patrick.net

artistsoul says

Then, the pool just has unhealthy people (adverse selection) & it will be impossible to cover the costs.

In 2014 we will get the mandated (and subsidized entry of millions of people into better programs), assuming the Republicans don't destroy government over this 2011-2013 (not likely) or take over completely in 2012 (entirely possible).

Most families will basically have government-subsidized health insurance, with the subsidies being $500/mo for a family of 4 earning $66,000 per year.

How we're actually going to pay for that subsidy is an open question.

Isn't repeal of Obamacare job 1 for republicans? House votes on this 1/12. So they don't get it done until a new Senate and/or president in 2012. Something to watch.

Troy says

How we’re actually going to pay for that subsidy is an open question.

We are just going keep stacking up debt of course.

The US pays twice as much for healthcare as the rest of the industrialized world per person, for worse results:

http://en.wikipedia.org/wiki/Health_care_system#Cross-country_comparisons

So there's huge potential for cost savings in simply peeling the insurance/hospital leeches off our collective body.

That means following the lead of countries like Germany and Japan, which are very rich but do not allow doctors and hospitals to bill infinite amounts of money.

Patrick, How about voting with your feet. Admittedly, the most you can probably knock off is ~$200/month (and then the SOBs decide to raise rates the next year, once they have ensnared you ). My choice for you and your family (after 'shopping' at healthcare.gov) would be Aetna Managed Choice Open Access Value 8000. I like it as the deductible is waived for the first five doctor and specialist visits (there is a $50 co-pay). Seems to be kinder/gentler catastrophic coverage. YMMV on the prescription drug benefit. Premiums should be $200 less per month (right?!)

American could go the route of Germany & Japan. Probably we will have to. But know that with that choice we have to adopt their standards of care including wait times, their views on death (how far they intervene) and about 30% of us have to go on a major ass diet to get the same outcomes. I can say that we can't afford to continue to do things as we are now.

APOCALYPSEFUCK says

Anyone of us is free to buy a hospital, of course, and fire whoever doesn’t please us or double our lifespans and frequency of sex to 10-100 times a day, etc. That Freedom is what makes America great!

Ah, if it were only that EZ.

justme says

So their benefit spending went up 12.9% but they raised my premiums 73.8%. That’s simply criminal extortion.

This is the essence of it. MarkSF and SFAce, how do you explain that? To me it looks simply like exploitation, blamed on Obamacare.

I don't know. I also have blue shield, which I pay myself being self employed. They raised the premium about a year ago. Then a few weeks ago I got something in the mail saying it was going up, then another letter a week later saying oh, by the way it's actually going up more, effective March 1.

Even after that, my premium has "only" gone up by 74% over the 5 years since I've been with them. (~12% increase per year).

It's getting the the point I wonder why I bother paying. My only real experience with the system 10 years ago pretty much convinced me the system is all about doing as much as possible, even if is obviously not effective, and extracting as much money as possible. (3D imaging CT scan didn't come out? Oh, well, we'll still bill your insurance CO $1,200.) Maybe I'll just ditch my motorcycle, and self-insure.

artistsoul says

Or it could be that the CA Blue Shield is in a death spiral.

Yes. A lot of the insured are perfectly healthy people that are disgusted by the costs of insurance. More every day. And that makes the pool of insured the more expensive cases. Rinse and repeat.

MarkInSF says

Maybe I’ll just ditch my motorcycle, and self-insure.

I'll be paying $222/mo in March for the $4500 plan.

It's got free preventative annual checkups (& labs I think) and no lifetime limit now, so ~$2000/yr actual cost.

I had a trip to the ER two years ago that I was billed $5000 for. Actual out-of-pocket cost was ~$600, that was with the $1700/yr deductible plan, when it was under $200/mo.

MarkInSF says

MarkInSF

Wow, how cool is this? I agree with MarkInSF! :)

Well, kind of...

The point Mark makes is where to point the blame. Maybe the Dr's, and nurses, and not necessarily the Non-profit Blue Shield.

I don't want to defend any of these parties.

The truth is, the reason health care costs have gone up, is because the Govt. has subsidized the industry over the past 50 years.

