Welcome to the Future of Your Health Insurance. It Sucks.

There have been numerous reports about the shortcomings of Obamacare which its boosters have either ignored or shouted down. And troublingly, the attitude is often “I got mine” as in “My kids are now covered under my policy” without questioning what the narrow and broader issues are.

Well, I’ll tell you I got mine too. My current policy, which on paper is actually quite good, has a lifetime cap. Under the ACA, it is grandfathered and the cap is removed. And I’m still here to tell you that the future sucks. This deal enriches Big Pharma and the health insurers at the expense of the public at large. And the result of that will be a worsening of the already lousy health care system in the US. And I can give you a feel for what your future is likely to look like. It’s not pretty.

Let’s start with some of the inaccurate praise heaped on the ACA:

It covers the uninsured. No, it only cover some of the uninsured. The CBO scored the ACA as leaving 30 million still uninsured as of 2022.

It will cover people with preexisting conditions. Um, maybe, until you need costly care. The ACA preserved a loophole you can drive a truck through: But the bill has a giant loophole: insurers can continue to cancel policies in the case of “fraud or intentional misrepresentation” as they do now. And the bar for fraud, per established case law, is remarkably low. Forgetting to tell your insurer about a past ailment, no matter how minor, qualifies. Say you forget to tell your new insurer that you had acne or a concussion in your teen years. That will more than do.

Insurers NOW frequently go over the records of people who have costly conditions or major surgeries with a fine toothed comb looking for ways to rescind policies. For instance, in 2010, Reuters reported:

WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.

WellPoint appears to have overstepped by using pretty much any weak excuse to rescind policies. But the low standards of the fraud out mean that there’s still plenty of room to drop coverage, particularly for patients over, say, 35, who have enough of a medical history that they can easily forget a minor ailment that their insurer finds and uses to ditch them. Remember, most people who undergo a medical bankruptcy had insurance.

Your health care will be (mainly) covered. Hahaha. I know high functioning people (as in couples where both spouses had advanced degrees, and one was on the board of a major medical devices company) who’ve been stuck with huge hospital bills. They’d thought everything was covered, and somehow items that were in the tens of thousands (in one case, totaling $75,000) wasn’t. And then there’s the “out of network” problem, highlighted this weekend by a New York Times story of parents who had a baby that had trouble sleeping and the pediatricians they saw were at a loss. The doctor who specialized in that sort of problem didn’t accept insurance. While he was able to help the baby, the parents had to foot all of the $650 bill.

Health insurer profit margins are capped. That is technically accurate but substantively misleading. The health insurer have been engaged in price gouging over the last two decades. Health insurers as of the early 1990s spent 95% of health care premiums on medical expenditures. They now spend less than 85%. The ACA requires them to spend 80% on health care costs. So the bill institutionalizes an egregiously fat profit margin.

Now if that doesn’t sober you up, consider a few more factoids: the ACA does indeed extend insurance to a large pool of formerly uninsured, and subsidizes insurance to lower income individuals. This should increase demand for health care services. At the same time, more and more doctors are opting out of taking insured patients, largely because they can’t stand the cost and hassle of fighting insurers to get paid. For instance, dermatologists want to do Botox and dermapeels, not acne. Endocrinologists are converting their practices to anti-aging. In New York City, it used to be not too difficult to find a pretty good primary physician. That is no longer true. When my old MD quit practicing (while I was overseas), the insane array of referrals I got for his replacement would make for a Woody Allen movie.

Now forgive the following discussion of my experience, but it actually sheds some light on what is likely to be in store for a lot of people.

I have what is on paper a terrific policy. My insurer is Cigna, and it’s an indemnity plan, which means no network (only 2% of the plans in the US are indemnity plans). I can see anyone I want to, including overseas, including specialists without a primary physician referral. If the doctor I see is in a Cigna network, I get the network price, otherwise, the price is the rack rate. I have a $500 annual deductible and a 20% co pay on everything up to $5000 a year, and over that level is considered “major medical” so no co-pay.

Now what is wrong with this picture? Cigna used to pay like clockwork. Over the years, they have been engaging in new and creative forms of denying coverage. And I don’t mean the usual nickel and diming of saying that the doctor’s charge is above “necessary and customary” and dumping more of the doctor cost on me. I’ve gotten pretty good at fighting those over the years, but truth be told, they don’t seem to think they make enough on me that way (and I’m healthy enough that with the pretty low premiums I pay, they’d still pay out less than 80% of my premiums if they just acted like grown ups and processed my claims).

So their new tricks are:

¶ Throwing out claims. This started about 3 years ago. I cannot think of a single piece of business mail I have sent in the past 10 years that hasn’t gotten to its recipient. But Cigna now manages not to receive 25% to 30% of the claims I send them. I now record everything I send, date send and what’s in the envelope, and have to call Cigna to follow up to see if they got it (yes, I could send it registered mail, but that’s a half hour tax on my time every time and I don’t have it to give).

¶ Claiming provider information is missing, such as their ID number or name. This is nearly always impossible given that the doctors either print out receipts with all that info on it or have pre-printed forms their staff fills in by hand. But they assert they don’t see it on the scanned forms, so they are either misrepresenting or have a remarkably high level of scanning errors

¶ Claiming my policy doesn’t cover stuff that it does. Because I have a New York state regulated conversion plan, they can’t change the terms without notifying the state first (to obtain approval, but it’s pretty much always given) and then me, in writing. They’ve never done that (except for occasional rate increases or various mandated by law disclosures). But they’ve tried denying services that are required to be covered by New York plans by law or ones that they’ve paid for for over 15 years (and therefore it’s clearly a policy item). And their staff now can only look see in the database for the last two years (a recent “improvement”), so the customer service reps (who are actually pretty diligent) can’t find past claims in the database to substantiate my position; I have to dig through my records and send in copies.

¶ Saying they previously paid out on a claim when they didn’t. That one is really cute. Again required having kept track.

¶ Saying a claim has been submitted too late. This is also cute in light of the ruses above (as in the last batch was “too late” because they’d said provider info was missing), and is a new strategy. Clearly not permitted, since they would have had to notify me in writing and failed to.

Now because I am a customer from hell and know where the New York health insurance conversion plan people are, I periodically have to write them to lower the boom on Cigna. This is super annoying and I avoid doing it till really necessary but works every time. And the New York health insurance bureau disproves all the demonization of government employees. They are smart and on the ball. The first time I contacted them about my Cigna run around, a staffer there called me back 3 times in 24 hours with questions and follow up and got after Cigna two days after that. I hardly ever get that level of service from professionals like accountants and lawyers.

This microcosm should give you some insight into the macro. I’ve been on my own in a “groupish” plan, which is the position many of the newly insureds will be in. You can expect insurance that is costly but doesn’t cover much. The wrinkle on my policy is it is nominally cheap and in theory covers a lot but in practice I pay a lot extra by virtue of all the time I spend fighting with Cigna. The only reason I prevail is I also happen to be in a state where I both have decent legal protection and a good state office to run interference if needed. That isn’t the case in a lot of states. Caveat emptor in our brave new world of health insurance exchanges.

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113 comments

  1. Clive

    I do hope you never fall foul of the other wheeze in private health insurance — denying coverage because a procedure is deemed “experimental” or “not proven”. Either that, or it is classed as a palliative.

    The patient group I’m involved with often has to help in cases where a claim had been rejected because a procedure isn’t in the view of the insurer one that is on their approved list for the condition even though the clinician concerned has stated that it is clearly indicated and will be performed with curative intent.

    It can take a long, long while for some advances in medicine to get through to the end of a FDA trial. During that period, the healthcare professionals move to viewing that treatment as customary and expected. But guess what, the insurers drag their feet and the patient faces that awful dilemma — fight the insurer (which can take a long while as you’ve found especially if you’re not really on the ball with your knowledge of your rights), pay up yourself, or don’t have the treatment.

    What I would say in addition to the hints and tips Yves mentions in the feature above is, if you’re struggling with this issue and you’re not as feisty as Yves (or not as familiar with what you’re entitled to) then find a patient group and see if they will lend some support. As with most things to do with fighting big business, as an individual you’re easy meat. If there’s a group of you, you can collectively get more leverage and risk a deluge of bad publicity for the wrongdoing insurers. If you win, you can share that knowledge with others in the same situation and this helps to force a change for the betterment of everyone.

