About that "They have to spend 85% of the premiums on care" talking point

[JVS]

Ok, fine. You're an insurance company, and one of your favorite methods of generating big profits has been eliminated. You can no longer profit from denying care to cut expenditures. But fear not. If the premiums get larger, you get to keep 15% of a bigger pot of money. So now not only do you not have incentive to deny care, which is good, but you no longer have incentive to struggle with the hospitals to keep costs lower. So you negotiate the price in a soft manner, then are forced to raise premiums, thus getting a bigger sum to take 15% of. And the saps who have to pay the insurance premiums? They're mandated to buy from you!

[sandnsea]

1. But as the subsidies go up

The taxes will go up and then the people with the money will start to squawk. And so will the business owners, etc. They will not be able to get away with it.

I wish people would ask themselves what they gain from nitpicking this bill apart.

There's plenty of things we could work together to improve. I don't know why we don't just focus on the things that are essential and leave the rest to worry about when HHS develops the regulations.

[robinlynne]

2. As the subisidies go up they will be eliminated. The public office will have failed.

the public option is only possible with a huge pool of members for that reason. If limited, according to the an who created the idea of the public option, it will not work. In addition there are no price caps. The public,option is going to cost what "the market" costs.

[sandnsea]

5. And that's when we get single payer n/t

[Name removed]

6. Deleted message

Message removed by moderator. Click here to review the message board rules.

[sandnsea]

7. Not exactly

It's more like thinking you might have to pay a hooker until you figure out how to cooperate and get a better deal.

We all know how much Republicans love hookers. So there you have it.

I don't see any way to get from point a to point b without a few years of dealing with the seedy insurance companies.

[Autumn]

35. Perfect

:spray: :spray: :spray: :rofl: :rofl: :rofl: :rofl: I am recommending this thread just because of your most excellent post.

[robinlynne]

8. nope. that's what kills the possibility of getting single-payer.

[sandnsea]

9. When people have health coverage

They won't give it up. When it becomes clear the only way for everyone to have health care is with a not for profit single payer system, people will accept it. That's the only way this country does anything, with a whack upside the head.

[robinlynne]

10. Then it would be happening now.

[JVS]

11. We currently lack an apparatus for transforming public will into reality.

[sandnsea]

14. We transformed public option will into reality

That's what the people wanted, the government to guarantee health care to everyone. That doesn't mean they wanted single payer.

They will, eventually. But not yet. We're going to have to go through this hoop first.

[Selatius]

19. The people wanted a strong Public Option. They got half that.

They did it by requiring a mandate and then matting on a small Public Option only open to people who are with employers who don't already have private health insurance. Everybody else who is with an employer who does have private insurance is barred. Personally, the prohibition to jump from a private plan to the Public Option really is disappointing.

Perhaps in another decade or two a reform will be instituted allowing people with private plans to dump them in favor of enrolling in an expanded Public Option, but the future is so hard to predict.

[sandnsea]

21. What person would pay their own public option

instead of letting their employer pay their insurance premium.

[Selatius]

30. Somebody who wanted a robust public option to keep down health care costs.

Otherwise, premiums would continue to rise, and employers would be more and more tempted to shift the costs of the group rates onto employees, like is already happening in a lot of workplaces.

[sandnsea]

31. lol, seriously?

You think someone would pay $500 a month for a public option instead of $100 a month for their employer based care? Just give up $400 a month that they need for food. Right. That's exactly what people will do.

The reason they are making people with employer based coverage keep it is so employers aren't scrambling trying to keep their premiums low if half their employees run off in 50 different directions. It's not feasible and it will actually drive premium prices up.

After 3-5 years, whatever the legislation calls for, businesses will be able to access the exchange too and that will have the same affect.

This is a good bill. People are not reading it.

[robinlynne]

43. Who says the public option will cost less than private insurance? they forgot to put

anything in the bill to keep the price down. As a matter of fact, the public option will be at "market rates".

[sandnsea]

13. All people don't have health coverage now

The people who can afford it aren't the ones who are going to want single payer. The uninsured, who can't afford health coverage, are going to. But they won't know that until they spend an amount of time with the assurance of health care. When you have it, you won't want to do without it. We've got to get everybody with health care so they will do whatever it takes to keep it, including single payer.

