In the end insurance cost will continue to climb until we control health care costs!!

Re: In the end insurance cost will continue to climb until we control health care cos

fmw said:

No. But they are responsible for the laws they pass.

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Sure.. but my point still stands.

Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

I'll just make note that you really have no rebuttal for the arguments I have made.

I created no strawman..

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That's quite simply a lie. If not, please go back to the previous post when I asked you to quote me, or my sources, claiming the positions you asserted I claimed. Thanks!

Yes.. you ended up agreeing with my position.. that's what happened. Which is that insurance companies have no problem going across state lines.. they simply choose not to because it would increase competition, decrease their monopoly on state markets and hurt their overall profits.

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I quoted experts, multiple, to defend my position. Yes, I know we should all defer to the ONE TRUE EXPERT, jaeger, who provides zilch to defend his position except the opinions of jaeger.

Of course it took you a while to come around to it..

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That's false, a lie. Your first reply to me was here.

My reply to you is here

I'll quote the exchange in context.

jaeger:

The real barrier to competition is that insurance companies by and large DO NOT WANT TO COMPETE!

Think about it.. if the goal of competition is TO LOWER PRICES... why would insurance companies want to engage in a price war? All it does is hurt their revenue.

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My reply:

Right. If Cigna has a market sewn up and BCBS comes in, for the same premiums, they have to run at a loss until they get enough clout to negotiate favorable provider contracts and then what have they won - the ability to compete head to head with another big player and smaller margins than in areas they have sewn up. This argument isn't actually a rebuttal to mine - it's in addition to it and I agree with it.

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I can only guess you don't bother to read my replies, because if you had you couldn't pretend/lie that it took me a bunch of posts to come around to your basic point, when I acknowledged it and agreed with it IMMEDIATELY.

with a lot of personal remarks on your part that were uncalled for..

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Pointing out your straw men and lies isn't a personal attack. Read what I write, and debate honestly and we can have a civil discussion.

Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

Sure.. but my point still stands.

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No but mine stands.

Re: In the end insurance cost will continue to climb until we control health care cos

JasperL said:

That's quite simply a lie. If not, please go back to the previous post when I asked you to quote me, or my sources, claiming the positions you asserted I claimed. Thanks!

.

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I already did Jasper.... now you want to make a nuanced position as if you didn't try to claim it was so hard for insurance companies to cross state lines.

If not.. then why the heck are you telling me that I am wrong.

I can only guess you don't bother to read my replies, because if you had you couldn't pretend/lie that it took me a bunch of posts to come around to your basic point, when I acknowledged it and agreed with it IMMEDIATELY

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No.. what you are hoping is that we all ignore the previous posts telling me.. when I said exactly the same thing before.. that I was wrong and the reasons were all wrong.. and you trotted out a bunch of "multiple experts".. to defend a position.. that ooops.. now you claim you don't have.

Claiming that you are the only one that has evidence,..and the usual BS that has nothing to do with the debate.. is personal.. especially when I have demonstrated not only multiple times expertise in this subject but also posted multiple times supporting evidence.

now.. you are trying to extricate yourself from the debate and find a way to declare some victory because you position has little to no merit. You glammed onto one piece of you argument.. in those experts that HAD A KERNEL OF TRUTH.. which I pointed out prior.

And you are acting as if this was your whole premise.. it was not. I HAVE read what you have written.. ALL that you wrote.. AND I read the opinion pieces you presented on insurance companies. (you know your experts). THATS what developed your position.. now maybe be know you want to distance yourself from ALL that you wrote and linked to..

but At least be honest with yourself if not with me.

Re: In the end insurance cost will continue to climb until we control health care cos

fmw said:

No but mine stands.

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If you are talking about your position that politicians bear responsibility for the bills they pass.. why yes.. that's about the only position that stands.

Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

I already did Jasper....

now you want to make a nuanced position as if you didn't try to claim it was so hard for insurance companies to cross state lines.

If not.. then why the heck are you telling me that I am wrong.

