WatchMy high-deductible Blue Shield plan premiums just went up 20% with no real explanation.
I try to shop for insurance on the web, but it's only a thicket of salesmen who won't give a clear quote and demand my phone number and email. And almost all "alternatives" are once again Blue Shield or Blue Cross which seems to have defeated the free market very effectively by combining as "Wellpoint".
Anyone have advice on getting reasonable health insurance in California?
Or should I just buy stock in Blue Shield? Ticker is WLP.
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Yet in comparison, those administrative burdens pale in comparison to the massive amount of fraud in government controlled healthcare each year http://ur.lc/iei (that doesn't even begin to include Medicaid fraud) , squandering billions of dollars that cannot be used for needed healthcare, because govt has no incentive to seriously crackdown on the fraud.
If we're going to examine the best alternatives with imperfect systems to choose from, then let's discuss which systems are the "least bad" by the numbers. Govt has the worst track record by far
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Menlo Park, CA
Premium
bob2356 says
When we first moved to California we had Kaiser for a year, and found the facilities to be dumpy and the office waiting time very long. Hours long. And we live very close to Stanford and Palo Alto Medical, and Kaiser won't pay for those, only for their own hospitals.
Maybe they've changed, but they were not at all impressive 12 years ago.
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Saint George, UT
elliemae's website
Kaiser is the ultimate HMO. The goal is to hold down costs by denying procedures. It works for them. I've had several clients who moved out of state and Kaiser refused to drop the coverage (thou legally they have to when requested).
HMO's work by providing services at plan providers, including hospitals. Even if another hospital is closer and the ambulance takes you to the closest hospital, services will be denied and it will be necessary for the patient to be moved to a provider hospital. I've seen this happen even though the doctors say it's not in the patient's best interest to move.
The greatest benefit to having Kaiser as insurance is for Kaiser.
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elliemae says
elliemae says
What huge profits? 4 cents on the dollar? What should it be capped at: 2 cents?
elliemae says
Since you talk about huge profits of insurance companies, despite their profits being quite low, what exactly are the "huge profits" from the big pharmas? Got a number?
elliemae says
And soon enough, they may not let Patrick buy an individual insurance policy in CA because they'd rather have a profit than a loss. Take a look at the article I posted. Should they deliberately operate at a loss, or be forced to?elliemae says
What about being allowed to do their jobs without the increased premiums due to the risks of being sued for malpractice? Why is it that my wife's OBY for one child could not deliver the next, because she stopped delivering all children due to the cost of malpractice insurance? She had a very long, incident free career, and her malpractice insurance increased substantially because of the increased statistical risk that she would be sued (whether for legitimate reasons or not), due to her extensive experience with no suits.
What are the profit margins of malpractice law firms? Do you think their profit margins should be capped to perhaps 4%, as well, or would this put too much of a dent in the DNC coffers? What has John Edwards done for the cost of health care and insurance?
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And this is why we need single-payer non-profit health insurance for all.
Until then we have to deal with the crooks who call themselves "heath insurance companies." They're really Cartels who have their own Death Panels. They can deny service for any reason even if you've paid up on time. That's not changing much with the so called Republican influenced "Health care Reform Bill."
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Portland, OR
Did you guys ever see this? It's an ex -executive of Cigna speaking out...aka whistle blower...Wendell Potter
http://www.youtube.com/watch?v=7QwX_soZ1GI&feature=player_embedded#!
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Bellingham, WA
Paralithodes says
Wellpoint 1Q10:
Total Revenue: $15.1B
SG&A: $2.2B (15%)
Operating Income: $1.4B (9%)
Shareholder profit: $880M (6%)
Shareholder profit would have been 8% had they not lost $305M at the dogtrack for the quarter:
The Indianapolis insurer said it paid $11.38 billion in claims in the three months that ended March 31, a drop of nearly 3 percent — or $343 million — from the first quarter of last year, when WellPoint also took a $305 million hit due to investment losses.
http://blog.taragana.com/business/2010/04/28/wellpoint-1st-qtr-profit-surges-as-weaker-flu-season-helps-insurer-keep-expenses-down-55075/
F---ers just raised my rates 30% on my $1750/yr deductible plan, too, from $200 to $250/mo. Decided to drop down to the $4500/yr deductible @ $180/mo and see if I can stay out of the hospital this coming year, too.
