Republican makes first move to work with Democrats on healthcare

Lafayette · Aug 2, 2017

From here: Republican makes first move to work with Democrats on healthcare - excerpt:

The Tennessee Republican said the Senate health committee "will hold hearings beginning the week of September 4 on the actions Congress should take to stabilize and strengthen the individual health insurance market so that Americans will be able to buy insurance at affordable prices in the year 2018."

Trump, frustrated that he and Republicans have not been able to keep promises to repeal and replace Obamacare, has threatened to let the law implode, including by cutting off about $8 billion in subsidies that are used to make Obamacare health plans more affordable for low income Americans.

Insurers, who are finalizing their insurance premium rates for 2018, have asked Congress to guarantee that those funds will stay in place for the rest of this year and 2018. Without the subsidies, they say they will need to raise premium rates by about 20 percent.

Without an answer, insurers have filed preliminary rates based on different parameters: Some set rates that assumed the subsidies would be paid, others set rates that assumed they would not, and some submitted two different set of rates reflecting both outcomes.

However, just how unprofitable is private HC-insurance that premiums must be raised? Not at all! See here: Profits are booming at Health Insurance Companies - excerpt:

The largest health insurance companies in the United States reaped historically large profits in the first quarter of this year, despite all the noise surrounding the Affordable Care Act's individual marketplaces.

Aetna, Anthem, Cigna, Humana and UnitedHealth Group — the big five for-profit insurers — cumulatively collected $4.5 billion in net earnings in the first three months of 2017. That was by far the biggest first-quarter haul for the group since the ACA exchanges went live in 2014. Other major insurers, such as the Blue Cross and Blue Shield company Health Care Service Corp., also are improving their ACA operations.

Something is very, very wrong with private insurance companies who profit from Health Care by Price Gouging. Health Care should be provided by the Federal government, just as is National Defense. Had the US a tried-and-true National HealthCare System, HC-providers would be obliged to accept government regulated prices for services rendered. And total costs would be far lower.

In the US, for example, a GP makes $200K a year (Bureau of Labor Statistics data from here). In Europe, the average GP does not even make half that amount ... and yet they have well-paying jobs.

Health Care in the US is a typical example of Price Gouging on behalf of both a Profession and Health Care Insurers. For a service as important as Health Care is to the nation, we should have the Federal Government providing it at affordable prices in hospitals it runs.

Which is how Health Care is done elsewhere in the world, and why those systems are rated better than ours in the US. See that sad fact underscored here: Country Rankings - National Health Care

Greenbeard · Aug 2, 2017

Lafayette said:
Something is very, very wrong with private insurance companies who profit from Health Care by Price Gouging. Health Care should be provided by the Federal government, just as is National Defense.

The profits you're talking about are coming primarily from those companies' government business.

Most of Aetna's revenue now comes from government programs

Here's a nugget that encapsulates the health insurance industry, despite all the noise surrounding the future of the Affordable Care Act: In the first quarter of this year, Aetna collected more premium revenue from government programs (namely Medicare and Medicaid) than it did from commercial insurance for the first time ever.

UnitedHealth's Government Growth Can't Be Ignored

UnitedHealth Group Inc. is out on Obamacare but in on the government.

The insurer's first-quarter earnings release on Tuesday revealed its Medicare and Medicaid businesses are growing rapidly, even as it has pulled out of the Affordable Care Act's individual exchange markets.

Humana profit beats on Medicare Advantage unit strength

U.S. health insurer Humana Inc reported higher-than-expected quarterly profit on Wednesday due to strength in Medicare Advantage, a program in which it manages government health benefits for the elderly and people with disabilities.

Medicare Advantage plans account for about a third of the more than 55 million people covered by Medicare and is the fastest growing government health program. It is an alternative to standard fee-for-service Medicare accounts and makes up the majority of Humana's revenue.

Anthem profit soars on higher membership growth and premiums

Premium rate increases and higher enrollment in Medicaid, Medicare and local group businesses drove revenue growth.

Cigna is literally the only one of the Big 5 whose first quarter earnings this year were driven primarily by commercial (not government) business, and that's because they missed the 2017 Medicare enrollment due to ongoing sanctions.

Lafayette · Aug 2, 2017

Greenbeard said:
The profits you're talking about are coming primarily from those companies' government business.

Who cares where the profits come from when they are wholly exaggerated? The costs are too damn expensive and the reason is that there is, in fact, very little competition.