  2. charles 2

    Forgive me if it is a stupid question, but have you considered the alternative of having no insurance at all and just save the money for contingencies ? Considering your line of work, if you have a chronic disease or cancer, you could maintain some of your activities and get treatment in countries where it is 3 or 4 times cheaper (over even more) like India, Malaysia or Thailand ?

    1. LAS

      Charles,

      This is a pretty smart question. I often wonder if private insurance is worth the cost because, besides the savings accounts we might be keeping instead, there are many procedures we would be vastly better off not having anyway.

      The affluent can self-insure successfully, but for them there is still the issue of identifying truly beneficial care. Private insurers argue they’re cost effective to the public purpose by dint of performing this evaluative role.

      The other real need is to identify chronic conditions, contagious conditions and situations we can actually remedy among people who make under median income. Everybody benefits when contagious or chronic diseases are controlled or eliminated, even/especially those who do NOT suffer from the condition.

      People need to recognize that they are not healthy solely due to their own means; people are healthy in significant part because their whole population is healthy. If your population is at risk, you too are at added risk. Take this recent debacle over contaminated injected steroids. In this instance, we can see that it’s not the poorest among us who have got the mennigitis and abcesses from subpar compounding. Those who got sick and died were those with the means to cover the procedure. So, in this case, having the means WAS the risk.

      I personally think private enterprise cannot ever really do what we need doing in healthcare. Like it or not a healthy public sector is the only thing we can count on for true public health care.

      1. Capo Regime

        An actual private enterprise system would work out a solution as would an actual public sector. These of course are notional concepts. In the U.S. there is no real private sector nor a real public sector. Its a crony capitalist system with insurance companies being de facto crown monopolies. The split of understanding the world along lines of private sector vs public sector is as useful as say diving the poltical sphere into democrats and republicans. Not real just myth and PR.

        1. liberal

          An actual private enterprise system would work out a solution as would an actual public sector.

          False. Market failure in health care/health insurance is inevitable due to its nature.

          1. Nathanael

            Kenneth Arrow wrote a paper explaining why “markets” can’t work in health care — back in the *1970s*.

      2. MOBlue

        What will happen to the people who would qualify for Medicaid coverage under the expansion, if their state refuses to expand the program?

        Quite a few states have already stated that they will not expand the program but I have not seen how it will actually effect the people in the state that have no insurance.

        1. rotter

          I cant prove this, but i am pretty sure all the states will accept the Medicaid expansion. I have been watching that farce and i do believe its mostly posturing, even from rectal fissures like rick perry. All State Govenors (with the exception of perry) have indicated publicly without reservation that they need and want the expansion. Govenors do not turn down Federal Money, not really. Some incompetent boobs, Like Booby Jindal pretended to once, but he came back for the check a month later

        2. LucyLulu

          I also believe the governors will back down and take the money. They won’t be able to resist the political pressure and at least in the early years, the federal government provides roughly 95% of the funding for the expansion. The difficult pressure will come not from the affected un/insured people but from providers such as hospitals which will have to pick up the tab for the uninsured……. meanwhile forced to accept the reduction in Medicare rates made possible and already agreed to by same providers, by the anticipated reduction in amount of unreimbursed care being provided due to lack of insurance coverage.

          However if any states do hold out and refuse, they don’t get any additional funds, and those who would qualify with the additional funding provided by Obamacare will remain uninsured. Assuming, that is, the uninsured don’t secede en masse from their home state to a state that did expand their Medicaid program.

      3. bmeisen

        Fundamentally there are 2 types of risk: one that relates to individuals, a private risk, and one that relates to populations, a public risk. Protection against private risk can be bought by individuals on a hopefullly free market. Protection against public risk must be organized at a group level. Public health insurance is an example of the fiscal benefits of solidarity. The appalling inefficiency of the private health care system in the US, and its overwhelmingly negative macroeconomic consequences should convince all Americans that while we as individuals can get along for a while without health insurance, the society as a whole must compell us to acquire it. And when we all participate, as has been amply demonstrated in social democracies, the costs go down!

    2. Yves Smith Post author

      1. My policy is very low cost and I can go directly to any specialist or doctor. I suspect any modern catastrophic policy would have lots of gatekeeping.

      2. New York is redlined as far as catastrophic coverage is concerned (probably due to propensity of insurers to engage in coverage denial/limitation per 1, versus the pretty effective insurance bureau which consumers can mobilize to go after them if they have a New York state regulated policy). You simply can’t get those policies now in NY. And under Obamacare, the insurers are planning to offer that only to young people who might otherwise opt out of insurance. I doubt anyone has any interest in offering a catastrophic policy to a 55 year old. I suspect that it would cost as least as much as what I am paying for my grandfathered policy

      3. My insurance covers care in Thailand, etc. I’ve submitted claims from Thailand, the UK and Australia and had them paid.

      So to your point, I could just treat it as a catastrophic policy and not submit routine claims, but I have this weird notion that people should live up to their contracts, so I feel compelled to make them pay for what they are obligated to pay.

      1. Don Levit

        You are absolutely correct about the catastrophic plans.
        Under the PPACA, they are offered to people only under the age of 30.
        And, their deductibles are similar to those of HSAs, which are not very large.

        I know of a well-respectee attorney who has applied for a waiver on HRAs. These are employer-funded lomited benefit plans, that allow you to raise the deductible to the level of coverage in your HRA.
        3 of my partners and I hope to receive a waiver on a simlar plan, but it is funded by the employee. For $300 a month, one can build $25,000 in paid-up benefits in 36 months, and $50,000 in paid-up benefits in 60 months. Paid-up means never having to pay another premium on $50,000 or $25,000 of coverage (as long as claims are not made). This allows the deductible to be raised to $25,000-$50,000, and have it funded, reducing premiums by 60-80%.
        We are meeting with Milliman, an actuarial firm, this week to plan how to apply for our waiver.
        Don Levit

      2. Crazy Horse

        Yves, the bottom line is the the US health care system is broken. Dysfunctional at many levels, not just due to the behavior of private insurance companies behaving like capitalists and seeking to maximize profits. Remove the layer of private insurance companies extorting their pound of flesh and you still have a inhuman system based upon profit and greed. It will never serve as anything but another path to debt slavery until it is entirely removed from the profit system and restructured as a public health care system.

        Take my recent experience with Medicare “insurance” (Part A & B for which I pay and extra $100 per month). I live in a predominately rural area with one small clinic/hospital located 70 miles from a large regional hospital. I experienced mild chest pain, and upon researching my symptoms on-line decided to see a physician. Upon arrival at the local hospital I was assaulted by a consortium of nurses and ex-Vietnam med techs. (LOL) Enough to make anyone’s blood pressure rise! Based upon an unusually high blood pressure reading they told me I was having a heart attack and loaded me into an ambulance. Turned out to be a miss-diagnosis, but i can’t fault them for an honest mistake.

        What I do object to is the $1,740 charged to me and the $10,480 billed to the taxpayer for Medicare as a result of a 22 hr. stay and observation in the hospital. Included in that bill are extortionist charges like $520 for a handfull of pills made in India and shipped to the US in 50 gallon drums with a retail value in their country of origin of perhaps $15. Or a ten minute “stress test” on a bargain basement treadmill for $776.

        It’s not hard to understand why the US ranks #37 in the world for quality of delivered health care. In almost any of the 36 countries that the World Health Organization ranks ahead of us the same care would either be free to the patient or cost less than the co-payment demanded of a US citizen “insured” by Medicare.

        1. Lidia

          Sadly, Medicare is still “an insurance”. Until the US has true single-payer where the patient never sees a bill, those games will be played. Hey, they probably will be played even under single-payer, but at least insane and fictitious charges can be batted about between politicians and providers without having to stress out the already-stressed sick person.

    3. charles sereno

      I come not to praise charles 2. His evil is apparent, or should be. Yet, has he not attended to concerns which afflict us all? And, in so doing, is he not a shining light of brevity and obfuscation? My heart goes out to him, a paragon of troll-o-bots, no doubt underpaid.

