Airline mergers serve as a cautionary example: the airlines were able to cost costs (as anticipated) but are now abusing the absence of competition with higher prices and onerous "fee" add-ons.
Allowing those mergers was a major anti-consumer mistake.
Allowing those mergers was a major anti-consumer mistake.
4
'The insurers insist that combining companies will lead to higher profits.They point to billions of dollars in efficiencies. Which will all be turned into additional profits.'
Fixed that for you.
Fixed that for you.
2
It could be the way to go..... one or two huge health insurance companies with morn folks under fewer tents costs would go down in rural America lives and go up minimally in urban populated regions. I'd hive a thumbs up and assess over tome.... if costs go up to high the Government can intervene. As a back up there is always Single Payer as an option and that option could keep insurers in line. What do we have to lose.
2
Doctor incomes are significantly higher in the United States than other industrialized countries, especially for specialists. Low reimbursements for general care encourage doctors to go into specialties. Allowing expansion of medical schools to provide more new doctors would also increase the supply, since caps on enrollment keep enrollments low.
Recently when I went to a dermatologist, he really discouraged me from getting a cyst removed from my back. I was told I had a really high deductible and my first appointment for the office surgery was cancelled and rescheduled. Since the doctor's website promotes Botox and other out of pocket procedures, I still insisted for the procedure.
Recently when I went to a dermatologist, he really discouraged me from getting a cyst removed from my back. I was told I had a really high deductible and my first appointment for the office surgery was cancelled and rescheduled. Since the doctor's website promotes Botox and other out of pocket procedures, I still insisted for the procedure.
Let me see now - what is the operational rule for mega insurance companies? I'll bet it is to take more money than they pay out. Of course I could be wrong. What do you think?
3
No, doubts do not remain for consumers. When have mergers that reduce competition ever left the customer better off? Company spokespersons always babble on about "cost savings" while trying to convince regulatory agencies, but if those ever eventuate, we don't see them.
I am currently a satisfied Cigna customer. After the merger, I am highly dubious that I will remain either satisfied or a Cigna customer.
I am currently a satisfied Cigna customer. After the merger, I am highly dubious that I will remain either satisfied or a Cigna customer.
5
No amount of financial manipulation can sustain an economy, when the real economy of goods and services has nearly been flogged to death in a rush by the corporate alchemists to convert wealth to paper.
The rich have run out of rope. They rode the wave of Quantitative Easing, which was the most spectacular market manipulation in market history into a Second Gilded Age, but that wave has crested with the cessation of bond purchases by the Fed. Now only further consolidation through mergers and acquisitions is left to them, and that means redundancy for the folks who work in the real economy, and unfair pricing due to the resulting Monopolistic lack of competition.
In the first Gilded age the rich wrongly thought that the point of alchemy was to turn everything into gold, when actually an economy requires that gold be turned into something else. The result was 1929, and the Great Depression. Today's masters of the universe have gone through the looking glass to: on a wave of public subsidy, super charged by untold billions of dollars in bond purchases, value paper above all else. Now we have just about run out of time, and most folks don't yet understand what has happened to them.
The rich have run out of rope. They rode the wave of Quantitative Easing, which was the most spectacular market manipulation in market history into a Second Gilded Age, but that wave has crested with the cessation of bond purchases by the Fed. Now only further consolidation through mergers and acquisitions is left to them, and that means redundancy for the folks who work in the real economy, and unfair pricing due to the resulting Monopolistic lack of competition.
In the first Gilded age the rich wrongly thought that the point of alchemy was to turn everything into gold, when actually an economy requires that gold be turned into something else. The result was 1929, and the Great Depression. Today's masters of the universe have gone through the looking glass to: on a wave of public subsidy, super charged by untold billions of dollars in bond purchases, value paper above all else. Now we have just about run out of time, and most folks don't yet understand what has happened to them.
2
This latest development in the healthcare industry makes me feel physically ill. I won't go to the Doctor though because I have a $40 co-pay and a $6000 deductable. My hope is as costs sky rocket for consumers there will be a ground swell of support from the people for Single payer as they come to understand that they are being robbed. What is so objectionable about paying taxes instead of premiums especially when they will be half as much? People can still buy supplimental insurance if they can afford it. In away it will be just like now except the tax payers wouldn't be paying the CEO's of 4 healthcare insurance companies billions of dollars; just cutting that expense would save individual americans hundreds of dollars a month. Every other developed country in the world believes healthcare is a human right. Americans view it as a another way to profit off the misery of their fellow Americans.
6
In 1976 there were about 40 different insurers writing medical insurance in the greater NYC area, today there are maybe 6. Medical insurance has become a regulated utility, to argue that a "free market" exists is nonsense. This started way before ACA, more than 20 years ago. so no blaming it on "Obamacare". When the brokers, who make a living providing a conduit to coverage, think consolidation is a bad idea, that tells you all you need to know.
2
I'm just sure that whatever economic benefits accrue to these large health insurance companies by merging would be passed along to their insureds... How about you? (Also, I truly believe that pigs can fly, there is a tooth fairy, and Sara Palin is really smart...).
5
If these guys end up controlling the market, then our choices will drop, especially with regards to what doctors and services we can use. More things can be forced into out of network status, so we will have to choose between the best care, or the reasonably priced care.... all in the interests of reducing costs. And think of the lobbying capabilities these behemoths will have... you will be out in the cold and there will be no recourse through the government to bail you out.
Heaven forbid you get something rare and expensive, it will be bankruptcy or worse... just what all this ACA stuff was designed to prevent! I can hardly wait! Basically this means that only the truly rich will be able to choose their care since they will be able to pay for it. The rest of us get the lower tier providers and options, and if it is not covered by the one or two big guys, you will be out of luck or dollars or both.
Heaven forbid you get something rare and expensive, it will be bankruptcy or worse... just what all this ACA stuff was designed to prevent! I can hardly wait! Basically this means that only the truly rich will be able to choose their care since they will be able to pay for it. The rest of us get the lower tier providers and options, and if it is not covered by the one or two big guys, you will be out of luck or dollars or both.
4
Less competition encourages price fixing. It happened with the music industry when they fixed CD prices, it happened in California with the energy scandal, it happened with the Archer-Daniels Midland Lysine lysine scandal, and it might have happened with the Comcast merger. I see NO advantage to anyone here but the companies.
7
A naive tale at best. As with hospital chain mergers, this only means consumer prices will rise. The stupidity or complicity of the Obama Department of Justice is sad for all of us. Has your cable/Internet provider merged, and if so did rates stabilize or go down-No. The triumph of hope over bitter experience to expect anything else here. So Big Pharma marches on and we pay 10x the world price for drugs; ditto with Internet providers, higher rates and lower speeds than the rest of the First World; hospitals in process, and now the insurers. Makes you think some folks do not really care about the consumer. Where are our socialist heroes, Sanders and Warren, in the midst of all this?
3
I would like to see laws for the following: $1,000 fine for insurers for failing to answer a customer call within 5 rings, or for dropping calls, or for hold times over 3 minutes; same for mis-informing a customer or giving them the run-around; limited ability to raise premiums every year, with total lifetime increases capped so we don't get stuck with unpredictable 30% increases forever; price transparency so customers know at the doctor's office how much their surgery/medication/test will cost; viable non-profit insurer options; 100% insurance portability; independent group buying options for consumers.
In fact if there's one law to pass, it would be the one eliminating tax credits to employers for providing health care coverage. This ties people to jobs when they'd rather move on, and has resulted in me being on 3 different plans in as many years, because my employer kept switching us.
Oh. I'd also like to be able to track my medical expenses for a year and submit for a tax credit at the end... no FSA/HSA guesswork... just, what did I spend and get that taken off my taxable income directly. This includes premiums for being self-insured.
In fact if there's one law to pass, it would be the one eliminating tax credits to employers for providing health care coverage. This ties people to jobs when they'd rather move on, and has resulted in me being on 3 different plans in as many years, because my employer kept switching us.
Oh. I'd also like to be able to track my medical expenses for a year and submit for a tax credit at the end... no FSA/HSA guesswork... just, what did I spend and get that taken off my taxable income directly. This includes premiums for being self-insured.
4
Qui Bono, who will benefit from further consolidation? Whoever has the power to set the price. Who might that be in markets where competition is lowered? The one who controls the largest number of subscribers. Who is that likely to be on the insurance side? The Big Three or Four. On the provider side who will it be? The one with the largest number of doctors and who has facilities in each niche in the market area.
Where will profits go when earned by lowering cost and increasing prices to customers? To the insurer and their shareholders, and management is a big class of shareholders. In the hospital/doctor arena the profits will go to investment in things that lock down the monopoly or oligopoly nature of the combine and to things and services of interest to the doctors and trustees or if for profit, back to shareholders.
Simple. Qui Bono assessment.
Where will profits go when earned by lowering cost and increasing prices to customers? To the insurer and their shareholders, and management is a big class of shareholders. In the hospital/doctor arena the profits will go to investment in things that lock down the monopoly or oligopoly nature of the combine and to things and services of interest to the doctors and trustees or if for profit, back to shareholders.
Simple. Qui Bono assessment.
2
Unfettered competition is good, say the apostles and priesthood of the capitalist religion.
Monopolies are good, say the apostles and priesthood of the capitalist religion.
Anybody see an inconsistency here?
If there is a candidate for President who can channel Teddy Roosevelt, I will vote for him. Or her.
As to technology solving the fundamental problems with our healthcare system:
Would Apollo 13 have been better off if, "Houston, we have a problem" had been responded to by a canned voice saying, "Due to unusual call volume......" or "Press 1 to leave a message"?
# Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
1 Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
* Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Hello? Hello? I pressed #,1,*Is there a live person there to whom I can report a menu loop problem, when I try to make an appointment with my doctor?
Personally, I recommend the solution posited by Edward Abbey in Chapter I of "The Fools Progress." Sort of Nedd Ludd meets the N.R.A.
Monopolies are good, say the apostles and priesthood of the capitalist religion.
Anybody see an inconsistency here?
If there is a candidate for President who can channel Teddy Roosevelt, I will vote for him. Or her.
As to technology solving the fundamental problems with our healthcare system:
Would Apollo 13 have been better off if, "Houston, we have a problem" had been responded to by a canned voice saying, "Due to unusual call volume......" or "Press 1 to leave a message"?
# Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
1 Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
* Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Hello? Hello? I pressed #,1,*Is there a live person there to whom I can report a menu loop problem, when I try to make an appointment with my doctor?
Personally, I recommend the solution posited by Edward Abbey in Chapter I of "The Fools Progress." Sort of Nedd Ludd meets the N.R.A.
2
Call me crazy, but I don't understand why the government would give the green light to these mergers. You are starting to see the same problems with the airline industry where (4) airlines basically rule 95% of the sky. I can't see the consumer being on the winning end of this ticket. Another real issue comes from little pricing controls on medical devices, pharmaceuticals, and supplies. Basically, the consumer is being raped when it comes to the end user costs of medical care in this country - especially when you compare the costs we pay to other industrialized nations with the same or better health care.
4
1. The government isn't giving the green light to these mergers.
2. Barack Obama invited insurance execs and their lawyers to the WH with Jonathan Gruber to write the legislative loopholes in the ACA that allow this to happen.
3. The government is allowed to operate, or exempt special-interest business entities from antitrust law that prevents monopolies. To get the insurance companies to buy into Obamacare, this is what Barack Obama gave them as a quid pro quo.
2. Barack Obama invited insurance execs and their lawyers to the WH with Jonathan Gruber to write the legislative loopholes in the ACA that allow this to happen.
3. The government is allowed to operate, or exempt special-interest business entities from antitrust law that prevents monopolies. To get the insurance companies to buy into Obamacare, this is what Barack Obama gave them as a quid pro quo.
4
Single payer now. Medicare for all.
10
Gains will NOT trickle down to insureds. I'll be a monkey's uncle if I'm wrong about that.
4
The only difference between the current arrangement and the single payer proposal, which Republicans rail against, is the exploitation of the consumer. With insurance, we get exploitation. With Medicare, we get very good cost containment with very little administrative friction.
The public is so stupid. And the politicians are so very crooked.
The bottom line with most activities has to be the money coming out of each person's pocket. In a rational world, the object would be to find the system which reduces that outflow. In this world, we went with the system which increases that outflow. We have literally handed the keys to the Treasury to the insurance industry.
Thanks, Obama. I hope you're proud of yourself.
The public is so stupid. And the politicians are so very crooked.
The bottom line with most activities has to be the money coming out of each person's pocket. In a rational world, the object would be to find the system which reduces that outflow. In this world, we went with the system which increases that outflow. We have literally handed the keys to the Treasury to the insurance industry.
Thanks, Obama. I hope you're proud of yourself.
2
Private insurance works this way: 1) Insurance companies have the discretion to charge at will; not everyone is in a group plan;2) the insurance business is an oligopoly;3) insurance companies write the terms and the fine print; 4) insurance policies last one year and are renewed at the discretion of the insurance company and its price. If they don't like the health outlook of an individual, they have the employee fired (if through the employer), refuse coverage; or charge a price the insured can't afford.
At a minimum, there should be a public option that is affordable with good coverage and the employer should have to suffer a $3000 penalty if the employee opts out of the plan. This is how it is supposed to be now but the Repubs will eliminate it if they can.
At a minimum, there should be a public option that is affordable with good coverage and the employer should have to suffer a $3000 penalty if the employee opts out of the plan. This is how it is supposed to be now but the Repubs will eliminate it if they can.
1
I say let them continue merging in the pursuit of ever fatter profit margins, and the when there's finally one, nationalise the beast. Single payer at last.
1
Anthem's track record for massive premium increases, poor payments to physicians, and sketchy coverage will place it alongside ISIS among historians for quality of care provided to its clients.
1
If their mergers will make health care more efficient, these health companies should logically also be arguing for the U.S. take the next step and go to a single payer.
5
The most powerful entities in an economic system based on greed will always be seeking to maximize their profits no matter what the cost to consumers. In the profit system it has always been whatever the market will bear, which means how much can you squeeze out of people before they get so angry they do something. We have used governmental power e.g. antitrust laws, to make it look like we are keeping this cancer under control, and still anyone who knows history knows there has been untold misery where a few people have lived lavish lives supported by the rest of us hard-working stiffs. How long before we get rid of this rotten situation and replace it with democratic economics?
We need someone like FDR, not just another corporate stooge mouthing populist platitudes who doesn't mean a word of it. We need the real deal.
We need someone like FDR, not just another corporate stooge mouthing populist platitudes who doesn't mean a word of it. We need the real deal.
3
Evidence: T-Mobile was NOT acquired by AT&T, that was the best acquisition that never happened. It freed T-Mobile to upend the mobile industry -- cutting the cord and costs for consumers and forcing their larger competitors to finally cut costs. There is still a long way to go but competition is essential to keep prices from rising.