I agreed with you immediately - quoted the exchange. If you can read, you can see it for yourself. If you doubt that I quoted it correctly, follow the links. I agree means I agree.

No.. what you are hoping is that we all ignore the previous posts telling me.. when I said exactly the same thing before.. that I was wrong and the reasons were all wrong.. and you trotted out a bunch of "multiple experts".. to defend a position.. that ooops.. now you claim you don't have.

Claiming that you are the only one that has evidence,..and the usual BS that has nothing to do with the debate.. is personal.. especially when I have demonstrated not only multiple times expertise in this subject but also posted multiple times supporting evidence.

now.. you are trying to extricate yourself from the debate and find a way to declare some victory because you position has little to no merit. You glammed onto one piece of you argument.. in those experts that HAD A KERNEL OF TRUTH.. which I pointed out prior.

And you are acting as if this was your whole premise.. it was not. I HAVE read what you have written.. ALL that you wrote.. AND I read the opinion pieces you presented on insurance companies. (you know your experts). THATS what developed your position.. now maybe be know you want to distance yourself from ALL that you wrote and linked to..

but At least be honest with yourself if not with me.

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jaeger, I don't know what your problem is, but you're either lying, or ignorant about what I wrote because you never read it in the first place. I just quoted the initial exchange in which I immediately agreed with you, and you're telling me I didn't, but the words are there in black and white, with links. "I agree" means "I agree." Not sure how much clearer I can be.

In any event, I have no interest in continuing this conversation. You're just not debating honestly - when not making up my positions, you're lying about them. I've got better things to do that respond to trolling.

Re: In the end insurance cost will continue to climb until we control health care cos

ModerateRN said:

Health control costs can spiral out of control because there is no regulation on pharmaceuticals and medical equipment. Just the other week I was looking into purchasing new binders for patients paper charts. I found them on the medical equipment company for $64. these are just a hard plastic binder capable of being wiped down with bleach. I found them from a non-medical equipment company, as far as I could tell they are identical except for company name, $20 a piece. Pharmaceuticals and Equipment are just a few ways that costs keep going up

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Spending on prescription drugs is only 8-13% of the total healthcare spending. The biggest chunks go to hospitals and physician services (over 50%).

Re: In the end insurance cost will continue to climb until we control health care cos

digsbe said:

Spending on prescription drugs is only 8-13% of the total healthcare spending. The biggest chunks go to hospitals and physician services (over 50%).

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1 reason would be the ungodly fees charged by Drs., Surgeons and Specialists
80 k for a consult on neck surgery?

Re: In the end insurance cost will continue to climb until we control health care cos

JasperL said:

jaeger, I don't know what your problem is, but you're either lying, or ignorant about what I wrote because you never read it in the first place. .

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Yeah.. I know what your problem is. You don't know what your position is. Try post #581
I stated that insurance companies having difficulty crossing state lines was BS.

Jasper said:

It's not BS

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Wait.. so I say its BS.. you say its NOT.. and that's "the initial exchange were I immediately agreed with you?

Oh but it gets better. The bolding is yours.

]

The bigger challenge for this idea, though, is that almost all health care is delivered locally. To succeed, insurance companies need a significant toe-hold with hospitals and other providers in their local market; an out-of-state insurer would lack that and thus struggle in its negotiations to form a delivery network. This is why many new entrants to the health insurance market haven’t succeeded. As the American Academy of Actuaries emphasizes, “For insurers to sell across state lines, they must develop provider networks by establishing reimbursement agreements with hospitals and physicians, or by purchasing access to an existing network. Any cost savings resulting from differences in benefit coverage requirements among states can be small compared to cost savings that can be accomplished through negotiating strong provider contracts.”

The bigger challenge for this idea, though, is that almost all health care is delivered locally. ]To succeed, insurance companies need a significant toe-hold with hospitals and other providers in their local market; an out-of-state insurer would lack that and thus struggle in its negotiations to form a delivery network. This is why many new entrants to the health insurance market haven’t succeeded

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Oh but you go on with why its such a struggle.

