If only the demonizing of the HCRP would stop and everyone would jump on the bandwagon to just make it BETTER!!!I hear so many points that are rigid, too many definitives. HCRP costs too much, can't/shouldn't have mandatory coverage, brokers will lose their jobs - become obsolete. When in reality, if EVERYONE would accept the fact we are presented with opportunity to finally fix or work towards fixing the broken healthcare system and take the position that as of this day the HCRP looks like this, so what can we do to make it better. Then tomorrow, do the same thing... just keep tweaking toward the creation of a good health care system. There is no one answer, just keep working toward better. We get too much of "How can I undermine the HCRP and make it fail, weaken it so its ineffective by withholding funds, win the political game, put out as much negative as possible to turn public opinion". We all stand to gain by a good, well-run healthcare system in this country with consideration for citizens, carriers, brokers and states. If funds are cut or its underfunded all the efforts, study, money and time will have been wasted because we'll end up with the same old phrase - "An inefficient government program" when it would be due to special interests undermining the entire project instead of trying to strengthen it and make it better with ideas and considerations from and for EVERYONE.
Without re-hashing the old debates...let's just assume for a second that the law is ruled unconstitutional for a moment...that the Congress cannot mandate that a citizen purchase coverage. What can be done then?
IF we were to have a National Health Care system- Single Payer would it be desirable to have all doctors work within a Single Payer system? I don't know if a move to a single payer system would be constitutional or not. I believe the government can and should indirectly impact the cost of healthcare by giving consumers tools to drive down the costs within the free market system...but a National Health Care system could work in theory (IF it were constitutional).
How could the Markets become more competitive?
Why not force the Insurance Carriers to offer 8 plan chassis that are identical to one another in plan design such as :
1. HMO- Similar to benefits of Kaiser $25 HMO in S. California (no deductible) Each carrier has its own network.
2. HMO - Similar plan- but with a $2000.00 deductible for Hospitalization- at lower cost
3- HMO Similar plan design to #1 but with a SMALLER network of doctors (no smaller than 50% of the size)- allowing the carriers to pay doctors within the plan less on its contracts.
and 5 PPO Network plans:
$30 Copay plan- $500 Ded for LAB/Xrays/Prescriptons with $3000.00 hospitalization/ in/patient surgeries deductible and a max out of pocket of $10,000 for the year. Basic 70/30 payout after deductible.
$50 Copay plan with $5000.00 ded for Hospitalizaton/ in/out patient surgeries and $10,000 max out of pocket for the year. 60/40 payout after deductible.
An HSA with $5000.00 Deductible max ded $5000 --no services other than free Annual Physical and OBGYN/Well baby ...til deductible and Max out o pocket are smet. All covered services 10% covered after deductible.
and 2 other plan designs...perhaps one with richer benefits and one with even higher deductibles...(and lower premiums to make insurance more affordable)
Next, a national campaign to encourage the insuring of oneself ...and education to cover the services one cannot afford to self insure.
Next a Electronic National Database of Doctors- Wiki Doctors perhaps, aided by the government, to help create a www.medicare.gov system of comparing services and premiums for basic services such as 3 levels of annual physicals...I like to call the:
1) Tap, Tap Cough,Cough -HOW u Doin' physical
2) Basic Diagnostic test physical
3) Give me the Works Physical
These 3 levels must be standardized ...and pricing published. IF a doctor wants to add more services, they must explain what they are...and publish those services costs too...(this data base may take time to establish, but the Medical codes exist or must be created).
Prescriptions and Medical Equiptment is another problem area...and perhaps some of you in the industry can shed light in how to regulate, lower costs without significantly harming innovation. Canada subsidizes the cost of meds...
I must agree that the best approach is for an individual to practice health conscious habits and to be responsible for his/her own preventive health measures. This approach should work with the majority of the population if they would choose to live responsibly. However, we still have a significant number of congenital birth anomolies which create huge healthcare burdens on families. Also, a normal part of the aging process seems to be that even the seemingly healthiest of persons can/will develop some disease, cancer or other health complication which results in a very expensive treatment plan. For these reasons, a simple solution is not available for our societal healthcare needs. Personally, I believe that everyone has the right to the best healthcare he/she can buy, but I do not agree that it is the role of our government to provide it. And herein lies the dilemma with the current administration plan.
Medical Underwriting has tightened up - Premiums have increased -- In-force plans are receiving increases -
Renewals are increasing - More liability for all. I have had to refer so much business to the State Pool.
Our work, as Brokers/Agents - Increasing, more paperwork, more liability and reimbursement decreasing.
