BlueCross BlueShield withdraws from Medicaid managed care program

[JimG]

The trouble with all third party payer programs is that the docs essentially become customers of the insurance company and the government and have to follow their cumbersome regs and record keeping requirements. I follow the Authentic Medicine Gazette weekly blog. Many docs are so tired of it that they are simply opting out of the whole mess in favor of direct pay by the patient. And it works better for all involved–at least docs and patients–they don’t deal with insurance.

 

[sallybutler]

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).

Unfortunately, this also applies to insurance companies. I have a friend who is only allowed to order insulin once a month. However, while one may normally take a certain amount each day, there can be days when one has to take more. The insurance company will not allow her to get the prescription refilled even one day early. She has ended up going to the emergency room to get insulin.

This is the plan her company decided to switch to in 2006.

 

[markomalley]

Unfortunately, this also applies to insurance companies. I have a friend who is only allowed to order insulin once a month. However, while one may normally take a certain amount each day, there can be days when one has to take more. The insurance company will not allow her to get the prescription refilled even one day early. She has ended up going to the emergency room to get insulin.

This is the plan her company decided to switch to in 2006.

This is the fundamental problem with any kind of third-party payer scheme (whether commercial or government). In order to control costs and prevent abuse, they will have business rules in place that have the effect of not respecting the individual needs of people and, ultimately, eliminating choice.

 

[Dawnia]

Unfortunately, this also applies to insurance companies. I have a friend who is only allowed to order insulin once a month. However, while one may normally take a certain amount each day, there can be days when one has to take more. The insurance company will not allow her to get the prescription refilled even one day early. She has ended up going to the emergency room to get insulin.

This is the plan her company decided to switch to in 2006.

Can’t she just have her doc up the prescription to give her wiggle room?

 

[pnewton]

The trouble with all third party payer programs is that the docs essentially become customers of the insurance company and the government and have to follow their cumbersome regs and record keeping requirements. I follow the Authentic Medicine Gazette weekly blog. Many docs are so tired of it that they are simply opting out of the whole mess in favor of direct pay by the patient. And it works better for all involved–at least docs and patients–they don’t deal with insurance.

It does not work well for those without unlimited income As long as one has money to pay for any medical procedure that comes along, of course that is better. The vast majority of Americans will never know what unlimited income is like.

 

[Corki]

It does not work well for those without unlimited income As long as one has money to pay for any medical procedure that comes along, of course that is better. The vast majority of Americans will never know what unlimited income is like.

This is only true because physician care and hospital care have become blended. Direct pay for doctor’s visits is a much more cost efficient and fair system than using an insurance company as a middle man with his hand out. One does not need more than modest income for this to be so.

Hospitalization is something else entirely. Surgery, X-rays, etc require an infrastructure.

In the past, insurance could be purchased separately (by individuals and employers) with major medical (hospital and accident) being a different coverage than basic health insurance. It was not at all uncommon for many people to purchase only major medical coverage and then to pay out of pocket (with savings from insurance premiums) for routine medical care.

 

[JimG]

It does not work well for those without unlimited income As long as one has money to pay for any medical procedure that comes along, of course that is better. The vast majority of Americans will never know what unlimited income is like.

Look up Dr. Josh Umbehr. His family practice is based upon a monthly fee model. Anywhere from $25 to $100 / month. There are no copays. You get unlimited service whenever you need it. His practice obtains wholesale medications from the same source as pharmacies and provides them to patients without a markup. They are cheap. He has some patients who do better financially signing up with his practice than going to the local free clinic–which does have co-pays. The practice can negotiate steep discounts for its patients with outside labs and imaging labs.

Insurance for specialists is still needed, but if a company self insures, it can design a much less expensive plan in connection with such a practice because most common procedures are already taken care of and need not be included in the insurance plan.

 

[freeRadical]

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.

In my opinion, people don’t really understand what Socialism really is, especially in America. There a lot of things in the US that people say are socialist, that are not.

 

[freeRadical]

Socialism is contrary to the Christian faith.

It’s only Socialism if the state owns the means of production.

 

[Zzyzx_Road]

Check out the Surgery Center of Oklahoma. Prices for their procedures are posted on their website. I promise you’ll be shocked …

Looking at the bigger picture, the real problem is that the major entities have turned health care into a rich feeding trough for corporate cronies by paying off Congress to gut to the Sherman Anti-trust Act. There are pricing practices among hospitals, pharmaceutical companies, medical device makers and insurance companies that in any other industry would produce a slew of convictions for price-fixing and cartel-like behavior. Because that’s exactly what it is: a bunch of cartels, nothing more. It’s basically legislated that every one of the cronies has their hand in the cookie and we peons are not allowed to make them withdraw those hands. The more hands in the cookie jar, the higher prices we pay.

In those areas of medicine that aren’t supported by insurance, the providers get paid directly by their patients. Who are mostly sensitive to prices. Hence the providers have to compete at least in part on the cost of their services. I’ll name some examples: laser eye surgery and plastic surgery. To a lesser extent, dental care in low income areas where the patients typically don’t pay for dental insurance.