  3. Barbara

    I hate to say it, but your experiences have been the same as mine over the last three decades. The shenanigans that insurance companies play is nothing new. All the new law means is that more poeple will see some claims paid, or not paid. At the very least, more will have access to our craptastic non system.

    On a side note, I know a few people who have low paying jobs, no access to care and chronic medical conditions that need treatment they can’t get right now. Their only hope right now is the new law and the tax credits they should see or the Medicaid expansion that will give them access. That is no small change for these individuals. None at all.

    1. scott

      This is why the Dems themselves will propose repealing Obamacare in 2014, in exchange for single payer (medicare for all). So many will be uninsured by then (part time or priced out) that the repeal will be supported by both parties.

      This was the plan all along. Obmacare was going to be a nightmare of government incompetence and corporate greed combined that would make us beg for single-payer (e.g. Canada).

      1. Capo Regime

        Nope–the dems love the big pharma contributions too much. They will support tooth and nail all that enriches their sponsors. Single payer will not yield much in the way of campaign contributions or big jobs for staff or former house memebers. Can’t give up a big chunk of economic activity as a source of income and political trading. Come now have some coffee and wake on up from fantasy land.

        1. Sharon

          If we were to go to a single payer system what would stop pharma from forcing treatments on us? They already control the FDA, the NIH and the CDC. Single payer, in my opinion would be a worse situation for all of us. There would be no barriers to the mass poisoning of the patient population with impunity. At least now we have a buffer, the insurance companies, they know what is making us sick.

          1. Lidia

            Sharon, you have no idea what you are talking about.

            I lived in Italy for ten years, and no-one is FORCED to have any particular kind of care that I am aware of. Logically, the impetus might be to withhold care rather than over-treat, but I saw none of that. All presenters I know who needed care received excellent treatment, but nothing was forced on anyone. You have a problem? You show up (first-come, first-served) at your primary care physician who has office hours most days of the week. I even had my doctor’s cell phone in case of emergency. Or, you can drive to the ER (“pronto soccorso”) which I did have to do one time. I waited about 1.5-2 hours, which is less than my mom’s elderly friend waited in the US when she had a dislocated shoulder (5+ hours wait). I merely had a back spasm so of course more serious cases cut in front of me.

            Where does your basis for this “forced care” statement come from?

          2. Lidia

            What is making us SICK, Sharon, is having to work 40 hours/week at minimum wage just to pay insurance premiums (for me they would be around $15k/year), forgetting about anything like housing, heat, or nutrition.

            Since this is unsustainable, it will not be sustained. People will find a way to cut out the parasitical middle-man, whether that is fee-for-service or self-medication or just flat-out dying.

      2. PeonInChief

        Oh, how I wish that were true! We’ll get single payer, or some variation thereof, when it becomes clear that there is no way that we can continue to support Big Insurance, Big Pharma etc. and still provide adequate health care to our population. And that’s likely to take a considerable number of years and waste a considerable sum of money.

    2. TK421

      “the Medicaid expansion that will give them access”

      But that’s up to the states, and they don’t have to expand Medicaid, right?

      1. Barbara

        Medicaid expansion is up to the states, correct. Yet these friends are in states that are going to accept the Medicaid expansion. One will be on Medicaid for sure, the others I guess will see tax credits to purchase coverage – we will see how that plays out. They are lucky that even this modest change was able to pass through a Congress that has half it’s members living in some very strange alternate universe where Darwin is the devil and a Wall Street banker is the God. I am lucky it passed, I help pay some of their bills when they can’t.

  4. jake chase

    This is one of the very best things ever written about health insurance. My own strategy as a self employed person living in Manhattan over twenty-five years was to carry no insurance whatsoever, avoid doctors like the plague, walk everywhere and eat everything in moderate amounts, rely on family genetics and never take drugs, even those sold over the counter. For chronic back pain (20 years) I took exercise, finally located a book by Dr. John Sarno, which said 95% of back pain is mental, and to cure it one need only read the book. I read the book. It worked. Over three years I met four other people who had the same experience.

    At 69 I have developed a heart arythmia for which I (reluctantly) take two drugs to lower my heart rate. I am told that if this condition persists it may kill me, but I feel fine, only slightly tired and needing periodic brief naps. I like my doctors personally but find their science rather sketchy under cross examination. They are experimenting and will admit it if you press them.

    IMHO people need to be less trusting of medicine and less fearful of dieing. Something will kill each and every one of us. Be careful of big pharma. The FDA is no longer the watchdog it once was. Avoid all drugs with relatively brief histories. I take nothing which has not been around for at least ten years. Most doctors are simply businessmen with a flair for scholastic performance. They must see too many patients to do a thorough job for most of them. Learn to do your own research. The Web makes this a snap. I routinely learn things about my condition that my cardiologist doesn’t know or has forgotten. I use him mostly as a source of prescription drugs, not advice. I suppose this sounds arrogant to some. Okay, don’t invite me to your next party.

    We got Obamacare because people became obsessed with ‘health care’ and business saw a ripoff opportunity. When I was twenty-six there was no health insurance of any kind. I developed phebitis in one leg on a delayed airplane landing while hovering over LaGuardia for two hours. The first doctor I consulted looked as though he had not had a patient in five years. He had been recommended by the NYC medical association. I tried his advice for a week and failed to improve, found a doctor at Columbia Presbyterian Hospital who saw me in his one man Park Avenue office, where he answered the telephone when it rang and opened the door himself. This doctor looked older than God and was exactly what a doctor should be: wise, knowledgeable and wickedly funny. He told me the previous doctor’s advice was excellent if my intent was to lose the leg. He told me to throw away my crutches, stop wrapping and elevating the leg and walk as much as possible. He charged about $20 and apologized while I counted it out in small bills. I began my course of ‘treatment’ by walking home and have kept walking ever since.

    If doctors, hospitals and drug companies had to rely on people paying them with their own money I believe we would get better service. Insurance only dilutes their effort, minimizes one’s ability to identify the best practitioners and enriches insurance company executives fully occupied in looting their companies, gambling with premium money in derivative markets, and stiffing customers whenever possible.

    This country needs higher wages for workers and incarceration for ninety percent of corporate executives. I think we will get there eventually, but eventually is a long time.

    1. Jim Haygood

      ‘If doctors, hospitals and drug companies had to rely on people paying them with their own money I believe we would get better service.’

      Unquestionably. One sees an immense amount of costly PR from hospitals, touting their high rankings in various specialties. But never, ever do they discuss pricing!

      When are hospitals gonna send out discount coupons, the way pizza joints and health clubs do? NEVER, as long as they’re cartelized and exempted from antitrust prosecution.

      True health ‘insurance’ would resemble the major medical policy with a $30,000 deductible, which I had from a professional society for a decade or so. If everyone were shopping around for routine procedures, prices would fall drastically, and the paperwork gauntlet would disappear to make it ‘easy to buy.’

      Now high-deductible policies are nearly useless, since price discrimination is the health cartel’s modus operandi — deep discounts to Medicare/Medicaid and large health plans; huge markups to uninsured walk-ins.

      By entrenching a rapacious cartel, Obamacare only ensured that health care costs will keep on outpacing inflation and dragging down U.S. living standards.

      1. Capo Regime

        Low premium HSA plans allow some bargaining and also cost containment. And are “affordable” subject to how much you can put in the HSA to offset the large deductable. Of course affordable depends on who is doing the affording… Then there is medical tourism. Mexican dentists are pretty good…

        1. Capo Regime

          Yes it is a rapacious cartel. You can negotiate a bit and sometimes in an odd way concierge medicine makes sense for some. But in the main–you are correct…

      2. Howard Beale IV

        I couldn’t even get a base price quote to get my cat’s teeth cleaned. The whole lack of any form of price transparency is perhaps the biggest reason why we’re in the mess we’re in for healthcare. Close to two decades ago 60 Minutes did a report on the charges generated by hospitals for a procedure and how the price of a lowly single dose of aspirin was several dollars.

        Until the base pricing model changes, noting will change.

      3. hunkerdown

        One sees an immense amount of costly PR from hospitals, touting their high rankings in various specialties. But never, ever do they discuss pricing!

        Poppycock. As a matter of fact, earlier this year Detroit Medical Center had a bunch of billboards along the Interstates bragging about spending $54 million here, $111 million there, and so forth on new or refurbished facilities.