It will be very challenging for many to continue with health insurance over the next 3 years - And, maybe even 2014.
And, the real problems of what is charged for services, not being dealt with - Just who will be paying....
I completely agree with Dave Weiss' comments on the health care problem. You have so many entities that are involved and responsible for resolving this issue, yet each party has their own agenda and no one is on the same page...not the insurance companies, medical profession, the lawyers, or the cosumers. Such indecisiveness will not lead to a practical and meaningful solution.
The problem with reform is simply put; every one wants to fight change. The inability to continue to make the same amount of profit as before has driven many insurers to fight reform. It is evident that every American need Health care period. However, the insurer and the US Congress can not see profit in taking care of every citizen. It is identical to the reasons why The VA works and Medicare don't.
The public blames the insurance companies, because they are the ones collecting the premium. Rate increases are viewed as an attempt by an evil corporation to get richer. There is a huge lack of understanding regarding why things cost as much as they do. Until that changes - and I don't think it will - the problem will be the same. The government will try to crack down on insurance companies as the "bad guys". Healthcare is expensive. If we aren't responsible for our own health, no one else will be.
My concern remains about disability benefits, wherein private companies are figuring ways to cut this benefit from Group benefits and Individuals not knowing the importance of this until it would be too late. The solution for health care would take years and managing cost would remain a concern for long.
Just seeing the dramatic rise in Individual premiums, I believe that the Exchanges in 2014 will drive people to it to reduce the monthly Health costs. Group Plans are the wave of the future.
One major hang-up in our "consumer driven" US model is the lack of cost/price information available to consumers seeking to educate themselves. Nobody knows (or can know) what the trip to the doctor or dentist might cost in advance, so how can you pick the conscientious care setting?
Health care providers use standardized diagnosis codes, procedure codes, treatment codes, even dental codes, but there's no way to compare what one clinic/hospital charges without advance knowledge of the corresponding codes' pricing. Same with Rx- you can't compare shelf rates or even contracted rates for meds. Yet we have industry standard rates for how long it should take to replace a car's A/C compressor, then you multiply 2.4 hours by that repair shop's hourly rate and bingo.
If there was mandatory price disclosure among health care providers, such "transparency" would truly allow health care consumers to create efficiencies in a free market setting.
Are there "con's" that outweigh the "pro's" of my point?
I wish there was an easy answer to the healthcare issues in the US. I was just reading in a forum the costs of plans for people who have to buy them as individuals and it really does seem like it would be better to save that cash and just put it towards any expenses that cropped up. It's prohibitively expensive to pay that money out "just in case".
The real solution to health care is not forced insurance. Since so many in our population cannot afford insurance or health care services, there must be underlying factors that health insurance cannot cure. There has been such an injustice in our country for so many years regarding the distribution of goods and services and the gap between the rich and the poor is widening. Prevention and intervention strategies are the cure for the burden of diseases and health care costs plaguing our nation.
Instead of using bandages to cover the real problems, how about solving the problems from the root - for a change? Health insurance is still too expensive, especially for the working poor. Think about our society on a whole, instead of our pockets. What the insurance companies make at the end of the day is more than enough to care for those who are less fortunate.
If we eat healthy, keep physically active on a regular basis, relax our minds, breathe clean air, get sufficient sleep and stop smoking our health status will increase, physician visits will subside and we will a lesser need for prescription drugs which lead to so many other side effects. These are not the only behavior changes that make for a better healthier life; however, these are major contributors to high morbidity and mortality ratios in our country. And don't forget a very important result - reduced health care costs. So why will we need to use insurance on a regular basis? Good question. We'll still visit our primary physicians for checkup, etc. and when necessary, visit emergency rooms, urgent care centers, surgery centers and the like.
What about the insurance companies? No worries, the health insurance industry will still make money especially with fewer claims and less administrative work - remember insurers don't give refunds when money is spent for services we don't use. But the optimum goal is to provide for more effective and efficient health care outcome - or at least I think that should be the first priority for insurers and their constituents and benefactors.
What should be the popular vote? That our community will feel better, walk stronger and live longer. I vote for effective prevention and intervention strategies that lead to better health outcomes and reduced health care costs. Forced insurance - I am not convinced.
I completely agree the only way we bring health care costs is to change behavior. I think "sin taxes" on high sugar high fat foods would be a good way to make people think about what they are eating. If you choose to smoke or drink alcohol we already have built in cost consequence for such behavior.
