it's their claim that will be denied.

These companies purposefully create a system where unclear policies, annoying bureaucracy, long hold times, snafus, and staff with the inability to answer questions or make decisions are built in, so that people will tire of trying to get what they deserve.

I want my public option.

Posted by: efemmeral | November 18, 2010 1:58 PM | Report abuse

well sure Ezra when you tell doctors what they're being paid there's little or no bureaucracy and when you standardize benefits for all there's little or no bureaucracy. Let me know when we'll be telling doctors what they can make here in the US and then I'll show you a system that has less occurences of inefficency. Let me know of a perverse system like we have here where doctors can own a surgery center and tell you that they're "in a network" for your visit but "out of network" for your surgery.

While you're at it explain to me why that's my insurance company's fault and not the doctor's? If a doctor is paid a set amount for whatever he or she does these issues ALL go away.

The lack of understanding of WHO is responsible here is mindboggling.

Posted by: visionbrkr | November 18, 2010 2:04 PM | Report abuse

effermerall wrote:

"What people like "54465446" don't seem to get is that some day, it's their claim that will be denied."

Of course, but the "one person" standard is never a way to rein in costs is it? That's a moral argument as in if one person can be benefited from a treament costing millions of dollars, is it worth paying for?

Perhaps you would say yes, but then we simply cannot provide any cost containment in the system.

This is one of those losing political battles where to be fiscally repsonsible is to be morally repugnant.

Posted by: 54465446 | November 18, 2010 2:27 PM | Report abuse

also when people are too stupid to understand the difference in the US between a denied claim and a claim paid out of network it kind of makes these studies meaningless unless of course your intent all along was to inflame idiots to scream FIRE in a crowded theater.


efemmeral,

your public option does not help AT ALL with these issues. If you could tell doctors in the US what they are paid for EVERY service provided that would solve all these issues but then again we'd have access issues which OOPS don't get addressed here. What a SHOCK.

Posted by: visionbrkr | November 18, 2010 2:31 PM | Report abuse

also as far as "denials"of claims go, doctors know up front exactly what Medicare does and does not pay for. Ask any doctor's office. They'll tell you that. With 1500 insurance companies doctor's don't even know if they participate much less what is covered so they throw whatever crap they want up for payment (many times billing multiple insurers for the same charge) to see what sticks. hence denials are overblown with insurance. But hey why let facts get in the way Ezra when you can incite a riot.

Posted by: visionbrkr | November 18, 2010 2:48 PM | Report abuse

*There is no free market in health insurance, anymore.*

There is no constitutional right in this country to be able to profit from the health insurance business model that you, personally, prefer. It may well be that you can't keep insurance companies in business by forcing them to insure patients with pre-existing conditions, but life does not always work out the way that an insurance company executive might want. I am sure that he can avail himself of any number of federal job re-training programs.

Posted by: constans | November 18, 2010 3:40 PM | Report abuse

"There is no constitutional right in this country to be able to profit from the health insurance business model that you, personally, prefer."

There's no constitutional right to run a business selling products to willing customers?

But there is a constitutional right for one set of citizens to force their quasi-social insurance models on the other citizens via the federal government?

Are there any rights left other than the government gets to do what it pleases?

Madison must be rolling over in his grave.

Posted by: justin84 | November 18, 2010 5:54 PM | Report abuse

"when people are too stupid to understand the difference in the US between a denied claim and a claim paid out of network it kind of makes these studies meaningless"

visionbreaker's running out of fingers to point at all the bad, stupid and greedy people (other than virtuous insurance brokers, of course!) whose fault it is.

You know what's stupid? Basing your outlook on the belief that people are stupid if they can't decipher the esoteric minutiae of in/out-of-network distinctions. And the in/out-of-network distinction is the fundamental stupidity.

Posted by: pseudonymousinnc | November 18, 2010 6:07 PM | Report abuse

actually it's who's not "whose"

only in pseudo's demented world is the answer of either "YES OR NO", "IN OR OUT" considered esoteric minutiae. in the rest of our world its a very simple answer that we are NEVER given. Try asking your doctor if you don't know. Better yet ask him or her what they charge.

Thank you for proving my point regarding fundamental stupidity.

Posted by: visionbrkr | November 18, 2010 7:07 PM | Report abuse

and it has nothing to do with being an insurance broker. it has to do with using common sense. You should try it sometimes.

Posted by: visionbrkr | November 18, 2010 7:08 PM | Report abuse

I was surprised by the rating of Canada, in the first graph especially. I've lived here 40 years, and my socialized system has provided my health care smoothly and transparently. I do also have a small supplementary Blue Cross policy left over from group coverage through my former employer, and I think it's a coin-flip whether it's worth it or not. However I must say they have provided welcome support when needed, and never quibbled the smallest quibble.