        Oh, that wasn’t what you were talking about? ;)

      4. Don Levit

        Plans with such large deductibles are very hard to find.
        Why? What insurer wants to cut its premiums 60-80%?
        Our hope is that a for-profit life insurer will be interested, in order so that its clientele will have more dioscretionary income for its life insurance products.
        Don Levit

    2. Paul Handover

      And, in turn, a very thought-provoking reply. As it happens, I’m 68 and a newish resident of the USA (Brit/Green Card holder). Yesterday was meeting with a local health insurance broker trying to ascertain what my options are. Frankly, nothing that doesn’t appear frighteningly expensive, with high deductibles and too much fine print to get one’s head around. So your thoughts are pushing my own buttons in terms of either going self-pay or taking out catastrophic insurance only (whatever that would mean!).

    3. Lidia

      Thanks, Jake! I am currently uninsured and have no intention of re-upping. Won’t bore you guys with an account of physician retardedness I recently came across here in the US, but suffice it to say that your post rings true.

  5. OMF

    Ultimately, I am skeptical that private health insurance can ever work at all. People cannot be relied upon to subscribe to it in the required numbers and more importantly, companies cannot be relied upon to provide a reasonable service when people pay for it. Given the present situation the options are:

    i) Simply have no health insurance. Fees are upfront and people can simply die or be bankrupted by a trip to the hospital.

    ii) Heavily regulate insurers and force people to have health insurance(at universal rates). This basically involves (or realistically should involve) nationalising the insurers, but frankly I think most people would e glad to see the back of them.

    iii) Universal health care/NHS type plan. All medical expenses are paid for by the public exchequer.

    No-one is going to like the medicine that goes with any of these options.

    1. Clive

      Agree with you OMF.

      For your i) above, if this unlikely situation were to come about, the cry would go up “someone has to do something” and we’d be straight back to one of the various scenarios we have to contend with now.

      For ii) this isn’t really a choice as you allude to. A fully private “market” for healthcare can’t possibly exist because no-one can put a price on pain, suffering and death. If you’re sick you’ll pay anything, even money you don’t have, to get well again. If you have insurance you’ll want the insurer to cover all your costs — but in time insurers will try (as Yves’ experience confirms) to wriggle out of any policy benefits. Regulatory action to make certain policy terms and conditions are fulfilled will always be attacked and undermined by the insurers. Regulatory capture is just as much of a risk in private medical insurance as it is anywhere else. If you nationalise the insurers (again, you’re right to say this is the only way to prevent abuses) then what you have is nationalised health system… which brings us to

      iii) An NHS type of system will always be at the mercy of austerity mongers, tea party-ers, fiscal cliff-ers etc. etc.

      Sometimes you really do despair !

    2. Ed

      In response to OMF:

      “) Simply have no health insurance. Fees are upfront and people can simply die or be bankrupted by a trip to the hospital.

      ii) Heavily regulate insurers and force people to have health insurance(at universal rates). This basically involves (or realistically should involve) nationalising the insurers, but frankly I think most people would e glad to see the back of them.

      iii) Universal health care/NHS type plan. All medical expenses are paid for by the public exchequer.”

      Option ii) seems to be how the issue is handled in many continental European companies. Essentially they consist of nominally private health insurance companies that are treated as utilities in terms of regulation.

      Option iii) also has been implemented in some countries (the UK and Canada being the best known examples). Incidentally, private health insurance still exists in both countries and is available for people who want it and can pay for it.

      Many people have proposed a version of Option ii) for the US, but I think iii) would work better for two reasons. First, when countries like Germany implemented their Option ii) system, their private health insurers were smaller and less powerful than is the case with current US insurance companies, and frankly easier to tame. Second, the US already has a substantial though fragmented provision for public health care (Medicare, Medicaid, the VA) and these could just be rationalized and extended to cover the entire population. The situation here is more similar to the situation in the UK in the years prior to the NHS.

      As for Option i), I can see a system where the taxpayer picks up the tab for catastrophic coverage, and routine and elective matters are purely free market. The only problem I can see is that for this system to work, its not a matter of regulating or nationalizing existing health insurers, you have to ban them outright. It seems less radical but is really much more difficult to implement.

  6. geoff gray

    i’m in the health care business–as in sending claims to insurers via an emr for thousands of docs–so have seen the extent of the debacle. a couple of points:
    1) medical loss for large insurers is 85%; for small 80%. health insurers are able to scam hte system andcount admin as health care.
    2) the cost of docs of dealing with so many different insurers–with sometimes different filing requirements, authorization requirements, etc–is costly.
    Upshot of 1 and 2 is that probably on 66% of health care premium is for actual health care.
    3) the obvious–insurers make money when they don’t pay premiums
    4) but also, to some small extent health insurers earn a reputation for efficiency and fair play–you don’t see aetna and the blues playing as many games.
    5) most important: obama said in 08 that he would “sign no healthcare bill that doesn’t have a public option. YOU CAN TAKE THAT TO THE BANK.”

    HAHAHAHAHA

    1. Sharon

      The problem with your conclusions is you are assuming that treatments are 100% the right thing to do. Many times they are not. The patient is the last consideration and it is profit that motivates treatment plans not patient care. Whilst I have no love for insurance companies I am not naive to the real elephant in the room – overtreatment for profit and the mass poisoning of the patient population. You can’t look at one side of the equation and not consider the other. In my opinion our cost is driven disproportionately higher by poisonous toxic treatments not insurance administrative costs.

      1. Klassy!

        I agree. It would be wrong to cast all the blame of rising health care costs on insurance companies.
        Here is a useful primer on how treatment guidelines are formulated:
        http://seattletimes.com/news/health/suddenlysick/
        That said, of course Medicare does a better job of containing costs. But, there is a limit to what can be contained unless serious reforms are made on the health care provider side.

  7. fresno dan

    “This started about 3 years ago. I cannot think of a single piece of business mail I have sent in the past 10 years that hasn’t gotten to its recipient. But Cigna now manages not to receive 25% to 30% of the claims I send them. I now record everything I send, date send and what’s in the envelope, and have to call Cigna to follow up to see if they got it (yes, I could send it registered mail, but that’s a half hour tax on my time every time and I don’t have it to give).”

    The above just goes to show the purposely antique way of doing things – why not send requests for reimbursement by e-mail??? Because the excuse of the claim was not received is just another scam to not pay.

    Also, this appears identical to the same shennaigans as used by Banks and mortgage companies. Modern American business, delivering fraud for your hard earned dollar.
    And again, all the laws to help consumers are ignored, while if you don’t pay….well, I expect someone will show up at your door one day to repossess your liver.

    1. Yves Smith Post author

      Exactly. Not only that, the only option they give me is a PO Box, which means I have to mail, no Fedex. I have a Kinko’s around the corner from me. I’d much rather pay the extra $10 (over registered mail) to save my time while having a way to prove they got my claims submission.

      1. Observer

        Very disconcerting since my workplace just switched to Cigna. At least with an exchange I might have a choice, although most likely not an affordable one, and I live in FL, which will mean a Federal exchange.

  8. John F. Opie

    Perhaps I’m just being naive, but most of these problems sound like simple attempted fraud: the insurance company receives payments for services that they have no intention of performing.

    Of course, at the end of the day, the entire ACA/ObamaCare appears to be a fraud as well: purporting to do one thing, but in reality doing something entirely different.

    As Yves notes, it fails to address both non-insured and pre-existing conditions, both of which were the major arguments for mandating this on the federal level.

    And I can add to the pre-existing condition problem: my wife has MS. I live in Germany as a US expat and we were planning on retiring to the US. At first we were simply going to forego insurance that covered her MS, as it is in remittance and after the first problem has not recurred. Now, of course, we have to acquire insurance: while no one can deny us insurance, the pre-existing condition of MS means that the bottom-of-the-barrel coverage would run us over $40k/year: that would be a substantial portion of our retirement income. They can’t deny her coverage, but there is nothing stopping them from charging for it.

    All I can see ACA/ObamaCare actually doing is making a huge, permanent mess of the health insurance industry, resulting in worse coverage, higher prices and doctors leaving the system because, at the end of the day, it’s not worth the trouble.