What needs to happen is that the entire edifice of law around health care needs to be blown out of the water. Only two laws should remain on the books: cannot refuse insurance to anyone and all companies must be allowed to compete across state lines. In the beginning, the economy will crash because everyone who’s been sucking up health care dollars without adding value will be out of a job. But what will happen on the other side is that insurance will be restored to its original purpose: catastrophic care only with health care savings accounts to make up the difference and providers will actually be forced to compete on price. For the poor, their health care accounts can be funded up to certain point by the state but they are left on their own to manage those funds. Following the crash, capital will be reallocated swiftly, funds that once had to be spent on health insurance and health care will be freed up for other uses, then watch the economy roar back.

Nah, never happen. The industry has its tentacles wrapped around Washington’s collective throats.

 

[sallybutler]

Can’t she just have her doc up the prescription to give her wiggle room?

She couldn’t at the time. And what made it even stupider was that they would pay for the ER visit.

 

[Dawnia]

She couldn’t at the time. And what made it even stupider was that they would pay for the ER visit.

:doh2:

 

[pnewton]

In the past, insurance could be purchased separately (by individuals and employers) with major medical (hospital and accident) being a different coverage than basic health insurance. It was not at all uncommon for many people to purchase only major medical coverage and then to pay out of pocket (with savings from insurance premiums) for routine medical care.

That is a better model than no insurance. What I would like to see would be a healthcare system, or even pieces of one, where a waiver of malpractice is used to slash the cost of healthcare.

 

[zz912]

It’s only Socialism if the state owns the means of production.

That’s communism. Like the other different flavors of the totalitarian left (fascism, socialism, communism, etc), the manner in which they exercise their totalitarianism is far less important than the fact that they are totalitarian.

 

[stinkcat_14]

That’s communism. Like the other different flavors of the totalitarian left (fascism, socialism, communism, etc), the manner in which they exercise their totalitarianism is far less important than the fact that they are totalitarian.

Whatever the definition of socialism is, the Church has never taught that nationalized health insurance is contrary to our faith. So while there may be reasons to be against nationalized health insurance, it is not contrary in any way to Church teaching. For example, Medicare is nationalized health insurance for people over 65. While it is a bad program and consists of subsidies to the wrong people, it is not contrary to what the Church teaches.

 

[Cricket2]

There is not an insurance company out there that ever operated at a loss. They lie if they say they have. They spend all their time worrying about risk management and making sure they pay out as little as possible and take in as much as possible. Time for them to go away and something else to be done.

 

[Trader]

There is not an insurance company out there that ever operated at a loss. They lie if they say they have. They spend all their time worrying about risk management and making sure they pay out as little as possible and take in as much as possible. Time for them to go away and something else to be done.

insure.com/articles/generalinsurance/insolvent-companies.html

You can believe that if you want, or you could actually research the facts. The link above is old, but it shows that in 1998, 20 insurance companies were declared insolvent, and in 1999, 35 were found insolvent. That is a small percentage of all insurance companies and the largest companies are usually in better condition than the small ones.

AIG was a very large insurance holding company that would have been liquidated in 2008 without a huge infusion of cash from the Federal Reserve, although it was not their insurance subsidiaries that were the problem. The reason for the Fed’s unprecedented action was that many more companies would have failed if AIG and the big banks had also been liquidated.

 

[freeRadical]

That’s communism. Like the other different flavors of the totalitarian left (fascism, socialism, communism, etc), the manner in which they exercise their totalitarianism is far less important than the fact that they are totalitarian.

No, Communism is when the means of production are held in common.

By the way, Fascism is not left on the political spectrum, it is far right.

The right can be totalitarian too.

 

[markomalley]

By the way, Fascism is not left on the political spectrum, it is far right.

The right can be totalitarian too.

Uh, not so much.

Fascism involves a directed economy. Although much of the means of production are retained by private owners, that production (such as, what is produced, how much is produced, how much is charged) is directed by the State.

Fascism is corporatist, but it’s a deal with the devil, as the State provides a controlling function on those corporations – essentially, they operate in a dirigiste environment.

Why in the world would a corporation support such a thing? Regular, predictable revenue at a regular, reliable profit. Those who can wield more influence in the government can get regulations adjusted to benefit them…and harm any potential competitors who may want to disrupt that stability.

While I recognize that most political scientists place fascism on the right side of the political spectrum, I, honestly, don’t see it. It makes no sense to think that Benito Mussolini would go from being a socialist to a fascist, if fascism was on the exact opposite end of the political spectrum. It DOES make sense if it was a more incremental change.

What I would see on the far right is a laissez-faire economy with a government that supports that type of situation (think about the “Golden 90s” Industrial Revolution era in the US).

(What does this have to do with the original subject of the thread? Obamacare applies this type of economic structure to the health care industry through its national regulation of insurance)

 

[estesbob]

Very telling when govt regulation force a company out of a market the Left blames the company.