I agree, everyone should be healthy. But, I personally know executives in the healthcare industry...yes, that smoke 3 packs of cigarettes per day??? What is that about? I personally know scientists that smoke. So, education is not a basis of health.
Most average people are not aware that their house will have a "lein" on it by the hospital should they pop in to have heart surgery with no insurance. Seriously, I go to public events with people who are driving Mercedes who tell me to my face they can't afford insurance? Hello?
I don't even have a finance degree and I can figure it out.
A federal judge has just determined the forcing of every financially able person cannot be required to pay for health insurance by the federal government because it is not constitutionally correct. Our president has again made a blunder, but this time the United States Constitution will prevail.
As a person that lived in Canada for 20 years and is now living in Texas, I am both disappointed and shocked that the United States is switching to a form of "socialized" medicine. Considering the huge financial burden this puts on the country, the current financial strains and unemployment concerns this country is currently facing, this was neither the time nor place for another major entitlement program. I agree that the US needed some changes to the current system, but the Obama administration has gone too far in my opinion!
After nearly 50 years selling Health Insurance, I honestly feel that the Premiums & the Cost of care are tied together. With so many different interested parties, there is little chance that a true solution is not obtainable in the foreseeable future.Neither the medical industry, the lawyers, the American People or the Insurance industry will be able to arrive at a common ground, It doesn't matter if we have Government or Private Insurance.The range of individual expectations for care is completely out of control and thus a solution for Health-care in this environment is unavailable.
The bottom line is health insurers adjust rates based on how much premium is collected, vs. claims being paid out. The only way to reduce both sides of the equation is to micromanage the networks that people use for health services. We need to revert back to HMO style plans, where referrals are required to see anyone other than a Primary Care Physician. By using PPO style plans, you gain more flexibility, but it also brings in the possiblity for doctors overcharging for services, that may or may not even be needed. The healthcare providers themselves are a big reason why private health insurance is failing.
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If only the demonizing of the
If only the demonizing of the HCRP would stop and everyone would jump on the bandwagon to just make it BETTER!!!I hear so many points that are rigid, too many definitives. HCRP costs too much, can't/shouldn't have mandatory coverage, brokers will lose their jobs - become obsolete. When in reality, if EVERYONE would accept the fact we are presented with opportunity to finally fix or work towards fixing the broken healthcare system and take the position that as of this day the HCRP looks like this, so what can we do to make it better. Then tomorrow, do the same thing... just keep tweaking toward the creation of a good health care system. There is no one answer, just keep working toward better. We get too much of "How can I undermine the HCRP and make it fail, weaken it so its ineffective by withholding funds, win the political game, put out as much negative as possible to turn public opinion". We all stand to gain by a good, well-run healthcare system in this country with consideration for citizens, carriers, brokers and states. If funds are cut or its underfunded all the efforts, study, money and time will have been wasted because we'll end up with the same old phrase - "An inefficient government program" when it would be due to special interests undermining the entire project instead of trying to strengthen it and make it better with ideas and considerations from and for EVERYONE.
Without re-hashing the old
Without re-hashing the old debates...let's just assume for a second that the law is ruled unconstitutional for a moment...that the Congress cannot mandate that a citizen purchase coverage. What can be done then?
IF we were to have a National Health Care system- Single Payer would it be desirable to have all doctors work within a Single Payer system? I don't know if a move to a single payer system would be constitutional or not. I believe the government can and should indirectly impact the cost of healthcare by giving consumers tools to drive down the costs within the free market system...but a National Health Care system could work in theory (IF it were constitutional).
How could the Markets become more competitive?
Why not force the Insurance Carriers to offer 8 plan chassis that are identical to one another in plan design such as :
1. HMO- Similar to benefits of Kaiser $25 HMO in S. California (no deductible) Each carrier has its own network.
2. HMO - Similar plan- but with a $2000.00 deductible for Hospitalization- at lower cost
3- HMO Similar plan design to #1 but with a SMALLER network of doctors (no smaller than 50% of the size)- allowing the carriers to pay doctors within the plan less on its contracts.
and 5 PPO Network plans:
$30 Copay plan- $500 Ded for LAB/Xrays/Prescriptons with $3000.00 hospitalization/ in/patient surgeries deductible and a max out of pocket of $10,000 for the year. Basic 70/30 payout after deductible.
$50 Copay plan with $5000.00 ded for Hospitalizaton/ in/out patient surgeries and $10,000 max out of pocket for the year. 60/40 payout after deductible.