Wellpoint's skim is more like 25%:
Overhead (SG&A + Operating Income) = ~25%
which is backed up by the fact that it only paid 75% of income as claims in the MRQ.
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Wellpoint, and others, may certainly have a quarter here and there that is more or less than 4%, and despite that the average over time is about 4%, 6 cents on the dollar is no "huge profit" either. Troy says
This, of course, is not = to profit, whether "huge" profit or tiny profit.
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Troy says
That does certainly suck (meant sincerely, no sarcasm at all).
The Government just raised the family rates on Tricare Reserve Select - a group of those covered where the primary beneficiary is typically under 60 years old, just get periodic health exams to continue coverage (to stay in the Reserve that is), maintain physical fitness standards - or at least weight standards, about 10% from last year, and it is not looking good for the future.
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Hmm. I heard they were raising their rates. They haven't raised mine yet.
Insurance companies get singled out as the villain, but they're really not the main villain. It's just very broken system, with very perverse incentives. The economics of insurance already do not mix well with free markets. Most of the reason for skyrocketing costs is more use of services, mostly with extremely little cost/benefit, mostly going into the hands of doctors & the parma/equipment/supplies/test industries around them.
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Bellingham, WA
Paralithodes says
WellPoint's job is to transfer money from its enrollees to the service providers its enrollees use.
For this service, it is taking a 25+% taste of the action, divided between administrative overhead + shareholder profit.
Canada's Medicare system runs at a 3% cost to its enrollees. But that's socialism, so it's bad.
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Troy says
Pretty loaded way that you describe it.... including the much larger overhead cost with the much smaller profit as "a taste of the action." They're capitalist, therefore they must be described in greedy, evil terms, right? You can describe it any way that you want, but why conflate them when you can just objectively argue that despite the fairly small profits that insurance companies make, the inefficiencies of the system is a huge problem to be addressed? You'd get a lot of conservatives to agree with you right off the bat. Claiming that these insurance companies make "huge profits" is simply engaging in, or being a victim of, propaganda. The issue is much larger thant this simple "huge profit" talking point.
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Paralithodes says
Which insurance company do you work for?
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Paralithodes says
I agree that the issue is much larger than this, but insurance company's profits are a large issue. They do make huge profits whether you admit it or not. Perhaps it will be clear if I ask you this--what do you consider a large profit, anyway? Not margin. $$.
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Bellingham, WA
Paralithodes says
I wouldn't be pissed off if the free market were working.
As a financially-responsible person, I consider health insurance a non-optional fact of life now (a fact that will soon become a mandated fact), and with all mandatory spending, the pricing power shifts to the seller.
It sucks to know that $50 of my check to BlueShield every month goes to their overhead, and that the free market is giving me zero choice in this matter, other than Kaiser, who nearly killed my Mom in the 1970s.
I don't begrudge first-movers in the wealth-creation sphere the profits they get from limited competition -- Google, Apple, Intel etc. have added an immense amount of wealth to the world to justify their financial windfalls. I simply fail to see Wellpoint's value-add, its raison d'être. As tatapu mentions above, saying they only have a 4% profit margin (aside from the fact it's closer to 10%), this profit margin is coming from an immense flow, $15B/quarter.
My State Farm policy is also mandatory, but I don't sweat how much money they're making from me because my total outgo is just $600/yr with them so it can't be that much, plus I have other choices for providers if State Farm gets too expensive. Similarly with the messed-up soda biz we have -- Coca Cola and Pepsico have established a duopoly with rather impressive (and apparently durable) profit margins, but water is a suitable substition good for me so they don't pull $50/mo from my wallet every month.