2
Maybe I'm a cynic, but I cannot understand why the government is approving these mergers. Isn't allowed in other industries, why in the health insurance industry? There must be a motive... is it to move towards a few insurers that will enable the government to move to a government facilitated, private single payer system?
Is it because the progressives and liberals in DC are making too much money and enjoying too many trips and perks from the insurance lobby?
Can government do anything right?
Is it because the progressives and liberals in DC are making too much money and enjoying too many trips and perks from the insurance lobby?
Can government do anything right?
2
$54 billion! Where does all that money come from? Where does it go if the merger goes through? The pockets of the CEO? The investors?
I suspect it came from premiums meant to cover medical care, or from denying/delaying payment for medical care, or from cutting the amount payed to providers and ends up as executive bonuses and investor dividends. This money should show up as administrative overhead or profit, but I suspect it is hidden in some way. This is another example of diverting funds meant to provide medical care into the pockets of investors and insurance executives making the patients and providers into the losers. Medical insurance should not be subject to the profit motivation of the business sector. It's one thing to maximize charges & minimize costs in order to maximize profits in the manufacturing & selling of automobiles. It's another thing to do the same thing in health care. The goal of the 3rd party payor should be to support the highest quality of care, to make sure patients get the care they need, and to make sure that the maximum amt. possible of the insurance premium goes towards pt. care. That is not how it works in today's for-profit insurance industry. There is a big difference between medicare and the for-profit insurance companies. When is the last you heard of a $54 billion merger with medicare? or a medicare executive getting $10-15 million in annual compensation? Medical insurance should not be a business based on quarterly profit reports.
I suspect it came from premiums meant to cover medical care, or from denying/delaying payment for medical care, or from cutting the amount payed to providers and ends up as executive bonuses and investor dividends. This money should show up as administrative overhead or profit, but I suspect it is hidden in some way. This is another example of diverting funds meant to provide medical care into the pockets of investors and insurance executives making the patients and providers into the losers. Medical insurance should not be subject to the profit motivation of the business sector. It's one thing to maximize charges & minimize costs in order to maximize profits in the manufacturing & selling of automobiles. It's another thing to do the same thing in health care. The goal of the 3rd party payor should be to support the highest quality of care, to make sure patients get the care they need, and to make sure that the maximum amt. possible of the insurance premium goes towards pt. care. That is not how it works in today's for-profit insurance industry. There is a big difference between medicare and the for-profit insurance companies. When is the last you heard of a $54 billion merger with medicare? or a medicare executive getting $10-15 million in annual compensation? Medical insurance should not be a business based on quarterly profit reports.
11
I'm not opposed to these mergers, but I'm not sure value to the consumers is the driving motivation.
What I think we're really missing is that what we need isn't bigger but different. See: http://kimbellardblog.blogspot.com/2015/06/jurassic-park-rise-of-health-...
What I think we're really missing is that what we need isn't bigger but different. See: http://kimbellardblog.blogspot.com/2015/06/jurassic-park-rise-of-health-...
of course consolidation in the private health insurance markets would be bad for consumers and for the country. they should be enjoined.
but, more importantly, this private move toward hyper-consolidation demonstrates the need for a "public option" for everyone--as the only way to offer true competition in this/these markets.
obamacare, dramatically increasing demand for health insurance without increasing supply of providers, cannot be the "end" of our transformation. we must have dramatically increased supply of providers, price control, and/or public insurance.
providing medicare/medicaid for all, to "compete" with private insurance, is our best direction. we cannot leave health insurance coverage to for-profit oligopolies.
but, more importantly, this private move toward hyper-consolidation demonstrates the need for a "public option" for everyone--as the only way to offer true competition in this/these markets.
obamacare, dramatically increasing demand for health insurance without increasing supply of providers, cannot be the "end" of our transformation. we must have dramatically increased supply of providers, price control, and/or public insurance.
providing medicare/medicaid for all, to "compete" with private insurance, is our best direction. we cannot leave health insurance coverage to for-profit oligopolies.
4
Ah, the Gilded Age of Monopolies........
I'm curious, how is it that I saw this coming and no one else did?
Truth? "You ain't seen nothing yet!"
I'm curious, how is it that I saw this coming and no one else did?
Truth? "You ain't seen nothing yet!"
5
Man, I sure am glad I've never gotten around to wasting my money on a health insurance plan.
And as long as the government penalty is lower than the costs of a health insurance plan, I will gladly pay the penalty.
Why should I give my hard-earned money to a bunch of middle men that have inserted themselves in between me and my healthcare provider?
Nope. Sorry. Ain't happening. I'd rather give my money back to the government for doing absolutely nothing than contribute to some greedy money-hoarding CEO's already outrageous income in return for the mere promise (meaningless as it is) that maybe perhaps possibly insurance might cover me should anything ever actually happen to me...
Remind me again: what service do health insurance companies actually provide?
And, no, telling people "your insurance won't cover that" is not a service.
And as long as the government penalty is lower than the costs of a health insurance plan, I will gladly pay the penalty.
Why should I give my hard-earned money to a bunch of middle men that have inserted themselves in between me and my healthcare provider?
Nope. Sorry. Ain't happening. I'd rather give my money back to the government for doing absolutely nothing than contribute to some greedy money-hoarding CEO's already outrageous income in return for the mere promise (meaningless as it is) that maybe perhaps possibly insurance might cover me should anything ever actually happen to me...
Remind me again: what service do health insurance companies actually provide?
And, no, telling people "your insurance won't cover that" is not a service.
9
Libby,
Like most people without insurance clearly you have not been seriously ill or injured. If that happens, and I hope it does not, we can't simply leave you on the side walk. You will be swept up by a competent ambulance crew and brought to a medical facility for care. That you won't be able to pay for.
Medical care for you that the rest of us will be forced to pay for through higher premiums and larger shares-of-cost. Since there's no talking to you, may we all suggest that you and those like you stay healthy and safe.
Like most people without insurance clearly you have not been seriously ill or injured. If that happens, and I hope it does not, we can't simply leave you on the side walk. You will be swept up by a competent ambulance crew and brought to a medical facility for care. That you won't be able to pay for.
Medical care for you that the rest of us will be forced to pay for through higher premiums and larger shares-of-cost. Since there's no talking to you, may we all suggest that you and those like you stay healthy and safe.
2
I've always heard that competition in the marketplace is good. As a customer, that makes clear sense to me.
Now I'm hearing that a lack of competition in the market place is good. As a customer, that makes no sense to me.
But as a provider, the lack of competition being good, makes perfect sense to me.
Now I'm hearing that a lack of competition in the market place is good. As a customer, that makes no sense to me.
But as a provider, the lack of competition being good, makes perfect sense to me.
1
Trickle down lives on. As usual, it is great for Mega corporations but screws the little guy. Bring back Glass Steagal.
3
"...Doubts Remain for Consumers"??? Is that some kind of cruel joke. Ask any physician who tries to care for patients what the experience is like to prescribe medications, order procedures, etc. Over the last 5 years it has gone from annoying to hellish. And this is before the final consolidation we are witnessing. It will only get worse, if that's even possible.
Every treatment decision is questioned--type of medication ordered, dosage, duration of treatment, on and on. And, of course, never questioned by a doctor. It's a computer algorithm delivered by an overly polite monosyllabic "care associate" or some other euphemistic title. When I have been dumb enough, frustrated enough to speak with an insurance company medical director--a so called "peer to peer", talk about euphemisms--I generally get an MD who seems to know nothing about patient care and treatment and who is simply following his/her new algorithm still designed to deny care. When I query why there is this or that "rule", the answer ranges from "I don't know" to "that's the rule". If asked to support the "rule" with data---so called "evidenced based medicine"--there is basically no response.
If there is truly anyone out there that doubts how adverse the impact of this consolidation will be, try flying on an airplane. Ah, the great benefits to the consumer of mergers. There's a reason we used to have laws against monopolies....
Every treatment decision is questioned--type of medication ordered, dosage, duration of treatment, on and on. And, of course, never questioned by a doctor. It's a computer algorithm delivered by an overly polite monosyllabic "care associate" or some other euphemistic title. When I have been dumb enough, frustrated enough to speak with an insurance company medical director--a so called "peer to peer", talk about euphemisms--I generally get an MD who seems to know nothing about patient care and treatment and who is simply following his/her new algorithm still designed to deny care. When I query why there is this or that "rule", the answer ranges from "I don't know" to "that's the rule". If asked to support the "rule" with data---so called "evidenced based medicine"--there is basically no response.
If there is truly anyone out there that doubts how adverse the impact of this consolidation will be, try flying on an airplane. Ah, the great benefits to the consumer of mergers. There's a reason we used to have laws against monopolies....
33
The problem: for profit. This is not compatible with optimal patient care
7
This issues exposes the folly of treating a universal need as a commodity. It is the role of government to supply basic services, and such items as water, gas and electricity are therefore treated as public utilities. Phone service, and gradually internet service, are or will be more heavily regulated because as a society we choose to define these as basic needs whose even distribution benefit society at large in a manner that the private sector cannot deliver. Likewise, as we come to see medical care in the same light, the consolidation of for-profit health care providers would of course lead to the diminution of service as expressed in this article.
3
What we are really arguing about here, and it is a CRITICAL argument that we must have, is which entity better protects the patient and his ability to pay for the healthcare he needs. Is it Big Medicine? Or Big Insurance?
Because we are getting Big Medicine at the fastest pace in the history of our nation, accelerated by the ACO models in PPACA. That's a given.
Now we are adding Big Insurance to the mix, perhaps necessary to keep Big Medicine from charging us all to death.
Do we need Big Insurance to protect us from Big Medicine?
I'd be more amenable to that argument if Big Insurance ran on the Not-For-Profit Blue Model, making local decisions rather than operating for the benefit of nebulous shareholders with no ties to any patient.
Anthem-Cigna and Humana-Aetna don't make decisions that way.
Patient loses all the way around.
WR
Because we are getting Big Medicine at the fastest pace in the history of our nation, accelerated by the ACO models in PPACA. That's a given.
Now we are adding Big Insurance to the mix, perhaps necessary to keep Big Medicine from charging us all to death.
Do we need Big Insurance to protect us from Big Medicine?
I'd be more amenable to that argument if Big Insurance ran on the Not-For-Profit Blue Model, making local decisions rather than operating for the benefit of nebulous shareholders with no ties to any patient.
Anthem-Cigna and Humana-Aetna don't make decisions that way.
Patient loses all the way around.
WR
13
If plans are going to be competitive, they have to offer the most affordable premiums and lots of smoke and mirrors.
Not-so-affordable "consumer-driven" plans are laden with high cost-sharing and/or limited networks. All this while hospitals and big groups gobble up private practices and, whipping doctors to be productive as they earn their salaries through relative value units.
If there were price transparency at the point of service, more doctors would fully understand how their profession has been compromised and demand single payer health care reform.
Not-so-affordable "consumer-driven" plans are laden with high cost-sharing and/or limited networks. All this while hospitals and big groups gobble up private practices and, whipping doctors to be productive as they earn their salaries through relative value units.
If there were price transparency at the point of service, more doctors would fully understand how their profession has been compromised and demand single payer health care reform.
1
Any chance we can consolidate the eyes, ears, and mouth back into the body? Somehow insurers managed to remove them from the body and stop covering life saving medical procedures. Apparently the insurers feel that seeing, hearing, and eating are not necessary. They would rather pay thousands to heal organ infections than a couple hundred to fix a bad tooth that sent toxins into the digestive system.
8
Unfortunately, this is what happens when the debate is about health insurance vs. a debate about health care. The insurance companies cover only what they feel like covering and pay claims only when they feel like it. Insurance companies are about making a profit for their shareholders, not about delivering health care. My insurer recently refused to pay for a biopsy to determine whether or not I had basal cell carcinoma. They'd pay a bit to remove it, but nothing to diagnose it. This is crazy madness. If we would move to a single payer system, we could start talking about health CARE and not healh INSURANCE. These combinations of insurers can only be bad for the consumer.
Insurance companies should not monopolize healthcare. There should be antitrust inquiries into the mergers. The federal system should intervene.
3
In Pittsburgh, two giants now deliver both healthcare & provide insurance. Both have non-profit designations, the amount of money spent on online, television, signage, branding, electronic medical records, auditing caregivers, establishing themselves in other states and countries, etc is outlandish. There has been no clear evidence that the consolidations, the buying of medical practices, introduction of electronic medical records have contributed significantly to improved patient care, fewer mistakes, lowered costs,... Consumers have been left to choose insurance products, & prevented from choosing a physician of based on quality, accessibility, or other factor of choice. Why, because that physician may no longer be permitted by entity that now owns his/her medical practice from seeing a patient based on what insurance the patient has been "forced-choice" to buy. Mergers, consolidations, have yet to create a mission that is patient/consumer centered. I think that if we look at the successful "for-profit" insurers, what will be found is that actuarials did a great job pricing their affordable care products to minimize risks of developing a large contingency of that consumer pool. They priced it so it was rarely chosen. There is no data that I know of that supports the mergers, acquisition, and control of the marketplace frenzy that is choking off freely accessible quality care.
3
I am a pediatrician with 33 years in practice.I welcome some of the positive changes from the ACA-especially coverage for babies born with congenital problems , previously called pre-existing conditions by insurers who rejected them. Coverage for 18-26 yo is also a step forward and so is the end of higher premiums for women. I have seen young people with tremendous potential denied the opportunity to contribute because the were not covered and could not get care . I HAVE SEEN FAMILIES LOCKED IN JOBS,UNABLE TO MOVE TO BE CLOSER TO THEIR FAMILYSUPPORT NETWORKS or change jobs because they cannot get coverage for a child with a chronic condition Adequate healthcare in a modern democracy is a human right , not a commodity and more than a citizen's right. It cannot be left to for- profit insurers. By doing so , costs will never be controlled for the benefit of patients and health equity with universal coverage will not be achieved. As CEO OF A NONPROFIT WITH 100 EMPLOYEES , I DREAD THE PREMIUM INCREASES as health insurers consolidate, leaving only one or two choices .Universal healthcare done right makes good business sense too.
6
It appears the marketplace is opting for a single-payer model. Shouldn't we just admit our mistake and make that a public plan? At least we'd have some say in coverage and cost. Right now, most of us are dependent on our employer to choose wisely. Crazy.
6
Never has "bigger" meant better for consumers. It is a blatant public relation lie, used over and over again in our corporation run country. They have used the infamous tactic, that when you keep saying it will be better for the consumer enough times, it has to be so.
The government and the media has fallen in that trap over and over again.
Anybody remembers the 'so called benefits' from big bank mergers, airline mergers, pharmaceutical mergers?
The government and the media has fallen in that trap over and over again.
