BlueCross BlueShield withdraws from Medicaid managed care program

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New York should not allow these insurance programs to get away with it. Money should never be an issue for providing health care, particularly to the most poor and vulnerable among us. If these insurance companies must operate at a loss, so be it. Operating at a loss is no excuse.
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This makes no sense. A company cannot operate at a loss indefinitely.
 
freeRadical said:
This makes no sense. A company cannot operate at a loss indefinitely.
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But, but, but…((sputters))

We’re told that it is irrelevant. We’re told that it is greed that is the root of all evil in the medical system. We’re told that money shouldn’t matter.

So if money shouldn’t matter, then shouldn’t a company be required to run at a loss by the government? If the company’s checks bounce, should not the bank be required to honor those checks? Shouldn’t the company’s vendors be required to provide supplies for free? Shouldn’t the employees all work for free?

C’mon man, where’s your heart?

;)😃
 
markomalley said:
So if money shouldn’t matter, then shouldn’t a company be required to run at a loss by the government? If the company’s checks bounce, should not the bank be required to honor those checks? Shouldn’t the company’s vendors be required to provide supplies for free? Shouldn’t the employees all work for free?
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To be fair, accoounting tends to get a little tricky with insurance. The state regulators determine how much in reserves the firm needs to have in order to pay off its claims. So an increase in revenues doesn’t automatically make available money to be paid in form of dividends for their investors, for example. When we say government should lay off insurance companies, we generally don’t want to interfere with the roles the state regulators play.
 
The system went off the rails when it stopped being insurance and started being Daddy.

Insurance, by definition, is supposed to be a hedge against catastrophic losses, not an everyday budgeting mechanism. The current “health insurance” system is roughly akin to people expecting their “auto insurance” to pay every time the car needs gas, an oil change, tires, muffler, etc. And then people wonder why it suddenly got so darn expensive.

There are really only two long term viable solutions, IMO.
  1. Establish a ‘two tier’ national health system in which preventive care and triage care is funded by taxpayer money with modest copays to discourage frivolous use. Anything more advanced still requires insurance (or cash) to pay for it.
  2. Restore health insurance to being INSURANCE on the catastrophic events only. Encourage, perhaps require people to setup medical savings accounts through employers that can only be used for qualifying health expenses.
In both cases, to help restore pricing sanity, the feds should establish rules that health care providers may establish their own rates, but must charge the same rates to EVERYBODY. No discounts to insurers or government programs. Write-offs to individual indigent patients requires paperwork. This one rule would go a LONG way to restoring the ability to comprehend costs to the medical world.
 
As has been noted, health insurance doesn’t actually provide health care, it just complicates it.

I came across this short video of a physician who’s practice succeeds by not taking any insurance whatsoever. It is the video at the beginning of the “Authentic Medicine Gazette” found here:

authenticmedicine.com/authentic-medicine-gazette/
 
ProVobis said:
You do have a point here. The whole morality factor should be examined when you have insurance companies, employers, etc deciding whom to accept or decline for needed healthcare treatment. A case could also be made that these are the entities that made healthcare so expensive in the first place.
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One visit to the upper management dining room in a major hospital complex would likely disabuse one of this belief.
 
manualman said:
The system went off the rails when it stopped being insurance and started being Daddy.

Insurance, by definition, is supposed to be a hedge against catastrophic losses, not an everyday budgeting mechanism. The current “health insurance” system is roughly akin to people expecting their “auto insurance” to pay every time the car needs gas, an oil change, tires, muffler, etc. And then people wonder why it suddenly got so darn expensive.

There are really only two long term viable solutions, IMO.
  1. Establish a ‘two tier’ national health system in which preventive care and triage care is funded by taxpayer money with modest copays to discourage frivolous use. Anything more advanced still requires insurance (or cash) to pay for it.
  2. Restore health insurance to being INSURANCE on the catastrophic events only. Encourage, perhaps require people to setup medical savings accounts through employers that can only be used for qualifying health expenses.
In both cases, to help restore pricing sanity, the feds should establish rules that health care providers may establish their own rates, but must charge the same rates to EVERYBODY. No discounts to insurers or government programs. Write-offs to individual indigent patients requires paperwork. This one rule would go a LONG way to restoring the ability to comprehend costs to the medical world.
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I’ll quibble with you No. 1 in an otherwise excellent post. There was a recent study in which it was concluded that “preventive care” does not alter outcomes. It’s doubly a shame because at present “well care” is paid a premium while the reimbursements are being reduced for “chronic care”. A fair amount of patient dumping is going on because of that.
 
I would think that Medicare and Medicaid fraud has more to do with their decision to scrap their involvement than anything the ACA requires of them.
 
One simple rule change would totally transform the system. Disallow third party billing. It seems like a totally unrealistic concept in today’s world, but it would be transformational overnight.

Let me give an example. I got a test recently. I couldn’t get anyone to give me a price. Even my "medical co-op wouldn’t give me a price. They said their contract was with the service provider. I asked who was writing their check each month!

Well, after 2 hours on the phone, I was finally exasperated and gave up. I had received prices from $1500 to $8800 for the same test.

Later I remembered I had been given the number to the practice where the test was done, so I finally called them. I am a cash patient as the co-op isn’t insurance and I’ve learned to ask for the cash price. I was floored when they said $375 complete. I triple checked, complete, like no other facility fee, dr fee, etc. yes, $375 complete.

Went in, had the test done and paid up front.

