NY Times Reports Insurers Told to Justify Rate Increases Over 10 Percent
Read the original article here http://www.nytimes.com/2011/05/20/us/politics/20health.html?_r=1&ref=health
This has been talked about for a while, and was part of the Obama Health care plan. While this is quite late, storys of plans attempting to increase small group premiums 20 percent or more are not uncommon.
Insurance companies remind me of government. They promise efficient and leaner health care because they control costs. For those of us in managed care plans, it seems they play the same game yearly; they financially chase us from one insurance plan to the next by raising our premiums, so we take the next best we can afford. This has been going on for years, and each year, we pay more for less, which I guess is the new insurance math.
In the article, insurers said the rule did nothing to address the underlying costs of health care, which they described as the main factor driving up premiums. The problem with that is many of the managed care reforms, paying doctors less, reimbursing primary care at levels requiring shorter visits so they can stay in business has resulted in doctors being more like referral agents, because, they cannot afford to take the time and help you with time consuming or complex problems. You find yourself going from doctor to doctor with hardly anyone caring enough to help you get the real answers you require. This costs big bucks. When insurers ask why, they should look into the mirror. One of my favorite examples of this is that your primary doctor would take ownership of when you were in the hospital and visit you when you are there. This has been replaced with the hospitalist. You know, the doctor you do not know who says high and you return home to the $300 per hello you are greeted to each morning. That used to be your personal doctor, the one you had the relationship with for about 1/3 of this. They stopped visiting when the insurers stopped paying them raising our cost for care.
A number of years ago surgi centers began to appear because they could supply surgical suites for doctors in a more cost effective atmosphere than hospitals could. These facilities proliferated as medical specialists invested in these facilities to offset the discounting of their services so they could afford to practice. Others did it just to make a buck because they saw these facilities being reimbursed hefty fees for merely hosting a procedure. It is not unusual for you to have a D and C for example, the doctor makes about $650, the anasthesiologist makes $400, the facility makes $2500 in network for the hour.
Why has nobody challenged this? Oh, thats right, the insurers through their clout and contracting were supposed to contain costs.
Other areas – Medicare is being drained by doctors who simply do not want to create guidelines for end of life care. They have us doing living wills, and all sorts of stuff to elderly people including procedures they could not possibly recover from. Recently, our patients mom who was sick passed away. Two years previously, at the age of $89, they suggested she could recover from a heart valve transplant. She spent two years in and out of hospitals and nursing homes until she passed on. Were is not for Medicare, I do not believe anyone would have entertained such an option. You and I paid for two years of this woman suffering and never going home. Soon, the bill for that care, not covered by medicare will likely reach her family and her estate. Was this really worth it? How many hundreds of thousands were spent, while the family was put through hope when it would have been more humane to just make her comfortable.
One would also question why out of network rates are sometimes 10x what in network visits are for the same service. Insurance companies will decrease these bills somewhat for out of network care but does such as disparity make sense, while in network doctors jump through hoops just to keep the doors open?
These are just a few examples of the waste in our system, some of which are purely the fault of managed care who promised cost effectiveness and now try to bill us for their short sightedness.
All of this comes to mind when again i have to hold my breath as I open my insurance quote for next year. That will happen this June. Hopefully, the new rules will put a dent in the games they play.