Anybody remembers the 'so called benefits' from big bank mergers, airline mergers, pharmaceutical mergers?
5
Blaming the Affordable Care Act for these mergers indicates a lack of understanding of the market. Large mergers like this one were occurring long before the ACA was law. The Anthem/WellPoint merger took place in 2004 and, during that same period, United was gobbling up medium-sized plans, like Golden Rule, all over the place. Whether the mergers are good for consumers or not depends a great deal on the strength of the regulators involved. For example, Kathleen Sebelius, as the Kansas Insurance Commissioner, blocked Anthem's attempts to acquire Kansas Blue Cross and Blue Shield because she saw no advantage for consumers -- and the Kansas courts backed her up. I doubt we'll see the same vigilance from the Connecticut Commissioner -- who is the presiding state regulator over the Anthem/Cigna transaction, since until recently she was a VP at Cigna.
6
Here is a plan:
Congress authorizes the expansion of Medicare to the general population as follows: Coverage for ages 55-64 effective 1/1/17; ages 45-54 effective 1/1/18; ages 35-44 effective 1/1/19; ages 25-34 effective 1/1/20 and all other age groups effective 1/1/21. Basic dental coverage for ages 0-21 effective 1/1/22.
The President is authorized to create a new agency named "The National Wellness, Health and Illness Service Agency (NWHIS) which shall develop and implement a full range of wellness prevention, health maintenance, diagnostic and treatment protocols and compassionate end of life programs.
NWHIS shall direct research priorities to include the efficacy, safety and expense of alternative providers, nutritional supplements, an improved environment, safer working conditions, safer housing, safer water, and other areas.
The NWHIS shall develop short and long range budgets for of prevention, maintenance and end of life programs and present those budgets to a panel of Americans who represent proportionately the economic, racial, regional and sexual demographics based on the most recent Census. NWHIS shall create a panel of providers, including alternative practitioners, wellness providers and members of the medical doctor establishment to advise on primary prevention, diagnosis and treatment.
These budgets inclusive of panel commentary summation shall be presented to Congress for approval.
Congress authorizes the expansion of Medicare to the general population as follows: Coverage for ages 55-64 effective 1/1/17; ages 45-54 effective 1/1/18; ages 35-44 effective 1/1/19; ages 25-34 effective 1/1/20 and all other age groups effective 1/1/21. Basic dental coverage for ages 0-21 effective 1/1/22.
The President is authorized to create a new agency named "The National Wellness, Health and Illness Service Agency (NWHIS) which shall develop and implement a full range of wellness prevention, health maintenance, diagnostic and treatment protocols and compassionate end of life programs.
NWHIS shall direct research priorities to include the efficacy, safety and expense of alternative providers, nutritional supplements, an improved environment, safer working conditions, safer housing, safer water, and other areas.
The NWHIS shall develop short and long range budgets for of prevention, maintenance and end of life programs and present those budgets to a panel of Americans who represent proportionately the economic, racial, regional and sexual demographics based on the most recent Census. NWHIS shall create a panel of providers, including alternative practitioners, wellness providers and members of the medical doctor establishment to advise on primary prevention, diagnosis and treatment.
These budgets inclusive of panel commentary summation shall be presented to Congress for approval.
1
Ed, just please tell me what one agency, program, etc. the US Gov't has run efficiently with full accounting?
One need only look at the exchanges. In regions where there is full competition, insurance rates are markedly lower than in regions with a small number of offerers. It's not difficult to see these proposed combinations will be bad for consumers. The situation is not unlike combination of the airlines. The question is: will the Justice Dept be myopic once again and let these go through or will it have the courage to stand for consumers and say NO WAY!
4
I am disappointed the ACA has not been better than I thought it would be. We need a universal healthcare system like every other developed country. This is not sustainable.
6
Before publishing the nonsense from Pembroke about independent pharmacies- did the reporter look around? Where are the independent pharmacies? Are they operating incognito or perhaps using the name of Walgreens?
3
I think it foolhardy to think that allowing mega firms to buy mega firms is smart, wise, proper.
Here in CA I'm paying $3.95/gal. for gasoline for my car. Oil companies are mega firms. Competition? It's a joke. There isn't any. So it will be with health care.
We need another Teddy Roosevelt to wage war on the huge companies. It's called anti-trust. And we need it now.
Here in CA I'm paying $3.95/gal. for gasoline for my car. Oil companies are mega firms. Competition? It's a joke. There isn't any. So it will be with health care.
We need another Teddy Roosevelt to wage war on the huge companies. It's called anti-trust. And we need it now.
6
One of the conditions for regulatory approval should be a "bump-up" in the percentage of revenue that must go to services - from 80% to something higher.
2
Mergers between large medical facilities and medical insurance corporations are about nothing more than who will become the "largest toy" in the toy chest. And in the end, the one with the most "toys" wins!
You can bet there aren't any PATIENTS sitting around those huge boardroom tables when these merger talks occur, even though THEY will be the ones to suffer the most in the end, as all of their toys will be gone.
You can bet there aren't any PATIENTS sitting around those huge boardroom tables when these merger talks occur, even though THEY will be the ones to suffer the most in the end, as all of their toys will be gone.
2
Well, duh! What a startling notion - that large companies might merge to their own benefit without passing lower costs along to the consumer. The difference of course is that in many cases health care, unlike a plane trip, is not optional. Having already bribed the insurance companies to accept Obamacare, the nitwits in Washington will no doubt meekly agree to allow them to continue to consolidate.
1
The fiduciary responsibility of the boards of any of these huge public entities is to return maximum profits to their investors. To assume anything else is laughable. Fewer and larger insurers just make for less competition and higher profits.
And I never had to take economics to know that.
And I never had to take economics to know that.
3
Consumers in the US face a similar situation with US airlines and US banks.
Scale economies increase with size, but costs do not fall in a straight line. Past a sweet spot, costs level and eventually increase.
Firms grown large either thru knocking off competitors or thru buying out competitors may lower production costs, but they also gain market power (meaning ability to administer prices).
To set the fairest prices, markets need producers (sellers) without market power to serve buyers who also lack buying power.
Scale economies increase with size, but costs do not fall in a straight line. Past a sweet spot, costs level and eventually increase.
Firms grown large either thru knocking off competitors or thru buying out competitors may lower production costs, but they also gain market power (meaning ability to administer prices).
To set the fairest prices, markets need producers (sellers) without market power to serve buyers who also lack buying power.
2
Using Express Scripts as an example of the economies of scale achieved through mergers in the health care field is a very poor choice. I don't know about relative costs from before and after the merger with Medco, but their customer service is now abominable. Their prescription fulfillment is poorer and their billing department obviously doesn't communicate at all with other operating departments. There's NO ONE who is capable of sorting out billing and product delivery issues. It's even difficult to escalate issues to management who know anything about their operations. Just terrible.
2
Americans will rue the day they didn't demand either a public option or a single payer healthcare system.
We will all be at the mercy of Wall St.entities whose sole purpose is to pay huge salaries to the CEOs and large profits for stockholders while denying treatment to as many people as possible!
We will all be at the mercy of Wall St.entities whose sole purpose is to pay huge salaries to the CEOs and large profits for stockholders while denying treatment to as many people as possible!
4
It's not only the mergers and acquisitions of insurance companies. This is also the case with ever larger and monopolistic group practices. Not only will rates increas, but customer service will deteriorate and more and more health care providers will be considered "out-of-network." When I orginally qualified for Medicare I had a Blue-Cross (i.e. Anthem) advantage plan. The customer service as abysmal, but I had an excellent local Blue Cross agent who would help take care of problems. When I moved to a different county my former policy wasn't available, so I switched to United Health Care. This turned out to be a blessing in disguise. UHC has a much better customer service.
Mount Kisco Medical Services acquired Mid-Hudson Medical Group, where I had been a patient for years. I can still use Mid-Hudson, but now it's out of network, so my out-of-pocket costs are much higher.
It's hard enough to find good medical care in this country for most of us, but nothing short of a universal health-care system will solve the problem of these huge monopolistic corporations which spend millions on lobbying and advertising and are purely motivated by profits. The quality of health care is purely incidental and an inconvenience to their CEOs and stockholders.
Mount Kisco Medical Services acquired Mid-Hudson Medical Group, where I had been a patient for years. I can still use Mid-Hudson, but now it's out of network, so my out-of-pocket costs are much higher.
It's hard enough to find good medical care in this country for most of us, but nothing short of a universal health-care system will solve the problem of these huge monopolistic corporations which spend millions on lobbying and advertising and are purely motivated by profits. The quality of health care is purely incidental and an inconvenience to their CEOs and stockholders.
3
Everyone - and I mean everyone - should read the book Catastrophic Care by David Goldhill. He points out that insurance is more like a payment mechanism than real insurance. He recommends moving to a system where we pay directly to hospitals and doctors, reserving insurance for true disasters (the way car and home insurance works) and holding out safety nets for the poor.
There's no reason for insurance to fund planned services, such as routine tests (many of which aren't medically necessary, according to published research). And if we paid directly we would bargain and negotiate and prices would come down, as they have for direct-pay services like Lasik.
Insurance companies are like medieval lords of the manor who have power over our lives, with virtually no accountability.
And as others have noted, dealing with Medicare is simpler, more straightforward and even more courteous than dealing with insurance companies.
Read that book - Catastrophic Care - and write to your legislators.
There's no reason for insurance to fund planned services, such as routine tests (many of which aren't medically necessary, according to published research). And if we paid directly we would bargain and negotiate and prices would come down, as they have for direct-pay services like Lasik.
Insurance companies are like medieval lords of the manor who have power over our lives, with virtually no accountability.
And as others have noted, dealing with Medicare is simpler, more straightforward and even more courteous than dealing with insurance companies.
Read that book - Catastrophic Care - and write to your legislators.
2
Another move towards the eventual checkmate of the American consumer.Lower costs from mergers leads to higher compensation in the C-SUITE , NOT LOWER PRICES FOR CONSUMERS!I was working in finance during the 1985-2000 period when many of these companies came public.The industry is run for the benefit of stockholders and management not the consumer. Prices go up because they are suppose to as quality goes down because that is where you get margin expansion.The most important thing in most people lives is their health and that of those around us.Only when we have a single payer system that works for the consumer will we have any real relief.One reason to vote for Bernie Sanders and against the CORPORATOCRATS,that infest our government.Those that serve will waiting to get the golden hand shake from those they use to regulate.
5
Anyone who thinks that the consolidation in the health insurance industry will lead to lower costs and improved outcomes is delusional. In the last decade and a half which has already seen many drug company, hospital, and insurance mergers, health care costs have risen from 13.8% of GDP to 18% of GDP which means that in 2015 the U.S. will spend $3.13 TRILLION dollars of its $17.4 trillion dollar GDP on health care. If this trend continues, and there is no reason to believe it will not continue, funds needed for a plethora of important programs will slowly dwindle, and in the not too distant future, we will be either bankrupt or close to bankruptcy.
3
Monopolies do not bring prices down. Where's a Roosevelt when you need one?
4
Prices will never "go down". The rate of inflation in health care CAN be slowed by efficiencies.
1
I guess we'll have single payor but it won't benefit us. It will help whichever weath insurance company remains standing after it's gobbled up the competition. Of course once that happens our elected officials might develop some common sense and ask why there are narrow networks which restrict people from seeing doctors they've developed relationships with and prefer to continue seeing. The fact is that the wealth insurance companies have been a major obstacle to patients and doctors maintaining relationships, to good medical care, and to people wanting to receive care unless they are in dire need. Since the insurance companies run our health, not our doctors, it's become much harder to know if our doctors are in charge of our health care or the insurance companies are. Given the fact that the insurance companies often lose our claims, deny our claims, delay our claims, refuse to allow us to go outside their narrow networks, find ridiculous reasons to say no, it's not hard to say that our health is not first in their minds. Their financial health is. The same could be said for hospitals and other facilities: they care more about their financial health than our physical or mental health.
As always the winners are the CEOs and the patients the losers.
As always the winners are the CEOs and the patients the losers.
3
Duped again America. We are like the heard being driven to the slaughter house, hoping all along that the next stretch of promised verdant prairie will is the intended destination.
The ACA was an impossible amalgamation, the impetus for which was the threat of grave political consequence certain to befall the new Obama presidency and the exuberant Democratic majority in Congress had they failed to get a healthcare deal -- just a devastating repeat of the prior Clinton abject failure to deliver on healthcare reform.
Everything that is evolving forth now is the poison fruit of the convoluted, extraordinarily complex, and mostly big pharma, and big insurance provider contrived ACA tree.
Health and life are inseparable. The elemental problem remains healthcare as just another incarnation of big business for maximum profit, a premise that is profoundly morally and socially misguided and just flat wrong.
The ACA was an impossible amalgamation, the impetus for which was the threat of grave political consequence certain to befall the new Obama presidency and the exuberant Democratic majority in Congress had they failed to get a healthcare deal -- just a devastating repeat of the prior Clinton abject failure to deliver on healthcare reform.
Everything that is evolving forth now is the poison fruit of the convoluted, extraordinarily complex, and mostly big pharma, and big insurance provider contrived ACA tree.
Health and life are inseparable. The elemental problem remains healthcare as just another incarnation of big business for maximum profit, a premise that is profoundly morally and socially misguided and just flat wrong.
1
If we follow these merger appeals to their logical end, then the ineluctable conclusion must be that, if bigger really is better for all involved, then a single payer plan must be the end goal.
3
Geez. This article was presented with a straight face? "Might" lead to problems for consumers?
My only question is which boards Obama will join once he's free to do so.
A little bit of dog kibble was thrown at the public with the passage of the ACA; the sirloin went to the insurers, who, you know, helped to write the legislation...
The crime at the heart of this is treating healthcare as a commodity from which profit is obtained. No civilized country does so.
Between my friend in the UK, with their system, and my ex-Noo Yawka (like I am) brother in Canada, with theirs, I only shake my head sadly, wondering when the rest of us get to join the club of decent countries. Thank God I'm now on Medicare and with an affordable--for now--supplemental policy. I haven't seen a physician in maybe 10 years and don't use prescription drugs, but anything can happen. The ginger and Vitamin C may not protect me forever. But then, Medicare might not either...
My only question is which boards Obama will join once he's free to do so.
A little bit of dog kibble was thrown at the public with the passage of the ACA; the sirloin went to the insurers, who, you know, helped to write the legislation...
The crime at the heart of this is treating healthcare as a commodity from which profit is obtained. No civilized country does so.
Between my friend in the UK, with their system, and my ex-Noo Yawka (like I am) brother in Canada, with theirs, I only shake my head sadly, wondering when the rest of us get to join the club of decent countries. Thank God I'm now on Medicare and with an affordable--for now--supplemental policy. I haven't seen a physician in maybe 10 years and don't use prescription drugs, but anything can happen. The ginger and Vitamin C may not protect me forever. But then, Medicare might not either...