Medicare, Medicaid, Social Security payments are issued by the govt. to Hospitals and Dr's. The Govt. has done a piss poor job of identifying fraud, over-payments, etc.

Additionally, the Hospitals can play all sorts of games when sending the bill to these Govt. programs.

The bills are always paid by the Govt.

I know this, because I've helped write software for Hospitals that does the payment requests to govt. programs and insurance companies. You wouldn't believe the games they play to get double billing, and over payments through. It's a true racket.

If you just turn off the spigot, the hospitals will be forced to stop these practices.

larrypatrickmaloney says

The truth is, the reason health care costs have gone up, is because the Govt. has subsidized the industry over the past 50 years.

Any form of rent-seeking is going to see great gains over the past 50 years. More consumer surplus means more money to shake down, regardless of gummint.

But yeah, the insurance subsidies in the ACA are a very troublesome thing w/o actual cost controls.

Cost controls require 'death panels' and 'rationing' etc so are better done by a heartless insurance company rather than politicians I guess.

I can see the reform as a solid first step towards Single Payer. Like DADT, sometimes it takes 20 years to get to where you want to go, ya know?

MarkInSF says

the system is all about doing as much as possible, even if is obviously not effective, and extracting as much money as possible. (3D imaging CT scan didn’t come out? Oh, well, we’ll still bill your insurance CO $1,200.)

Yes, that seems to be the core of the problem. I also agree with larrypatrickmoloney that subsidizing unreasonable billers just encourages them to do more of the same. And I agree that single-payer is the ultimate solution. Insurance companies have a strong interest in pumping up medical bills so that they can take their 20% of a larger number.

larrypatrickmaloney says

The truth is, the reason health care costs have gone up, is because the Govt. has subsidized the industry over the past 50 years.

There is the small matter of increases in treatments that seems to have slipped you mind. Prior to 1960 which is conveniently 50 years ago many conditions that are commonly treated today were death sentences. There was no treatment, people simply died. Many other conditions were debilitating, people were simply left to manage the best they could. Most medical technology used today didn't exist. Average lifespan has increased something like 20 years in those 50 years. You may not care about living those extra 20 years, but I sure do. Words of wisdom from a bumper sticker I once saw "Ass, gas, or grass nobody rides for free".

larrypatrickmaloney says

I know this, because I’ve helped write software for Hospitals that does the payment requests to govt. programs and insurance companies. You wouldn’t believe the games they play to get double billing, and over payments through. It’s a true racket.

Can you provide some concrete examples of how common billing scams work?

larrypatrickmaloney says

I know this, because I’ve helped write software for Hospitals that does the payment requests to govt. programs and insurance companies. You wouldn’t believe the games they play to get double billing, and over payments through. It’s a true racket.

Looks to me like you just confessed to being a willing accomplice to defrauding the government.

Great job on the CBS-5 interview yesterday, Patrick.

The link is on the front page news section but should also be here, I think.

http://sanfrancisco.cbslocal.com/2011/01/06/california-federal-officials-vow-to-fight-blue-shield-rate-hike/?source=patrick.net#ad_1

cool interview. I hope it makes a difference.

From: http://www.healthcare.gov/law/provisions/preventive/index.html
Under the Affordable Care Act, you and your family may be eligible for some important
preventive services —which can help you avoid illness and improve your health—at no additional cost to you.
Definition preventive services: Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
Supposedly, older plans are grandfathered in and don't have to include these services. Patrick, can you confirm if this is the case with your plan? I would have assumed the same for my (job related) insurance, but I got a letter recently that seems to indicate preventive care would be included. It may be the case that Aetna just decided to drop the co-payments for these services to be ACA compliant.
Nice job on the interview, BTW. You are a one man PIRG.

At least they are still writing policies for you! Here in Virginia and many other states insurers have stopped writing "child only" policies since they can not turn down children based on pre-existing conditions. I have complained to the insurance board and my representivies to no avail.

Yes, I'm pretty sure it's pointless to complain to your representatives, because they don't actually represent you. They represent corporations like the insurers who provide re-election campaign cash.

