THE HEALTH-INSURANCE industry’s version of health-care reform is: “You pay more. We profit more."

[DailyGrind51]

Vivian G. Weisman: Guarantee health reform, not higher profits

01:00 AM EST on Tuesday, December 23, 2008

Vivian G. Weisman

THE HEALTH-INSURANCE industry’s version of health-care reform is really “You pay more. We profit more.”

That’s why you won’t be surprised to learn that the claims by Karen Ignagni, chief lobbyist for America’s Health Insurance Plans (AHIP) (“Insurance firms want health reform now,” Dec. 16), that health insurers want to help hard-pressed American families and businesses are worth about as much as the paper they’re written on. I do not trust the health-insurance lobby to fix the health-care mess.

Just the other week President-elect Obama called on America to enact “affordable, accessible health care for every American in 2009.” The president-elect warned that past reform efforts have been “derailed by Washington politics and influence-peddling.” The insurance industry has done its best to derail reform in the past, and we need to make sure that AHIP does not derail reform this time.

Under AHIP’s plan, health-insurance companies can keep charging whatever they want, increasing their profits while sticking families, small businesses and taxpayers with high costs. You know how the fine print in an insurance policy comes with nasty surprises?

Well, check out the fine print in the AHIP plan, fine print like Health Savings Accounts with big deductibles and out-of-pocket expenses as high as $5,600 for individual coverage and $11,200 for family coverage. Under AHIP’s proposal, your insurance company gets to decide what benefits to provide and whether or not to approve the care your doctor says that you need.

AHIP’s plan still lets insurers charge you higher premiums for having a health condition, for getting older, or even for being a woman. They want the ability to sell insurance across state lines because it wipes out state consumer protections, such as the requirements we have in Rhode Island that insurance policies cover certain necessary procedures and mental-health services. Insurance companies hope to make like credit-card companies and set up shop in states with the loosest regulations.

With no controls on premiums, lousy coverage and sky-high deductibles, AHIP knows that people will still be in danger of medical bankruptcy. Their solution isn’t to give people good health coverage but rather to have the government bail out families who go bankrupt because they have lousy health coverage. We thought that the purpose of health-care reform was to provide access to health care and stop families from going bankrupt!

The insurance industry is enjoying increased profits today even as more and more people lose insurance. For example, according to a report released last year by the Northwest Federation of Community Organizations, between 2004 and 2007, United HealthCare of New England saw its profit increase 86.7 percent, from $13.4 million to $25.1 million – even as its membership decreased 30.5 percent.

Of course, there’s nothing in the industry’s plan that would limit their multimillion-dollar CEO salaries or require companies to spend the lion’s share of health-insurance premiums on providing health care instead of on administrative costs, huge salaries for top executives, and skyrocketing profits, which can leave the state.

Now we need to get Congress to join with President-elect Obama in standing up against the health-insurance industry and enact health-care reform in 2009 that puts the health of our families before the profits of the insurance industry. We need regulations that stop insurers from excluding pre-existing conditions, and from dropping people from coverage costs or greatly increasing their coverage when they do get sick. We need a public-health-care option for people to be able to buy into, in the event that they cannot get coverage from their employer or on the very expensive individual market.

We don’t need another industry bailout like that proposed by AHIP. To join with us in the effort to gain a guarantee of quality, affordable health care that serves the needs of Rhode Island families and businesses, go to www.healthcareforamericanow.org.

Vivian G. Weisman is executive director of the Mental Health Association of Rhode Island.

http://www.projo.com/opinion/contributors/content/CT_insure23_12-23-08_AGCM652_v17.3e31a13.html#

[WCGreen]

1. There can be no meaningful health care reform as long as private insurance

is in the mix. There financial goal is to collect as much money as they can and then pay out the least amount that they can get away with...

Why is this so hard for politicians of both parties to understand...

Oh wait, yea, the Insurance companies are huge contributors to political campaigns and those in office have great benefits.

[pansypoo53219]

2. no idea

why people can't understand insurance companies are a big part of the problem.

[Raster]

8. Insurance companies are THE problem.

There is NO place at the healthcare table for these parasites. None.

[tbyg52]

12. For-profit healthcare should be an oxymoron. nt

[DailyGrind51]

7. If we permit the health insurance companies a voice in reform,

they will wait for an opportunity to return to the status quo if and when a "friendly" Congress and Administration assumes power. Remove them permanently from the health-care delivery funding equation!

[Wapsie B]

3. A big obstacle to meaningful healthcare reform is with insurers and providers.

There's this need on both sides to bring in the same revenues as before. Neither one wants their slice of the pie reduced. I disagree with Ms. Weisman in that public health care should not be an option. Put everyone in the public system, but fully fund it. Of all the trillions lost by the defense department and no-strings bailout for the financial industry for god's sake there's got to be money around to fully fund the Medicare system. It's just a matter of priorities and reallocating funds. Take the health insurance burden off the backs of employers and give everyone public health insurance coverage.