4
Bigger never is bigger. Mergers and acquisitions always have winners and losers. Redundant employees, oftentimes the older and more highly compensated, are laid-off. Building empty-out, adding to a potential commercial del estate blight. Investor may be either winners or losers--depending on which company they owned stock in. But the customers, they merely find less options, fees rise (often to pay for the overpriced target company acquired), and they rarely, rarely are ever winners.
http://thetruthoncommonsense.com
http://thetruthoncommonsense.com
3
This reminds me of the story of Little Red Riding Hood.
The consumer is off to see Gramma. (Healthcare). But the wolf (insurance company) is disguised as Gramma. (Insurance provides no "care" at all, but is pure rent-seeking. (gobbling up at least 20% of the healthcare dollar)
Beware the wolf!
Single payer healthcare takes you safely to Gramma.
The consumer is off to see Gramma. (Healthcare). But the wolf (insurance company) is disguised as Gramma. (Insurance provides no "care" at all, but is pure rent-seeking. (gobbling up at least 20% of the healthcare dollar)
Beware the wolf!
Single payer healthcare takes you safely to Gramma.
4
So what is new, this is morally corrupt capitalism that the Republicans are so proud of would deliver. It will deliver cost reduction to the Mega Insurance companies with over 20% of all patient population under their thumb and that the Republican Reaganomics never worked, the theory of trickle down economics never worked and would not work in this case.
The insurance companies are running their companies like they should to maximize profit, this profit comes at the expense of Patients.
Among the major Presidential candidates only Bernie Sanders is speaking of a single payer system, a system that is a must if we are serious about controlling and managing the runaway inflationary pressure on healthcare. ACA is the first step towards towards a sustainable single payer system.
The powerful lobbies of AMA, AHA, and the drug industry gets their profits by the patient being sick and vulnerable. We should learn from other countries and stop unnecessary fleecing the patient.
The insurance companies are running their companies like they should to maximize profit, this profit comes at the expense of Patients.
Among the major Presidential candidates only Bernie Sanders is speaking of a single payer system, a system that is a must if we are serious about controlling and managing the runaway inflationary pressure on healthcare. ACA is the first step towards towards a sustainable single payer system.
The powerful lobbies of AMA, AHA, and the drug industry gets their profits by the patient being sick and vulnerable. We should learn from other countries and stop unnecessary fleecing the patient.
13
Dr. Ben Carson's criticism of health insurance companies (Wikipedia reference)
In a 1996 interview, Carson said that he found the "concept of for profits for the insurance companies" absurd. He continued, "The first thing we need to do is get rid of for-profit insurance companies. We have a lack of policies and we need to make the government responsible for catastrophic health care" In 2014 Carson wrote, "...we need to remove health care from the political arena and recognize that any government proposals affecting the health of all citizens should be free market-based and should be so appealing that it would not be necessary to force citizens into the program.
In a 1996 interview, Carson said that he found the "concept of for profits for the insurance companies" absurd. He continued, "The first thing we need to do is get rid of for-profit insurance companies. We have a lack of policies and we need to make the government responsible for catastrophic health care" In 2014 Carson wrote, "...we need to remove health care from the political arena and recognize that any government proposals affecting the health of all citizens should be free market-based and should be so appealing that it would not be necessary to force citizens into the program.
1
One of the obvious and most important things that regulators could do to help lower health care costs is to require that patients be informed what a medical service is going to cost them, before they undergo the service. This should take in to account all components of the cost - the physicians' fees, the facility costs, drug costs, the negotiated discounts, the co-pay's, the deductibles, etc. This shouldn't be too hard for providers and insurers to do, after all, they are able to figure out how much to bill the patient after the service is rendered.
If patients knew in advance what their medical care was going to cost, they could make informed decisions about where to get their care, and perhaps for some non-essential medical services, about what care was necessary.
If patients knew in advance what their medical care was going to cost, they could make informed decisions about where to get their care, and perhaps for some non-essential medical services, about what care was necessary.
3
That's not possible. Have you ever heard of medical complications? There is no way to know what a patient is going to need from a hospitalization or surgery. Medicine is not black and white. The human body is very complicated.
There are also medical emergencies. I am sure if you were having a heart attack, you wouldn't have time to look at several facilities and doctors to decide who is going to give you the best rate.
There are also medical emergencies. I am sure if you were having a heart attack, you wouldn't have time to look at several facilities and doctors to decide who is going to give you the best rate.
We're constantly told that the "marketplace" is the deity we should all bow down to. That government and it's regulations are not needed, because the marketplace will make it right. Well, we have seen, through consolidation in other industries (airlines, cable tv, etc), that consolidation just leads to higher costs for consumers and bigger profits for Corporations. Why do regulators continue to believe the corporations lies on the benefits to the consumer? I guess to answer my own question, it's because the regulators are in the "pocket" of the corporations. After all, they need to secure their own job opportunities when they leave the government.
6
There is a fundamental difference between attaining greater efficiency through so-called "economy of scale" and mere consolidation. The former involves complex innovation made possible and necessary when systems grow; the latter reduces complexity, and constrains choice.
This is yet another chapter in the saga of The Economics of Inequality in America.
This is not about the two or three fold difference in means between the middle class and upper middle class. It is about the ten thousand fold difference between the upper 1 percent and everyone else.
This is yet another chapter in the saga of The Economics of Inequality in America.
This is not about the two or three fold difference in means between the middle class and upper middle class. It is about the ten thousand fold difference between the upper 1 percent and everyone else.
2
Whatever advantage for the consumer comes of these consolidations will be unintended consequences. We all know that health insurance companies rarely make decisions with the premium payer or the benefit recipient in mind. The portion of law that requires insurers to document paying eighty cents on the dollar annually for claims payouts or make refunds to policyholders will have to suffice as a brake against the all too apparent avarice of health insurers.
3
As an Anthem customer, I am already bracing myself for the huge rate increase that will inevitably follow the merger. Notwithstanding claims that the merger will create greater efficiencies and so on, the sad truth is that the premium increases will be needed to fund Anthem's massive executive bonuses. I object.
5
Single payer would solve many, many problems created by health insurance companies.
6
Lets take this one step further. A single health care provider. Medicare for everyone. If nothing else it would remove a few conflicts of interest:
> Seven figure salaries for corporate CEOs.
> Shareholder dividends.
> Seven figure salaries for corporate CEOs.
> Shareholder dividends.
5
What terrible irony that the Obama administration's timidity in refusing to even propose a public option, let alone single-payer Medicare for all, for the Affordable Care Act instead is leading to a single for-profit payer. What a dream for the conservative champions of greed to have a nationwide oligopoly -- soon to be a monopoly -- not subject to any nationwide price regulation in lieu of competition. Way to bend the cost curve UP, federal government!
2
If you think that reducing competition in the marketplace helps consumers to obtain lower cost health insurers, the insurance companies will be happy to enroll you in the P.T. Barnum school of credulous Americans. The insurance companies are first and foremost beholden to their investors, and their investors want to see better returns. This has nothing to do with benefiting consumers and everything to do with consolidating big insurance companies marketplace positions and improving their value to their investors. Call me cynical, but if you read Wendell Potter's Deadly Spin, an insider account of how the insurance companies successfully fool Americans and their political leaders into looking upon them as forces for positive change in the health care system, you too will become a cynic.
3
This will produce greater operational efficiency? I'll tell you what produces great operational efficiency: Medicare, where the overhead is 2-3 percent compared to 20 percent and more with the commercial insurors.
Commercial health insurance is the land of the corporate robber barons, and now they are forming larger conglomerates to better dictate the terms of service to the American people.
Commercial health insurance is the land of the corporate robber barons, and now they are forming larger conglomerates to better dictate the terms of service to the American people.
3
Like other monopolies, healthcare companies are buying share to get higher profits. Show us some statistics in which monopolies actually benefited the consumer. With fewer options, people who have difficulty getting insurance will have even harder times.
In the past, there is a reason why there were rules against monopolies. That reason has not changed but the laws have stepped aside.
By the way, I thought reports were supposed to remain impartial; saying that concerns may be "overblown" sounds very much like the opinion of the reporter. Let the speakers speak for themselves, sans comment.
In the past, there is a reason why there were rules against monopolies. That reason has not changed but the laws have stepped aside.
By the way, I thought reports were supposed to remain impartial; saying that concerns may be "overblown" sounds very much like the opinion of the reporter. Let the speakers speak for themselves, sans comment.
Where I live in Alabama, before Obamacare and after there has only been one health insurance provider. As an individual policy holder, I have never been able to compare what I have with other insurance companies. It is not at all comforting to me.
2
"When...Express Scripts and Medco Health Solutions, merged in 2012, many experts were worried that the market would be significantly less competitive, recalled Adam J. Fein, president of Pembroke Consulting, a company that follows the pharmaceutical industry.
“Many of the fears that were advertised did not come to pass,” he said.." Maybe not there, Mr. Fein, but the number of calls I get from angry members asking me why " I can't get my medicine , Medco won't pay for it no more.." No, the formulary for Express scripts leans toward, cheaper or generic substitutes for the name brands those members know works. All in the name of $$$$$.
“Many of the fears that were advertised did not come to pass,” he said.." Maybe not there, Mr. Fein, but the number of calls I get from angry members asking me why " I can't get my medicine , Medco won't pay for it no more.." No, the formulary for Express scripts leans toward, cheaper or generic substitutes for the name brands those members know works. All in the name of $$$$$.
Just what kind of water is Mr. Bertolini and Mr. Cordani drinking? "Create value for our customers..." and "cost improvements go back to the employer, ... and/or individual." These statements are the same that telecommunications, transportation, and media companies have issued before, during, and after mergers. The only winners are the stockholders in the companies, the consumer will lose. Sadly, the FTC and DOJ accepts these statements hook, line, and sinker.
1
The mega-insurers will just consolidate their practices of rejecting legitimate claims, especially those submitted by individuals who lack a hospital's administrative super-structure for handling claims. The insurance companies routinely reject individual claims that should be paid; they seem to hope that the insured person will be too busy or too sick to appeal the denial.
Ephemeral is the in,y word that comes to mind when insurers talk about rationalising costs. Ten only winners in this consolidation will be the managers of the companies with consumers as the biggest losers.
These facts will not change in one, five or twenty years. It will only change when costs are reduced by the unholy nexus Of PHARMA companies, insurer managements and doctors decide that costs needs to be reined in.
Alternative to this is rationing of healthcare which politically will never fly.
These facts will not change in one, five or twenty years. It will only change when costs are reduced by the unholy nexus Of PHARMA companies, insurer managements and doctors decide that costs needs to be reined in.
Alternative to this is rationing of healthcare which politically will never fly.
1
Few will argue that health insurers make their profits for their bondholders, shareholders, executives, bureaucrats and patron politicians by physically and fiscally rationing access to physicians, institutions, diagnostics, treatments, preventative and palliative care. In addition, premiums, co payments and deductibles ensure profits because the insurance companies remain unchecked concerning the quality of service provided by the doctors or hospitals contracted by the insurance companies.
The McCarron Ferguson Act, ACA and ERISA laws allow insurance companies to collusively ration care for profit with no risk whatsoever.
The McCarron Ferguson Act, ACA and ERISA laws allow insurance companies to collusively ration care for profit with no risk whatsoever.
2
"The insurers insist that combining companies will lead to lower prices and better care for their customers. They point to billions of dollars in efficiencies".
How is this merger of giants any different from "consolidations" in the airline, telecommunications, and banking industries? Mergers in those industries conspired to keep consumer fees high and choices low. While I know healthcare is vastly different from booking a flight, for example, the omens bode ill for true benefits to consumers.
What's left unsaid in this article is the amount of profits from fees will be directed to shareholders. After all, these companies are for-profit entities. It's the same problem that affects consumers of product like prescription drugs, medical devices, and hospitalizations. Most health entities are publicly traded companies, meaning, a large slice of profits go to stockholders.
Were I king (queen, obviously), I'd rid the healthcare maw of insurance companies all together, or at the very least, reduce their significant parasitic middleman role in the delivery of care. All they do is add a layer of costs, by fooling around with physician networks, and allegedly bargaining with hospitals. They are, and should be, just processers of claims--about the only thing they do well.
The proposed mergers veer dangerously towards monopoly. All you have to do is look at the American Airlines-US Air merger to see how easy it is to squeeze consumers when you corner the market.
How is this merger of giants any different from "consolidations" in the airline, telecommunications, and banking industries? Mergers in those industries conspired to keep consumer fees high and choices low. While I know healthcare is vastly different from booking a flight, for example, the omens bode ill for true benefits to consumers.
What's left unsaid in this article is the amount of profits from fees will be directed to shareholders. After all, these companies are for-profit entities. It's the same problem that affects consumers of product like prescription drugs, medical devices, and hospitalizations. Most health entities are publicly traded companies, meaning, a large slice of profits go to stockholders.
Were I king (queen, obviously), I'd rid the healthcare maw of insurance companies all together, or at the very least, reduce their significant parasitic middleman role in the delivery of care. All they do is add a layer of costs, by fooling around with physician networks, and allegedly bargaining with hospitals. They are, and should be, just processers of claims--about the only thing they do well.
The proposed mergers veer dangerously towards monopoly. All you have to do is look at the American Airlines-US Air merger to see how easy it is to squeeze consumers when you corner the market.
6
Insurance is an industry where the insurer charges the highest possible premium for coverage, disputes coverage whenever possible, and then pays the minimum possible on covered claims. When you are dealing with an unscrupulous insurer, this is a formula for serious abuse and very high profits. If the answer for health care insurance is bigger is better, we had better make sure there is extremely effective regulation to prevent abuse.
6
The whole thin is ONE BIG SCAM. Health Insurance is no longer affordable, either by small business owners or by individuals. Essentially for any "affordable" policy, for just basic coverage, you have a deductible of $6000-7000, which the majority of people will never get close to in a year and then on top of that you have the cost of the yearly premium. Unless you get hospitalized or have a chronic illness, you pay up to at least 10K/year out of pocket for very little. AND that means using "in network", "approved drugs" (often generic and manufactured in India). So much for choice. Who is benefiting? Those with chronic or catastrophic illness, sure, but mostly--BIG INSURANCE, i.e., CORPORATE AMERICA with their CEO culture and their SHAREHOLDERS. Bottom dwellers, getting rich off of the sick. So disgusting. Obama has NOTHING to be proud of. Every time a democrat has even hinted at "fixing" the problem, like the Clintons way back, the INDUSTRIAL GIANTS react with new schemes to make money. Lots of it flows to advertising and lobbying, so that all politicians, no matter the party, are in cahoots. And the Republicans declare we have the best health care in the world. Drinking that Kool-Aid like they do on Faux News......The whole medical system, enabled by the government program medicare, is corrupt and broken.