Insurance companies blocked the one thing that would fix our system, a public option:

http://en.wikipedia.org/wiki/Public_health_insurance_option

If you had the option to join Medicare, we would not even need to have this discussion. But the insurers whipped up tea party hysteria about the public option and managed to twist the healthcare bill to protect their profits above our health, so we're all fucked for now.

It's time to DEMAND a public option.

issue H1Bs for doctors from India and China... of course over AMA (American Medical Association)'s dead cold body
:-)

Good idea! Increasing supply will actually reduce costs.

Too bad most government programs increase demand through subidies, just raising prices and accomplishing exactly nothing except extra profits for the well-connected.

Rates are approved by government. This is just the price increases that are justified in order to cover all the "preexisting" and other benefits.

If you think rates are high, ask the federal officials as to why they approved the hikes. Also ask Obama why he decided to pass the healthcare bill that doubled the healthcare costs in one year.

Good idea! Increasing supply will actually reduce costs.
Too bad most government programs increase demand through subidies, just raising prices and accomplishing exactly nothing except extra profits for the well-connected.

exactly what I meant to say. Thanks Patrick.

ChrisLosAngeles says

Rates are approved by government. This is just the price increases that are justified in order to cover all the “preexisting” and other benefits.

Not in California. The insurers can charge whatever they want here and the insurance commissioner can do nothing about it.

Even BS doesn't claim the price increases have anything to do with the healthcare bill. They're just doing it because they can.

ChrisLosAngeles says

If you think rates are high, ask the federal officials as to why they approved the hikes. Also ask Obama why he decided to pass the healthcare bill that doubled the healthcare costs in one year.

Again, that's just not true. Federal officials do not approve hikes. It's all "free market" in theory, but a pay-or-die monopoly in reality. Obama's big mistake was in not going far enough: he should have:

1. Insisted on a public option to privide at least a little compeition.
2. Insisted on premium caps.

Not in California. The insurers can charge whatever they want here and the insurance commissioner can do nothing about it.
Even BS doesn’t claim the price increases have anything to do with the healthcare bill. They’re just doing it because they can.

ChrisLosAngeles says

If you think rates are high, ask the federal officials as to why they approved the hikes. Also ask Obama why he decided to pass the healthcare bill that doubled the healthcare costs in one year.

Again, that’s just not true. Federal officials do not approve hikes. It’s all “free market” in theory, but a pay-or-die monopoly in reality. Obama’s big mistake was in not going far enough: he should have:
1. Insisted on a public option to privide at least a little compeition.

2. Insisted on premium caps.

I didn't know they can still raise rates without approval. They could prior to reform, but even after reform as well?

Another huge concern to me is that a lot of these increases are across the board by every insurer, I would imagine at least one would not raise rates and stay competitive (free market right?)... but absolutely all have raised their rates and raised them significantly.

Here's a reply I got just today from my state senator's aide:

Hi Patrick,

Thank you for your email about the Blue Shield rate increases. We have
received quite a few similar emails.

You may already know this, but California is one of a handful of states
that doesn't require regulators to pre-approve rate hikes. There was a
bill last year that would have changed this, which Senator Simitian
voted for, but the bill failed in a Senate vote. This bill has been
reintroduced as AB 52.

Until the Insurance Commissioner and Department of Managed Health Care
have legal authority to block premium increases, there is very little
anybody can do to stop them from being implemented.

Best,

Tyler Haskell
Office of State Senator Joe Simitian
(650) 688-6384

I think we should all contact our reps and support AB 52. Here's a pretty easy way:

http://salsa.wiredforchange.com/o/6563/p/dia/action/public/?source=patrick.net&action_KEY=3043

I think we should all contact our reps and support AB 52. Here’s a pretty easy way:
http://salsa.wiredforchange.com/o/6563/p/dia/action/public/?source=patrick.net&action_KEY=3043

The thing is that if they have to cover preexisting conditions, rates will go up a lot. So this is not unreasonable. It's perhaps a reality check. A claim for a single diabetic, hypopheliac, etc... can go over a million dollars a year in our current system. That has to be basically accounted for in the rates.