]The biggest problem with the idea is a practical one, Hitter said Any insurer entering a new marketplace has to sign contracts with providers and hospitals in that state to offer those services. It’s difficult work already but far tougher when a company doesn’t have a footprint in that state. “Creating the network is not such a simple thing,” she said. “You have to really worry about network adequacy.” ]

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Again.. this IS WHAT YOU LINKED TO AND QUOTED... now does it sound like you are agreeing with me that Insurance companies ARE ALREADY providing services across state lines? Do those quotes make it apparent that insurance companies are already crossing state lines when it comes to employers and that they already have networks to pay bills. That healthcare already crosses state lines and insurance companies are remaining profitable?
HMMM.. doesn't seem so to any rational person. Then..in that same post you added another quote:

Given both the ACA provision authorizing cross-state sales and state legislative activity that has signaled interest in the idea, why haven’t insurers offered products for sale across state lines? A range of key voices—including state insurance officials, the National Association of Insurance Commissioners,6 the American Academy of Actuaries,7 and health insurance policy experts8—have raised a variety of issues with cross state sales, noted below, and emphasized the high cost of creating provider networks in new markets as a primary concern and significant barrier to entry for insurers.
Critics also emphasize that selling insurance across state lines creates practical challenges for insurers and regulators. Because health care is inherently local, setting up provider networks is a costly and significant barrier to entry in new markets. Out-of-state plans may have a small market share, thus limiting insurers’ ability to negotiate with health care providers and create an adequate risk pool to distribute costs across insured individuals and groups. Insurers are best able to negotiate provider discounts, and thereby lower premium costs, when they have a significant share of the market.

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now.. I pointed out that you first two quotes/links.. ARE the BS.. insurance companies do not "face struggles/ barriers and what not in crossing state lines.

The REAL truth is in the last statement from the quote.. which in reality..points out out the REAL issue.. which is that if they don't have a monopoly.. they can't gouge providers prices as much as in states they have a monopoly. THUS the issue is not that they have challenges/barriers/struggles in going across state lines...

I just quoted the initial exchange in which I immediately agreed with you, and you're telling me I didn't, but the words are there in black and white, with links. "I agree" means "I agree." Not sure how much clearer I can be.

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Right.. the initial exchange were you disagreed with me.. "its not BS".. and went on to provide multiple opinion quotes from your links.

Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

Yeah.. I know what your problem is. You don't know what your position is. Try post #581
I stated that insurance companies having difficulty crossing state lines was BS.

Wait.. so I say its BS.. you say its NOT.. and that's "the initial exchange were I immediately agreed with you?

Oh but it gets better. The bolding is yours.

]

Oh but you go on with why its such a struggle.
Again.. this IS WHAT YOU LINKED TO AND QUOTED... now does it sound like you are agreeing with me that Insurance companies ARE ALREADY providing services across state lines? Do those quotes make it apparent that insurance companies are already crossing state lines when it comes to employers and that they already have networks to pay bills. That healthcare already crosses state lines and insurance companies are remaining profitable?
HMMM.. doesn't seem so to any rational person. Then..in that same post you added another quote:



now.. I pointed out that you first two quotes/links.. ARE the BS.. insurance companies do not "face struggles/ barriers and what not in crossing state lines.

The REAL truth is in the last statement from the quote.. which in reality..points out out the REAL issue.. which is that if they don't have a monopoly.. they can't gouge providers prices as much as in states they have a monopoly. THUS the issue is not that they have challenges/barriers/struggles in going across state lines...



Right.. the initial exchange were you disagreed with me.. "its not BS".. and went on to provide multiple opinion quotes from your links.

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Okee dokee. Nice talk. I backed up my opinion with multiple experts, jaeger says multiple experts are stupid and he's the smart one. I don't agree. Others can judge for themselves.

Re: In the end insurance cost will continue to climb until we control health care cos

JasperL said:

Okee dokee. Nice talk. I backed up my opinion with multiple experts, jaeger says multiple experts are stupid and he's the smart one. I don't agree. Others can judge for themselves.