An HSA with $5000.00 Deductible max ded $5000 --no services other than free Annual Physical and OBGYN/Well baby ...til deductible and Max out o pocket are smet. All covered services 10% covered after deductible.
and 2 other plan designs...perhaps one with richer benefits and one with even higher deductibles...(and lower premiums to make insurance more affordable)
Next, a national campaign to encourage the insuring of oneself ...and education to cover the services one cannot afford to self insure.
Next a Electronic National Database of Doctors- Wiki Doctors perhaps, aided by the government, to help create a www.medicare.gov system of comparing services and premiums for basic services such as 3 levels of annual physicals...I like to call the:
1) Tap, Tap Cough,Cough -HOW u Doin' physical
2) Basic Diagnostic test physical
3) Give me the Works Physical
These 3 levels must be standardized ...and pricing published. IF a doctor wants to add more services, they must explain what they are...and publish those services costs too...(this data base may take time to establish, but the Medical codes exist or must be created).
Prescriptions and Medical Equiptment is another problem area...and perhaps some of you in the industry can shed light in how to regulate, lower costs without significantly harming innovation. Canada subsidizes the cost of meds...
I must agree that the best
I must agree that the best approach is for an individual to practice health conscious habits and to be responsible for his/her own preventive health measures. This approach should work with the majority of the population if they would choose to live responsibly. However, we still have a significant number of congenital birth anomolies which create huge healthcare burdens on families. Also, a normal part of the aging process seems to be that even the seemingly healthiest of persons can/will develop some disease, cancer or other health complication which results in a very expensive treatment plan. For these reasons, a simple solution is not available for our societal healthcare needs. Personally, I believe that everyone has the right to the best healthcare he/she can buy, but I do not agree that it is the role of our government to provide it. And herein lies the dilemma with the current administration plan.
Medical Underwriting has
Medical Underwriting has tightened up - Premiums have increased -- In-force plans are receiving increases -
Renewals are increasing - More liability for all. I have had to refer so much business to the State Pool.
Our work, as Brokers/Agents - Increasing, more paperwork, more liability and reimbursement decreasing.
It will be very challenging for many to continue with health insurance over the next 3 years - And, maybe even 2014.
And, the real problems of what is charged for services, not being dealt with - Just who will be paying....
I completely agree with Dave
I completely agree with Dave Weiss' comments on the health care problem. You have so many entities that are involved and responsible for resolving this issue, yet each party has their own agenda and no one is on the same page...not the insurance companies, medical profession, the lawyers, or the cosumers. Such indecisiveness will not lead to a practical and meaningful solution.
The problem with reform is
The problem with reform is simply put; every one wants to fight change. The inability to continue to make the same amount of profit as before has driven many insurers to fight reform. It is evident that every American need Health care period. However, the insurer and the US Congress can not see profit in taking care of every citizen. It is identical to the reasons why The VA works and Medicare don't.
The public blames the
The public blames the insurance companies, because they are the ones collecting the premium. Rate increases are viewed as an attempt by an evil corporation to get richer. There is a huge lack of understanding regarding why things cost as much as they do. Until that changes - and I don't think it will - the problem will be the same. The government will try to crack down on insurance companies as the "bad guys". Healthcare is expensive. If we aren't responsible for our own health, no one else will be.
My concern remains about
My concern remains about disability benefits, wherein private companies are figuring ways to cut this benefit from Group benefits and Individuals not knowing the importance of this until it would be too late. The solution for health care would take years and managing cost would remain a concern for long.
The bottom line is all the
The bottom line is all the congressman should have same retirement and health care system as anyone out, no separate plan, period.
Just seeing the dramatic rise
Just seeing the dramatic rise in Individual premiums, I believe that the Exchanges in 2014 will drive people to it to reduce the monthly Health costs. Group Plans are the wave of the future.
I am with you. The general
I am with you. The general public will flood to the subsidized plans and will be forced to separate from their agents.
One major hang-up in our
One major hang-up in our "consumer driven" US model is the lack of cost/price information available to consumers seeking to educate themselves. Nobody knows (or can know) what the trip to the doctor or dentist might cost in advance, so how can you pick the conscientious care setting?
Health care providers use standardized diagnosis codes, procedure codes, treatment codes, even dental codes, but there's no way to compare what one clinic/hospital charges without advance knowledge of the corresponding codes' pricing. Same with Rx- you can't compare shelf rates or even contracted rates for meds. Yet we have industry standard rates for how long it should take to replace a car's A/C compressor, then you multiply 2.4 hours by that repair shop's hourly rate and bingo.
If there was mandatory price disclosure among health care providers, such "transparency" would truly allow health care consumers to create efficiencies in a free market setting.