4
Our government run health insurers are far more efficient than any of the various private insurers I have dealt with over the years. Nobody at Medicare/Medicaid or the VA makes a salary even close to what those in the C-suites at the insurance companies make. And the government run plans can plan intelligently, with long return-on-investment horizons rather than the drive to please the stockholders in the next quarter. The broker quoted in the article is right. Less competition means more cost.
13
The lengths that the Times go to here are astounding.
Did any sane person not see this coming as a result of Obamacare?
It is inexcusable for the Times and the media to ignore this and to not hold Obama accountable for allowing Jonathan Gruber and the insurance companies to have pajama parties in the WH writing the loopholes that allow a monopoly to happen.
As result, those of us who are "young and healthy" are going to pay the costs for old people, and when we need medical care we will have fewer choices and higher prices.
Barack Obama is a disgrace.
Did any sane person not see this coming as a result of Obamacare?
It is inexcusable for the Times and the media to ignore this and to not hold Obama accountable for allowing Jonathan Gruber and the insurance companies to have pajama parties in the WH writing the loopholes that allow a monopoly to happen.
As result, those of us who are "young and healthy" are going to pay the costs for old people, and when we need medical care we will have fewer choices and higher prices.
Barack Obama is a disgrace.
3
Seriously?
Bush the First, took us into a war!
Bush the Lessor, lied to the American people and took us into two unnecessary vanity wars that will cost the US close to 3 trillion dollars when all costs are added up!
But, Obama is a disgrace for trying to provide healthcare to millions of people!
Are you on the payroll of the Koch boys?
Bush the First, took us into a war!
Bush the Lessor, lied to the American people and took us into two unnecessary vanity wars that will cost the US close to 3 trillion dollars when all costs are added up!
But, Obama is a disgrace for trying to provide healthcare to millions of people!
Are you on the payroll of the Koch boys?
Obama is "trying" to provide healthcare to 6 million Obamacare enrollees by taking it away from 12 million Americans who liked the plan they had?
You're not being serious are you?
Let Obama "try" to do that on his dime, not mine.
You're not being serious are you?
Let Obama "try" to do that on his dime, not mine.
1
I believe in universal healthcare, and know it works because I have worked in all the countries where it functions well.
I read both Bills in Congress that became the ACA and the ACA itself.
The emerging monopolies in health insurance, pharmaceuticals, and Walmart-style hospitals were completely predictable the minute the ACA passed.
I wrote an Op Ed piece then: we had just created the General Motors of healthcare, at the same time General Motors was dying.
Here's why. The ACA is not about healthcare, it is a management policy document - a centralized "command and control" design based upon the systems GM, Ford, ATT, and others created in the early 20th century.
It literally makes it the law of the land to put a very small number of managers (fewer than 1,000) absolutely in control of the health delivery for more than 300 million people.
It is simply the largest single command and control management model ever attempted in human history, at a time when humanity has moved from command models to emergent, user-assembled social models (Google, etc).
The ACA implicitly mandates insurance/pharma cartels, and, as evidenced by the problems of healthcare.gov (that Amazon could have built in months), the ACA command system, like that of GM, will spawn rigid systems, that will continually break down.
Unless...
..the command authority is shifted from central Washington DC to the local regions where complex healthcare decisions can be customized to the patient. Like Tesla.
I read both Bills in Congress that became the ACA and the ACA itself.
The emerging monopolies in health insurance, pharmaceuticals, and Walmart-style hospitals were completely predictable the minute the ACA passed.
I wrote an Op Ed piece then: we had just created the General Motors of healthcare, at the same time General Motors was dying.
Here's why. The ACA is not about healthcare, it is a management policy document - a centralized "command and control" design based upon the systems GM, Ford, ATT, and others created in the early 20th century.
It literally makes it the law of the land to put a very small number of managers (fewer than 1,000) absolutely in control of the health delivery for more than 300 million people.
It is simply the largest single command and control management model ever attempted in human history, at a time when humanity has moved from command models to emergent, user-assembled social models (Google, etc).
The ACA implicitly mandates insurance/pharma cartels, and, as evidenced by the problems of healthcare.gov (that Amazon could have built in months), the ACA command system, like that of GM, will spawn rigid systems, that will continually break down.
Unless...
..the command authority is shifted from central Washington DC to the local regions where complex healthcare decisions can be customized to the patient. Like Tesla.
3
Marty: What are we doing tonight? With nothing to do the weakminded ensure that nothing gets done. The Patient Safety and Affordable Care Act has some saving graces which the industry did not want but accepted because that "Act" preserved the special interests real objective, To make money. The quality of care and its costs/expense were side issues.
Here is what a representative in New York State said when their insurance rates were reduced about 30% on average, "The New York Health Plan Association was not pleased with the DFS reductions. The approvals do not reflect rising pharmacy costs and increased expenditures related to hospital consolidation, said Paul Macielak, president and chief executive of HPA, in a statement."
So the implication is that the insurers acknowledge that provider mergers increases costs/expenses up to 30% (less prescription drugs).
One Payer. Universal, Under an Expanded Medicare with a National Wellness and Health Service with Liberty and Justice for ALL.
Bernie Sanders has a plan that helps everyone not just the 1%.
ALL the Republican candidates want Medicare, Medicaid and Social Security destroyed outright or by deviously designed voucher and similar for profit plans.
Wake up Americans and smell the new military-industrial complex called provider-insurer death squads.
Here is what a representative in New York State said when their insurance rates were reduced about 30% on average, "The New York Health Plan Association was not pleased with the DFS reductions. The approvals do not reflect rising pharmacy costs and increased expenditures related to hospital consolidation, said Paul Macielak, president and chief executive of HPA, in a statement."
So the implication is that the insurers acknowledge that provider mergers increases costs/expenses up to 30% (less prescription drugs).
One Payer. Universal, Under an Expanded Medicare with a National Wellness and Health Service with Liberty and Justice for ALL.
Bernie Sanders has a plan that helps everyone not just the 1%.
ALL the Republican candidates want Medicare, Medicaid and Social Security destroyed outright or by deviously designed voucher and similar for profit plans.
Wake up Americans and smell the new military-industrial complex called provider-insurer death squads.
The American public has been duped time and time again, by the idea that the free market is the panacea for all issues, the biggest one being health care.
If you look at the actual return on investment, placing the money spent on private health insurance into a single payer system like an expanded Medicare program would be cheaper and better for people in the long run. Especially, since taxpayers are already paying for Medicare on top of private insurance. If you want to talk about economies of scale, there is no comparison between the consolidation of private companies down to a few providers and a single Medicare trust.
This myth propagagated by politicians the programs like Social Security and Medicare are money pits just isn't true. The only reason why they experience finance difficulties is because Congress continues to raid the trust to pay for their budget shortfalls (as this new Congress did again the minute the session opened). Al Gore scared Congress when he proposed the idea of the lockbox when he ran for President.
If you look at the actual return on investment, placing the money spent on private health insurance into a single payer system like an expanded Medicare program would be cheaper and better for people in the long run. Especially, since taxpayers are already paying for Medicare on top of private insurance. If you want to talk about economies of scale, there is no comparison between the consolidation of private companies down to a few providers and a single Medicare trust.
This myth propagagated by politicians the programs like Social Security and Medicare are money pits just isn't true. The only reason why they experience finance difficulties is because Congress continues to raid the trust to pay for their budget shortfalls (as this new Congress did again the minute the session opened). Al Gore scared Congress when he proposed the idea of the lockbox when he ran for President.
15
Freeze health insurance rates. That will stop the too big syndrome. As Scott in Chapel Hill says we need a single payer system that only Bernie Sanders is talking about.
10
All of this talk about efficiency is downright hilarious coming from an insurance company executive. Why? The entire business-model is based on obfuscation, tactical delay, and the bait-and-switch. In other words, insurance companies are intentionally inefficient, so that they can delay payment, and make money off of your wasted time--and blood. He knows it, and you and I know it.
What he'll soon know is the sweet taste of nationalization, and, hopefully, the eternal public shame befitting a liar.
What he'll soon know is the sweet taste of nationalization, and, hopefully, the eternal public shame befitting a liar.
3
Yet another article that demonstrates that health care for profit is immoral.
13
The best example we have of the effects of mergers and consolidation of services among large companies is the telecommunications business. We were promised more competition and lower prices when the "baby Bells" were broken up and eventually consolidated. The net result was that competition went down and prices went up. Same with the merger of the big banks. Do we really think the story will be any different with the merger of health insurance companies?
3
Obama's Affordable Care Act is quickly becoming UNaffordable, thanks to Obama and the Democrats allowing the insurance companies to merge and rake in trillions of dollars, pay their CEOs billions of dollars, and continue to stick it to the insured.
3
Now it is "the federal health care law?" Call it what it is: Obamacare.
Obamacare has vastly increased the regulatory burden on the delivery of healthcare. Only large organizations have the economies of scale to compete. In essence, the small provider of healthcare has been regulated out of existence. If this only meant that professional expertise and management would be brought to smaller service providers, it would be wonderful. But what it really means is that competition will decrease, which in the long run will lead to less innovation. Less innovation will lead to higher healthcare costs and worse results.
Some people urge that we double down on this fiasco and adopt a single-payer system, in which healthcare is administered by a financial monopoly--the government. Health care choices and pricing will be determined by administrators who have no clue what people really would pay for anything, given the choice. Consequently, we'll get a lot of what we don't need, and little of what we do. Healthcare will be delivered by greased palms bestowing pork-barrel subsidies.
Obamacare has vastly increased the regulatory burden on the delivery of healthcare. Only large organizations have the economies of scale to compete. In essence, the small provider of healthcare has been regulated out of existence. If this only meant that professional expertise and management would be brought to smaller service providers, it would be wonderful. But what it really means is that competition will decrease, which in the long run will lead to less innovation. Less innovation will lead to higher healthcare costs and worse results.
Some people urge that we double down on this fiasco and adopt a single-payer system, in which healthcare is administered by a financial monopoly--the government. Health care choices and pricing will be determined by administrators who have no clue what people really would pay for anything, given the choice. Consequently, we'll get a lot of what we don't need, and little of what we do. Healthcare will be delivered by greased palms bestowing pork-barrel subsidies.
2
Universal health care.
9
One hates to belabor the obvious, but these worries evaporate in a single payer health plan. The quest for profits by private companies will always come at the expense of the patient.
15
So "Big Gummint" bad... too much inefficiency and red tape.
"Big Bizness" good... much more responsive and efficient.
OK. Got it....
"Big Bizness" good... much more responsive and efficient.
OK. Got it....
2
What a crude and unfortunate thing to say. Ok. Got it.
We need Bernie Sanders for President. At least he will be working to help Americans get affordable health care. Medicare for all will eliminate profit driven insurance companies that do not care about ill people.
Here is where Bernie Sanders stands on health care: "Health Care for All: The United States remains the only major country on earth that does not guarantee health care for all as a right. Despite the modest gains of the Affordable Care Act, 35 million Americans continue to lack health insurance and many more are under-insured. Yet, we continue paying far more per capita for health care than any other nation. The United States must move toward a Medicare-for-All single-payer system."
Here is where Bernie Sanders stands on health care: "Health Care for All: The United States remains the only major country on earth that does not guarantee health care for all as a right. Despite the modest gains of the Affordable Care Act, 35 million Americans continue to lack health insurance and many more are under-insured. Yet, we continue paying far more per capita for health care than any other nation. The United States must move toward a Medicare-for-All single-payer system."
16
Before these already huge insurance carriers form yet another mega monopoly, they need to get together to create and establish patient advocacy groups within their organizations for customers who pay their premiums, and their salaries. First priority must be to reduce, regulate, restrict and demand lower costs passed on to them and their patients. If they can't see it, or recognize the disparities within the health-care communities that persist in leveling obscenely high costs for hospitalization, tests required procedures, the piracy will continue. And that's precisely what they've become...pirates.
2
The only way this could ever be good was if insurance companies were more tightly regulated like utilities or like they are in other countries (e.g. Germany) that use private companies to provide public insurance. Some experts feel that is ultimately how national insurance will come to the USA.
This would require Congress, though, so not too optimistic.
This would require Congress, though, so not too optimistic.
5
“The insurers insist that merging will accomplish more innovation as they borrow new approaches from one another.”
This statement would almost be funny, if it weren’t so tragic in its implications, and so devoid of any sense of history:
--John D. Rockefeller probably learned from the companies he bought to create his vertical trust, Standard Oil, until it was broken up.
--The 4 airlines controlling 80% of US air routes probably picked up information from their mergers and acquisitions, including price collusion.
--Former FED Chairman, Alan Greenspan, tacitly once agreed with the insurers with, “Let the markets regulate themselves”, until the 2008 financial meltdown occurred.
--The people writing the Pacific trade agreement probably agree, but since nobody knows what they’re discussing, we’ll just have to guess.
So, with a health care system:
--already the most expensive in the world,
--with double-digit annual cost increases in the face of single-digit annual inflation, and
--the only national system run by profit-making companies, getting fewer and fewer in number
it’s hard for us to expect “innovation”, or that we should not expect:
--reduced competition,
--price collusion,
--the creation of vertical/horizontal trusts, and
--increased costs from the mergers themselves.
This article is really not about health care. Its underlying, false premise is whether monopoly-capitalism should replace free-market, competitive capitalism in this country.
This statement would almost be funny, if it weren’t so tragic in its implications, and so devoid of any sense of history:
--John D. Rockefeller probably learned from the companies he bought to create his vertical trust, Standard Oil, until it was broken up.
--The 4 airlines controlling 80% of US air routes probably picked up information from their mergers and acquisitions, including price collusion.
--Former FED Chairman, Alan Greenspan, tacitly once agreed with the insurers with, “Let the markets regulate themselves”, until the 2008 financial meltdown occurred.
--The people writing the Pacific trade agreement probably agree, but since nobody knows what they’re discussing, we’ll just have to guess.
So, with a health care system:
--already the most expensive in the world,
--with double-digit annual cost increases in the face of single-digit annual inflation, and
--the only national system run by profit-making companies, getting fewer and fewer in number
it’s hard for us to expect “innovation”, or that we should not expect:
--reduced competition,
--price collusion,
--the creation of vertical/horizontal trusts, and
--increased costs from the mergers themselves.
This article is really not about health care. Its underlying, false premise is whether monopoly-capitalism should replace free-market, competitive capitalism in this country.
10
Right. Innovation for insurance companies means learning new ways to deny procedures or medications and ways to keep medical providers on the phone trying to get things authorized until they give up. Most patients do not have any idea how much time is wasted by providers just trying to get things either approved (that are black and white, evidence based medicine) or to have denials reviewed. One of the many frustrating aspects is talking to a clerk that has no medical background or to a nurse that is following a script and doesn't even know what the medication is used to treat. Often, when you ask for the medical director, they will tell you they don't know when he or she will be in! That's American medical care…worst among nations. We have rationing…it's called private insurance and most patients don't even understand this.