Wow, talking about a broken system. I’m not alone. I’ve discussed the same situation with others and they had a similar experience without the positive ending of my situation. Even if I had billed through the co-op I would have paid more because my annual deductible had not been met…

We need to re-connect the payer and provider. This doesn’t mean I am suggesting doing away with insurance, only that those who receive the service must pay and bill their insurance company. The practice could still wait until the insurance paid the client. That way the customer would know what insurance paid and be able to negotiate the same price for themselves.

Sorry about the long post.
 
Restoring the connection between the payer and the provider is the only way to fix the system.
 
Cricket2 said:
You are right, money should never be an issue for caring for the sick.

Blue Cross and Blue Shield, at least where I live, are among the most expensive companies out there, and the worst for what they will and will not cover. And no one needs to tell me about their losses. They don’t operate on any real loss. Never have. It is just in how you manipulate the numbers and who they want to make rich.

The only people I feel sorry for are the sick and poor, who seem to be “bottom of the barrel” concerns for companies like this one. As far as I am concerned we should get rid of all insurance companies. They have been ripping the people off for years. And I don’t just mean medical insurance. I mean car, house, all of it. It is the biggest rip off going in this country.

There are other ways to insure people’s cars and homes. Private insurance companies are not it, because all they care about is their bottom line. And no I am not a Socialist. There are just some things that need to be provided for all people, and at reasonable prices. Insurance and health care are among those things.
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You are if you advocate for the elimination of the private market and government control of things.
 
zz912 said:
Socialism is contrary to the Christian faith.
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The church of course has never taught that government run health insurance is immoral. One may argue whether or not it is prudent, but a Canadian style or British style healthcare system is not inherently immoral. It might be foolish and imprudent, but the Church does not teach on that issue.
 
JimG said:
This family practice physician does not take any insurance. He does not deal with insurance. The patients in his practice pay a flat monthly fee for unlimited service. And it’s not just for rich patients. This is going to be a growing trend.

youtube.com/watch?v=bGZaRnC1wNg
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Another trend is the “pay what you can” offices, especially among chiropractors. They don’t take insurance and they are able to provide better service.

My experience is that it ends up costing less to frequent these types of docs. I use a chiro who doesn’t take insurance, my son has insurance through work and uses a chiro that takes his insurance. I get more visits for less out of pocket cost than he does. Same level of service.
 
stinkcat_14 said:
The church of course has never taught that government run health insurance is immoral. One may argue whether or not it is prudent, but a Canadian style or British style healthcare system is not inherently immoral. It might be foolish and imprudent, but the Church does not teach on that issue.
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No, but Britain is currently considering a legalizing euthanasia in large part due to rising costs. Knowing our system is already insolvent before most of the Obamacare costs have kicked in, I think it sends us down a path to immoral behavior.
 
Dawnia said:
Another trend is the “pay what you can” offices, especially among chiropractors. They don’t take insurance and they are able to provide better service.

My experience is that it ends up costing less to frequent these types of docs. I use a chiro who doesn’t take insurance, my son has insurance through work and uses a chiro that takes his insurance. I get more visits for less out of pocket cost than he does. Same level of service.
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Yup. I recently had a test done. I belong to a medical co op and so tell the physicians I don’t have insurance - which is true, the co op states clearly it is not insurance. Insurance cost for the test $1400. My cash price-$375. Insurance is not the panacea it is made out to be.

For office visits I usually pay about $50. My company’s insurance co pay is now $40…
 
ChurchSoldier said:
Um, Obamacare is designed to do this. The objective is not to have insurance but a single payer system; that being the government. The next stage of the game he will begin blaming the insurance companies and point out how they are really the one’s “hurting the little guy”, then come up with draconian and fiscally unsustainable laws to get them out of the medical insurance business.
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Oddly enough, making a “single payer” program would have used much less paper; actually, it would have been just one sheet of paper compared to the tome that is Obamacare (most of which, btw, is amendments to previous laws).

Seriously - we already have"single payer" programs for the elderly (Medicare) and for the poor (Medicaid) and a government health care program for veterans (the VA). Honestly, all Congress would have had to do with regard to a single payer program for all would have been to modify the Medicare act to (1) increase Medicare taxes and (2) eliminate the age limit for Medicare. It would have been a one-page document. And it could have been done in any of the various Medicare reauthorizations.

People forget that insurance companies actually backed Obamacare the way it was written. Why? The individual and corporate mandates (which are the parts of Obamacare most disliked by private citizens). And the USCCB supported the House version of Obamacare (which blocked funding for abortions through Obamacare).

I honestly don’t know what the solution is to reducing health care costs so that ordinary people can have affordable access to health care. I don’t think Obamacare, as written, is the answer, nor do I think repealing it is the answer. And I don’t want the government nor an insurance company saying that because a needed treatment is absurdly expensive, they would rather pay for my being euthanized (which is what is happening in Oregon). And I think it’s a complicated problem, due to the outlandish costs of med school, the high rates of liability insurance for doctors, exhorbitant pricing of insurance, and so on.
 
powerofk said:
Seriously - we already have"single payer" programs for the elderly (Medicare) and for the poor (Medicaid) and a government health care program for veterans (the VA). Honestly, all Congress would have had to do with regard to a single payer program for all would have been to modify the Medicare act to (1) increase Medicare taxes and (2) eliminate the age limit for Medicare. It would have been a one-page document. And it could have been done in any of the various Medicare reauthorizations.
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And this is what scares me about a single payer.

Have you ever been on one of these government run healthcare programs? I have, and I have run into everything, from the government refusing to pay bills, miscommunications between entities, causing me to wait all day for dearly needed antibiotics, intrusive (and non medical) questions and suggested tests, and doctors over diagnosing, because why not, the government is paying for it (better to bill for two visits, since the reimbursement rates are so low).
 
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