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Yeah.. nice talk,. first you didn;t agree with me.. and bring opinions pieces... that leave out the actual facts.. which is that insurance already crosses state lines and has for a long time.

Then when I point out that fact.. you "agree with me".. and get all upset and call me a liar and ignorant.

Then I point out your actual conversation and you are back to the "I back up your opinion with experts"..

No. what you really did is back up your opinion with opinion pieces by people that left out some VERY important facts.. which is.. that healthcare and healthcare insurance already crosses state lines and guess what.. insurance companies manage JUST FINE. Employer based insurance does just that.

As far as "experts stupid"... no I think that people that wrote those opinion pieces probably new EXACTLY what they were doing when they spouted misinformation about the insurance industry. Heck.. even YOU admitted at some point that I was right. Because healthcare does cross state lines. Employer based plans do all the time. Yet insurance companies manage to do just fine.

Oh.. and as far as experts.. I am one.

Just others can judge for themselves. And anyone objective will have to admit.. that I am correct in this.

Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

Yeah.. nice talk,. first you didn;t agree with me.. and bring opinions pieces... that leave out the actual facts.. which is that insurance already crosses state lines and has for a long time.

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No one claimed it didn't. That's the lie/strawman you made up.

Then when I point out that fact.. you "agree with me".. and get all upset and call me a liar and ignorant.

Then I point out your actual conversation and you are back to the "I back up your opinion with experts"..

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That's correct. I don't know if you misunderstood their point or are intentionally missing the point. Hard to tell. But you never actually disputed the points asserted - you just moved the goal posts.

No. what you really did is back up your opinion with opinion pieces by people that left out some VERY important facts.. which is.. that healthcare and healthcare insurance already crosses state lines and guess what.. insurance companies manage JUST FINE. Employer based insurance does just that.

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Again, no one made the claim insurance companies are incapable of crossing state lines. I asked you repeatedly to quote me or the sources making your made up claim and you cannot do it. They obviously do it, which I've also acknowledged many times.

But here's the point. Cigna is the dominant insurer in my area. If Acme Health Insurance from Texas can offer the same policies Cigna does at the same price, and make the same gross margin on each policy sold, why isn't Acme and UHC and all the rest pricing policies in Knoxville competitive with Cigna. According to you, Acme will pay the big local hospitals and the big physicians groups the same rates on every procedure, right, because Cigna, although commanding a huge share of the insured in this area, doesn't use that clout to negotiate more favorable reimbursement rates with providers, such as the local hospitals, than any insurer with 50 customers in Knoxville will have to pay. This is your theory and I just want to make sure I have it right.

As far as "experts stupid"... no I think that people that wrote those opinion pieces probably new EXACTLY what they were doing when they spouted misinformation about the insurance industry. Heck.. even YOU admitted at some point that I was right. Because healthcare does cross state lines. Employer based plans do all the time. Yet insurance companies manage to do just fine.

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Hilarious - how many times are you going to repeat this straw man - that I or the experts argue that healthcare does NOT cross state lines? No one made that claim, but you're beating the ever loving **** out of this created position.

The argument is about whether or not allowing insurers to "cross state lines" will increase local competition, and if residents of Chattanooga, or Athens, GA, which currently only have one insurer offering policies to individuals, will after the change be able to get policies from United, BCBS, Cigna, and Acme from Texas. Competition!! We know the answer - supposedly opening up the state to outside competition fails, every time it's tried.

You say it's because they don't WANT to compete, and there is certainly a lot of truth to that, but it does NOT explain why Acme Insurance, or some other smaller competitor, doesn't just accept the same provider rates Cigna pays, which is apparently possible with little to no work, and make a positive gross margin on every policy. Do that in enough new markets and you've got a good business strategy going!

Oh.. and as far as experts.. I am one.

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If you want to claim expertise, please detail it for us. What kind of health care provider are you? How many employed? In what field(s)?