[Oregone]

4. "I wish people would ask themselves what they gain from nitpicking this bill apart"

Uh, you realize this is going to become a law, right? Its not a Dan Brown novel we are talking about here

[ThomCat]

36. You're talking to a dedicated PR rep for the insurance industry apparently.

:shrug:

[aquart]

15. They've been able to get away with it just fine so far.

[sandnsea]

23. That's why we're reining them in?

Taking away their anti-trust exemption, taking away pre-existing conditions and recission, regulating how much they have to pay out, forcing them to provide defined benefits. And if they don't shape up, people will be ready to go further the next time.

What single payer people have to face is that the profit isn't only in the insurance companies. From pharmaceuticals to home health corporations to oxygen companies to MRI manufacturers - there's profit at every level. Health care is expensive.

[DireStrike]

27. "If they don't shape up, people will be ready to go further the next time"

If this plan winds up costing Americans more, the Democrats will be crushed at the polls. Health insurance reform will be branded as an awful idea. The insurance companies will be bailed out by the next administration with even more power than they have right now.

[DireStrike]

26. The subsidies WILL NOT GO UP

Not enough. Not ever.

What entitlement program now pays out as much as, or more than it did when it began, when adjusted for inflation?

It is ALWAYS easy to fail to increase entitlements. There are so many opportunities and most of them are politically invisible.

[sandnsea]

32. And then people will be forced to cancel policies

we'll start to slide backward, and then they'll realize they have to do something different. Either insurance companies will make less profit to stay in business - or we'll get single payer.

[DireStrike]

38. How are people gonna cancel their policy when it's mandated by law?

They are going to move to the cheaper insurance companies? Rofl. No such thing. In theory we should be doing that now. By your logic, prices should already be at about the lowest possible level. Good old rational self-interest and all that. Invisible hand of the market, rah rah.

It won't happen. And if it did, the only investment a corporation of that size is willing to make is into lawyers. It is cheaper, faster, and easier to find a way around the law than to actually follow it and provide services. Why run a business when you can get away with a racket?

Maybe we will have sham insurance companies start up that charge a nominal fee and cover almost nothing, just as a method to dodge the mandate. But then the insurance company would fight to outlaw these and they would win. Because they are in charge.

[sandnsea]

39. That's the entire point

It has to be made to work some way or other, because people will be mandated by law. They'll like having health care and they'll want it to be affordable and they won't want to be fined. It'll have to be made to work.

[DireStrike]

41. Or, everyone on the bottom will get screwed as much as possible.

Who is more likely to be forced to comply with the law, the enormous corporations or the powerless people? And why on earth would they blame the insurance companies, who fought this regulation tooth and nail? They will know where to place the blame. The media will certainly help.

[robinlynne]

3. You know you have made an interesting point. This is the halliburton/kbr

method of payment which leads to stealing money directly from the government. If this were to work they would needs scores of professionals to check for price gouging for every service, every patient....

[truedelphi]

12. As someone who was told by an HMO that tumors inside their body could

be destroyed by a bath of hot water, I am not at all sure that it matters if we all get insurance coverage. We need more protections than just insurance coverage.

We need to have a way to appeal the treatments that are prescribed. A way to make sure that proprer treatment is not delayed. that proper treatment is done by adequately trained personnel in a timely manner.

Americans get inadequate procedures recommended, they get stalled (Well, while they stall us,we get sicker and die.)

And remedies that are truly affordable are kept illegal (in the case of marijuana which has been known to shrink certain tumors.) If an herb that grows easily, is readily available and thus cheap, helps with major health problems, no Big Pharma company out there will have it run through the FDA required tests.

The FDA does not allow for the prescription of any herb unless it has been tested. My tincture of Black Walnut has helped a friend with her fibromyalgia - but despite the effectiveness of this, the drug companies would see to it that such a simple inexpensive remedy is kept off market. Lyrica, the Big Pharma answer to neuropathy, is one of the most expensive drugs out there - and is now the drug of choice among doctors for msot fibromyalgia patients. But it doesn't help you get better - it just puts a lid on the pain.