Let 'em merge. It'll be that much easier to transition to single-payer.
1
Beside the point, why do we spend $3 trillion when the same care should cost $2 trillion?
See the disparity in US healthcare spending and healthcare outcomes when compared to other developed countries; 10 others in the Commonwealth Fund report, 33 others in OECD reports.
"The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. " - Commonwealthfund.org
"The share of GDP allocated to health spending (excluding capital expenditure) in the United States was 16.4% in 2013, compared with an OECD average of 8.9%. This has remained unchanged since 2009 as health spending growth matched economic growth. United States spent the equivalent of USD 8713 per person on health in 2013, compared with an OECD average of USD 3453. Public sources accounted for 48% of overall health spending, compared with an OECD average of 73%." - OECD Health Statistics
See the disparity in US healthcare spending and healthcare outcomes when compared to other developed countries; 10 others in the Commonwealth Fund report, 33 others in OECD reports.
"The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. " - Commonwealthfund.org
"The share of GDP allocated to health spending (excluding capital expenditure) in the United States was 16.4% in 2013, compared with an OECD average of 8.9%. This has remained unchanged since 2009 as health spending growth matched economic growth. United States spent the equivalent of USD 8713 per person on health in 2013, compared with an OECD average of USD 3453. Public sources accounted for 48% of overall health spending, compared with an OECD average of 73%." - OECD Health Statistics
4
Healthcare is a big business. Eventually it will all dwindle into one big plan socialized medicine.
For-profit health "care" is one of the most immoral and inhumane ideas humanity has come up with yet.
6
Consolidations lead to greater efficiencies of course. Those efficiencies and the resulting cost savings lead to bigger profit margins. Consumers will not see a reduction in premiums.
1
Stunning how careful the Times writer Reed Abelson was to avoid mentioning that the insurance monopoly that will victimize us all is a direct result of Obamacare.
The insurance companies were on the WH steps with Jonathan Gruber to help draft the loopholes that allows them to form a monopoly outside the reach of law enforcement.
There are three kinds of exemptions/exceptions that Obamacare created for the insurance companies, and they could use all three to avoid ever being held accountable.
Less choice, less coverage, higher prices, more uninsured.
The Obama Legacy.
Proud yet, libs?
The insurance companies were on the WH steps with Jonathan Gruber to help draft the loopholes that allows them to form a monopoly outside the reach of law enforcement.
There are three kinds of exemptions/exceptions that Obamacare created for the insurance companies, and they could use all three to avoid ever being held accountable.
Less choice, less coverage, higher prices, more uninsured.
The Obama Legacy.
Proud yet, libs?
1
The law was passed in the halls of congress not on the WH steps. Any compromises that were made were made to garner Republican support. Democrats want to eventual;y eliminate those big bad insurance companies you fret over so much but that's (cue the horror movie organ music) socialized medicine and the Republicans will have none of that. Your logic is flawed, your support for Republicans, who have shown no concern for you, is puzzling and, as always, your invective is juvenile. If your the best the Republicans have to carry their water,then I have to ask. Proud yet Reps?
The "fixed amount" that insurers are required to spend on care is actually a fixed proportion of premiums. The rest is profit and administrative expense. Therefore, to increase profits, the insurers need to maximize premiums.
The markets with more insurers tend to have lower premiums, so in order to maximize premiums, insurers need to consolidate.
This incentive structure is contrary to the best interest of both healthy consumers and consumers in need of health care. A structure that rewards commitments to healthy living, wellness, and early diagnosis and treatment of chronic conditions would benefit us far more.
How about allowing more profit to insurers who can show that those they insure are adopting healthier lifestyles and a health-promoting relationship with the health care system? Insurers should be rewarded when individuals that they insure show increased commitment to healthy choices in a plan year compared with that individual's previous year.
The markets with more insurers tend to have lower premiums, so in order to maximize premiums, insurers need to consolidate.
This incentive structure is contrary to the best interest of both healthy consumers and consumers in need of health care. A structure that rewards commitments to healthy living, wellness, and early diagnosis and treatment of chronic conditions would benefit us far more.
How about allowing more profit to insurers who can show that those they insure are adopting healthier lifestyles and a health-promoting relationship with the health care system? Insurers should be rewarded when individuals that they insure show increased commitment to healthy choices in a plan year compared with that individual's previous year.
1
Time for single payer ! Why have your premium go through only 3 companies when you can send your premium to the government.
2
Duh.
"Cutting off" treatment to those who can be prematurely discharged/sent home in desperate need of further treatment/written off as 'fixed' is epidemic, especially in mental health care where problems are likely to be chronic and require extensive treatment. The conservatives continually blame 'the mentally ill' for the gun massacres in this country but don't want to make the insurances companies provide decent care.
This mess went on for decades before Obamacare. The bigger the corporation, the fewer places there are left to appeal to or that exist as an option.
Monopolies. Buy everything up and dictate policy.
Fewer and fewer options.
The profit motive. We'll be rid of this when we have national single payer health care.
The great thing about the ACA is people can't be denied coverage because of pre-existing conditions anymore. That has allowed at least 16 million more people to get covered. It was well worth doing.
The rest of this system is as broken and venal and polluted as it ever was.
I'm hoping Hillary Clinton will fix this once and for all.
"Cutting off" treatment to those who can be prematurely discharged/sent home in desperate need of further treatment/written off as 'fixed' is epidemic, especially in mental health care where problems are likely to be chronic and require extensive treatment. The conservatives continually blame 'the mentally ill' for the gun massacres in this country but don't want to make the insurances companies provide decent care.
This mess went on for decades before Obamacare. The bigger the corporation, the fewer places there are left to appeal to or that exist as an option.
Monopolies. Buy everything up and dictate policy.
Fewer and fewer options.
The profit motive. We'll be rid of this when we have national single payer health care.
The great thing about the ACA is people can't be denied coverage because of pre-existing conditions anymore. That has allowed at least 16 million more people to get covered. It was well worth doing.
The rest of this system is as broken and venal and polluted as it ever was.
I'm hoping Hillary Clinton will fix this once and for all.
“If plans are going to be competitive,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group, “they have to offer the most affordable premiums.”
Hahahahaha!!!! As any self-employed person over 50 knows, the joke's on us.
Hahahahaha!!!! As any self-employed person over 50 knows, the joke's on us.
1
Too big to fail is never a good idea. It never trickles down either,so get over that stuff. Health insurance should never be for profit. Companies might be people, according to the Supreme Court and the Rep. contenders, but companies can never be your friend. It's against their mandate. The Medical Industrial Complex is not a force for good. There is no reason for health insurance companies. They have no dog in the fight. They're there to make a profit, nothing else. We are the only developed country in the world that let's this legalized graft go on. We're the only ones to put this thin layer of capitalism between a doctor and a patient that sucks up 40% of the operating costs, for no reason what's so ever. This is an industry that we can't let get too big to fail, because we should be rooting for it's failure.
3
Is the NY Times aware that Aetna currently only offers a limited "Exclusive Provider" option (aka limited providers) to individual buyers of insurance in NY and NJ? And that starting January 1, 2016 Aetna will no longer cover individual buyers of health insurance in NY and NJ whatsoever?!
I just learned this the hard way after my Cobra ran its 18 month course. But after 12 years of paying premiums to Aetna for a PPO plan (first 50% under my former employer and then 100% under Cobra) you would think I would get some preferential treatment, particularly as I hardly made any claims. No apparently health insurance is a smash and grab business.
I just learned this the hard way after my Cobra ran its 18 month course. But after 12 years of paying premiums to Aetna for a PPO plan (first 50% under my former employer and then 100% under Cobra) you would think I would get some preferential treatment, particularly as I hardly made any claims. No apparently health insurance is a smash and grab business.
3
Would Apollo 13 have been better off if, "Houston, we have a problem" had been responded to by a canned voice saying, "Due to unusual call volume......" or "Press 1 to leave a message"?
Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Hello? Hello? I pressed #,1,* Is there a live person there to whom I can report a feedback loop problem, when I try to make an appointment with my doctor?
Personally, I recommend the solution posited by Edward Abbey in Chapter I of "The Fools Progress."
Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Technology will solve all your problems, say the apostles and priesthood of the corporate tech religion.
Hello? Hello? I pressed #,1,* Is there a live person there to whom I can report a feedback loop problem, when I try to make an appointment with my doctor?
Personally, I recommend the solution posited by Edward Abbey in Chapter I of "The Fools Progress."
3
Unbridled and unfettered competition is good, say the apostles and priesthood of the free market, capitalist religion.
Monopolies are good, say the apostles and priesthood of the free market, capitalist religion.
Anybody see a problem here?
Monopolies are good, say the apostles and priesthood of the free market, capitalist religion.
Anybody see a problem here?
2
Well, if 3 companies are better than five companies, then one single payer government system would be best. If we are headed in that direction, let's just go there now.
6
It is a given that the consumer is going to get screwed more in the future from these ill-fated "deals."
Consumers have NEVER benefited with these large, over-priced transactions. The only beneficiaries are the execs who cash out, as well as the accountants, lawyers and the financial mafia.
Consumers have NEVER benefited with these large, over-priced transactions. The only beneficiaries are the execs who cash out, as well as the accountants, lawyers and the financial mafia.
2
If there is a candidate for President who can channel Teddy Roosevelt, I will vote for him. Or her.
1
Just let everyone have the option of buying into Medicare and see how this all plays out.
3
OK, everyone who thought the healthcare industry was going to play fair when Americans did not receive a single payer plan with the ability to negotiate items like RX, please raise your hand. Get real! This is America where corporations rule and citizens take it on the chin and in the wallet. Another gift from your bought and sold members of congress, all of whom get all of their healthcare covered by your taxes for life and at a very small personal cost for their whole family. Getting close to the time when you go back to the voting booths and re-elect them, like you always do.
11
Merge, merge, merge--efficiency, efficiency, efficiency. It's so obvious--a single payer health plan.
4
I believe health insurance should be a monopoly run by the United States Government. It should be an expanded Medicare program that covers people under 65, and prescriptions with little or no copayments. Private insurance companies take too much money while providing no real health care. Keep the Doctors, nurses and staff, leave the insurance guys on the golf course.
5
I have no doubt that the three remaining insurance companies will decide after this merger to give all insured not simply an across the board reduction in premiums but a big fat "consolidation refund" just to demonstrate their love for their customers. In addition, they will also begin offering free home health care visits by real doctors and one day test results, just like in the movie "As Good As It Gets"!
But wait that's not all! The administrators of these "behemoths" will also agree to reduce their multi-million dollar salaries to just $70,000 a year and raise the pay of all nurses and other staff members to this same amount like the credit card processing company in Seattle recently did. And as the economy improves who knows what else they will do for us. I have absolutely no doubt that this consolidation will soon have us all singing "Happy Days Are Here Again!" Just watch!
But wait that's not all! The administrators of these "behemoths" will also agree to reduce their multi-million dollar salaries to just $70,000 a year and raise the pay of all nurses and other staff members to this same amount like the credit card processing company in Seattle recently did. And as the economy improves who knows what else they will do for us. I have absolutely no doubt that this consolidation will soon have us all singing "Happy Days Are Here Again!" Just watch!
2
Obamacare dictates the maximal profit insurers can get is 20 cents out of each premium dollar, called the 80/20 rule. Insurers can increase their profit by volume so consolidation helps. Since the insurance exchanges have done the marketing for them, they no longer need to spend as much on marketing such as TV ads because most information about their plans must be posted on the exchange for comparisons. There should be no reasons for insurers to increase the premiums much except for the risk pool issue during the transition into Obamacare when sick people with pre-existing conditions are now part of the insured pool. Healthy new enrollees would also want to use care initially but will slow down their need for care later. Who would want to see doctors often if you are healthy? We all have better things to do, don't we?
Of all things, health care should be at coast, never for profit. When will the
U.S. come to its senses?
U.S. come to its senses?
3
It's amusing to see would-be monopolists pretending that their mergers will be good for the consumer. Lack of competition is good for no one except the handful who line their pockets with their ill-gotten gains.
Already, many insurance markets are insufficiently competitive, and in those areas, insurance costs are higher and serves worse.
Here's a proposal: ban profit-making insurance companies entirely, and replace them with non-profits, like the traditional non-profit Blue Cross/Blue Shield plans.
Otherwise, it's going to be your life and health against the greed of the insurance company -- and in that situation, your life and health are never going to win.
I'm a fan of the profit motive when it comes to something like smartphones, but when it's a matter of life and death, I don't want to be at the mercy of sociopathic corporate greed.
Already, many insurance markets are insufficiently competitive, and in those areas, insurance costs are higher and serves worse.
Here's a proposal: ban profit-making insurance companies entirely, and replace them with non-profits, like the traditional non-profit Blue Cross/Blue Shield plans.
Otherwise, it's going to be your life and health against the greed of the insurance company -- and in that situation, your life and health are never going to win.
I'm a fan of the profit motive when it comes to something like smartphones, but when it's a matter of life and death, I don't want to be at the mercy of sociopathic corporate greed.
9
Josh, for many years, as a then-Noo Yawka, my options under employer health plans were limited to Blue Cross/Blue Shield, and they were horrendous in the good old days. The premiums I paid, as a percentage of my salary, were pretty burdensome and the service was abysmal.
The only solution--and you know it too--is Medicare for all. No middlemen. National healthcare. Not in our lifetimes, though...
The only solution--and you know it too--is Medicare for all. No middlemen. National healthcare. Not in our lifetimes, though...
Private health insurers only add additional costs to what is already the most expensive healthcare system in the World--BY FAR!. They extract money, create very limited networks of care, create impossible to understand billing with copays, deductibles, etc., all aimed at increasing their profits. At the same time, they provide absolutely no healthcare as they are insurance companies not doctors.
Our healthcare system is perverse and dysfunctional. There is something very morally wrong with a Country in which healthcare stocks are the leading performers. All that means is we are getting fleeced for healthcare.
Only one candidate is talking about single payer healthcare--Bernie Sanders. The rest are quite pleased with continuing to allow private health insurers to continue destroying our system of healthcare.
Our healthcare system is perverse and dysfunctional. There is something very morally wrong with a Country in which healthcare stocks are the leading performers. All that means is we are getting fleeced for healthcare.
Only one candidate is talking about single payer healthcare--Bernie Sanders. The rest are quite pleased with continuing to allow private health insurers to continue destroying our system of healthcare.
17
If you look around the world, you will see two things.
First there is no such thing as a single-payor system, All the "national" healthcare systems have local "safety valves" of payment that supplement the core state subsidies. And, increasingly there is cross-border international health insurance to pick up the slack that cannot be covered by central state-run systems.