    Obama, Pelosi and Ried should have paid attention to what doctors are supposed to do: first, do no harm.

  9. John

    I’ve also been wondering about the fraud issue. There MIGHT be some hope on that point.

    Previously, insurers could claim that any omission in an insurance application was material to (affected) their decision to insure, because they would have charged a higher premium if they’d known of the condition. So the omission cheated them out of money, which justified refusal to pay the claim.

    But if they now have to issue the insurance regardless of pre-existing conditions, maybe one could argue that omissions of information about pre-existing conditions don’t matter anymore and so don’t give a basis for canceling policies. However, if insurers can charge higher premiums based on pre-existing conditions, then that’s a loophole so large that Obamacare is largely meaningless for people with individual or small group policies. Does anyone know if that’s true?

    BTW, the business about “losing” claims in the mail sounds like it would be a fun class action if others have the same experience.

    1. Larrin Sandford

      Fraud doesn’t exist in the universe of incorporation.

      Incorporation = no jail, no justice, no problem. A complete bastardization of the entire legal system.

      Anyone expecting solutions from such organizations is an idiot.

  10. Sissy

    18 years ago I was diagnosed with breast cancer. Cigna was our insurer. After 7 months, they still had not paid the hospital bill. I called them and they said they never heard from the hospital. The business office at the hospital told me they had called, written and faxed them over and over again, with no reply. My father, husband, brother and sister-in-law were all practicing at the hospital at the time and my husband was chief of staff and on the board of directors of the hospital. I told cigna not to insult my intelligence and if the bill was not paid ASAP I would call my senators, congressman, the insurance commissioner and anyone else I could find. The bill was paid within the week. We later switched to another insurer. I am a baby boomer and I always remember my father reminding my mother to pay the MAJOR MEDICAL policy premiums when they came due. One of the problems, as I see it from a patient’s standpoint and the doctor’s standpoint is that people want everything FREE. The price of everything would go down in healthcare if everyone paid out of pocket, except for major medical issues. Why couldn’t we all just have major medical and forget wellness visits, drug coverage, etc. People go to the doctor at the drop of a hat because they think it’s free and owed to them. Being from a docto’s family, my children and I get no perks:Professional courtesy has been gone for decades:SO WHAT? I’d rather pay for my flu shots, meds, etc. than fight with the insurance company. Things are going to get bad very soon. I do hope everyone that is so pleased about obamacare understands what’s coming. So, boomers, beware, better take care of ourselves, because no one else will have the time or inclination to do it for you!

    1. Fred H

      Horse shit, Sissy — you’re biased to the point of unreasonable. What part of anyone making minimum wage being able to afford a $100 office visit for routine antibiotics is reasonable?

      No one wants anything for free, but when public health can do the same job for $15 or $25 it isn’t the patient that is broken.

      It’s the greed at Sissy’s residence.

    2. Stephen Zielinski

      One of the problems, as I see it from a patient’s standpoint and the doctor’s standpoint is that people want everything FREE. The price of everything would go down in healthcare if everyone paid out of pocket, except for major medical issues. Why couldn’t we all just have major medical and forget wellness visits, drug coverage, etc. People go to the doctor at the drop of a hat because they think it’s free and owed to them.

      I believe “free” is the wrong word to use in this context. Single payer advocates believe health care is an entitlement — i.e. a service they have as a matter of right. Those services would not be “free” since the a government entity would use tax revenue to pay for them.

      When Washington, DC blowhards decry entitlements, they are attacking social rights Americans have because they are citizens of this country.

      Can the United States afford such a health care system? Yes! We know this to be the case because the United States can afford a global empire which serves no humane purpose.

      1. Antifa

        National healthcare and national education is properly among the primary domestic expenses of our Treasury — the same as highways, airports, the FBI, the Army, the Navy, the Coast Guard, the CIC and the EPA.

        Government funding and promoting of the health and education of its citizens is the root cause of that nation’s survival, first off. Second, it is that nation’s entire hope for prosperity.

        What is now given unstinting and unbudgeted to wars for empire is the due of every breathing American, to be used to care for and educate every one of us.

        Not to arm a tiny core of super troops and drones to go make the world safe for Goldman Sachs.

  11. Fred H

    Wake me when doctors give a damn about people’s health over money.

    These are the care-givers and many times the business. They are complacent and their “AMA” is a racketeering syndicate that would make Al Capone proud.

    Doctors be damned.

    1. Jefemt

      If we believe in markets, choices, consequences, Sissy is on to something on pay-go. if we each ‘got to’ pay for our annual baseline bloodwork, check-up, teeth cleaning out of pocket, we each might start to pay a little more attention to the choices we make at the dining table and with our personal hygiene, exercise regimens, etc (walk, bike, drive to destination ‘x’?) We each should expect to be responsible for at least this level of our own health care. We lived in Canada for three years , flat fee $5.00 to see a doc. This did give a false incentive to see the doc more often. I have no insurance, flying wild in my 50’s…. have skin cancer and see doc for annual perusal and liquid nitrogen blasts… I ask about a cash discount each and every time- my case has no co-pays, insurance process, coding involved. As has been noted countless times, here and elsewhere, 35% of the current fee system goes to admin. So I always ask for a cash discount (true cash, no credit card), they always say no, always point out in my best iteration of Stentor that I can muster so all in the waiting room can hear, “It seems to me that since 35% of this process is administrative, and I am handing you cash, I really should get at least a 30% discount” . To no avail. Otherwise, I avoid docs like the plague. It amazes me and is quite humorous that in this nation of saavy businessmen and go-go hey hey pro-business mentality that we continue to insist on a free open market system of insurance, as opposed to a single payer system with capped profit margin. How the discussion got from CARE to INSURANCE is astounding but unsurprising. Lets roll out a request for bids to have the entire nations’ business to Blue Cross, Aetna, United Health, etc, for say a ten year period at 5% profit. Instead, we have institutionalized the MIC equivalent of $700 hammers and toilet seats on the care front. We are truly idiots allowing the continued ruination of the nation with the crooks running things inside the Beltway and in NYC. From the oil patch…

      1. alex

        Canada … flat fee $5.00 to see a doc. This did give a false incentive to see the doc more often

        And yet the cost of Canadian healthcare is less than American healthcare, has equal or better outcomes, and is truly universal. Longer lifespans too.

        And paying for routine tests and so forth out of pocket is the worst possible idea. Even our miserable insurance companies realize that, and often waive copays for wellness visits and the like.

        Frankly I’m tired of this endless pull-it-from-your-posterior theorizing about proper incentives and blah, blah, blah. Look at the numerous examples around the world that actually work, and provide better care at lower prices than in the US. Empirical data always trumps silly theorizing.

  12. notexactlyhuman

    Indeed, health insurance is not synonymous with health care. Especially not for-profit health insurance corporations whose mission it is to maximize profits above all else at the expense of its customers. It’s a busted model. We Americans are largely stupid..

        1. Klassy!

          Actually I was thinking more along the lines of public water sanitation, air quality standards, a true social safety net, occupational safety regulations– you know– all the stuff job creators tell us we can’t afford if we want to be competitive.

    1. Observer

      It’s a complicated situation and there is no easy answer, but I believe the for-profit publicly held corporate model is the biggest problem. If you’re old enough, you may remember when hospitals were not-for-profit, as was BCBS. Then came HCA. These days, many hospitals are run by publicly held corporations. Nursing homes are also now run by a handful of large, for-profit, publicly held corporations. Home health care is going the same way, as is some Hospice care. Labs are for-profit; you can buy Lab Corp stock if you want to. Insurers are publicly traded, unless you’re lucky enough to qualify for Medicare. Drug companies are publicly traded.

      My point: Every time you get sick in the US, someone at every point along the way is taking their cut. Their mission is NOT to provide healthcare; it is to generate profit, and therefore dividends, for their stockholders. If it’s a bad quarter, what’s the first thing any corporation does? Cut costs: buy cheaper supplies, reduce staff, outsource functions, etcetera. Therefore, your cost increases while the quality of the care you receive decreases.

      I agree there are many other problems with our so-called system of healthcare. But not everything is a widget. Some things are best done without a profit motive, like health care, police and fire services – you see my meaning.