Also, do you own a health insurance company? If not, then on what basis do you claim expertise in insurance company marketing decisions, and expertise on what steps are needed to enter a new market? How do you know why when Cigna has a dominant share, that some other insurance company doesn't decide, "You know, all we have to do is start marketing policies in Knoxville, and we'll make the same margins Cigna does in that market. What do we have to lose? This is an easy way to expand, grow our customer base!" Please explain why when Georgia and other states opened up their markets, no one, not a single company, took them up on their offer when these potential new entrants into the GA market can make the same money the dominant players do in a state with 10 million residents?

Just others can judge for themselves. And anyone objective will have to admit.. that I am correct in this.

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Right, because you claim you're an expert and cannot or do not offer any other confirmation that your "expert" opinion is the only rational one.

Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

Just others can judge for themselves. And anyone objective will have to admit.. that I am correct in this.

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Let me just repeat what the stupid experts, such as the America Academy of Actuaries, the guys who actually price policies, claim:

“For insurers to sell across state lines, they must develop provider networks by establishing reimbursement agreements with hospitals and physicians, or by purchasing access to an existing network. Any cost savings resulting from differences in benefit coverage requirements among states can be small compared to cost savings that can be accomplished through negotiating strong provider contracts.”

Click to expand...

What part, exactly, of that claim is to use your description, "...that's BS. Total BS."

1) If Acme wants to offer policies for sale in Knoxville, they do NOT have to develop provider networks or establish reimbursement agreements with hospitals and big physician groups?

2) If Acme want to offer policies for sale, the differences in benefit coverage requirements are major compared to the cost savings that can be accomplished through negotiating strong provider contracts?

This is the claim by the National Academy for State Health Policy, which compared to you, are idiots apparently.

"Because health care is inherently local, setting up provider networks is a costly and significant barrier to entry in new markets. Out-of-state plans may have a small market share, thus limiting insurers’ ability to negotiate with health care providers and create an adequate risk pool to distribute costs across insured individuals and groups. Insurers are best able to negotiate provider discounts, and thereby lower premium costs, when they have a significant share of the market."

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Which of those claims is "Total BS" and why? Please be specific. Thanks!

Just for example, if an insurer has a significant share of a given market, they are NOT better able to negotiate provider discounts than Acme from Texas with a customer pool of 50 insureds? Seems odd, so can you explain why clout and market share provide no advantages in the health care market, like they do in every other market? Thanks.

Re: In the end insurance cost will continue to climb until we control health care cos

JasperL said:

Let me just repeat what the stupid experts, such as the America Academy of Actuaries, the guys who actually price policies, claim:

If Acme wants to offer policies for sale in Knoxville, they do NOT have to develop provider networks or establish reimbursement agreements with hospitals and big physician groups?

Click to expand...

since Acme already sells insurance to employers that crosses state lines into Knoxville and already sells supplemental plans that cross into Knoxville.. ACME ALREADY has provider networks and reimbursement agreements with hospitals and physician groups.

If Acme want to offer policies for sale, the differences in benefit coverage requirements are major compared to the cost savings that can be accomplished through negotiating strong provider contracts?

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Since Acme is already making a profit selling to employers that have employees in Knoxville. They don't need to get any MORE cost savings than they can already experience. Since premiums are not set at cost.. but are a function of what the market will bear.. there is plenty of room for Acme to continue to make a profit without gouging providers or customers.

Which of those claims is "Total BS" and why? Please be specific. Thanks!

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I was. The fact is.. that your "experts",, have very very conveniently omitted the facts that insurance already crosses state lines.. and in all likelihood.. since that's the case.. Acme already has provider agreements. Or can develop them very easily. They also omit the fact that pricing of premiums is not simply cost.. that premiums are based on what the market will bear. and in a monopoly situation.. the market can be forced to bear a much higher price if demand is high.

In other words.. its NOT NECESSARY for insurance companies to have a monopoly and drive providers into the ground in order to still make a profit and be viable.

Just for example, if an insurer has a significant share of a given market, they are NOT better able to negotiate provider discounts than Acme from Texas with a customer pool of 50 insureds?