Rather than me ranting here, I suggest you read this Harvard Business Review article here: Health Care Needs Real Competition - excerpt:

Here’s the good news: Thanks to the Affordable Care Act, or Obamacare, more Americans have access to health care than ever before. The bad news? The care itself hasn’t improved much. Despite the hard work of dedicated providers, our health care system remains chaotic, unreliable, inefficient, and crushingly expensive.

There is no shortage of proposed solutions, many of which have appeared in these pages. But central to the best of them is the idea that health care needs more competition. In other sectors of the economy, competition improves quality and efficiency, spurs innovation, and drives down costs. Health care should be no exception.

Industry executives may think they have more than enough competition already. They spend their days fighting to keep patients from being lured away by competitors, new entrants, and alternative sources of care. Their cost of delivering care continues to climb while hard-bargaining insurers hold the line on reimbursements, or even reduce them. Compounding the problem, the services that account for most of providers’ profits, such as radiology and ambulatory surgery, are the ones most vulnerable to poaching. It’s hard to sleep at night when every one of Michael Porter’s five forces is arrayed against you.

Many health care organizations have sought to stymie competition by consolidating, buying up market share and increasing their bargaining power with insurers and suppliers. From 2005 to 2015, the number of U.S. hospital mergers per year doubled.

The point being made: The business of Health Care in America is NOT truly competitive and never will be.

So much more reason that - like any other Key Public Service - it should be managed by the government ...

NB: And were it managed by the government, whilst costing far less, perhaps Americans would be living longer. At the moment, for about equivalent life-styles, Americans are living 3-years less than Europeans. (Don't believe it? See here.)

countryboy · Aug 2, 2017

Greenbeard said:
The profits you're talking about are coming primarily from those companies' government business.

Most of Aetna's revenue now comes from government programs

UnitedHealth's Government Growth Can't Be Ignored

Humana profit beats on Medicare Advantage unit strength

Anthem profit soars on higher membership growth and premiums

Cigna is literally the only one of the Big 5 whose first quarter earnings this year were driven primarily by commercial (not government) business, and that's because they missed the 2017 Medicare enrollment due to ongoing sanctions.

Wait, haven't you been critical of the administration for threatening to stop "cost sharing" payments? You can't have it both ways. :roll:

Greenbeard · Aug 2, 2017

Lafayette said:
Who cares where the profits come from when they are wholly exaggerated?

You said they shouldn't be profiting, we should have public insurance. Well, public insurance increasingly flows through private (often for-profit) insurers--in the case of the biggest insurers, "public" insurance (Medicare and Medicaid) is where they make most of their money these days. That's the reality of the world today.

The costs are too damn expensive and the reason is that there is, in fact, very little competition.

Rather than me ranting here, I suggest you read this Harvard Business Review article here: Health Care Needs Real Competition - excerpt:

But that's an article about providers, not insurers. It's a good article but if your argument is that provider consolidation is the problem (it may well be), then "price gouging" is something that's happening to insurers, not something they're doing.

countryboy said:
Wait, haven't you been critical of the administration for threatening to stop "cost sharing" payments? You can't have it both ways. :roll:

Have what both ways?

ALiberalModerate · Aug 2, 2017

Lafayette said:
Who cares where the profits come from when they are wholly exaggerated? The costs are too damn expensive and the reason is that there is, in fact, very little competition.

Rather than me ranting here, I suggest you read this Harvard Business Review article here: Health Care Needs Real Competition - excerpt:

The point being made: The business of Health Care in America is NOT truly competitive and never will be.

So much more reason that - like any other Key Public Service - it should be managed by the government ...

NB: And were it managed by the government, whilst costing far less, perhaps Americans would be living longer. At the moment, for about equivalent life-styles, Americans are living 3-years less than Europeans. (Don't believe it? See here.)

Wait a second. You start with an opening post blaming high premiums on price gouging by insurers, you then follow that up with a post about how many healthcare markets are monopolies and thus can demand far higher reimbursement rates from insurers. Thus in your first post, its all the insurers fault, in your second post its all the providers fault. Which is it?

digitusmedius · Aug 2, 2017

The fact that government pays private insurance companies to provide coverage that government fails to cover it is a further indictment of our rubegoldbergian contraption of health care in this country.

Lafayette · Aug 2, 2017

SouthernDemocrat said:
Wait a second. You start with an opening post blaming high premiums on price gouging by insurers, you then follow that up with a post about how many healthcare markets are monopolies and thus can demand far higher reimbursement rates from insurers. Thus in your first post, its all the insurers fault, in your second post its all the providers fault. Which is it?

It's both - open your eyes.