People think of bureaucracy as a huge, unthinking machine. Yes, that's what it is. It is huge to achieve the economy of scale, and unthinking so that what it does is reliable and timely.

A car is also a huge, unthinking machine. I don't want it making quirky decisions or trying out novel, interesting routes all on its own. That's not its job, and neither is a small, nimble, unpredictable bureaucracy. I'll take big and clunky, thanks very much.

Noni

Posted by: NoniMausa | November 18, 2010 7:32 PM | Report abuse

@visionbrkr:

Sure, you can ask a primary care physician whether he's in or out of network. But suppose you go to an in-network hospital. Which radiologist, anesthesiologist, etc. will see you? Are they in-network? (I've had this happen, it's not theoretical; my wife's epidural cost us much more than the entire rest of the delivery).

As for asking the doctor what they charge:

Quick, for the problem you're going in for, will the doctor be using CPT 90804 or 90806 to treat you? What's your insurer's UCR and/or negotiated rate (depending on if you're in or out of network) for that procedure? (Hint: They will treat this like a nuclear launch code). What are the conditions for which the insurer will cover that treatment at all? (Again, it's secret).

Know how I know you've never been sick?

Posted by: mutterc | November 18, 2010 7:43 PM | Report abuse

mutterc,

actually I have been sick although thankfully not seriously. My wife has had 3 kids as well. Have we gotten bills sure. Mostly from anesthesiologists who as you can surmise don't participate with any insurance becuase guess what, THEY DON"T HAVE TO. If you need anesthesia you need anesthesia so about 5-10 years ago they realized they were giving up 40% of their incomes to insurance companies. Who does it hurt that they don't participate with any insurance? PATIENTS that's who. Do they care? I don't think so. Who do you blame? Insurance companies. It wasn't insurers who dropped anesthesiologists from their networks it was the other way around. Same example goes for ER doctors.

As far as coding goes its all out there. I've said for a long time that there should be complete, 100% transparency there. While there are thousands of difference codes simple data entry can put the figures to the web for every provider. It should be a requirement. Canada does it for each province why can't we? I blame insurers too. They hide transparency to a point because they're worried for example that Aetna will think Cigna knows their "trade secrets" about what their discounts are. All the big players are about the same though. Its possible for all of it to be put online so DO IT.

Also if you go to a hospital that participates the hospital should be REQUIRED to have you seen by ONLY in network providers if you choose. They should be required to have staff radiologists, anesthesiologists etc that participate for you to use. Its like going to a restaurant and having them have to run out to another restaurant because they don't have your appetizer on their menu and they charge you 10x what their menu shows. Sorry, doesn't work for me. The system is entirely too doctor centric and not nearly patient centric enough for me.

As far as aking your insurer, you don't need to know about UCR or negotiated or "contracted rates". Call your doctor. Get their tax ID number, the diagnosis and procedure code and if you call you insurer and give them this most states REQUIRE them if you ask to run a "dummy claim" through their system to know exactly how your plan will process that claim. Then like anything else write down the name of the person you spoke to. If states currently dont' force this to be disclosed, THEY SHOULD.

Although that's the "hard way". To me the easy way is to require doctors to be paid a set rate for ALL COMERS, insurance, medicare, private pay. Same as Canada and other socialized medicine countries because as you'd see not only would you reduce cost substantially you'd also have transparency and a much nicer graph above for the US in comparison to the rest of the world. But sadly we're too doctor centered here. Eventually costs will FORCE that to change.

Again its not quite as simple as yes OR no, in OR out for friends like pseudo but it could be if we focused on patients and not on inflating doctors salaries

Posted by: visionbrkr | November 18, 2010 9:52 PM | Report abuse

mutterc,

actually I have been sick although thankfully not seriously. My wife has had 3 kids as well. Have we gotten bills sure. Mostly from anesthesiologists who as you can surmise don't participate with any insurance becuase guess what, THEY DON"T HAVE TO. If you need anesthesia you need anesthesia so about 5-10 years ago they realized they were giving up 40% of their incomes to insurance companies. Who does it hurt that they don't participate with any insurance? PATIENTS that's who. Do they care? I don't think so. Who do you blame? Insurance companies. It wasn't insurers who dropped anesthesiologists from their networks it was the other way around. Same example goes for ER doctors.

As far as coding goes its all out there. I've said for a long time that there should be complete, 100% transparency there. While there are thousands of difference codes simple data entry can put the figures to the web for every provider. It should be a requirement. Canada does it for each province why can't we? I blame insurers too. They hide transparency to a point because they're worried for example that Aetna will think Cigna knows their "trade secrets" about what their discounts are. All the big players are about the same though. Its possible for all of it to be put online so DO IT.

