The problem with insurance and insurance companies is that people don't pick their own. Their employer picks it. Under the current system in the US, there is very little competition in group health insurance that has anything to do with what is best from a consumer's POV. Although the comsumer has very little say in the insurance their employer selects, they are paying for it. It is a cost of employing a person.
Group insurance is subject to all kinds of mandates. For example, pregnancy coverage is always included even if there is no possibility of any of the group becoming pregnant. In some jurisdictions, In Vitro Fertilization coverage is mandated. Having a baby may be very important to a woman but I don't see how her wanting it should translate into everyone else having to pay higher insurance. In some, athletic trainer coverage is mandated. Does anyone want to try to explain why everyone should have to pay higher insurance so a few could have a personal trainer?
Some years ago, group coverage was much cheaper than an individual policy. Now, because of mandates and other regulations required for employer paid group policies, you can get individual insurance cheaper even though the administrative and sales costs for the individual policy is much higher.
If a person was picking their own insurance, most would shop for the coverage they wanted at the best price they could get. Insurance companies would have to compete on price and quality. Slow pay or denial of payment would become significant in a person choosing a company. Some companies would also offer continuing coverage as a way to get people to change.
There are some insurance companies that pay promptly and only deny claims when there is a valid reason. There are others that routinely deny payment or are just slow pay as a way of reducing cost. With employer paid insurance, the employer's goal is to get the lowest cost insurance that will still be good enough, or at least sound good enough, to let them attract and keep employees. The individual employee rarely has any say in the coverage or the company's payment tendencies.
IMO, employers should not be in the business of brokering insurance for their employees. Everyone should buy their own the same why they buy a car or the insurance for that car.
For those that cannot get private insurance because of pre-existing conditions, the government should provide some means for them to get coverage for those specific conditions.
For those that truly cannot afford insurance the government should provide some means for them to pay for it but let them choose the company and coverage and provide some sort of incentive for them to make wise choices.
Concerning CMS (Medicare, Medicaid, etc), if it is so great, why are so many doctors opting out? For some specialties, it may be fine but for others it is a disaster. Many practices in some specialties simply do not take CMS paid patients. One of the services we provide is giving the practice the ability to track their costs and expenses with filtering, one of which is the payor. It is very unusual that they are not shocked when they see the numbers from CMS cases. They usually know that CMS pay at a lower rate but it’s a real eye-opener when they see the actual payments vs their expenses. In some specialties they always lose money on CMS cases.
As an example, CMS pays about 15% of what private payors pay for anesthesia services. They do not cover the cost of the provider. The business has to take the loss to provide the service. If they do not have a large percentage of CMS paid patients, they will eat it as a cost of doing business at that hospital/surgery center. When an anesthesia group is bidding to provide the coverage for a hospital, one of their main considerations is the payor mix. If there is high percentage of CMS patients many groups will either decline to even bid or will require a stipend from the hospital.
As long as the consumer is not paying the bill, either directly or though their choice of insurance, there is no incentive for them to be concerned about cost. I would bet almost everyone would be driving a more expensive car if they could pick whatever they wanted and someone else would pay for it.
For those that do not believe in competition, spare me. We will never agree, so why engage.
(not because european health care sucks, I'm saying just cause everywhere is a pretty sh&%^y system, and so it would take something new and outside the box to fix it)