      1. Don Levit

        Blue Cross and Blue Shield lost its federal tax exempt status in 1986, with the passage of IRC section 501(m). The primary reason was that it had evolved into its for-profit competitors, and was no longer worthy of its tax advantage.
        In order to fully qualify as a 501(c)(4), it had to offer insurance that was not available commercially.
        That is our goal come 2014, with the introduction of the exchanges, to offer a unique valuable plan.
        Don Levit

  13. Cynthia

    “Worries Grow as Health Jobs go Offshore”:

    http://articles.latimes.com/2012/jul/25/business/la-fi-healthcare-offshore-20120725

    Under normal circumstances, I’m opposed to off-shoring of jobs. But if Well Point and other healthcare insurers can reduce co-pays for office visits and monthly insurance premiums they charge their policyholders by sending managed care jobs and utilization review jobs overseas, I’m all in favor of it.

    Needless to say, since there’s nothing normal, much less acceptable, about healthcare costs spirally out of control, I’m looking forward to seeing overpaid electronic paper-pushing nurses losing their jobs to modestly paid electronic paper-pushing nurse in India and the Philippines. This would also result in more healthcare dollars being freed up to pay RNs to do what they are REALLY trained to do, which to care for patients. I have yet to figure out why RNs who are employed as glorified office workers are paid substantially more than RNs who are employed as highly-skilled clinicians, especially given that they never have to deal with life-and-death issues and never have to put their licenses on the line caring for and treating patients — something which is always the case for nurses working at the bedside.

    But that’s the reality we face, ridiculous though it is. Hopefully healthcare providers will follow suit and do what healthcare insurers are starting to do, which is shipping these and other electronic paper-pushing jobs overseas. If hospitals and other providers don’t start doing this, then they’ve undoubtedly got their priorities all backwards. Listen up hospitals, as a rule of thumb, any nursing job that can be easily automated should be targeted for off-shoring, this includes overpaid jobs in nursing education and nurse administration.

    The only reasonable and justifiable argument to oppose off-shoring of care management and utilization review is that patient confidentiality would be breached. But since banks and credit card companies have managed to offshore many of their on-line services and back-office jobs without compromising banking and credit card records, then there no reason in the world why healthcare insurers, as well as healthcare providers, can’t also offshore many of their on-line services and back-office jobs without compromising medical records. In fact, I imagine that if given a choice, tough those it is, most people would choose to have their banking records secured under lock and key than their medical records.

    1. Observer

      Get real. Outsourcing is never the answer, no matter what industry you’re talking about. What you really need is a union and some state regulation mandating nurse-to-patient ratios that are actually realistic.

      1. Cynthia

        Apparently, you, “Observer,” didn’t read my comment, otherwise you would know that I was NOT complaining about the high cost of nurses, who work at the bedside ACTUALLY caring for patients — the ones whose level of productivity is strictly monitored based upon a given nurse-patient ratio. Quite the contrary. I was complaining about the high cost of electronic paper-pushing nurses that work behind the scenes, employed as care managers and utilization review managers, none of whom have anything to do with caring for patients, and very few of them are being monitored for their level of productivity by health insurers, even less so by health providers.

          1. Cynthia

            If we can’t have single payer healthcare, aka Medicare-For-All, then we should offshore the entire health insurance industry to India and the Philippines, including all executives and all of their administrative underlings. This would cause wages at both the executive and administrative level in hospitals and other top-heavy, bureaucrat-infested providers to drop to more reasonable levels. That way we’ll be well on our way to having affordable, high quality healthcare.

          2. JTFaraday

            Well, as I think we can predict from the tech field, what follows and accompanies off-shoring is on-shoring.

            It’s possible those professionals and para-professionals who would still propose to live by the sword haven’t thought this all the way through.

            Although, at the moment, this is what I would predict whether said professionals attempt to play it this way or not, and not to reduce costs to the public but to increase profits for executives and shareholders.

        1. LucyLulu

          RN for 30 years here. Have worked in case management, utilization review, but mostly “bedside”. I call bullsh*t on Cynthia. First, I’ve NEVER had an insurer monitor my productivity. Insurers can care less if I have 16 patients or two. By the same token, if by health provider, she means administration, I don’t recall them ever NOT being concerned with productivity. If you’re UR for three units and you don’t get approval all your patients to continue to be hospitalized so the hospital can get paid by insurer, or let the doc know that the insurer said no so the doc can write the discharge order, you really think nobody cares???? Try again. And all require expertise and skill. If you don’t understand what is going on at the bedside and what the patient needs, AND can ascertain it by quickly skimming over a chart, how do you persuade an insurer the patient isn’t ready to go home yet? And if your relative ends up in case management, you damn well want somebody who knows what they are doing, because that is the treatment you will likely be stuck with.

          Offshoring to Asia? Yikes! Not on my life if its me or a loved one in the hospital. Damn scary idea. Maybe CNA’s could give bedside care while remotely supervised by nurses in India? Geez. I really hope Cynthia doesn’t know what UR and CM nurses actually do.

  14. Capo Regime

    To play on the headline–its not the future. Health insurance sucks now. And it will continue to suck and get suckier. Odd how people continue to advance solutions and think that it will “get fixed” etc. Corrupt systems do not reform themselves they only change due to collapse or extreme failure.

  15. Furzy Mouse

    another slimy shenanigan that Oxford engaged in, while I was working in NYC, was to claim that I had to pay for medical tests that were “covered”….oh, but then, it was the co-pay (never mentioned prior to the procedure) that I had to pay. After duly coughing up the $50 or whatever, Oxford, and the company doing the test, would keep insisting that they were not paid! Happened several times. And I want to toss in several dentists in this complaint…twice I wound up with pretty rotten ones, who caused unmentionable pain, not to mention expense and lousy results…and then had the nerve to sue me for the balance of the treatments THAT WERE NEVER DONE, BECAUSE I WOULD NOT SEE THEM AGAIN!!

    1. David Chaney

      Thanks Yves. As always right on target and way ahead of the curve.

      In my case I am thankfully very healthy but self employed, so have an individual policy. Blue Shield in CA has tried everything to cancel since I hit fifty, and then went nuts went I hit fifty-five. This of course after paying 20 plus years of premiums and only having a bi-annual (at most) physical.

      At fifty BS a) doubled my premiums
      b) at fifty immediately tried to say I paid the bill a day too late, so policy was cancelled (Saw this coming and sent payment certified return receipt.) When confronted with the fact they had the check by the 28th (“but we didn’t post it” they said) (Also, a month in Blue Shield land is 28 days – if your check arrives on the 29th, you’re cancelled.) Had to threaten to call the CA insurance commisioner. Just as in the case Yves cited, the CA insurance commissioner is no joke and helped me in the past.
      c) Now that I’m fifty five, Blue Shield doubled my premium again, just shy of $1,000 a month. That’s a lot of money with a $4,500 deductible. But try to do the Paul Ryan Shuffle – i.e. finding a new policy post 50 (not to mention post 65 with a worthless coupon in your hand.)

      Oh the pain…..

  16. Cynthia

    Yves (or anyone else here),

    Do you think that health insurance premiums will be lower and/or policy holders will have more consumer protection as well as better insurance coverage under an insurance exchange program that’s by run the federal government, as opposed to an exchange program that’s run by a state government? I ask this question because states like Texas and Alabama, to name a few, who chose to opt out of a state-run exchange, will have, by default, their exchanges run by the federal government.

    1. Finnucane

      Because Gubmit bad, Gubmit bad, Gubmit bad. (The bitter fruits of the successes of the Civil Rights movement. Why, really, do white people, particular in the South and the fly-over states, hate the federal government?)

  17. briansays

    ah yes CIGNA like Aetna based in Conn. well represented thru the years by Joe Lieberman who made sure we didn’t get a public option

    it will be interesting to see who/how pays him back now that he is retiring

    course as a career public employee i’m sure he keeps the healthcare

  18. Susan the other

    Medicare for All. The sooner the better. What politicians are doing now is playing off one interest against another – the drug monopoly cartel against the insurance monopoly cartel against the AMA against struggling small businesses and even against big corporations. We are all disgusted with the health “care” industry. No other country on the planet allows health care to be profiteered like this. We have politicians to thank for this mess.

