<blockquote>I would be interested in knowing how you made your living prior to living off the dole - I'm not expecting a straight answer on this one, but thought I would ask.</blockquote>
So the Bad Cop is back again. Thank you, I've already volunteered enough personal information. That's as straight an answer as I think you deserve.
I will say, though, that it was almost as though my employer belonged to a Health Plan of the Month Club. A plan would come in offering attractive rates, but then after a while, WHAM! and they were hunting for another new plan. Things are the same now, only more so. Take the burden off employers with single-payer universal coverage.
<blockquote>...but if you make over 150% of poverty, pay out of pocket. </blockquote>
Is that an <i>order?</i> :-) Oh, sorry, rude of me. I see you've gone up from "not under the poverty line" to 150 percent over it. How generous.
<blockquote>I'm not confident about any numbers now after reading the link you posted.</i>
Good. Out, but not over.
You are one ornery old coot aren't you? It would be amusing if the country weren't basing policy upon such irrational logic and anecdotes that pass as trends. Between the fiscal conditions, the Republicans alleging death panels and Sebelius killing a non-partisan scientific study because some influential people complained, I'm beginning to believe that we're really in deep trouble. People can't have a reasonable discussion or disagreement without being slotted in the enemy camp.
I would be interested in knowing how you made your living prior to living off the dole - I'm not expecting a straight answer on this one, but thought I would ask.
Re the anger meds, it was a joke (though you do seem very angry) but if you make over 150% of poverty, pay out of pocket. If you make less, no problem with being on RxD.
Re being a net plus contributor currently, it does not absolve you (sorta reminds me of Vichy France). I believe a significant portion of Medicare spending occurs in the last 2 yrs of one's life (and I'm fairly certain 10% occurs in last 2 months) so when its all said and done under the current arrangement you will make out well even if your jackpot turns out to be a ominous benefit.
I'm not confident about any numbers now after reading the link you posted. I'm finding it hard to trust anyone's numbers without knowing what they are trying to accomplish. For example, in the press release, the information on profits includes the one-time WP sale we mentioned earlier which inflates profits, but hey why note this it would dilute message. The profits also include self-insured business as well as insured business and there is a big difference (70-85% MLRs on insured vs. 80-100% on the self-insured business depending on how a self-insured company computes the plan). The kff premium data is great as broad survey information but the details vary widely (the kff study states this clearly). Premium changes don't account for benefit changes. Since plans are segmented, it does not account for adverse selection impacts (since some plans for an employer are omitted). It does not account for the fact that more people are moving from group-based plans to individual coverage (which I would imagine has a higher administrative cost and churn based on what I've read). Your link references the Harvard study on uninsured mortality (which fits the agenda), but it does not mention the Kronick study (which does not). Both credible studies as far as I know.
I wasn't surprised that the health expenditure data from CMS actuarial data is not a complete view of spending since it includes a number of extrapolations including enrollment which is limited to a subset of plans in the market (I was actually surprised by this one after reading their methodology early this evening). Since health spending in their model is based on price x enrollment., an under- estimate of enrollment is not a great way of calculating health spending.
If I wanted to show that costs are driving premiums, I could focus on large self-insured employers who pay fixed fees to the insurers. If the model outlined in your link were accurate and premiums were growing faster than costs, then you would think that the large self-insured entities were making a profit off their employees since they are responsible for the premiums not the insurers. The premiums are directly correlated to the claims costs for self-insured. If you don't understand self-insured plans, look them up.
My simple point is that the information is one-sided, skewed to rally support around a particular goal ( I realize that other organizations are doing the same for the other side of the coin, I've seen this in action as well). Everyone seems to be determining their agenda, then finding or bending the facts to match their agenda. For people in the middle its very frustrating dealing with your types (on both sides of the argument). It would have been great to have seen a really open, transparent, objective process over the past year. No wonder the nation is so divided - each has its own set of facts.
Also, if you want to go after insurance companies, you'd be better off pointing to information like this rather than relying on faulty data extrapolations.
www.insurance.ca.gov/0400-news/0100-press-releases/2010/release032-10.cfm
Upset that your monthly Anthem Blue Cross Health Insurance Premium charges will increase by 39% in 2010 after 2009's 20% increase (in this time of "no inflation")?
Just remember that Private Health Care Payments = Government Health Care Payments + 20%.
That's all!
The "Maximum Benefit Allowance" for over 8000 procedures codes with private health care supplied by Anthem Blue Cross Blue Shield is the Medicare rate (ie: government single payer rate) plus 20%. That is Anthem’s “Maximum Benefit Allowance” even if your private health insurance premiums are double or triple what you would pay into a government option.
You pay so much up front as a policyholder of an investor owned health insurance company, while medical providers who actually do the work on you get paid so little out the back door. Why should Anthem pay any more than 20% higher than government reimbursements? Doctors cannot negotiate with large health insurance companies. They simply take what the health plan offers as reimbursement, or they leave the health plan.
Private health insurance companies only need to pay out a little bit more than government reimbursement rates to claim the high ground of the "socialized medicine" hot button "debate". But then private health insurance companies work tirelessly to avoid payment, deny treatments, create unending confusion and complexity, increase paperwork for policyholders and providers, etc etc etc.. The great thing about this setup is that private health insurance companies can always shout out how they pay doctors MORE than government health insurance, but they never say exactly HOW MUCH MORE, even if you are paying monthly premiums that are double or triple than what you’d end up paying to the government to buy into medicare… A very large protion of the huge pile of money Americans pay to the health insurance industry is skimmed off as profit for wall street investors, and high salaries / bonuses for executives.
Here it is, straight from the horse’s mouth.
(exact copy of text from my recent Anthem BCBS rejection of appeal letter requesting payment to a health care provider...
< <<<<<<<<<<<<
"Anthem's maximum benefit allowance (MBA) is based on a calculation. The calculation is determined
by multiplying a payment rate or unit value assigned for a particular service performed by a professional
(i.e., a physician) or hospital by a conversion factor. (Unit x Conversion Factor= MBA)
The Medicare "Physician Fee Schedule" establishes the payment policies and payment rates for over
8,000 procedures that are performed by physicians and by certain non-physician practitioners such as
nurse practitioners, physician assistants, and physical therapists. Payment rates or values are assigned for
a particular service, such as repair of a wound or lesion,drain/inject joint/bursa, reconstruct lower jaw
bone, etc. (Medicare: Relative Value Unit (RVU) x Conversion Factor = Medicare allowable)
To determine the payment rate for a particular service, Medicare applies a conversion factor expressed in
dollars. The same conversion factor applies to all services paid under the fee scheduled and is updated
annually.
Anthem applies its own conversion factor to determine the payment rate for a particular service.
Anthem's conversion factor is greater than Medicare's. As a result, Anthem's MBA is greater than
Medicare's allowance, and typically is between 1l5% and 120% of Medicare. The unit value used by Anthem is the same value determine by Medicare for its RVU.
Medicare's conversion factor : 37 .01
Anthem's conversion factor : 44.04 (@ 119% higher than Medicare)"
I really enjoyed exploring your site. good resource ... thanks for sharing the info, keep up the good work going....
Pages