Reasons for or against Health Care Reform

[Chuck]

Originally Posted by PinkFloydActuary

Exactly. I'm still baffled by the perception that insurance companies don't try to be as efficient as possible. Is there no incentive today to be competitive and keep rates down?

I thought part of the intent of HCR was to keep the markets competitive. Setting the MLR where its will likely force more consolidation and offer less choices. In the small group market, do you have more or less companies competing when SGR in that state includes MLR and modified community rating.

The only saving grace here is that a lot of the details are being farmed out to the NAIC. They may not be perfect, but at least they mostly understand insurance, which is more than we can say for Congress...

I think one of the mostly unspoken beliefs involves the 15 -25% (?) in distribution/marketing/sales costs. Apparently insurance companies unecessarily market and incentivize sales and while we need to compete, we really don't need to compete. All somebody needs to do is fire their field force (or direct sales infrastructure), lower costs, put their products on a website and just wait for the business to roll in. After all, we've just been handed 31 million new customers on a silver platter.

Then the followup to that is if we had single payor, those costs would most definitely disappear. Of course they probably would, but they don't talk about what those costs are replaced by.

[FormLetter]

Originally Posted by twig93

Wrong, doctors offices have massive staffs who do nothing but deal with insurance companies. That's part of the reason HMO's are often cheaper for a comparable level of benefits.

My chiropractor estimates that 25% of his expense is in billing insurance companies. (Counting all compensation, including his own as "expense".)

Your chiropractor doesn't have to accept insurance.

That might highlight the fact that most of his patients wouldn't be willing to pay $80 per visit. They are willing to pay the $20 copay (which I know a lot of chiropractors actually waive anyway), just not the full price of the visit.

[Incredible Hulctuary]

Originally Posted by twig93

So for example, if I'm a Native American I don't have to have the coverage. But if I want it, I can get it... even if I have a pre-existing condition. So I'll just sit around without insurance until I get sick and then I'll buy the insurance. Anti-selection at it's finest.

Know any more details behind the Native American exemption? It might be applicable only to those who live on reservations.

Even if I'm not so lucky as to be Native American (or one of the other classes exempt from the mandate), I can do the same thing and pay the paltry fine, which is a lot less than the insurance premium.

The only way for this to work is for it to be truly cost-neutral to the individual or the employer making the decision.

Based on some examples I've seen, the after-subsidy cost to individuals making under $20K-$30K would be almost the same as or less than the fine.

[whisper]

Originally Posted by FormLetter

That might highlight the fact that most of his patients wouldn't be willing to pay $80 per visit. They are willing to pay the $20 copay (which I know a lot of chiropractors actually waive anyway), just not the full price of the visit.

A friend of mine one day looked at the chiropractor charge for some of the services he was getting. $80 would be cheap...

[FormLetter]

Was he looked at billed charge or allowed charge?

[whisper]

Originally Posted by FormLetter

Was he looked at billed charge or allowed charge?

I believe he looked at what the insurance company was paying. He was rather shocked at the amount - especially the for the value added. I think the charge was about $300 for him to sit on a table and stretch (without the doctor doing something at the same time).

[Brad Gile]

Originally Posted by whisper

A friend of mine one day looked at the chiropractor charge for some of the services he was getting. $80 would be cheap...

A little Wisconsin history here. Back in the late 70s or early 80s, there was a push for mandated Chiropractic insurance benefits. At that time, chiropractic office visits were much less than doctors and proponents of a mandate harped on this and they hired a heavyweight actuary (E. Paul Barnhart!) to do an actuarial cost analysis for them. His analysis was well done except that he failed to consider the possibility that, with mandates in hand, the chiros just might crank up their rates!

The legislature passed a bill and the guv signed. Yep, chiropractic charges skyrocketed shortly. I suspect this was duplicated in other states passing chiropractic mandates. Slam dunk.

[Wigmeister General]

I'm buying a lot of guns, bullets, canned foods and storing fresh water in strategic places all over the world.

[twig93]

Originally Posted by FormLetter

Your chiropractor doesn't have to accept insurance.

That might highlight the fact that most of his patients wouldn't be willing to pay $80 per visit. They are willing to pay the $20 copay (which I know a lot of chiropractors actually waive anyway), just not the full price of the visit.

What he does is give patients without insurance (or with insurance that doesn't cover chiropractic) a hefty discount. A massage therapist working out of his office flat out won't accept insurance. She's good enough that she stays booked even without accepting insurance.

[twig93]

Originally Posted by whisper

A friend of mine one day looked at the chiropractor charge for some of the services he was getting. $80 would be cheap...

Huh, the fee for an adjustment at my chiropractor is less than $80... with or without insurance.