Health insurance is different -- the only substitute good is a shotgun in your mouth if you can't afford medical treatment due to being uninsured.
Health insurance can be socialized to create better outcomes for all (except for the skimmers in our current system). Which reminds me, I do have a third choice, moving to another first-world country -- Japan, Oz, NZ, Canada, Denmark, France, Germany -- that does run a socialized single-payer system.
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Portland, OR
And in today's news...Regence sued over denied surgery claim
http://www.katu.com/news/local/95191264.html
She said it's especially frustrating since Regence was willing to pay for a more expensive procedure to fuse Wampold's spine, but not for the cheaper disc replacement that would have helped her the most.
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Saint George, UT
elliemae's website
Lawsuits like this should happen more often. Insurance companies should have to pay for procedures instead of spending hundreds of thousands of dollars on denials.
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I was recently talking to a doctor at Kaiser. When a patient needs to see a specialist -- if the specialist is not currently with a patient -- they will come directly to the doctor's office. The patient doesn't even have to walk down the hall. And, get this, the doctor is there when the specialist sees the patient, so they get some on the job training (which helps reduce later referrals and increase the doctor's depth of knowledge). The doctor believes the quality of care that patients get is better than at the last place the doctor worked.
And a little more on the innovation front to reduce health care costs.
So far, Geisinger says it is pleased with the early results. In an unpublished review of 2008 data, Geisinger experienced an 18 percent drop in hospital admissions; overall medical expenses fell 7 percent. Geisinger expects to publish a study on its results later this year.
Patrick, any news on the insurance front? The PA Kaiser seems to get some love on Yelp (as well as some detractors).
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Redwood City, CA
I had Kaiser for a couple of years, I used them occasionally, my wife used them more often. She preferred them to blue shield. We were never denied anything, never had any issues. My wife learned later that they had cut a couple of corners, some tests that other doctors said should be done yearly, they did every 18 months. I'm not totally sure how "abusive" that is. She's young, so likely the time frame was enough, maybe doctors outside are trying to make more money, or fear being sued for not pushing for tests as often as possible? I enjoyed them the few times I went there though, had good experiences.
I of course have a backup plan. If things go south quickly with denials for something that obviously needs taking care of, I'll go to Canada and get it done. Others on here don't have that possibility and I feel for them.
Blue shield has been pretty good, but is also scary. I've seen far too many people stuck with large bills through them. Perhaps not for denials but for things they didn't cover in some way completely. I use blue shield HMO through the Palo Alto foundation, so all my referrals are within one building and it works like Kaiser did more or less.
Insurance companies can only claim profits of so much, but if they charge more, and pay out more, they can increase their bottom line, while not increasing their profit margins. If you make 2% on $100 that's $2. If you raise expenses to $1000, now you're making $20. Still 2%, but a huge jump in profits.
The system isn't designed to help people get better as fast as possible either. It's designed to frustrate them and cause them aggravation while they fight for drugs, care, procedures ever day when they are sick. I've now seen several people in this boat, and I'm simply amazed at their ability to juggle life + getting better from cancer + fighting every day for some drug or test to get covered + cover all their financial obligations as well!
It's a broken system. Most people don't need it, so they don't realize how broken it is. When they do need it, they become the minority, and aren't heard enough. Some get fixed, some die, and others are left hanging. The hanging ones aren't loud enough to let the rest of us know what's going to happen to use later on in life! We're *ALL* going to need medical at some point in our lives.
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Paralithodes says
That's not right. Take a medicine that cost $1800 which actually took $0.20 in materials to truely make.
A patient with insurance buys it netting them practically $1800 in profits (but of course you have to recoupe for R & D). These companies earn so much money that their tax rate is practically 50%. So real profit here is $900.
The company then just gives the medicine away for free to ones in need (no insurance) and writes off that they've donated $1800. The $1800 they've earned in the previous sale becomes non taxable income. So they saved $900 on taxes they would have paid had they not given the medicine away for free. There's no such thing as a free lunch.