Second, all the effective systems have LOCAL control. Even in small Sweden the authority is local, and they have started privatizing pharmacy.
Bernie Sanders comes from Vermont. His political theories may be interesting (he is sort of a calm, not insane, Donald Trump).....but he comes from the state with perhaps the largest amount of local control and decentralized government in the US.
Check this out. Vermont has perhaps the most lax gun laws in the nation. Why? Because they still run largely on the town meeting model, for real.
So really nice for Bernie Sanders to talk about central command, but please notice that he lives in perhaps the most socially free part of the United States.....with the most local forms of government,
First there is no such thing as a single-payor system, All the "national" healthcare systems have local "safety valves" of payment that supplement the core state subsidies. And, increasingly there is cross-border international health insurance to pick up the slack that cannot be covered by central state-run systems.
Second, all the effective systems have LOCAL control. Even in small Sweden the authority is local, and they have started privatizing pharmacy.
Bernie Sanders comes from Vermont. His political theories may be interesting (he is sort of a calm, not insane, Donald Trump).....but he comes from the state with perhaps the largest amount of local control and decentralized government in the US.
Check this out. Vermont has perhaps the most lax gun laws in the nation. Why? Because they still run largely on the town meeting model, for real.
So really nice for Bernie Sanders to talk about central command, but please notice that he lives in perhaps the most socially free part of the United States.....with the most local forms of government,
So you believe that CMS which knows waste, fraud and abuse consumes $1 trillion of the $3 trillion we spend on healthcare, that's $1 out of every $3 spent that helps nobody but crooks, is the way to go?
Giving everybody an insurance card is just as stupid, as we are finding out now: because insurance cards nor insurance companies give care while physicians and nurses are in short supply and this gets shorter in ratio as we give more insurance cards out. Who do you think gets cut out of care? Single payer will simply be like throwing gas on a raging fire!
Giving everybody an insurance card is just as stupid, as we are finding out now: because insurance cards nor insurance companies give care while physicians and nurses are in short supply and this gets shorter in ratio as we give more insurance cards out. Who do you think gets cut out of care? Single payer will simply be like throwing gas on a raging fire!
Sometimes consumers are conflicted themselves. It is not only "size matters" but also they are at a loss with bewildering array of choices. Insurance is about creating a large enough pool to allow sustainability irrespective of one's political affiliation. The idea behind having some utilities with near monopoly is to allow scale. When the left wanted the single payment system, what were they expecting? Did they want it for free really? Then they are not honest with themselves. Being big in itself is not a problem, it is how a company treats its customers that matters
Single payer is without profit. It's the profit the Left objects to. Insurance companies notoriously treat their customers badly.
The goal of corporations in health care is to make a profit, which comes in two ways: first that each company competes against the other companies for a bigger slice of the health care pie, and second that the health care sector competes against the other sectors of the economy to make the health care pie bigger. The companies vary in their success against each other, but they are winning the competition against the rest of the economy, the corporations and individuals who are their customers. We spend nearly twice the percent of GDP as other prosperous countries, and there are still many people who are not getting all the health care they need.
Bigger health care providers are more easily able to win the competition with their customers over rates. They promise that competition will lead to lower rates, but their main competition is the rest of us and not each other, so cost savings are unlikely. Our medical industries are doing exactly what they are supposed to do, so we have to force them to modify or suppress their nature.
Bigger health care providers are more easily able to win the competition with their customers over rates. They promise that competition will lead to lower rates, but their main competition is the rest of us and not each other, so cost savings are unlikely. Our medical industries are doing exactly what they are supposed to do, so we have to force them to modify or suppress their nature.
4
The third way they seek to profit is by denying legitimate claims. I have repeatedly had this problem with Anthem Blue Cross when I submit a covered claim because the doctor's office doesn't do that administrative work. The last claim I submitted was "lost" after I mailed it in, and had to be re-submitted. Previously, covered claims were denied for non-sense and inconsistent reasons, but eventually paid. These are small claims amounting to less than $50, but the insurers seem to have a practice of rejecting individual claims, apparently hoping the insured is too busy, or too sick to contest the denial.
1
Yes, the near monopolies in the airline, banking, and cable TV industries have been such a great benefit to consumers that air fares have doubled, while service deteriorated, the economy almost collapsed, and our cable rates are double what they are in Europe.
We need more competition, not less, across all aspects of corporate America. We pay more for health care than all of the industrialized countries in the world, and reducing competition in the insurance industry will only mean we pay drastically higher premiums.
We need more competition, not less, across all aspects of corporate America. We pay more for health care than all of the industrialized countries in the world, and reducing competition in the insurance industry will only mean we pay drastically higher premiums.
154
"Advocates and experts say that while health insurers may reap monetary benefits by combining, gains might not trickle down."
Correction: "Gains will never trickle down."
Trickle down is when someone urinates slowly. Those below get wet and smell funny. But any gains? Ha! Ha!
But there is an up side as strange and ironic as it will be. Karl Marx said capitalism will lead to socialism. When the insurance sharks and their counterparts on the provider network sides are finished with their buying and selling of each other as if health care is just a used car in a lot, a strange thought will occur to Americans.
That thought will be: "Now that there are just a few insurance crooks and a few networks of money grubbing providers, why not have only one insurer and one network?" The savings of the 10-20% profits and compensation expenses and savings of 10-20% marketing costs will be totally unnecessary and the savings of 10-20% administrative costs will amount to a big savings of 30-60% which will, actually will, reduce government and corporate expenses and most importantly reduce my personal and family expenses and taxes for insurance and medical care.
Who said Marx was dead? The same persons who represent the 1%, claim God is alive and not an opiate. I wonder where the candidates stand on this exploitation. We know Bernie Sanders has a realistic plan that will work for Americans to fix the problems brought on by the medical care and medical care insurance oligopolies.
Correction: "Gains will never trickle down."
Trickle down is when someone urinates slowly. Those below get wet and smell funny. But any gains? Ha! Ha!
But there is an up side as strange and ironic as it will be. Karl Marx said capitalism will lead to socialism. When the insurance sharks and their counterparts on the provider network sides are finished with their buying and selling of each other as if health care is just a used car in a lot, a strange thought will occur to Americans.
That thought will be: "Now that there are just a few insurance crooks and a few networks of money grubbing providers, why not have only one insurer and one network?" The savings of the 10-20% profits and compensation expenses and savings of 10-20% marketing costs will be totally unnecessary and the savings of 10-20% administrative costs will amount to a big savings of 30-60% which will, actually will, reduce government and corporate expenses and most importantly reduce my personal and family expenses and taxes for insurance and medical care.
Who said Marx was dead? The same persons who represent the 1%, claim God is alive and not an opiate. I wonder where the candidates stand on this exploitation. We know Bernie Sanders has a realistic plan that will work for Americans to fix the problems brought on by the medical care and medical care insurance oligopolies.
100
ed g, I agree with all of what you express in your comment, and particularly on your accurate definition of "trickle down".
Considering that America's richest 400 people (who own wealth equal to the bottom 150 million Americans) are currently in the process of choosing our political elites (without any input from the rest of us) I would say we are far more likely to see our system turn fascist before it turns socialist.
M&A guys love building bigger business. Of course this lessens competition. Of course it will drive up the cost to consumers. That's what our Congress wanted when they passed the Affordable Care Act. The SINGLE PAYER option was taken off the table. Now, the %age requirement for health care needs to be watched carefully.
25
Yes, the Corporate State and their government push-overs made sure of two things with the ACA.
1. They didn't disrupt employment-based health care too much. Employers depend on keeping their workers indentured to their jobs, willing to work under any conditions and forego wage increases to keep their health care.
2. preserve and enhance the lucrative profiting off health care delivery.
The Market Cap for the Health Industrial Complex has doubled with the passage of the ACA.
http://biz.yahoo.com/p/5mktd.html
If Americans want something better like single-payer, Medicare model ( minus the privatization of the Advantage plans, drug plans and Medigaps), they will have take it from the Corporate State along with their puppets in government.
1. They didn't disrupt employment-based health care too much. Employers depend on keeping their workers indentured to their jobs, willing to work under any conditions and forego wage increases to keep their health care.
2. preserve and enhance the lucrative profiting off health care delivery.
The Market Cap for the Health Industrial Complex has doubled with the passage of the ACA.
http://biz.yahoo.com/p/5mktd.html
If Americans want something better like single-payer, Medicare model ( minus the privatization of the Advantage plans, drug plans and Medigaps), they will have take it from the Corporate State along with their puppets in government.
Bigger insurers are certainly better than smaller insurers because the Law of Large Numbers statistically plays in everyone's favor, including the insurer and subscribers. Realistically, a single-payer system will give us all the largest insurer possible in the nation and everyone benefits except for existing parties who make big profits out of our fragmented health care system. I believe some day we will realize that "Needs will eventually overcome politics." and adopt Universal Healthcare like all other developed countries, because we can no longer afford the more than 20% of our GDP in health spending even in this capitalistic country. It's going to happen. The longer we wait, the less money we will have for other necessities of the society such as funding basic science and education. What we do today does have an impact on our future.
15
This consolidation of insurers was entirely foreseeable before the ink was even dry on the ACA. The ACA was written by and for the insurance industry, since the government believed there was no chance of passing a single-payer, Medicare-for-all statute. So now we have a situation where the balance of power has shifted away from consumers and toward the insurance companies to a much greater extent than ever before, and the consolation is supposed to be that at least more people are covered (at least to a very minimal extent) by virtue of the redistributive pricing/subsidy/taxation features. This is mind-blowingly inferior to a single-payer system for all concerned, and also inferior to a properly regulated market-driven system (emphasis on properly regulated).
34
Yep, back to the waste bin and drawing board with ACA soon as Sanders and a Congress functioning on behalf of Americans are elected in 2016. The collusion of for-profit industry and compliant legislators from POTUS on down, with the exclusion of citizens' advocacy for a proven-to-be-practical single-payer option, was known by all to be drenched in contempt for the voters those elected ever few years go through the motions of pretending to represent even as the sausage was being made. Single-payer again, maybe Medicare for all, with negotiation allowed for bulk purchase of pharmaceuticals until that vampire industry is is either nationalized and/or has its predatory fangs removed. Y'all know the song, know what's wrong, your reps turned whores to play along . . .
If ever there was a case for antitrust enforcement to prevent a restraint in trade, this is it. It is absolutely crucial for the US to get the Dept of Justice involved to prevent these health insurance mergers from going through.
The US has several recent examples where the consolidation of an industry e.g. the airlines mergers have harmed individual consumers. There is no doubt that individual consumers will be harmed should these proposed health insurance mergers go through. No value will be created for the consumer with these mergers.
Let these health insurers compete on the basis of price. Nothing would be better for our economy than some real competition between these market participants.
The US has several recent examples where the consolidation of an industry e.g. the airlines mergers have harmed individual consumers. There is no doubt that individual consumers will be harmed should these proposed health insurance mergers go through. No value will be created for the consumer with these mergers.
Let these health insurers compete on the basis of price. Nothing would be better for our economy than some real competition between these market participants.
74
Healthcare is very different from airfare or car purchase competition. Let's not fool ourselves. Without price transparency, there is no competition, period. How often do you compare price and service for healthcare? IF we continue treating healthcare as a commodity that needs competition, we are falling into the trap profiting parties want us to believe. We should have one price for each service no matter if you are in NYC or North Dakota, but let providers compete with their better service quality for more patients. That's how Germany, France, and many other developed countries do.
21
The biggest fallacy in the "health care as a competitive market" thinking is that it can never be a truly free market. A free market depends on the consumer being able to walk away. As in "Nice car, but I can't afford it, so I won't buy it".
Is that a realistic option in health care? Can the consumer (aka sick patient) be expected to walk away?
Health care is like a utility, which the government has appropriately identified as a basic need that will be allowed to remain in private hands, but tightly regulated so that all its citizens have a reasonable chance at access and to prevent price gouging. Government has failed to treat health care like that because it got to the game too late, and the insurance and pharmaceutical industry lobbies have succeeded in pressuring policy makers in to maintaining our expensive, dysfunctional (but profitable for them) system.
Is that a realistic option in health care? Can the consumer (aka sick patient) be expected to walk away?
Health care is like a utility, which the government has appropriately identified as a basic need that will be allowed to remain in private hands, but tightly regulated so that all its citizens have a reasonable chance at access and to prevent price gouging. Government has failed to treat health care like that because it got to the game too late, and the insurance and pharmaceutical industry lobbies have succeeded in pressuring policy makers in to maintaining our expensive, dysfunctional (but profitable for them) system.
2
They won't. Their trade group is basically a price-fixing meeting.
Like alcoholism, things in this country won't improve until we "hit bottom." Under a GOP rule by antonyms (legislation gets the very opposite name to what such legislation does), we are hurtling there.
Sane people apply the brakes. Politicians know they don't have to. Like some mafiosi, they are "made men" when they get elected to two terms in Congress, with a lifetime income floor of a pension, lifetime health insurance for their families, and entrée into the world of either lobbying or corporate boards.
Like alcoholism, things in this country won't improve until we "hit bottom." Under a GOP rule by antonyms (legislation gets the very opposite name to what such legislation does), we are hurtling there.
Sane people apply the brakes. Politicians know they don't have to. Like some mafiosi, they are "made men" when they get elected to two terms in Congress, with a lifetime income floor of a pension, lifetime health insurance for their families, and entrée into the world of either lobbying or corporate boards.
These recent mergers are big business at its worst. The executives running these mega monsters are primarily concerned with making their shareholders happy - and by doing so, they themselves received millions of dollars in salaries and bonuses. Obamacare was a careful deal between President Obama and the health insurance companies - all citizens are forced to purchase health insurance, and the federal government would pay a large portion of lower income people. While it was being touted as the only way we could keep premiums down - that was far from the truth. Now we are told that Anthem is raising their premiums this next year 25-50%. To make matters worse, the Insurance Commissioner (who receives the majority of his/her campaign funds from insurance companies) passively red stamp any request to raise premiums. And, lest we forget - the Commissioner of insurance in all states go on to being lobbyists for the insurance industry. Dirty business!
52
Prostitution should be legal only in the street or the bedroom, not in the confluence of the boardroom and legislative/regulatory chambers.
But hey. Isn't Obama a socialist?
This is a head-scratcher for me.
The fact of fewer and larger health insurance providers gives them leverage to reduce costs.
Yet . . . essentially all of the health care providers (from primary care physicians right up through the surgeons and specialists) in my neighborhood here in Maine are allied with and bill through a local regional hospital.
That hospital and its tentacles are part of the "in-network" of my employer's medical plan.
Yet they bill me for the difference between their own billing cost for a procedure and the compensation they receive as an in-network provider. Can any one explain how that is justified?