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Sure.. of course.. but two points to that... number one.. is that the ASSUMPTION that's being made here is that being able to negotiate better provider discounts is NECESSARY for Acme to compete and be profitable. That's a false assumption. Sure they would like to be able to do it.. but that does not mean that a monopoly is necessary to be profitable.

Secondly.. its entirely possible in the medical field that by paying providers MORE.. costs will actually reduce for insurers. Its entirely possible that if Acme from texas came in and offered providers MORE money than a bigger competitor.. they would actually be more profitable and have less costs per patient than the bigger competitor.

And your welcome for the education.

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Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

JasperL said:

Let me just repeat what the stupid experts, such as the America Academy of Actuaries, the guys who actually price policies, claim:

since Acme already sells insurance to employers that crosses state lines into Knoxville and already sells supplemental plans that cross into Knoxville.. ACME ALREADY has provider networks and reimbursement agreements with hospitals and physician groups.

Click to expand...

I see, the question is whether or not allowing insurers to sell across state lines will entice new competitors. We know so far the answer is NO, and are discussing why that might be. The "experts" not you claim that one significant barrier is the need to negotiate provider contracts in every local market in a state, to sell insurance across that state. In Tennessee that's perhaps 100 hospitals and many hundreds, perhaps thousands, of other healthcare providers.

Now you've changed the facts by assuming that, I suppose, every insurer has already negotiated all those contracts! Neat trick! You assumed the issue away with a wave of your hand and by moving the goal posts to a different stadium!

Since Acme is already making a profit selling to employers that have employees in Knoxville.

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Pause here - dishonestly conflating the employer market, which is dominated by large employers who operate in entirely different competitive spaces, largely not regulated at all by states, with the individual and small group market. You know better than to compare apples to dump trucks. Hackery noted. Carry on, though.

They don't need to get any MORE cost savings than they can already experience. Since premiums are not set at cost.. but are a function of what the market will bear.. there is plenty of room for Acme to continue to make a profit without gouging providers or customers.

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Baseless assertion. How do you know this? Do you run insurance companies?

I was. The fact is.. that your "experts",, have very very conveniently omitted the facts that insurance already crosses state lines.. and in all likelihood.. since that's the case.. Acme already has provider agreements. Or can develop them very easily. They also omit the fact that pricing of premiums is not simply cost.. that premiums are based on what the market will bear. and in a monopoly situation.. the market can be forced to bear a much higher price if demand is high.

In other words.. its NOT NECESSARY for insurance companies to have a monopoly and drive providers into the ground in order to still make a profit and be viable.

Sure.. of course..

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We'll pause here. The claims I made and backed them by experts are really just two:

1) New entrants have to negotiate with the providers in a local area. Obviously true, you just assumed that it's already BEEN DONE in a neat move of the goal posts.
2) That the dominant player or players are able to use their market clout to negotiate better terms with providers than a newcomer. Now you concede this too is true. "Of course..." it is.

So what part of the analysis was "Total BS."?

but two points to that... number one.. is that the ASSUMPTION that's being made here is that being able to negotiate better provider discounts is NECESSARY for Acme to compete and be profitable. That's a false assumption. Sure they would like to be able to do it.. but that does not mean that a monopoly is necessary to be profitable.

Click to expand...

Great, you're an expert in insurance company operations so you'll have no trouble providing stats on the difference between the rates paid by Cigna to the major providers, and the rates paid by Acme, as a share of total premiums. Is this difference 2%, 8%, 15%? Higher? In other words, what kind of discount does Cigna command on average by virtue of their dominant position?

After you've done that, please tell us the operating profit margins of Acme in Knoxville overall, and what kind of operating margin they can expect competing head to head with Cigna and having to pay (some percentage you'll tell us) higher prices to providers. Thanks!

Secondly.. its entirely possible in the medical field that by paying providers MORE.. costs will actually reduce for insurers. Its entirely possible that if Acme from texas came in and offered providers MORE money than a bigger competitor.. they would actually be more profitable and have less costs per patient than the bigger competitor.

And your welcome for the education.

Click to expand...