If they can ideally have a balance of how much they sell and how much they give away, they'd earn the same amount of money regardless of whether it was sold to the end user, or just handed out to them.
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I have been really happy with Kaiser. I moved here 2004 and I really have had very few complaints. I am dealing with a serious health problem and have had zero issues with cost related to treatment items, believe me it has been really expensive. I have been denied nothing. Yes, you are not going to be able to go outside their system without eating the cost. This is very similar to what a single payer system might look like. They provide insurance, drugs, tests, doctors and hospitals and various other facilities. They will occasionally contract out some services, my experience with this has been they choose first class contractors. My understanding is that the service does vary somewhat from area to area and my experience is in Marin/Sonoma and SF facilities.
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Insurances that handle California.
United Healthcare
Pacificare
Humana
Cigna
Aetna
I think Great West Healthcare (but this is also Cigna)
That is pretty much it.
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rdm says
Yes you have been denied nothing. But see the old controversey with Kaiser is that your PCP probably sees something else that is wrong with you, but keeps his mouth shut unless you complain about it.
Would they deny you treatment had you complained about it? Probably not.
Kaiser MD's are paid salary + bonuses. What they base their bonus on - only god knows.
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Oakland, CA
Actually, I've had Kaiser for the last few years after being soaked by a Pacificare PPO plan and the threat that my premiums would double (United Healthcare took Pacificare over that year and it's a terribly evil company). I developed a relatively simple arrhythmia that came out of nowhere and the cardio-electrophysiologist tried to ablate it twice. I was left with huge bills that took me almost two years to resolve.
So, when open enrollment came up I switched to Kaiser with caution and nervousness because of their reputation. It was what I could afford.
I chose a PCP who specializes in treating chronic conditions. This electrical issue with my heart is chronic. She was the first doctor in all my years of seeing private practitioners using PPO insurance plans who took my insomnia seriously. I was sleeping a total of only 3.5 hours per night and in about 10-15 minute spurts. It took me a good 2-4 hours on average to fall asleep. Other doctors dismissed the insomnia or wrote me prescriptions for Ambien and other sedating drugs that are only supposed to be taken occasionally. Most sedating drugs really don't work well for me. I feel drugged but I still don't sleep. I've been an insomniac all my life. My mother reports that I've had trouble falling asleep and staying asleep since I was two years old. It runs on my Dad's side of the family.
She ran a few tests and then prescribed a cheap old drug and the Sleep Lab set me up with a sleep machine. I sleep better than I've ever slept. It's transformed my life radically.
Kaiser's Sleep Lab is top notch here in Oakland. They are extremely friendly and they give free-bees occasionally if you have issues with the parts for your sleep machine. Also they are always there to answer questions or give advice over the phone.
My cardiologist at Kaiser is friendly and has been competent enough to continue my treatment in consultation with my old cardio-electrophysiologist who started me on beta blocking anti-arrhythmics when the surgeries didn't work.
I've even used their mental health services. The clinicians I've seen have been excellent. It's too bad that they don't offer ongoing therapy for people in the mental health field because I believe we shouldn't be practicing psychotherapy without being in psychotherapy ourselves. We hold a lot for the people whom we serve and we should have a therapist of our own to lean on. I use them when I feel I need a "tune up" for mood issues related to on the job stress. I get just enough sessions that I get through some of the worst burnout that happens as a result of my job.
One of the maintenance medications I take wasn't on their formulary. I was concerned that when I switched to Kaiser they'd force me to switch to something I didn't want to take that was on their formulary. Instead my PCP simply entered a code into their system and I'm charged the "brand" price for that drug which isn't on their formulary.
My PCP helped me to get my cholesterol which was borderline down with diet, exercise, and niacin supplements so that I could avoid having to take cholesterol drugs that might mess with my liver. High cholesterol runs on my Mom's side of the family. No matter how thin people are on that side of the family or how they eat no animal products, they have insanely high cholesterol.