[Name removed]

16. Deleted message

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[quaker bill]

17. So

at the current 70 percent, this incentive is smaller? How does that work?

Perhaps if we just guarantee them a fixed kings ransom regardless of the number of people they insure or amount of care they pay for, the incentive to manipulate the market will disappear....?

[robinlynne]

33. There was a better suggestion. Services would be priced at medicare cost plus

15% or 55. not sure. Rates would be tied to medicare rates. That was not put into the bill. Instead the "public option" ratesw will be determined by "market rates".

[KG]

18. as long as insurance cos are left with a hand in the cookie jar, they will find a way to screw

us. what's so hard to understand about that? :eyes:

[TheWebHead]

20. hospitals had negative margins in 2008

in many areas, nationally at 0.37% in Q3 2008.. Operating margins right now, about at the norm, are 3-4%. They get some other income from investment income and donations. Hospitals and health insurers have some of the lowest profit margins in business. Wellpoint's pre-tax margins in 2008 were 5.5%, while Dreamworks Animation in 2008 were 26% for example. I know first hand they're tough w/ hospitals and care providers because my doctor required some out of pocket fees to see them because they thought the reimbursement rate wasn't acceptable... 18 months later they worked out an agreement.

[Kansas Wyatt]

24. But how much of that is due to....

Them jacking up the rates 2 to 3 times on people without insurance and know they cannot pay?

By doing that, you are able to shave off any profit on the books and make it look like you are losing money.

[rucky]

22. I knew a greater mind than I would figure out how they'll game this. n/t

[Romulox]

25. And the more unaffordable you make it, the more public susidy dollars you get!

Which means this thing is guaranteed to cost us more up front as consumers and as taxpayers.

Which I have no problem with, if we simply eliminate the profit-driven middle man. As it stands, it's just another guaranteed monopoly feeding at the public trough--like defense contractors, e.g.

[earthboundmisfit]

28. Another guaranteed monopoly

feeding at the public trough - and taxpayers get to subsidize the shareholders' dividends! What a deal!

[truedelphi]

29. Like you say, many of us wouldhave no problem with spending the dough on this plan

If first we cut out the over paid middle man.

[bvar22]

34. !

All your money is belong to us!
Thank You Democratic Party.
The Republicans could have NEVER gotten away with this!

[quiet.american]

37. Okay, you knew it was coming :) .... except:

There is also a price-gouging clause that requires insurance companies to... well, you can read it for yourself:

Sec. 104. Sunshine on price gouging by health insurance issuers. Establishes an annual review process for increases in health insurance premiums by the Secretary of HHS in conjunction with the States that requires insurers to submit a justification for any premium increase prior to implementation. Effective for plan years beginning January 1,2010.

Add to that affordability credits, caps on premiums and out-of-pocket costs for individuals and families and then you'd have a proper rant.

[ipaint]

40. One rather large problem.

http://www.opensecrets.org/revolving/top.php?display=G


Former employees of federal agencies can often find good (and lucrative) jobs as lobbyists, capitalizing on the connections that they forged while in public service. An Environmental Protection Agency administrator may go on to lobby his former colleagues on environmental issues, and a White House staffer can tap her West Wing connections when she starts a new job on K Street. The White House is traditionally the executive branch's largest supplier of fresh lobbyists; the office of the president employs a large team of staffers of varying seniority. But public servants switching to careers as lobbyists (and back again) come from agencies as varied as the Department of Defense, NASA and the Smithsonian Institution. Agency employees strolling through the revolving door include those as powerful—and well connected—as secretaries of state and as far from Washington as Peace Corps volunteers. The agencies shown here have employed the greatest number of former lobbyists—or sent the greatest number of former employees to lobbying firms and interest groups.

--------------------

Health and Human Services

http://www.opensecrets.org/revolving/search_result.php?agency=Dept+of+Health+%26+Human+Services&id=EAHHS

[optimator]

42. all by design

or the framework would have been subsidies directly to doctors which would actually lower costs.