The practitioners (GPs, Surgeons, nurses, etc.) are the ones giving their prices to the insurers who then, based upon that information, calculate the cost-of-insurance for Health Care premiums! The practitioners are for the most part independent. Even some nurses.

Look at the BLS data for HealthCare average salaries, here: Occupation Code 29-0000 - Healthcare Practitioners and Technical Occupations - the mean salary in that occupation is $79K a year. And at the upper-end, a GP earns $200K, and a surgeons $253k.

And on top of that comes the Insurance Companies' cut of the loot ...

PS: Which leaves Mr. & Mrs America to pay through the nose for a life-span 3-years less than do Europeans. As seen in this infographic here.

ALiberalModerate · Aug 2, 2017

Lafayette said:
It's both - open your eyes.

The practitioners (GPs, Surgeons, nurses, etc.) are the ones giving their prices to the insurers who then, based upon that information, calculate the cost-of-insurance for Health Care premiums! The practitioners are for the most part independent. Even some nurses.

Look at the BLS data for HealthCare average salaries, here: Occupation Code 29-0000 - Healthcare Practitioners and Technical Occupations - the mean salary in that occupation is $79K a year. And at the upper-end, a GP earns $200K, and a surgeons $253k.

And on top of that comes the Insurance Companies' cut of the loot ...

PS: Which leaves Mr. & Mrs America to pay through the nose for a life-span 3-years less than do Europeans. As seen in this infographic here.

That is not how it works though. Insurers negotiate reimbursement rates for procedures done by providers in their network. Health systems have departments devoted to coding bills to maximize reimbursement from those insurers.

The average unsubsidized health insurance plan for a family in the United States runs between 20k and 22k a year. Let's say you cut out all the insurance executive bonuses out of that, cut out any stock dividends out of that, and cut the insurers profit margin. You will have then taken that 20k to 22k a year premium down to say 18k a year. That is a savings, but it is still extremely expensive.

Point being that the main reason why health insurance premiums are so high, is that health care itself is so expensive in the United States.

BTW, average salaries for doctors vary considerably. Orthopedic surgeons average 519k a year, Cardiologists 512k a year, Urologists 419k a year.

https://www.forbes.com/sites/jacque...rst-paying-jobs-for-doctors-2/2/#53cf94864d4c

Lafayette · Aug 2, 2017

Greenbeard said:
You said they shouldn't be profiting, we should have public insurance. Well, public insurance increasingly flows through private (often for-profit) insurers--in the case of the biggest insurers, "public" insurance (Medicare and Medicaid) is where they make most of their money these days. That's the reality of the world today.

But that's an article about providers, not insurers. It's a good article but if your argument is that provider consolidation is the problem (it may well be), then "price gouging" is something that's happening to insurers, not something they're doing.

The insurance companies take the provider cost as a base, and add their own cost-plus-profit in their policies. (That's "Business101"!) Have a look at the mean Medical Care service-costs here at the Bureau of Labor Statistics site for Healthcare Practioners and Technical Operations.

In a National Health Service, it is the Service that sets the price for medical treatment (which they negotiate with professional organizations). That means, all medical treatments. The same service negotiates pharmaceutical costs, which is why BigPharma breaks-even in Europe but goes to the US to gouge-out their real, mind-blowing profits.

When there is No Real Competition in any market, the comparatively few market-participators benefit by employing higher margins in their pricing*. Who is really "competing" in the market for Medical Services (of all kinds)? Which is why, dammit, the Healthcare Professions should be working at government set pricing-schedules!

Nobody ...

*In fact, the US has been allowing oligopoly-pricing to happen in a great many of its markets. Why? Because politicians get a lot of their campaign-funding from ... business-people! (Whaddaya know, Joe?)

Lafayette · Aug 2, 2017

SouthernDemocrat said:
That is not how it works though. Insurers negotiate reimbursement rates for procedures done by providers in their network. Health systems have departments devoted to coding bills to maximize reimbursement from those insurers.

The average unsubsidized health insurance plan for a family in the United States runs between 20k and 22k a year. Let's say you cut out all the insurance executive bonuses out of that, cut out any stock dividends out of that, and cut the insurers profit margin. You will have then taken that 20k to 22k a year premium down to say 18k a year. That is a savings, but it is still extremely expensive.

Point being that the main reason why health insurance premiums are so high, is that health care itself is so expensive in the United States.

BTW, average salaries for doctors vary considerably. Orthopedic surgeons average 519k a year, Cardiologists 512k a year, Urologists 419k a year.