So, I use Kaiser regularly and I'd say that I'm a heavy user of their services. I haven't been denied any care, other than wanting more psychotherapy due to the profession I'm in.
And, I've just been chosen to be on a patient panel of satisfied Kaiser patients. We're going to be answering questions from Kaiser physicians on how to improve their level of service.
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So why isn't health "insurance" more like car insurance? First, you don't use your car insurance to get your oil changed (preventative maintenance) why should you use health "insurance" to cover health PM like physicals, teeth cleaning, eye exams, etc? Don't you think if health "insurance" was used as pure insurance costs should go down? Second, why do I see a thousand geico, esurance, progressive, all state, etc. etc. etc. commercials no matter what state I go to? Why can't I buy health insurance the same way?
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Oakland, CA
Why is it that I see tons of Kaiser, United Healthcare, Cigna, and Blue Cross ads on television around here?
And why is it that I see bazillions of pharmaceutical commercials for various drugs that do anything from control your bladder to lower your cholesterol to brighten your mood to control your hallucinations to shrink your prostate to increase your sex drive to give you erections, etc.?
Why is it that I can live without a car, ride public transportation, take cabs, and walk to avoid paying car insurance or maintanance but I can't seem to get away from needing regular maintenance on my body that will continue to age and break down with time?
Why is it that certain people can't understand that auto insurance is something that covers a want? Health insurance is different in that it covers a need. All people eventually need to see a doctor. Therefore everyone needs to pay for it somehow. Responsible people who are fortunate enough to be able to afford it do it through insurance so they don't end up bankrupt (if they are lucky enough not to get too sick so that they have to pay beyond what their insurance covers.) Not everyone needs a car and therefore not everyone needs auto insurance.
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I agree choice (freedom) is nice.... If you choose not to drive a car, you don't have to buy insurance. If I choose not to buy health "insurance" too bad for me... not you. Why is it that people can't see that buying or not buying something is a choice/freedom?
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Forcing everyone to get health insurance covers the people that are extremely troubled with their health. In their situation, they do not want to by insurance/assurance. They are simply trying to get more from the bucket than what they are putting in. They can keep draining the system all they want. But those people will still be prone to sickness. It just becomes a burden to society.
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Redwood City, CA
@vain
Drug manufacturing isn't as simple as mixing A and B together to get a drug. Some are very expensive to make.
Second, drugs take roughly 13 years to manufacture, from the date on inception to sell date. We have 20 year copyrights, which means that gives them roughly 7 years to make all that money back. Drugs in general take about 1B to get from inception to the shelf. This also include failures, etc. On average it's about 1B to get each drug the shelf. Then they have 7 years to recoup that money.
If the drug is for curing diabetes, you're set! You could charge $5 and make a fortune. If it's a drug to prevent kidney rejection after a transplant, there are far fewer people to sell to, and you still need to make up that 1B. Some drug treatments cost 100's of thousands per treatment.
Here is the big kicker though, and a major issue to deal with. Countries like Africa simply told the drug companies "We're breaking the copyright and making your Aids drugs, and you make $0, or you can sell the $1500 drugs for $1" They have the right to protect their citizens.
Now people are probably familiar with the 80% discount for Canadian drugs. (You've probably seen 50% discounts online, but the people selling from Canada are making another 30% or more!) Canada has done something similar to Africa, negotiating drug costs way down. Same with the rest of the world. The only place that hasn't done this, is the US. While these drugs make profits for the companies in the rest of the world and they aren't going to turn down sales, they aren't going to recover their 1B R&D. The US pays for almost 90% of drug development costs. To bring costs down, all other countries are going to have to pony up as well. Good luck :)
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pkennedy says
True, BUT
1. Pharma spends more on lobbying lawmakers than research.
2. Pharma spends more on advertising the most profitable drugs than research.
3. Pharma spends a lot of R&D making minor changes to existing drugs going off patent soon in order to gain a new patent.