If it can be justified, then pricing advantage granted to the insurers as a result of consolidation can only be seen as shifting more of the burden to the insured.
The fact of fewer and larger health insurance providers gives them leverage to reduce costs.
Yet . . . essentially all of the health care providers (from primary care physicians right up through the surgeons and specialists) in my neighborhood here in Maine are allied with and bill through a local regional hospital.
That hospital and its tentacles are part of the "in-network" of my employer's medical plan.
Yet they bill me for the difference between their own billing cost for a procedure and the compensation they receive as an in-network provider. Can any one explain how that is justified?
If it can be justified, then pricing advantage granted to the insurers as a result of consolidation can only be seen as shifting more of the burden to the insured.
17
That's interesting. It was my understanding that in-network providers were prohibited from "balance billing". Out of network, no. That's how it works with my insurer. Have you spoken to your insurance company?
We'll end up with single payer, only not the one we wanted.
40
"Trickle down" is the idea that most of us are eating the crumbs that fall from wealthy people's and corporations' tables, and in order to improve our lot, we need to buy them much better food.
28
What ever happened to antitrust laws? They were enacted to protect the consumer; now all laws seem to be enacted to protect profits for stockholders and CEO's jobs.
79
You can thank Ronald Reagan and the Supreme Court for weakening the Sherman antitrust laws.
First Reagan, in thrall to Milton Friedman's religion of "efficiency," gutted the Department of Justice's budgets for enforcement of the Sherman antitrust laws. Also, Supreme Court rulings also helped to gut enforcement of these laws.
While Clinton tried to stem the tide, presidents since have pretty much given up and let corporations have their way with the American consumer.
Sadly, the worst of the lot seems to be Obama, whose administration seems to be downright anti-consumer.
First Reagan, in thrall to Milton Friedman's religion of "efficiency," gutted the Department of Justice's budgets for enforcement of the Sherman antitrust laws. Also, Supreme Court rulings also helped to gut enforcement of these laws.
While Clinton tried to stem the tide, presidents since have pretty much given up and let corporations have their way with the American consumer.
Sadly, the worst of the lot seems to be Obama, whose administration seems to be downright anti-consumer.
1
Gains from any big joint has never trickle down to the mere mortals.
11
Are you kidding with this headline NYT??? This benefits the insurance industry and the insurance industry only... Everyone in their right mind knows that. Capitalism trumps democracy ... Another screw you to the little guy.
61
Doubts? Patients can only benefit from having a plethora of health insurance companies because only competition, and differing plans and interpretations of what is or is not medically necessary. Only competition, in addition, can attract better doctors to better plans, and only with competition can a doctor, just as a patient, can gain leverage --by moving to the competitor.
These mergers should not be allowed. They are monopolistic, they reduce patient choice, they reduce the options of providers, and increase costs and expenses while, without competition, reducing treatment options.
These mergers should not be allowed. They are monopolistic, they reduce patient choice, they reduce the options of providers, and increase costs and expenses while, without competition, reducing treatment options.
20
these mergers should be outlawed. and not only in the 'health' industry. there is no choice or fairness without competition, and innovation will also suffer.
23
Shouldn't all health insurance companies be not for profit? And then we get into the discussion of how you measure improving health care quality. There are good metrics having to do with quality of life and outcome measures, health exams that prevent diseases, and educating consumers to live healthy life styles. But the notion of improved operational efficiencies and lower premiums, while laudable, fail to address co-pays, deductibles, hospital bouncebacks and access to top tier experts.
18
Of course the savings are unlikely to trickle down.....without a major change in insurer mindsets. Remember that when MLRs are required to be at a certain level, if medical spending goes down for more than a year or so, so does the rest of the budget - advertising, salaries, offices.....annoying products and services that members don't want....
As we reach a de facto monopoly for health insurance, perhaps the insurers should be looked at like old fashioned electric utilities. Rates based on return on capital. Or better yet, how about age-adjusted community rated premiums.
Single payer is still the best option. If the insurers want to administer it, which they already do for Medicare, let them do that. Then they will compete on the ability to provide the best service at the best price....and not compete with each other.
As we reach a de facto monopoly for health insurance, perhaps the insurers should be looked at like old fashioned electric utilities. Rates based on return on capital. Or better yet, how about age-adjusted community rated premiums.
Single payer is still the best option. If the insurers want to administer it, which they already do for Medicare, let them do that. Then they will compete on the ability to provide the best service at the best price....and not compete with each other.
19
Get Real!!! I was in charge of selecting health insurance for the small company i worked for well prior to Obamacare---i was utterly amazed that bids for coverage came in at almost identical prices for the same benefits. If anyone believes that any of the"savings" generated by mergers will benefit the insured i will eat my hat.......oligopoly pricing does not benefit consumers--be it air fares. cell phone rates, etc.
84
It will be great when the insurers get big enough that they can dictate lower prices from doctors and hospitals for us. These mergers must be allowed to happen.
1
If they were able to "dictate" lower prices, they would not pass the savings on to
consumers. Why should they? Only real competition or regulation from above can do that.
consumers. Why should they? Only real competition or regulation from above can do that.
2
So you want insurers to "dictate" your health care? As if they know what good health care is.
It is a hard enough metric for the professional who deliver it to measure; insurers care about profit, which they can measure quite easily. And do.
It is a hard enough metric for the professional who deliver it to measure; insurers care about profit, which they can measure quite easily. And do.
Please NYT's, do a follow-up every quarter and tell us how much better it becomes after all the mergers, especially for the CEO's! Then maybe the shareholders... then way down on the list... tell us about the Doctors and healthcare workers... then last on the list, tell us about the customers... The customers always come out last in mergers! Service goes down, premiums go up, coverage goes down and health care providers blame the insurance companies, insurance companies blame the health care providers and before long, no one cares for the customers who need help. We've all seen it before with the airlines, the cable companies, the phone companies, the oil companies, the utilities, the grocery stores, the software giants, the car companies and so on. Thanks Regulators!
38
Duh. The private health insurers combine because it makes sense to have a Medicare for all or single payer/insurer health insurance system that covers everyone and that is funded like the military is: through the federal government.
Healthcare and healthcare insurance are public goods, just like the USA military. Although the Bush Junior Administration tried to promote the use of mercenaries, e.g. Blackwater of the time, and of private companies to provide support services, the USA military is the most socialized institution in the USA. Communist in fact, given that the USA government, i.e. the people, also own most of the means of production, aside from fully funding military services. That is not to argue that the size of the expenditure on the military in the USA makes any rational sense - it does not, by a factor of 10 or so - but the concept remains.
It is worse than pathetic that the PPACA is touted as some kind of "signature" law for the Obama Administration. It is not. It is in fact almost entirely a law that has features once promoted actively by Republican politicians, not by Democrats.
It is the basis of blanket condemnation of USA politicians that the USA collectively still cannot achieve even remotely the level of efficacy of the health systems in all other industrialized countries, where key health statistics are superior and the costs of medical care and its financing are less than 1/2 of the per capita expenditure in the USA.
Healthcare and healthcare insurance are public goods, just like the USA military. Although the Bush Junior Administration tried to promote the use of mercenaries, e.g. Blackwater of the time, and of private companies to provide support services, the USA military is the most socialized institution in the USA. Communist in fact, given that the USA government, i.e. the people, also own most of the means of production, aside from fully funding military services. That is not to argue that the size of the expenditure on the military in the USA makes any rational sense - it does not, by a factor of 10 or so - but the concept remains.
It is worse than pathetic that the PPACA is touted as some kind of "signature" law for the Obama Administration. It is not. It is in fact almost entirely a law that has features once promoted actively by Republican politicians, not by Democrats.
It is the basis of blanket condemnation of USA politicians that the USA collectively still cannot achieve even remotely the level of efficacy of the health systems in all other industrialized countries, where key health statistics are superior and the costs of medical care and its financing are less than 1/2 of the per capita expenditure in the USA.
27
I'm guessing from the lack of commentary that everyone is so very tired of trying to change "the system." But isn't that the way it's planned? Do nothing, lie where you can as often as you can, and eventually, it all goes away and the status quo or worse goes forward. Nothing short a major revolution will ever change the systemic dismantling of the middle class in this country. Bernie Sanders? Maybe? Voters?
41
In my experience as both a patient and a healthcare provider, what the insurance companies euphemistically call "innovation" means forcing people to do everything electronically so you cannot get the information you need in a timely manner from a human being on the telephone.
I am expected to waste my unpaid time on the computer trying to get paid or reimbursed, trying to get claims through, trying to get errors corrected (of which there are many), etc. The insurance companies want to do less and less and keep more and more of the money. What a scam....
I am expected to waste my unpaid time on the computer trying to get paid or reimbursed, trying to get claims through, trying to get errors corrected (of which there are many), etc. The insurance companies want to do less and less and keep more and more of the money. What a scam....
100
If our nation's health care services are to be put into the hands of just a few private, for-profit corporations, regulators should first determine that they are capable of serving even their current policy holders. My experience with Anthem BC California is that they are woefully understaffed with poorly trained customer-service agents and health plan advisors who are only to eager to transfer you to someone else; an outdated phone system that disconnects you after holding for a long time; and a website that still cannot be counted on for up to date information about in-network physicians. I can't imagine that service will improve with the addition of tens of thousands of policyholders.
36
In a piece on 60 Minutes last night, it appears that Anthem is notorious for denying payment for long-term inpatient mental health treatment, with some of the "doctors" having denial rates ranging from 85% to 100%, and with a Dr. Timothy Jack being the supervisor overseeing Dr. Tim Jack (they are actually licensed doctors, but I don't like to think of them as real doctors).l
1
Now what if there was just one great, big insurer.
But make it a mutual insurer, owned by all the policyholders, and coincidentally, make all the citizens of the US policyholders?
It could focus on keeping costs down, it wouldn't have to please profit-seeking shareholders, it could negotiate the heck out of contracts.....
But make it a mutual insurer, owned by all the policyholders, and coincidentally, make all the citizens of the US policyholders?
It could focus on keeping costs down, it wouldn't have to please profit-seeking shareholders, it could negotiate the heck out of contracts.....
148
You are advocating for a single-payer system as in Canada.
Having been a patient and a doctor in both systems, I agree with you for the most part. Overall access to care in Canada is **much** better than in the USA. There is no question that wait lists for certain specific procedures do get out of hand in Canada, though. The challenge for the US as things move forward is to broaden coverage to all Americans without rationing care.
Having been a patient and a doctor in both systems, I agree with you for the most part. Overall access to care in Canada is **much** better than in the USA. There is no question that wait lists for certain specific procedures do get out of hand in Canada, though. The challenge for the US as things move forward is to broaden coverage to all Americans without rationing care.
15
When insurer consolidation ends, the only insurer left standing has to be nationalized and we already have the federal health insurance exchange in place to enroll everyone. Insurers know numbers better than most of us. Their consolidation is the proof that in insurance the more subscribers there are for each insurer, the cheaper it costs to insure loss (health claims) because of the Law of Large Numbers, which is one major principle in insurance in addition to the heterogeneity required among subscribers for spreading risk. If Medicare costs the least to insure the oldest population (55+ million seniors with very low heterogeneity), Medicare for everyone will save us more billions/yr than you can imagine.
4
Mike, I am absolutely advocating for a single-payer system.
2
Of course the benefits won't trickle down. Who would expect that they would in a triopoly or quadropoly? If you want to know what will happen, consult the airline industry. None of the cost savings of consolidation redounded to the benefit of consumers. Rather, consolidations have resulted in higher effective prices through added fees, reduction in the number of flights and routes, overcrowding on planes, reduced value of frequent flyer miles, etc. The Justice Dept Antitrust Division and the FTC are both asleep at the wheel.
39
Ya think? In other breaking news, it gets dark at night, and the sun rises in the East.
This has always been the argument against "Romneycare", "Obamacare', or the ACA, whatever the moniker, the nonsensical Republican effort to prolong private profit and delay the implementation of single-payer system for all.
This has always been the argument against "Romneycare", "Obamacare', or the ACA, whatever the moniker, the nonsensical Republican effort to prolong private profit and delay the implementation of single-payer system for all.
58
Get rid of ACA, and health care costs will rise. Count on it!
5
“If plans are going to be competitive,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group, “they have to offer the most affordable premiums.”
Of course, that assumes that there is sufficient competition. Hmmm...
Of course, that assumes that there is sufficient competition. Hmmm...
13
This they will do in an evanescent and ever shifting cartel called a "network".
4
The only way for less competition to result in lower prices for consumers is if there was effectively no competition already. Sounds about right.
6
Companies will charge the absolute maximum that they can charge. That is their duty to shareholders.
Ie, any savings from efficiencies will (and arguably should) go to shareholders.
The only way to hold down cost is through competition or regulation.
Ie, any savings from efficiencies will (and arguably should) go to shareholders.
The only way to hold down cost is through competition or regulation.
62
"..any savings from efficiencies will (and arguably should) go to shareholders."
Next time you go in for surgery, be sure to post the name of your insurer here so we can all evaluate the investment opportunity.
Next time you go in for surgery, be sure to post the name of your insurer here so we can all evaluate the investment opportunity.
1
There is regulation in name only....they bribe their way out of any meaningful regulation as do most industries.
1
Do you know that fully 85% of the premiums are mandated to go to pay for health services? The larger insurers are able to negotiate better rates with the service providers who have larger geographic foot-prints. The administrative economies of one IT department, one accounting department, etc. are real savings that any business should be rewarded for.
We, as consumers, will lose. Anyone who has ever taken Econ 101 knows the importance of competition and choice. The less choice, the more insurer power. We've already seen this with our clients who are in the Affordable Care Act's health insurance exchanges that have little competition. The government needs to step up. Politicians need to step away from all of the campaign funding they are taking from insurers. Elected officials owe their constituents, not their fundraisers.
123
I am afraid that is why the U.S. is the only country in the industrialized world that still doesn't have some form of Universal healthcare, YOU HAVE BEEN ARGUING ABOUT IT FOR OVER SIXTY YEARS! There is also the minor issue that politicians don't want to bite the hand that feeds them and the healthcare industry has one of the biggest set of hands.
53
This scam addlepates everyone with confusing choices.
5
Right. Because adding even more rapacious for-profit health insurance companies into the mix is going to bring down health care costs? How exactly, does a superfluous middle man that does nothing but exact dollars out of the healthcare system do that?
Medicare for all baby, Medicare for all.
Medicare for all baby, Medicare for all.
1
The risk pool on a state-by-state basis leaves a disproportionate adverse-risk pool in places such as New Mexico, where the ACA (aka Obamacare) cost-shifts a disproportionate burden of the high-risk population onto the fewer others like me. I could cut my health insurance payment by 75% if I were to establish residency in a coastal state of the US with Humana coverage.
Sorry NYT...in this case, bigger is better!