[Mnemosyne]

4. Precisely. KnR. n/t

[demodonkey]

5. K & R The ONLY solution is single-payer with FULL health, dental, mental, & long-term care, FOR ALL.

Everybody in, nobody out, and NO PROFITS OFF OF SICKNESS AND SUFFERING!!

[99th_Monkey]

6. Ironic & sad how our "healers" have become Vampires on the neck of the Public ~nt~

[OneBlueSky]

9. I'm still waiting for an answer to this question . . .

What percentage of our healthcare dollar goes to non-healthcare-related items such as corporate profits, executive salaries and perks, marketing and advertising, etc.? . . .

I'd really like to know exactly how much the HMOs, insurance companies, and drug companies are skimming off the top of our healthcare system . . . since that's all money that, if actually spent on healthcare, would reduce our costs dramatically . . .

if someone's posted this info and I just missed it, I do apologize . . . please post it again . . . thanx . . .

[truedelphi]

11. I posted a figure, and someone corrected me b saying

24% and then someone corrected me later on to 30% so I woul dsay maybe between 24 and 30 % depending on what factors you are putting into the calculations.

I know that one of the major HMO's whose executive lives in MN - his salary is more than all 3100 employees of a Rhode Island Hospital that has been trying to obtain the right to receive an extra 10% reimbursement, for their services, from that HMO!

[OneBlueSky]

13. thanks . . . that sounds ridiculously high, and I wouldn't be surprised . . .

if it's even higher . . . a lot of it involves how creatively they can manage their books, which I'm sure they're experts at . . .

[Greyhound]

14. Impossible to put a hard figure on it because (surprise!) the insurance companies

have over a century of experience at hiding their costs and expenses. http://www.medicalnewstoday.com/articles/8800.php">This latest study fixes the waste at 24%, but if we we look at it from the perspective of health insurance and deniers profits, http://www.fortunesmallbusiness.com/magazines/fortune/fortune500/2007/industries/Health_Care_Insurance_Managed_Care/1.html">the numbers get much worse.

It is safe to say that the only thing standing between us and universal health care in the US are the insurance and denial industries (Oh, and their accompanying campaign contributions).

[truedelphi]

10. Karen Ignagni, chief lobbyist for America’s Health Insurance --

She is my least favorite American policican. though hnot elected to any office, she wields far more power than Sarah Palin would have had in a postion as VP.

I wish there was a law that every time she was on TV, Michael Moore was required by the broadcasters to be standing next to her. He really pummelled her when the two of them were on Oprah.

[Princess Turandot]

15. One of the biggest mistakes IMO in the insurance model payment system..

came with the great expansion of so-called managed care during the 1980's. Everyone pointed to systems like Kaiser Permanente in California as an example but if I recall correctly, Kaiser did everything: provided outpatient services with docs they employed and owned many of the hospitals they used, which gave them accountability for the care as well as the premiums.

When HMOs began to greatly expand nationally in the 1990's but now as health insurers/gate-keepers alone, they were being paid premiums to not provide healthcare to people. Many of the most obscene profits for insurance companies came from that and it even included non-profit insurers established to provide coverage for the working class/ municipal employees etc. Working in hospital finance in NYC, I recall one HMO which declined 65% of its insured visits to emergency rooms as 'non-emergent'. It was the perfect scam since patients could not be billed under this contract, so they had no reason to complain to their employer about their experience, since it could not impact them personally. The NYS health department finally issued rules on what a prudent person would view as an emergency, so some of this crap stopped. Another, set up to serve medicaid (poor people) hmo services failed to adequately explain to patients that they had to use one specific hospital for all services, including in emergencies, even ones that resulted in hospitalizations. The patients kept coming back to the place within blocks of where they lived, not understanding that they could no longer do that. (At the place where I worked, we saw the patients first then fought with the HMOs for some reimbursement.)

My favorite story however was the non-profit hmo which demanded a 20% reduction in fees that they had paid us for years. At the same time, they increased their own premiums to us for the few of our employees that used them instead of our main insurer by 12%.

In NYS, for several decades, ending in the mid 90's, the state set hospital rates on a very detailed calculation which in effect had Medicaid and Blue Cross pay the lowest rates and the other commercial companies would pay about 10% than the low rate Blue Cross was afforded, largely because BC would insure all comers. (Medicare did its own thing most of the time.) Rates went up 2 to 4% a year. No insurance companies pulled out of the state and not so many companies were carrying on about health costs.


Then came the HMOs. Just making some number up as an example, if someone is paying $100 a year in premiums, it's one thing to have 10% or whatever the number is, going to insurance company costs and 90% to the providers. But when you switch that $100 to $10 for company costs, $20 to 'manage care' and 70% to the healthcare providers, you pulled a large amount of money out of the actual health delivery system, forcing it to look for ways to get higher reimbursements or cut costs just to get even with where they were before. It also reduced the quality of care since the only way to substantially reduce a hospital's costs is to reduce employees since payroll is the highest cost. It was a bad deal all around.