Also if you go to a hospital that participates the hospital should be REQUIRED to have you seen by ONLY in network providers if you choose. They should be required to have staff radiologists, anesthesiologists etc that participate for you to use. Its like going to a restaurant and having them have to run out to another restaurant because they don't have your appetizer on their menu and they charge you 10x what their menu shows. Sorry, doesn't work for me. The system is entirely too doctor centric and not nearly patient centric enough for me.

As far as aking your insurer, you don't need to know about UCR or negotiated or "contracted rates". Call your doctor. Get their tax ID number, the diagnosis and procedure code and if you call you insurer and give them this most states REQUIRE them if you ask to run a "dummy claim" through their system to know exactly how your plan will process that claim. Then like anything else write down the name of the person you spoke to. If states currently dont' force this to be disclosed, THEY SHOULD.

Although that's the "hard way". To me the easy way is to require doctors to be paid a set rate for ALL COMERS, insurance, medicare, private pay. Same as Canada and other socialized medicine countries because as you'd see not only would you reduce cost substantially you'd also have transparency and a much nicer graph above for the US in comparison to the rest of the world. But sadly we're too doctor centered here. Eventually costs will FORCE that to change.

Again its not quite as simple as yes OR no, in OR out for friends like pseudo but it could be.

Posted by: visionbrkr | November 18, 2010 9:53 PM | Report abuse

and in actuality some insurers (AETNA) do have discounts to a point listed on their website if people cared to look.

http://www.aetna.com/externalweb/documents/transparency_map_final_120508.pdf


They also (Aetna) has payment estimators for providers so they can better estimate a patient's responsiblity. Now would providers share this with complete openess with patients? Maybe, maybe not. But the systems exist.

http://www.navinet.net/aetnaestimator/overview.htm


but i guess its just easier to demonize insurers for folks like Ezra. the fact of the matter what bugged me most about this blog post from Ezra is the headline grabbing statement: "Think government is bureaucratci and rationing happy? Try dealing with insurers"?

Sorry but this shows a total lack of intelligence on the subject on his part and for someone who at times has said that insurers aren't the problem he sure is sounding like someone who's got an ax to grind.

Posted by: visionbrkr | November 18, 2010 10:03 PM | Report abuse

@visionbrkr if you enjoy the benefits of your profit-making insurance system, have at at. I pray you don't find yourself in a life-threatening emergency situation where you will find out what the reality is.

With its 17 - 25% annual increases and its denial of claims for silly or inscrutable technical reasons, my insurance company has failed me miserably. I have spent countless hours on the phone and writing appeals. I am not a stupid person. This is a money-grubbing system that is playing against the consumers best interests, but if you want to be a part of it go ahead. Just don't deny me real choice.

I want the public option.

Posted by: efemmeral | November 19, 2010 5:49 AM | Report abuse

efemmeral,

the fact that you don't get that it's the providers of care that drive the costs up 17-25% and not insurance companies (who's profits have dried up over the last 5 years) just goes to show you have your head in the sand. I for one wish you had your public option so you could see it as the fool's paradise it really is. Studies showed that premiums in the public option were at or greater than insurance companies and there was no talk that the public option would be a panecea where everything you'd ever want would be covered for you. Also there's no guarantee that wherever you went would accept the public option. There was talk that doctors groups would boycott medicare and in turn the required public option participation(and there still is almost monthly now that the doc-fix is on a month to month schedule).

As I've said before I'd much prefer a system where all providers of medical service would be told what they could charge from either the public option or private insurers but again doctors in the US would never allow that. I guess a handful would be most would balk at it.

Your willingness to let Ezra and those that inspire hatred as opposed to looking at the real drivers of cost is sad.


Why is it that you consider the insurance companies are part of the "money grubbing system" but don't blame providers of service who actually DRIVE the costs?

Posted by: visionbrkr | November 19, 2010 7:12 AM | Report abuse

@visionbrkr As far as I am concerned, Ezra is inspiring discussion, not hatred. I'm not sure why you're so overheated, but be that as it may.

The discussion was about health insurance. If the discussion was about the cost of medical care or medical devices I'd have plenty to say about that. On the other hand, my personal physician hasn't raised his prices in years, although my insurance company has.

Sorry, but my insurance company posted a third quarter increase in profits of 21% last year while they raised my premium by 17%. I don't believe that insurance company profits have "dried up." Cite your sources on that, please.

In any case, why are you so determined that others should not have the public option? If it's as bad as you say, we won't choose it, will we. Who are you to deny my choice?

Posted by: efemmeral | November 19, 2010 10:49 AM | Report abuse

efemmeral,

How do you know you're doctor hasn't inreased his charges? You don't see his bill, your insurance company does. Your copay is not his charges. I'd highly doubt your doctor gives you a list of all of his or her charges that they billed last year vs this year. NO doctor does that.