Big Pharma is neither good, bad, or benevolent, they are simply a business, which like any other business will do anything within the law to make profits. If they feel getting 90% of costs from the huge markups in the US is in their best interest then that is the way it will be.
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jkingeek says
Not true, unless you have enough money in the bank right now to pay off a worst case scenario medical problem. Otherwise you are just gambling with other peoples money. Everyone else will pick up your unpaid medical bills if something happens when you are uninsured.
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bob2356 says
Here's the analogy I'd use: If you choose to drive, you must buy car insurance. If you choose to live, you must buy health insurance.
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Rate hike warnings:
President Barack Obama warned U.S. insurance firms on Tuesday not to use his healthcare overhaul as an opportunity to push through big rate increases and said the federal government would work with states to monitor them....
Obama's warning followed a Kaiser Family Foundation report that showed health insurers are raising prices by an average of 20 percent for working-age adults who buy their own policies.
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Redwood City, CA
@bob2356
Without doing any research, I could maybe see more on advertising than research. Maybe. Lobbying? No way.
You can't spend billions on lobbying. These companies are investing billions. No one is spending billions lobbying.
They are tweaking current drugs because new drugs are becoming harder and harder to find. We're entering a time when we either have to change drug research strategy, or live with fewer new drugs. Durgs aren't often "made", they're pulled from nature and then tested against problems to see if they cure anything. So we've tapped out most of that type of research already.
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@bob2356, I'm not gambling with anyone's money... If I don't buy health "insurance" and I get sick, I don't get care, I'M screwed by my poor CHOICE not to buy insurance, NO ONE else. The point is that should be my choice as a free man.
@tatupu70, Analogy doesn't work. Driving is a choice, existing is not. Feel free to go down the path I assume you will take this....
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jkingeek says
I was being somewhat facetious, but that's the point isn't it? Existing is not a choice so you can't choose to not have health insurance. Unless we as a society decide it's OK to let you die. Which is a very poor policy choice.
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By your logic we should all be forced to buy/rent housing too.... what if by choice I decide to live in a tent in the woods? Should society decide for me that that's not the right thing to do and force me to buy/rent housing? Where do we draw the line and let people be responsible for themselves? Don't get me wrong, I understand health care is expensive and I don't claim to have all the answers to lowering it. But, we can not and should not "as a society" decide for an individual what they have to do.
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Redwood City, CA
@jkingeek
You *will* need medical care at some point. This isn't like car insurance where you *might* need it, and many won't ever use it. You *will* need it. If you don't understand this, then you're young and feel invincible, or uninformed of necessity of health care and you need help there too.
If you choose to live in a tent, that doesn't really effect the population. However, the population won't stand to let people die. Which means the population will have to step in, if the need arises. I don't think I've ever seen someone with cancer, and without insurance say "I'm sitting at home, waiting to die. I didn't buy insurance, so I'm not looking for any help either. ops.. my bad..." People either can't purchase it for some reason or another, or don't understand how it is going to impact them if they don't. Finally their mistakes cost the population. Living in a tent doesn't.
It's about society and it's values.
Live in a tent like a crazy man. OK.
Die at the curb of hospital an agonizing death. Not OK.
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jkingeek says
Well--as a society we have decided that being homeless is OK. Just go to any major metropolitan area and you'll see people without homes, so clearly we've drawn the line before that.
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@ pkennedy
I don't feel invincible, I understand that if I eat fast food everyday and don't exercise I will have health problems. Therefore I CHOOSE not to eat fast food everyday and I CHOOSE to exercise. I also understand that there is a chance of developing some random disease or cancer at some point in life. Therefore I CHOOSE to have health "insurance." We should not take away choice (freedom) in the name of making society feel better about itself. Everyone dies, no amount of money can ever change that fact. Don't get me wrong, I don't want people to die prematurely but the fact is it happens all the time. A lot of times it happens after being treated with the best health care known to mankind. Forcing people to buy health "insurance" isn't going to change that but it will set a precedent that it's OK for society to decide what YOU have to do/buy.