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Market reform health insurance now

Original post made by common sense now, Another Palo Alto neighborhood, on May 21, 2008

If you claim to care about market reforms of insurance, here is a quick, simple reform suggestion that would dramatically alter the situation and allow us to see whether health care insurance really can be subject to positive market forces. We could do it now, it wouldn't be nearly as tough as enacting single payer. If it worked, people would be a lot more willing to believe that marketplace forces could serve for good, and as more than just a cover for monopolistic practices and racketeering in the healthcare arena.

Here's some background:
Blue Cross Blue Shield settles class action filed by 900,000 physicians, May 2007
Web Link

Despite this huge settlement, Blue Shield of California keeps up the bad faith claims practices. Department of Insurance press release, December 2007 (by conservative Republican Insurance Commissioner):
Web Link

Why are insurance companies allowed free reign to determine the medical necessity of medical care anyway? Especially after the care has already been provided and all they are doing is hurting patients, doctors, and driving up the cost of health care with monstrous and unnecessary bureaucracy to the tune of $450 billion a year?

If insurance companies want the right to deny care prescribed by a licensed doctor, they should have to describe specifically in their insurance policies, up front, the things they do NOT cover, so that doctors and patients can choose. If a licensed doctor deems the care medically necessary and prescribes it, and it isn't explicitly excluded, it should be covered. Period. If insurance companies don't like paying for a specific kind of care, they could, once a year, amend their exclusions and add that care. Then at least policyholders would be able to more honestly compare plans, and sick people could count on their coverage (rather than counting on being harassed out of their coverage) when they need it. And doctors could practice medicine again. AND it would take the incentive out of this hugely wasteful bureaucratic machine that insurance companies have created specifically to cheat sick people.

Comments (5)

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Posted by common sense now
a resident of Another Palo Alto neighborhood
on May 22, 2008 at 9:52 am

Not a single comment. Wow, that speaks volumes for how tainted the idea of market-based reforms of our system have become - largely because of how (as I mentioned above) free market benefits have been sadly (or ignorantly) and improperly used as a cover for monopolistic practices and unfettered racketeering in healthcare.

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Posted by Carol Mullen
a resident of Old Palo Alto
on May 22, 2008 at 10:42 am

Diagnosis and treatment codes are hidden from patients. They don't match to disease or care. It's hard to have an informed opinion unless you're someone who's worked in the system.

What do you think of the proposal to have the National Academy of Science set a basic package (through its Institute of Medicine) and require all insurers to compete on extras and/or price?

The basic package is to be set by studying existing packages, and choosing the one that works best.

People not offered private insurance can opt in to the Congressional package.

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Posted by common sense now
a resident of Another Palo Alto neighborhood
on May 22, 2008 at 1:00 pm

The fundamental problem is not the insurance package, it's that insurance companies are allowed so much leeway to avoid honoring their contracts, and they do. It has become the bent of their business. It doesn't really matter what the package is if the insurer won't pay when the time comes. All this talk about different insurance packages is just more rearranging the deck chairs on the Titanic.

I have federal coverage, same as the Congress. Because of court cases in recent decades, there is less accountability than with all other private insurance, and you can guess the results (unless you happen to be in Congress, and believe me, the insurers know the difference). Insurers can't cancel your coverage, but federal workers can't sue them if they don't pay.

Again, if insurers had to fully disclose what they DON'T pay for up front, and had to just cover it if it wasn't specifically excluded and a licensed doctor prescribed and deemed it medically necessary, it would be easier to compare policies. And it would take the incentive out of the insurance industry's huge paperwork machine, which is primarily there to create windfall profits by delaying and denying care.

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Posted by Carol Mullen
a resident of Old Palo Alto
on May 22, 2008 at 4:22 pm

Well, of course, if the penalty for fraud isn't to lose the market and pay an enormous fine- ask Blackwater about that. Americans do seem to believe in long-distance, mechanical diagnosis and hands-off care.

Lawlessness won't cover that. Germany has basically a market system, multiple insurers, but a company can't participate if it's caught cheating.

The French system produces much better health statistics at lower cost, but it is true that there the government is afraid of the people, and here we are afraid of the government.

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Posted by whatever
a resident of Midtown
on May 23, 2008 at 10:56 am

No comments because you are so far off the page, and we have all been down this so many times, we quit.

Carol: please give statistics to support your claim. For example, odd, but our deaths from Cancer are 1/2 of France's deaths from cancer. Hmm..must be our horrible health care system.

And, I have no fear at all from my government. Not one, never. Hell, I can commit high treason now, giving classified secrets to the New York Times, and suffer no consequences.

In France, if you express an opinion that a court doesn't like, you can go to jail and/or get fined. Ask Brigitte Bardot.

However, both of you, believe what you want through your prism. At least here nobody will jail you or fine you for expressing an opinion.

While you are at it, read 1984, by Orwell.


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