Although 59% does seem like a lot, but I don't know numbers for blue shield. Maybe it barely makes the mark for them, after all they have to compete with Kaiser, Healthnet and Pacificare, etc...

ChrisLA says

if they have to cover preexisting conditions, rates will go up a lot

No, not necessarily. One huge problem is that the insurers are happy to pay inflated prices for treatments as long as they can get their 20% of that huge number. If we limit what insurers can take in, then we limit what they pay out, and we force limits on what hospitals and doctors can charge. Right now, it's unlimited and going to the moon. Not for better treatment, but just because they've got us by the balls. We pay several times as much for the same treatments as customers in other countries.

ChrisLA says

after all they have to compete with Kaiser, Healthnet and Pacificare

No, actually they do not compete at all. Health insurance companies are exempt from anti-trust laws because of their excellent corporate lobbying (also known as bribes). They all coordinate their prices so that the customer has nowhere to go for a better price. You're also forbidden from buying insurance from out of state. There is no free market at all for health insurance. The only thing you can do to save money is to die. It's pay everything you own or die, very simple. And that is now the American way.

We should all support AB 52 so that the state government has some say about unfair premium hikes, like it does in other states.

CA government does have some say, but only after the rate change, and also only if the company's MLR is under 70%.

"At present, the commissioner can block increases only if insurers spend less than 70% of premium income on claims. Jones' office said Blue Shield's March 1 increase was under review."

http://articles.latimes.com/2011/jan/05/business/la-fi-insure-rates-20110106

Since the new MLR guidelines are in force now, there's really nothing the state can do.

Austinhousingbubble says

On a related note - I thought this was rather interesting, in case anyone missed it:
http://www.youtube.com/watch?v=6xlpcDnr7eM

I've never seen this interview. Just jaw-dropping. Like Patrick says.... pay or die...what a ****** system.

The thing is that the fact that it is ran for profit makes it terrible.
Insurance companies - profit.
Hospital networks - insane profit.
Pharmaceutical companies - insane profit.
Government paid off officials - corruption.

Its like real estate industry, like water industry, like fuel industry. System designed to keep people permanently paying.

Sold my first individual health insurance policy 25 years ago, (Blue Shield CA).

After I found that BS CA let customers do Broker of record changes, and followed Blue Cross of CA (now Anthem ) after usually a 6-18 month lag, I developed a Blue Cross CA book of business, instead of Shield.

This is why Anthem has become the dominant player in CA health insurance, and the most stable. Shield (with Kaiser) as a non-profit (socialist ) oriented player, has done better with large group / government sector.

Patrick, you apparently did not find a good CA broker. Anthem is THE insurer of choice for most small business. This is info is avail at CA DOI website.

PS You pay ZERO extra for a broker.

Update.

Guardian just announced dropping out of medical insurance.

The individual medical market is cracking.

Still waiting for Oregon regulators to approve HealthNet plans & rates for 2011.

25 year veteran says: Obama and crowd (like fellow Ivy League Know nothing egghead Peter R. Orszag) know almost zero about health insurance.

USSR / CUBA Venezuela ... here we come.

Barney might be swingin with Nancy in a few years

forwardmover says

Update.
Guardian just announced dropping out of medical insurance.
The individual medical market is cracking.
Still waiting for Oregon regulators to approve HealthNet plans & rates for 2011.
25 year veteran says: Obama and crowd (like fellow Ivy League Know nothing egghead Peter R. Orszag) know almost zero about health insurance.
USSR / CUBA Venezuela … here we come.
Barney might be swingin with Nancy in a few years

Not a good comparison.

USSR/Cuba - doctors work for the government, healthcare wasn't done for profit.
USA - exact opposite, it's all for profit... pay or die system.

Sold my first individual health insurance policy 25 years ago, (Blue Shield CA).

After I found that BS CA let customers do Broker of record changes, and followed Blue Cross of CA (now Anthem ) after usually a 6-18 month lag, I developed a Blue Cross CA book of business, instead of Shield.

This is why Anthem has become the dominant player in CA health insurance, and the most stable. Shield (with Kaiser) as a non-profit (socialist ) oriented player, has done better with large group / government sector.