Thank you for a very cogent reply! (You cannot imagine how rare it is on this forum!)

And I must agree - medical practitioners are overpriced for the services they deliver. And I have posted the Bureau of Labor Statistic Professional Wages site above to show the mind-blowing salaries that GPs and Surgeons are getting (at above $200K a year). I don't know where you get your figures from, but neither will I quibble about them.

GPs and Surgeons can remain in private-practice in Europe, but the "market for their services" is run by the National HealthCare Insurance Office that negotiates their pricing. So, if a practitioner wants to practice medicine, s/he is obliged to employ the NHC-service pricing. These remunerations are negotiated periodically, but the fact of the matter is that European doctors earn only half as much as t=do US doctors.

Many work for private "medical care centers" (aka "hospital") that align themselves with national healthcare services salaries.

ALiberalModerate · Aug 2, 2017

Lafayette said:
Thank you for a very cogent reply! (You cannot imagine how rare it is on this forum!)

And I must agree - medical practitioners are overpriced for the services they deliver. And I have posted the Bureau of Labor Statistic Professional Wages site above to show the mind-blowing salaries that GPs and Surgeons are getting (at above $200K a year). I don't know where you get your figures from, but neither will I quibble about them.

GPs and Surgeons can remain in private-practice in Europe, but the "market for their services" is run by the National HealthCare Insurance Office that negotiates their pricing. So, if a practitioner wants to practice medicine, s/he is obliged to employ the NHC-service pricing. These remunerations are negotiated periodically, but the fact of the matter is that European doctors earn only half as much as t=do US doctors.

Many work for private "medical care centers" (aka "hospital") that align themselves with national healthcare services salaries.

In a different thread on this subject I get into a debate with a specialist here in the United States about healthcare costs. It was my contention that costs are well out of line here in the United States compared to our peer nations, he argued that costs are justified (and of course he did not like insurers). While I never fully agreed with him, he brought up some good points. You can read the exchange, it starts here and then continues back and forth through the thread: https://www.debatepolitics.com/heal...ple-solution-healthcare-2.html#post1067462796

Lafayette · Aug 5, 2017

SouthernDemocrat said:
It was my contention that costs are well out of line here in the United States compared to our peer nations, he argued that costs are justified (and of course he did not like insurers).

"Justified" is simply a matter of "are we stoopid enough to accept what the rest of the civilized world refuses".

The cost of just about any service of the nature of US HealthCare is in salary-costs.

From here a detailed explanation (date 2002) of the nature of US HEALTHCARE COSTS (seriously reduced text from the original worth a read):

A free market for medical services with unregulated pricing often makes charges for US health care seem excessive to international payers. Fortunately, US health care market dynamics allow payers to implement cost containment tactics to ensure that health care providers accept payments below their normal prices. Even so, the costs for medical care in the US may appear very high from an international perspective. Following is a closer look.

In fundamental contrast to the public health agendas of most industrialized nations, the US federal government does not assume the role of a public provider of healthcare. It does not create the funds to make the investments in facilities and delivery of the services, nor does it directly control the production costs or pricing of health care ...

... The US has one of the world’s highest national health care expenditures representing 13% of Gross Domestic Product, much higher than other OECD countries, who range between 9-11% of GDP. US health care expenditures per capita in 1998 were $4,178 compared to $2,424 in Germany, the second largest per capita health care spender among the OECD countries.

Some often-cited reasons for the higher costs for health care in the USA are ...

See the rest in more detail linked above ...

PS: Note that the author is a Dane, thus coming from a system of governmental supplied National Heathcare!

Lafayette · Aug 5, 2017

SouthernDemocrat said:
In a different thread on this subject I get into a debate with a specialist here in the United States about healthcare costs. It was my contention that costs are well out of line here in the United States compared to our peer nations, he argued that costs are justified (and of course he did not like insurers). While I never fully agreed with him, he brought up some good points. You can read the exchange, it starts here and then continues back and forth through the thread: https://www.debatepolitics.com/heal...ple-solution-healthcare-2.html#post1067462796

Yes, the author is giving a "personal description" of how awfully expensive is the US system. And, as I keep repeating it is due to the very large overhead costs of running it.

With this very important criteria: Healthcare is NOT an ordinary service. It is intensely human-power based. Salaries in the job are hallucinatory - with GPs earning $200K a year (average).

The fundamental reason for the European National HC-systems was to control the costs. Which it does by mandating the cost of the services (both personnel and pharmaceutical)!

International comparative-cost chart:

US_health_spending_is_much_greater_for_all_categories_of_care_slideshow.jpg

Note the difference in "yellow" of administrative costs ... !