  19. JB McMunn

    Right now insured people are disconnected from the true cost of health care. That $20 co-pay for your blood pressure medicine might be only 10% of the total cost.

    The fastest way to slash health care costs is to make health insurance illegal and let the free market go to work. The price of everything related to health care would drop faster than a pair of Kardashian panties.

    Barring that, I’d make all co-pays a percentage of the cost, not a flat rate. Make the patient think about costs at the margin.

    1. Bill

      No, SOME people are disconnected from the true cost of health care, the REST of us are paying through the nose.

    2. Lidia

      “That $20 co-pay for your blood pressure medicine might be only 10% of the total cost.”

      And then again, it might be 2000% of the cost…

  20. Kelly

    Health insurance and Healthcare are two different things and I think that is where folks get confused. I have an insurance policy but no access to healthcare with a $4500 deductible. My premiums started at $168 an year and a half ago are now $249. Plus Aetna will decide how much my out of pocket goes toward the deductible, so I may pay $1000 but they may only credit me $500, based on usual and customary BLAH, BLAH, BLAH, so I really don’t know how much out of pocket I’ll pay until insurance kicks in. Luckily Im in good health. But I get the feeling we are increasingly on our own. So in the words of Sargent Esterhaus, “Let’s be careful out there”

  21. petridish

    Hard to believe that this argument still has to be made.

    Charging for something that you never intend to provide–SELLING NOTHING–is the medical insurance business model, pure and simple.

    The medical insurance industry is the buggy whip industry of the 21st century only now we have a law that keeps it alive.

    An affordable, accessible, effective health care system is a BENEFIT of a robust economy and such a system should be expected to keep the population HEALTHY not maintained in an increasingly expensive, diseased state. Presumably a successful healthcare system would DECREASE its own cost with time as the population becomes healthier and needs fewer expensive services. Good luck with that.

    Look to the military industrial complex to see where this is going and STAY OUT–American “healthcare” could kill you!

  22. n

    I have coverage through the new PCIP. The deductible on emergency care is 5000. and after that it covers like 18%. Yes that really inspires me to see everyone else get screwed as long as I can keep it.

    1. Crazy Horse

      There is only one difference between being insured and being uninsured. Being insured means you have the right to hire a lawyer to sue on your behalf when the insurance company refuses to pay. Of course the lawyer will cost you twice as much as a first class airline ticket to Thailand, Colombia or Mexico, a week on the beach, and equal quality treatment in a private hospital in one of the many countries the World Health Organization ranks above the USA–.

      Insurance—not just of the medical kind— is simply an extortion racket. Ask the people in NY and New Jersey who have discovered that they have no coverage because hurricane Sandy miraculously became a flood event instead of a hurricane just before destroying their homes.

      Once you have accepted the fact that you have to leave the USA to find affordable quality health care, why not consider the next step? Emigrate to one of the same countries where the overall quality of life is simply better than in the Empire of Greed. And if nothing else, your conscience will rest better knowing that the biggest portion of your tax dollars no longer go to maintaining the Empire’s Imperial Military Machine.

  23. Doug Terpstra

    ACA is the penultimate “Death Panel Profiteers Bailout Act” — pure and simple protection racketeering by government gunpoint. It’s all about accelerating the looting under the Shock Doctrine formula, and like “fixing” Social Security, it could only have been inflicted by a nominal Democrat. The new Pied Piper of Wall Street is about to lead the spineless, clueless liberal lemmings over the cliff with hardly a whimper of protest. What a spectacle to behold.

  24. George Dawson, MD, DFAPA

    Many parallels between the regulation of the health care industry in favor of managed care companies and pharmacy benefit managers and against patients and the regulation of the financial services industry against investors.

    Maybe you could write your next book about it?

  25. Mark

    When health care can be had in Tiawan or other countries for 1/5 th of the US cost, why go bankrupt ? If you only like to see your doctor live like a king and you her serf, ignore medical treatment in other countries.
    It’s the medical community who perpetuates the lie that the US has the best care in the world.

  26. Bill

    “New York health insurance conversion plan people are,…”

    Can you post?

    I wish to report fraud with a doctor system and can’t find anyone to listen and take action.

  27. Caitlin

    We self-insure for a family of 4. This year, we received a letter from our provider that our insurance would increase by more than 40% (from $1,344 to $1,960/month). So, this will be the year where we switch to a high deductible plan with HSA and begin keeping some of our money.

    Most interesting to me, though, is the language our non-profit insurer used to explain the rate increase. First, they noted how costs are always rising due to the large number of people with unhealthy lifestyles and associated diseases. Then they noted the increased use of expensive medical technologies. Last, they noted that due to changes in state law (triggered by the ACA/Obamacare), they now do not have the opportunity to review and select patients for inclusion. Our state (Washington) used to have a high-risk health pool that people rejected by insurers used. Now everyone is being funneled into the overall program, and if my letter is accurate, we are all being unabashedly billed for it.

    Last but not least, they noted that these problems have led to them operating at a loss in 2011 and (projected) 2012. They believe the rate increases will help THEM get on a stable footing in 2013.

    I’m kind of grateful for their honesty, albeit appalled. To me, this letter pretty much narrates how they (and other insurers) are not ever going to be able to get out of the muck, now, and that they will be billing all of us for it — so that they can stay alive.

  28. Westcoastliberal

    Most of the healthcare problems in the US are due to insurance companies marking up everything 200-1000%. Want to see what procedures/surgery REALLY costs when paying cash(w/o insurance)? Check out the prices at the Surgery Center of Oklahoma:
    http://surgerycenterok.com/pricing.php
    Seems to me most of their total prices equal about the copay amount of most insurance plans!
    IMHO the only real hope we have is to demand a single-payer plan here in America. Everything else is just PR.

  29. Me

    I had a form of cancer that will come back. I know this, as does my wife. It is only when, we don’t know. I hope I have lots of time before I have to go back into treatment, but you never know. Before I got sick I was living in China, before that California. I had two jobs, worked my ass off, made decent money and paid a lot in taxes. Never got help from the government, but was glad that a small portion of my tax dollars went to help others.

    When I got sick I was told by doctors in China that I might not be able to have children after the treatment, I was told a week before treatment. So my wife and I tried to get pregnant. If I were to die I’d like to have a son or daughter to live on. I wanted kids, I was just going to wait. Well, she got pregnant and I have a two year old son.

    I would probably be dead if it weren’t for Medicaid. I was only covered because of my son, who is a miracle in many ways. Right now I am still on the program and I honestly can’t get off. If I make too much I can be thrown off but I also couldn’t afford my own care, forget my wife and kid. I am in school right now but also working. I am stuck, because of this insane health care system, working but having to work for less money than I would otherwise. I got hired about six months ago and had to talk with my wife about possibly ASKING for lower pay.

    Should I just die? Am I too much a burden? If I were to stay on a public plan, does it make sense to put me in a situation where I have to make less than I could possibly earn on the job market? I would have no problem, for example, staying on the public plan but having my paycheck garnished to pay for as much of my coverage as I could. That isn’t an option though.

    If I am thrown off Medicaid I will either die or someone that loves me will go broke saving me life. I can’t leave the country either, at least not until I can earn an advanced degree and could earn even more money. So I am at the mercy of the electorate, the out of touch and bought off parties.

    Some will read this and shrug, maybe say “sorry, but that’s life”. The situation is depressing enough, to think I’m nothing but a burden in the eyes of many makes it worse. Its also sad that the ACA doesn’t do much for people like myself.

    To hell with Obama, a disaster of a president and we don’t even have the horrible austerity coming our way yet.

  30. Ray Phenicie

    I’d switch insurance comapnies. Not all insurance companies are guilty of the above practices all of the time. Some of them are guilty of the stated practices some of the time.

  31. cripes

    I see several posts above complaining that patients would be more “responsible” if they were forced to pay out of pocket for routine medical services. You know, the tired old, “frivolous” patient visit scam.

    One, the US has the lowest doctor visit utilization rates in the industrialized world–about one visit per patient per year. So that’s not the problem.

    The problem is uninsured / underinsured people who lack regular medical care showing up at emergency rooms and hospitals (or morgues) with untreated chronic medical problems.

    The problem is a system that leaves millions unable to access essential care, even the “insured.”