You want proof, here goes.

http://money.cnn.com/magazines/fortune/fortune500/2009/industries/223/index.html

United's profits down 36%
Wellpoint down 25.5%
Aetna down 24.4%
Wellcare down 117%
Amerigroup down 143.5%

Of the top 14 insurers in this market segment profits raised on 4 and went down on 10 some substantially.

also check the below politifact article.

http://politifact.com/truth-o-meter/statements/2009/jul/23/barack-obama/health-insurance-company-turned-profit-not-rec/

As i've said before I wish you could have your public option so it could be seen as the red herring it is. there's no savings there and the lies of the left will be proven out.

in the below time frame insurers profits were 3.3%. Should they be zero, SURE. That still would have made your increase last year 14%. And then some would go under because they couldn't afford to process/pay claims and then when that happens i'm guessing you'd be not so happy claims wouldn't be paid.

http://mjperry.blogspot.com/2009/08/health-insurance-industry-ranks-86-by.html

Posted by: visionbrkr | November 19, 2010 11:52 AM | Report abuse

'actually it's who's not "whose"'

Actually, that's a grammar pedant FAIL on top of a basic argument FAIL. That you follow mutterc's comment with a thousand words of inside baseball makes my point for me.

I understand why this hasn't got through to you all these months: fish don't feel wet, because water's what they live in. You might live and breathe and pay the mortgage with this esoterica, but that doesn't make the basic conceptual frameworks self-evident or coherent or commonsensical or sensible.

Posted by: pseudonymousinnc | November 19, 2010 12:11 PM | Report abuse

@visionbrkr

Sorry, profits going down is not the same as them drying up. You made it sound as if insurance companies are not making profits at all, but they are. The links you provided clearly show that.


By the way, I don't think there's a point in having a conversation with a person who implies that I am a liar in order to try to make his point, so this is the end of our interchange. But of course I see what the doctor charges me. His charges -- not a "copay" -- are on the copy of the bill I take home after an appointment and appear again on the explanation of benefits I receive from the insurance company along with the amount they will pay or apply to my deductible.

You may be selling insurance, but it's obvious you have very little real life experience with using it, and very little compassion for the people who do. Buh bye.

Posted by: efemmeral | November 19, 2010 2:47 PM | Report abuse

efemmeral,

i'll waste my time one last time with you with a fact that i posted on another board on here. 50% of employees with employer sponsored healthplans are self insured which means the employer (think IBM, HP, NBC etc) are receiving the profit. The insurer just collects an admin fee that is very small especially compared with the work that is garnered getting the discounts, building networks etc.

Of that other 50% a large portion of those are non profit insurers so the actual figures when not distorted (NOT BY YOU) are much smaller but the pundits that like to push their points don't bother to mention that.

Do i wish the system was differet, absolutely. I've said before I'd be all for single payer as long as it was a model that was not government run. The problem that people don't get is that providers drive cost, not insurers. If your doctor hasn't increased these costs he or she is WAY outside the norm from everything i've seen and i see it on a daily basis.

I also have plenty of real life experience not only myself using it but with others using it too. I had a friend that went to a local hospital 2 years ago and his surgery got completely botched and he was septic. He spent two years in and out of hospitals. The insurance company spent about $2 million he said on his claims and he had no issues. Sure that's not the norm to people that like to bash them but I wonder if we spent 2+ trillion in healthcrae costs AND insurers seem to deny about everything (as some like to suggest) then exactly WHERE does that 2 trillion go?

And as far as compassion goes I have plenty of it. I just don't have much for people that don't understand the systems and yet rail on it for something better that's no better than what they have. For example how are the high risk pools working out? Never hear about it on here but no one's in them for the most part because no one can afford them. The prices are exorbident because of what doctor's charge.

Posted by: visionbrkr | November 19, 2010 4:02 PM | Report abuse

In the US, it is the government sponsored health care programs that spend the most money. Medicare D may be the worst health care benefit ever devised. (Put Billy T in jail now!)
Most other insurers are non-profit.
We pay more in malpractice insurance, we pay for more expensive drugs, we largely have fixed instead of percentage co-pays, and we are massively over treated by a pop-sci. People pay the same amount for the best and worst doctors, giving the worst doctors no incentive to compete on price.

Just for a minute, take phara spending out of those graphs. We are massively overdrugged.

Just for a minute, take our massive obesity problem into account.

Don't look at the aggregates, look at the subset of America that has low life expectancy, poor health habits, and high government subsidized costs. The answer is clear.

Just take a look at Singapore for a moment- surely paying out of pocket for most expenses via HSAs is the real winner.
http://blog.jparsons.net/2009/08/why-singapores-health-care-system-beats.html

Posted by: staticvars | November 21, 2010 1:40 AM | Report abuse

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