PS:Note also that the above is "per capita" costs, meaning the costs are displayed as "per head of population using the service"!
PPS: Note also that the US is paying TWICE the per capita cost of Canada. Now does anyone understand why Hillary went to Canada to understand the cost-structure BEFORE proposing a NHS-solution in her husband's administration? Which the Replicants sunk with some silly-assed TV-advertising "Harry & Louise" that Americans swallowed hook, line and sinker.

digitusmedius · Aug 5, 2017

SouthernDemocrat said:
Let's say you cut out all the insurance executive bonuses out of that, cut out any stock dividends out of that, and cut the insurers profit margin. You will have then taken that 20k to 22k a year premium down to say 18k a year. That is a savings, but it is still extremely expensive.

Are you sure that's all the savings would be? How much of a profit margin would that leave them? What if there were a zero profit margin--i.e., the kind Medicare has?

ALiberalModerate · Aug 5, 2017

digitusmedius said:
Are you sure that's all the savings would be? How much of a profit margin would that leave them? What if there were a zero profit margin--i.e., the kind Medicare has?

Well let's look at Humana, they had a Medical Loss Ratio in 2015 of 86.7% for its retail plans. So basically, 13% of premiums go to administrative costs, operating expenses, profits and so on, and the rest remaining 86.7% pays providers. So even if you cut that 13% down to Medicare levels, you are still left with very high premiums. Moreover, Medicare's administration costs are more than the 3% often touted because it is partially administered by outside agencies. Medicare is still more efficient than private insurance, but not that much more efficient.

Anyway you slice it, the problem is that healthcare itself is too expensive. High insurance premiums are just a symptom of that. Blaming high healthcare costs on insurers is like blaming high gas prices on the gas station attendant.

digitusmedius · Aug 7, 2017

SouthernDemocrat said:
So even if you cut that 13% down to Medicare levels, you are still left with very high premiums. Moreover, Medicare's administration costs are more than the 3% often touted because it is partially administered by outside agencies. Medicare is still more efficient than private insurance, but not that much more efficient.

I hear or read that claim a lot but never any corroboration. I'm not saying it isn't correct but where do you get that? And why is that the case? Is it that Congress deliberately sets this up to make sure some extra federal money lands in various congressional districts or some rich guy's company (see Ross Perot's EDS which owed its success to doing Medicare work, something that the government might well have done itself). In any case, much of that sub-contracting is just another way to spread government pelf around. And are you suggesting that the source of the problem are the medical providers and hospitals by the statement below?

Blaming high healthcare costs on insurers is like blaming high gas prices on the gas station attendant.

I wouldn't necessarily argue disagree with that if you were. BTW, I'm a KC native myself. Go ROYALS (damn it!).

ALiberalModerate · Aug 7, 2017

digitusmedius said:
I hear or read that claim a lot but never any corroboration. I'm not saying it isn't correct but where do you get that? And why is that the case? Is it that Congress deliberately sets this up to make sure some extra federal money lands in various congressional districts or some rich guy's company (see Ross Perot's EDS which owed its success to doing Medicare work, something that the government might well have done itself). In any case, much of that sub-contracting is just another way to spread government pelf around. And are you suggesting that the source of the problem are the medical providers and hospitals by the statement below?

I wouldn't necessarily argue disagree with that if you were. BTW, I'm a KC native myself. Go ROYALS (damn it!).

An explanation of Medicare's administrative costs is here: https://www.forbes.com/sites/theapo...icares-low-administrative-costs/#6ebcf080140d

digitusmedius · Aug 8, 2017

SouthernDemocrat said:
An explanation of Medicare's administrative costs is here: https://www.forbes.com/sites/theapo...icares-low-administrative-costs/#6ebcf080140d

I'd sure like to get a source other than Forbes for how "inefficient" Medicare is but even that article doesn't try to get around what the problem is when you're insuring only the portion of the population with the highest health care needs. No matter what system is used, health care coverage really relies on an "all-in" premise to be able to work.

Republican makes first move to work with Democrats on healthcare

Lafayette

Greenbeard

Lafayette

countryboy

Greenbeard

ALiberalModerate

Pragmatist

digitusmedius

Lafayette

ALiberalModerate

Pragmatist

Lafayette

Lafayette

ALiberalModerate

Pragmatist

Lafayette

Lafayette

digitusmedius

ALiberalModerate

Pragmatist

digitusmedius

ALiberalModerate

Pragmatist

digitusmedius