    The problem is dummies who feed into right-wing tropes about reducing the shitty care we have because patients abuse “free” care.

    Morons who never had to spend days with a sick child in Bellevue’s emergency room (now closed indefinitely) praying a doctor will actually see and treat their uninsured child, or face bankruptcy, denial of life-saving care or battles with “insurance” companies when they are deathly ill to get the care they PAID for.

    The idea that we will “save” health care money by restricting care is a sick, evil fascist lie. The truth is that saving money means wresting a sick health care system from the looters that are extracting rent from everyone through criinal insurance, hospital overbilling and pharma monopoly gouging.

    If you want to trade actual medical care for a bag of vitamins and calvinist self-flagellation, go right ahead, but don’t foist that shit on the rest of us.

    1. ginnie nyc

      Amen, I say to you, my friend, AMEN. Too bad if a virus crosses the blood-brain barrier, or you’re hit over the head (TBI), or a cab zaps you. Staying away from the doctor and vitamins will not fix those scenarios, and I know whereof I speak.

  32. Ms G

    And as if none of this were bad enough, have we heard of the latest IRS “tweak” whereby, instead of being able to deduct medical expenses above 7.5% of gross adjusted income, the deductible amount will now start at “above 10%.” That’s a massive effective tax hike on all persons who pay out of their own pocket for a HI policy.

    Obama wasn’t out trumpeting this little detail this week, I noticed.

    Yves — I have the exact same stories about “we didn’t get the mail” — I concluded that my NY State insurer (one of an effective tri-opoly in the state) has a special team in the mail room that takes half the incoming mail everyday and chucks it into a shredder — it’s probably called the “Lost Claims Group” or something like that. Full story of my endless battles with my own NYS insurer (and the NYS Commissioner of Insurance, which is now part of “Department of Financial Services”) another day. It’s a good one, though, I promise. I too feel that in exchange for my monthly (overpriced) premiums the insurer should be delivering on its part of the bargain.

  33. Ep3

    ‘well why don’t the gubment stay out of your healthcare?’. Sorry yves, thats what I hear when u say u call the govt institution and they actually help you.

    Two things. First, you are in a quasi group plan. What about full blown employer plans?
    Which leads me to the second question. I think we are all being herded into individual plans as costs push employers to drop standard policies. And then looking at the ACA, which encourages these exchanges for individuals to shop for plans, and then it provides individual tax incentives. And finally we have already seen this conversion beginning with Medicare. Each person selects a plan for coverage beyond the basic, because basic Medicare sucks for coverage. So all that has to be done is cut Medicare out as the middle man between the insurers and the suckers, oops I mean customers.
    This makes me sick

  34. Fran

    I would imagine that changing 1/5 to 1/6 of the economy isn’t very easy. This is a start. It’s not the best…but it’s better than it was.

    Baby steps: just try and get more next time.

    Single payer; if financed per capita, is the most logical. But since when has logic ruled in the ruling capital of any empire???

    1. Brooklin Bridge

      Yea, once they get the cat-food thing going properly, they can re-visit the HC thingy and start really fu*king with us.

  35. cripes

    Yeah, the comments are always good, so let me add, to the wealth of detail and anecdotes before, this little nugget of the zeitgeist of the whole thing:

    Working in bi-partisan harmony, the duopoly parties (North American and European) will (are) orchestrate(ing) a mass gang-rape of the entire working population of the former first (western) world economies as never seen since at lest the Weimar (when he Germans took the brunt of capitalist despoilation). But it won’t be simple collapse, it will be a managed collapse of an aggressive totalitarian supranational hyper-technocratic corporate-state. It’s class genocide.

    Serving the interests of billionaires everywhere, regardless of color! Long live O’Bama!
    Tighten your seat belts.

  36. bhikshuni

    I wish NC readers & writers would also consider this issue in purely economic terms.

    The way I see it (having lived in the least developed countries nearly 20 years), Americans “loan” their risk to the insurers.

    Because of universal health care in developed countries, our American risk pool is a captive market; the insurers can’t easily expand market share into Europe, etc.

    I’m sure I am naive here, but the laws of supply and demand should be in the insureds’ favor. There is a limited (albeit growing) risk pool, and more insurers than insurees.

    Therefore, the insurers should be competing for our favor, to get our risk.

    Why don’t we start third party, member-owned co-op insurance companies, like credit unions and block out a market share?

    I know here in SoCal there are now pseudo insurance companies, meaning subscribing to a low-cost maintenance only service provider, with a emergency care, and little median coverage. Poor man’s health insurance, in other words.

    If you all think you have it bad, we graduate students are forced by universities to buy their insurance (Kaiser upped premiums 20% last year without improving service), with premiums paid with student loan debt!

    American money god is diabolical!

  37. RaisedbyWolves

    Good list, but there is a grander problem overall: a for-profit healthcare system is not just expensive, it’s immoral. It pits humanistic values against capitalistic ones. It forces the value of human life and health to be pitted against someone else’s profit – the person who profits has all the control. It’s immoral, period.

  38. Phil

    Last year I chose a high deductible HSA plan. Pretty much worked out OK all year because we didn’t have any major incidents and I learned how to cut down my regular Rx expenses by getting my physician to write generic and buy mail order from Costco. But then one kid took a spill last month and knocked out a tooth. In the course of an hour we were at the dentist, the orthodontist, and the ER. Fortunately the dental is covered under a traditional PPO plan. But because of the high deductible the ER bill, which will probably be at least $1,200 if experience is any guide, is all mine. Here’s the thing though: When the dentist suggested we go to the ER to have the boy checked for concussion I HESITATED. I’m sorry, any system that incentivizes people to avoid care is BULLSHIT. P.S. During open enrollment for next year I switched back to a PPO plan for healthcare. My family’s health is too important to risk on YOYO (Your On Your Own) economics. There’s only one way out of this mess, and it starts with single payer. But I agree with a lot of those here who say our current corrupt political system is unlikely to deliver it. As a result I will be encouraging my kids to seriously entertain making their futures in a more civilized country like Canada or the UK.

  39. Myshkin

    Judging the ACA as a failure is like judging democracy as a terrible governance system, it’s miserable but it’s the best we can come up with. We move on from there. I’m not an apologist for Obama, he’s in some ways occupying the ground of a centrist Republican of yore, hence we got the old Republican health plan that was the 1993 response to Hillary Clinton’s Health Alliances.

    Single payer was off the table early on and what we got may have been all that was possible, though perhaps Obama could have used the bully pulpit more effectively. Yet he was dealing with Democrats like Senate Finance Comittee Chair Max Baucus who would not allow testimony in initial hearings from single payer experts and advocates, he even had a couple arrested who stood up in protest during a hearing. He, like many Democrats and Republicans, is compromised by campaign funding from the industry.

    The reason why many progressives held their nose and supported the ACA when it finally emerged was the hope that it was a first step toward a universal system. Eventually politicians faced with balancing budgets will theoretically have to face reality and tinker with the system to improve it and make it more cost effective.

    Vermont is already on track for instituting its own single payer state system springboarding off the ACA.

    http://www.boston.com/news/local/vermont/2012/11/09/health-reform-track-with-election-results/YH53lsUrf4pBI2HBaJrjSK/story.html

    Once there are functioning examples at the state level of a more affordable, effective and easy to use universal system the shift towards a national plan will conceivably be politically possible.

    Once Americans see that government can positively effect their lives through general welfare programs, (“stuff, they want stuff” as Bill O’Reilly put it) interest in protecting programs and being involved in the poltical process will intensify. It’s one of the few reasons I can think of for voting for centrists like Obama when necessary while supporting third party candidates in local races where they have a chance of winning.

  40. Anthony

    It sucks so hard its not even funny. I don’t have healthcare. Don’t want it, don’t need it. Apparently I have to pay a fine for this freedom…what the hell?

  41. Nathanael

    The worthless Obamacare system will be irrelevant in a few years. Vermont will have single-payer in 2017. California has a strong movement (California OneCare) to establish single-paper on the same schedule, and it will likely succeed before 2017.

    We need such a movement to be more successful in New York.

    (And yes, I am not going to bother to try to rescue the people in Mississippi; if the better states have single-payer, people and businesses can and will move, and eventually the rest of the country will be forced to follow.)

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