Patrick, you apparently did not find a good CA broker. Anthem is THE insurer of choice for most small business. This is info is avail at CA DOI website.

PS You pay ZERO extra for a broker.

Hi there Patrick- This is Liz Jacobs from the communications department of the Calfornia Nurses Association. We are working with Consumer Watchdog on protesting the Blue Shield rate increase. We are having a rally and press conference on FEb 1st in San Francisco and would really like your involvement. Please contactr me at 510-273-2232 or ljacobs@calnurses.org. Thanks so much
Liz Jacobs

Patrick, be careful about working with a lobbying organization like the CNA. They look out for THEIR MEMBER'S interests, not ours. They do good work for their membership, and sometimes that work may even overlap with what is in the public interest, but don't be confused about their mission. I don't know enough about Consumer Watchdog to know whether they are an effective consumer advocate -- although it appears that they may be partially responsible for Eric Schmidt stepping down from the CEO position at Google.
forwarfdmover says: You pay ZERO extra for a broker.
Wow, just like real estate. Thank heavens for pricing transparency. In a brokers defense, (if they are worth their salt) they will go up to bat for you with the insurance company. But, as they say, nothing in life is free.

Thanks EBGuy. At least in this case it looks like their members' interest overlap with ours.

Not exactly sure why they are protesting Blue Shield though. Are nurses somehow not getting paid because of Blue Shield's price gouging?

EBGuy says

forwarfdmover says: You pay ZERO extra for a broker.
Wow, just like real estate.

I agree. That's way too much like real estate. Obviously someone pays for the broker, and it's got to be the person paying the premiums.

OK, after studying the CNA for a bit, it seems that their financial interest is in keeping legal minimum ratios of nurses to patients, and in guaranteeing nurse pensions.

Those things are basically good, but could of course be abused, by guaranteeing that we all pay more for extra nurses that may not really be needed, and by perhaps making taxpayers liable for nurse pensions.

http://www.nationalnursesunited.org/issues/entry/ratios

It all depends on the exact numbers.

Anyway, I'm happy to help them protest Blue Shield, which really is screwing me.

My sister in Michigan is a nurse. I wrote her about this and she confirms my suspicion that the ratios in California are mostly about protecting nurse jobs at the expense of the public.

The legally required California nurse to patient ratios seem too low. It's kind of a scam and is probably one of the things driving up medical costs here.

So to summarize:

1. Yes, we need minimum nurse ratios.
2. The minimum nurse ratios in California take it too far, and look like an unneeded cost driving up the cost of health care.

Pat, 1:6 is really low. I've never had less than 8 in one shift. No wonder California is broke. Michigan is broke too. That ratio must drive up the demand for nurses to unreal levels- a constant shortage.

Jo

--- On Thu, 1/27/11, Patrick Killelea wrote:

> > From: Patrick Killelea > > Subject: Re: nursing ratios
> > Date: Thursday, January 27, 2011, 10:16 PM
> > Wow, in CA the law says they must
> > have 1 nurse for every 6 psych patients. Do you think that's
> > about the right number, or are they just trying to employ
> > more nurses?
> >
> > 1 to 35 is crazy though, for sure.
> >
> > Pat
> >
> >
> > Josephine wrote:
>> > > Pat, No mandatory nurse ratios here in Michigan. My
> > last night on the
>> > > last job I was the only nurse for 35 psych patients.
> > I've decided to
>> > > take a break for now.
>> > >
>> > > --- On Thu, 1/27/11, Patrick Killelea > > wrote:
>> > >
>>> > >> From: Patrick Killelea > > Subject: nursing ratios
> > Date: Thursday,
>>> > >> January 27, 2011, 7:21 PM Hi Jo, does Michigan
> > have mandatory nurse
>>> > >> to patient ratios like California does?
>>> > >>
>>> > >> http://www.nationalnursesunited.org/issues/entry/ratios
>>> > >>
>>> > >> Pat

I switched to Blue Cross in the end. If everything goes through, my rate will hopefully go from $1120.00 to $575.00 per month for me, my wife and 3 yr old. Much better but still...screw Blue Shield.