Are there "con's" that outweigh the "pro's" of my point?
Kevin Johnston
I wish there was an easy
I wish there was an easy answer to the healthcare issues in the US. I was just reading in a forum the costs of plans for people who have to buy them as individuals and it really does seem like it would be better to save that cash and just put it towards any expenses that cropped up. It's prohibitively expensive to pay that money out "just in case".
The real solution to health
The real solution to health care is not forced insurance. Since so many in our population cannot afford insurance or health care services, there must be underlying factors that health insurance cannot cure. There has been such an injustice in our country for so many years regarding the distribution of goods and services and the gap between the rich and the poor is widening. Prevention and intervention strategies are the cure for the burden of diseases and health care costs plaguing our nation.
Instead of using bandages to cover the real problems, how about solving the problems from the root - for a change? Health insurance is still too expensive, especially for the working poor. Think about our society on a whole, instead of our pockets. What the insurance companies make at the end of the day is more than enough to care for those who are less fortunate.
If we eat healthy, keep physically active on a regular basis, relax our minds, breathe clean air, get sufficient sleep and stop smoking our health status will increase, physician visits will subside and we will a lesser need for prescription drugs which lead to so many other side effects. These are not the only behavior changes that make for a better healthier life; however, these are major contributors to high morbidity and mortality ratios in our country. And don't forget a very important result - reduced health care costs. So why will we need to use insurance on a regular basis? Good question. We'll still visit our primary physicians for checkup, etc. and when necessary, visit emergency rooms, urgent care centers, surgery centers and the like.
What about the insurance companies? No worries, the health insurance industry will still make money especially with fewer claims and less administrative work - remember insurers don't give refunds when money is spent for services we don't use. But the optimum goal is to provide for more effective and efficient health care outcome - or at least I think that should be the first priority for insurers and their constituents and benefactors.
What should be the popular vote? That our community will feel better, walk stronger and live longer. I vote for effective prevention and intervention strategies that lead to better health outcomes and reduced health care costs. Forced insurance - I am not convinced.
I completely agree the only
I completely agree the only way we bring health care costs is to change behavior. I think "sin taxes" on high sugar high fat foods would be a good way to make people think about what they are eating. If you choose to smoke or drink alcohol we already have built in cost consequence for such behavior.
I agree, everyone should be
I agree, everyone should be healthy. But, I personally know executives in the healthcare industry...yes, that smoke 3 packs of cigarettes per day??? What is that about? I personally know scientists that smoke. So, education is not a basis of health.
Most average people are not aware that their house will have a "lein" on it by the hospital should they pop in to have heart surgery with no insurance. Seriously, I go to public events with people who are driving Mercedes who tell me to my face they can't afford insurance? Hello?
I don't even have a finance degree and I can figure it out.
A federal judge has just
A federal judge has just determined the forcing of every financially able person cannot be required to pay for health insurance by the federal government because it is not constitutionally correct. Our president has again made a blunder, but this time the United States Constitution will prevail.
As a person that lived in
As a person that lived in Canada for 20 years and is now living in Texas, I am both disappointed and shocked that the United States is switching to a form of "socialized" medicine. Considering the huge financial burden this puts on the country, the current financial strains and unemployment concerns this country is currently facing, this was neither the time nor place for another major entitlement program. I agree that the US needed some changes to the current system, but the Obama administration has gone too far in my opinion!
This activity is nice. I like
This activity is nice. I like the concept of a virtual Easter egg hunt. Well, this should get me in for the Activity #3 pot!
Checking in for Challenge #3.
Checking in for Challenge #3. Looking forward to exploring our blogging possibilities.
After nearly 50 years selling
After nearly 50 years selling Health Insurance, I honestly feel that the Premiums & the Cost of care are tied together. With so many different interested parties, there is little chance that a true solution is not obtainable in the foreseeable future.Neither the medical industry, the lawyers, the American People or the Insurance industry will be able to arrive at a common ground, It doesn't matter if we have Government or Private Insurance.The range of individual expectations for care is completely out of control and thus a solution for Health-care in this environment is unavailable.
The bottom line is health
The bottom line is health insurers adjust rates based on how much premium is collected, vs. claims being paid out. The only way to reduce both sides of the equation is to micromanage the networks that people use for health services. We need to revert back to HMO style plans, where referrals are required to see anyone other than a Primary Care Physician. By using PPO style plans, you gain more flexibility, but it also brings in the possiblity for doctors overcharging for services, that may or may not even be needed. The healthcare providers themselves are a big reason why private health insurance is failing.
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