Interesting. Insurers who pay MORE to providers make more money than those insurers who negotiate lower payments. How does that work, and please cite the examples of this in the real world. Thanks!

Click to expand...

Re: In the end insurance cost will continue to climb until we control health care cos

JasperL said:

jaeger19 said:

I see, the question is whether or not allowing insurers to sell across state lines will entice new competitors. We know so far the answer is NO, and are discussing why that might be. The "experts" not you claim that one significant barrier is the need to negotiate provider contracts in every local market in a state, to sell insurance across that state. In Tennessee that's perhaps 100 hospitals and many hundreds, perhaps thousands, of other healthcare providers.
!

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Yep.. and those "experts".. again fail to account for the fact that those insurers are already selling policies that cross state lines. They already negotiate provider contracts in those markets. already done. and anyway. its easy to do.. easy.

Now you've changed the facts by assuming that, I suppose, every insurer has already negotiated all those contracts! Neat trick! You assumed the issue away with a wave of your hand and by moving the goal posts to a different stadium!

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Wow.. that's funny. And you have assumed that NONE of those companies have negotiated those contracts. Apparently you think that there are a plethora of insurers out there that are mom and pop insurers that only insure people in their local region. and their insurance never crosses into the next town or state.

Bwahh.. and you have assumed that setting up these contracts is really difficult. When I get these contracts.. its a phone call and a fax and or a email. Wow.. that was hard.

Pause here - dishonestly conflating the employer market, which is dominated by large employers who operate in entirely different competitive spaces, largely not regulated at all by states, with the individual and small group market

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Pause here.. dishonestly thinking that the provision of healthcare and how we interact with insurers.. which is the issue here.. is substantially different between employer insurance and individuals insurance. I am dealing with Blue Cross.. whether its an individual policy or an employer policy.

Setting up a contract is not rocket science... particularly if an insurer is not trying to using their monopoly to gouge me.

Baseless assertion. How do you know this? Do you run insurance companies?

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I was on the board of a large non profit.. yes.

]

1) New entrants have to negotiate with the providers in a local area. Obviously true, you just assumed that it's already BEEN DONE in a neat move of the goal posts.
2) That the dominant player or players are able to use their market clout to negotiate better terms with providers than a newcomer. Now you concede this too is true. "Of course..." it is.

So what part of the analysis was "Total BS."?

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As I have stated.. neither. Whats BS is the assumption.. that this constitutes any actual BARRIER.. or hindrance to insurance companies to participating across state lines.

Great, you're an expert in insurance company operations so you'll have no trouble providing stats on the difference between the rates paid by Cigna to the major providers, and the rates paid by Acme, as a share of total premiums. Is this difference 2%, 8%, 15%? Higher? In other words, what kind of discount does Cigna command on average by virtue of their dominant position?

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Well.. it depends on the markets.. but here is the thing.. while Cigna may get an larger discount.. Acme may actually pay more per procedure to providers.. BUT actually save money over Cigna.

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Re: In the end insurance cost will continue to climb until we control health care cos

Interesting. Insurers who pay MORE to providers make more money than those insurers who negotiate lower payments. How does that work, and please cite the examples of this in the real world. Thanks!

Click to expand...

Absolutely.. I enjoy educating people.

Acme insurance company has negotiated very hard and has the lowest reimbursement. The only provider that can/will accept their rate is Giant Medical system.

Cigna insurance company is new to the area and doesn't have the market share or inclination to negotiate as hard. It has several independent practices including Giant Medical system that accept their insurance.


Acme insurance has a patient that goes into Giant Medical. The total bill is 7,500.

A Cigna insurance company has a patient with the exact same thing that goes to an independent practitioner and then goes to Giant Medical for their tests. total bill.. 2500.

Why?

Its simple. Self referral and overutilization. The reason that Giant Medical can accept those rates is in part because larger is more efficient.. but ALSO because they own their own referral sources.. so they can generate utilization. So though their physician reimbursement and other reimbursements are LESS.. their physicians are encouraged in many ways to order specialist referrals, tests, diagnostics etc that generate more income.

Meanwhile.. the independent practitioner has no fiscal reward for ordering more tests or other expensive diagnostics.. so though they get paid more..for their visit.. they order the test that's necessary and that's it. So the overall cost to Cigna.. is way less.. several times less than it is for Acme.

A personal example:

I was traveling and stopped in to see a friend of mine. His wife was having terrible pain when she came home from work and he asked me as a friend to look at her. She basically had muscle pain in her upper trapezius and sub occipital muscles (the back of your head and neck). All muscular.. no radicular signs (no nerve signs).. She had postural problems, and some arthritis in her neck.

I happened to have my TENS unit along as I use one. So I suggested that we try that since she was hurting and ice and some gentle stretches. In 20 minutes she was a LOT better. During the length of my trip I let her borrow my TENS unit.. and she had tremendous relief. Now my friend works for one of my competitors.. a very large hospital system. (multi state).. and his insurance is not accepted by our facilities because it pays so little. He wanted to go through his insurance.. which I understood. I suggested that all he needed to do was have her see her GP and have him give a referral for a Tens unit. (I also suggested they discuss anti-inflammatories, and physical therapy but I could see that she was not interested).

this was a no brainer.

So I called a couple of months later to see how she was doing.
She went to the big medical system he worked for since they accepted her insurance.
Her GP ordered in house x rays (which of course were negative). He then told her "this is not my area". :shock: So he ordered a referral to a pain specialist (who worked for the hospital). The pain specialist ORDERED AN MRI (in house again) . (remember.. no radicular symptoms at all)., the MRI was of course negative except for some disc degeneration and arthritis. He then told her that she did not need a tens unit but needed a portable interferential unit. He had the in house medical supply come up and order her an interfential unit.. and then fit her for a "vest" that went with the interferential unit. the vest was not covered by insurance thought he unit was.. out of pocket cost for the vest 1200.

When it all arrived.. the vest never came even close to the area that she had pain.. (it didn;t come close to the upper trapezius and sub occipital muscles)... so the unit was completely ineffective.

So.. all said and done.. Cost to the insurance company was about 2900 dollars. Cost to her was 1200.

IF she had a different insurance that we accepted and gone to one of our facilities? The GP would have given her a referral for a tens unit.. total cost to the insurance company for effective treatment? about 300 dollars...

Re: In the end insurance cost will continue to climb until we control health care cos

jaeger19 said:

JasperL said:

Yep.. and those "experts".. again fail to account for the fact that those insurers are already selling policies that cross state lines. They already negotiate provider contracts in those markets. already done. and anyway. its easy to do.. easy.

Wow.. that's funny. And you have assumed that NONE of those companies have negotiated those contracts. Apparently you think that there are a plethora of insurers out there that are mom and pop insurers that only insure people in their local region. and their insurance never crosses into the next town or state.

Bwahh.. and you have assumed that setting up these contracts is really difficult. When I get these contracts.. its a phone call and a fax and or a email. Wow.. that was hard.

Pause here.. dishonestly thinking that the provision of healthcare and how we interact with insurers.. which is the issue here.. is substantially different between employer insurance and individuals insurance. I am dealing with Blue Cross.. whether its an individual policy or an employer policy.

Setting up a contract is not rocket science... particularly if an insurer is not trying to using their monopoly to gouge me.

I was on the board of a large non profit.. yes.

As I have stated.. neither. Whats BS is the assumption.. that this constitutes any actual BARRIER.. or hindrance to insurance companies to participating across state lines.

Well.. it depends on the markets.. but here is the thing.. while Cigna may get an larger discount.. Acme may actually pay more per procedure to providers.. BUT actually save money over Cigna.

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This is tiring. You're not trying to have an honest debate and I have no interest in chasing your straw men and red herrings around.

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Re: In the end insurance cost will continue to climb until we control health care cos

JasperL said:

jaeger19 said:

This is tiring. You're not trying to have an honest debate and I have no interest in chasing your straw men and red herrings around.

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Yes it is tiring. you have no interest in honest debate. You have no real response other than personal attacks.

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