My son and I were just in the emergency room on separate days. My son never saw a doctor but a nurse sewed up a wound after giving him an x-ray and some pain killer for the pain. HIs total charge was over $6,000 from the hospital but the insurance company got the bill cut in over half and we owed just $500.
I was in the emergency room for five hours and my bill for a supposed appendicitis was close to $17,000. On an hourly basis that is $3,400 per hour. A cat scan was the big expense at $9,400. I laughed when I saw this last number as that was the amount my family spent for one week in Spain including our airfares. Our insurance company got the bill lowered to under $10,000 and we owe $1,300.
When the New York Times writes that 'competition is good for consumers and taxpayers'; I wonder if they understand the 'pricing power' of hospital's emergency rooms. Without a 'true competitor' within a 20 minute drive, our local hospital should be the one looked at by anti-trust regulators. Our insurance company saves our family money. The local hospital charges us what they can get away with and then hides behind being a 'non-profit'.
I was in the emergency room for five hours and my bill for a supposed appendicitis was close to $17,000. On an hourly basis that is $3,400 per hour. A cat scan was the big expense at $9,400. I laughed when I saw this last number as that was the amount my family spent for one week in Spain including our airfares. Our insurance company got the bill lowered to under $10,000 and we owe $1,300.
When the New York Times writes that 'competition is good for consumers and taxpayers'; I wonder if they understand the 'pricing power' of hospital's emergency rooms. Without a 'true competitor' within a 20 minute drive, our local hospital should be the one looked at by anti-trust regulators. Our insurance company saves our family money. The local hospital charges us what they can get away with and then hides behind being a 'non-profit'.
6
I am cheering the mergers. The fewer the insurance companies, the sooner we get to single-payer, Medicare for all.
1
That consolidation in the insurance industry would be accelerated by Obamacare follows as the night follows the day in terms of the basic laws of economics.
This was foreseeable, and foreseen by those who argue for a single payer system, and a single payer which doesn't have for-profit skin in the game.
That's also called the Federal government, or Medicare if you're >64.
The arms race between the insurance companies and the providers?
A querelle des voleurs.
At one time in the evolution of social utility, a private sector health insurance industry was useful. No longer.
As anyone who goes into the front office of a provider environment can tell you by just looking around. All the fragmented private sector insurance industry does is add unnecessary cost by adding otherwise unnecessary jobs in the form of form filers and other processing middlemen - on both sides of the transaction.
And then, of course, huge executive bonuses in the back office.
And that's at both the the provider and insurer level.
Would it surprise you to hear that the CEO of the average Medical School in the U.S. makes more than the University President of which that Medical School is a part?
Though still not as much as the football and basketball coach, of course!
Surely there is a more productive and less inefficient way for society to organize to distribute jobs and money among all the people.
By the way, if Obamacare had had the Public Option, things would be on a better consolidation track.
This was foreseeable, and foreseen by those who argue for a single payer system, and a single payer which doesn't have for-profit skin in the game.
That's also called the Federal government, or Medicare if you're >64.
The arms race between the insurance companies and the providers?
A querelle des voleurs.
At one time in the evolution of social utility, a private sector health insurance industry was useful. No longer.
As anyone who goes into the front office of a provider environment can tell you by just looking around. All the fragmented private sector insurance industry does is add unnecessary cost by adding otherwise unnecessary jobs in the form of form filers and other processing middlemen - on both sides of the transaction.
And then, of course, huge executive bonuses in the back office.
And that's at both the the provider and insurer level.
Would it surprise you to hear that the CEO of the average Medical School in the U.S. makes more than the University President of which that Medical School is a part?
Though still not as much as the football and basketball coach, of course!
Surely there is a more productive and less inefficient way for society to organize to distribute jobs and money among all the people.
By the way, if Obamacare had had the Public Option, things would be on a better consolidation track.
3
The Affordable Care Act, with its 20,000 pages of new regulations, has led to seismic shifts in every aspect of health care. All to move millions onto Medicaid.
We are now experiencing the fallout. In some states, Insurance Commissioners are forcing health insurers to raise their rates to avoid going out of business. The worst part, that rarely gets mentioned, is that people are still rationing their care because of high out-of-pockets.
A behemoth health insurance Act for a highly complex industry, obviously too complex for the Affordable Care Act planners.
We are now experiencing the fallout. In some states, Insurance Commissioners are forcing health insurers to raise their rates to avoid going out of business. The worst part, that rarely gets mentioned, is that people are still rationing their care because of high out-of-pockets.
A behemoth health insurance Act for a highly complex industry, obviously too complex for the Affordable Care Act planners.
1
Based on my experience in price-fixing, with five producers there are 20 2- way channels to police. With three producers there only six such channels. For the latter price-fixing is a piece of cake."
2
Are these mergers just a private sector path to a single payer system? The primary goal of a private company is to make profits for its investors. Whether it's health care or a widget, the 'product' that produces this profit is just a necessary thing. If we ever finally get to government sponsored universal health care at least the primary goal will be providing health care. One way insurance companies increase profits is by making services more difficult to access, either through increasing out of pocket costs via high deductibles or by reducing the number of providers so that getting an appointment is difficult. Lets look at what happens when reimbursements to health care providers are decreased. The provider's expenses do not decrease, and there are only so many hours in the day. Either the provider must see more patients for less time or close up shop. We have an image of health care providers earning lots of money. It may still be true for some specialists, but for most it is no longer true. If we want to reduce health care costs, we need to begin looking at a single payer system that is not motivated by profits. Money will be saved on marketing, administration and all the billing woes that come from a constantly changing landscape of different plans, different companies, different rules, etc. Even more focus can be put on prevention. Will it be perfect? No, but it may be better and more equitable than what we have now.
1
"The companies say that being bigger will give them the ability to negotiate lower prices with hospitals, physicians and drug makers and make health care more efficient".
This is patently untrue. A glaring example was cost for a generic statin.
My insurer pushed the largest mail order pharmacy where a 90 day supply had a co-pay of $35. I went to a local pharmacy and asked for a quote for the generic statin off-plan and was given a quote of $15 for 90 days. To confirm, did an internet search for online pharmacies and 15$/3months was the going rate.
The companies have never had an incentive to lower prices. The ACA permits Insurer's to have an overhead of 20%. The higher the costs, the larger the 20%
This is patently untrue. A glaring example was cost for a generic statin.
My insurer pushed the largest mail order pharmacy where a 90 day supply had a co-pay of $35. I went to a local pharmacy and asked for a quote for the generic statin off-plan and was given a quote of $15 for 90 days. To confirm, did an internet search for online pharmacies and 15$/3months was the going rate.
The companies have never had an incentive to lower prices. The ACA permits Insurer's to have an overhead of 20%. The higher the costs, the larger the 20%
5
Keep these mergers coming and we will end up with single payer system.
3
Let's see, if having larger insurance companies will reduce costs, why don't we have just one insurance company with one insurance plan. We could call it Medicare and make it non-profit. We could then eliminate advertising and physicians would have only one form to fill out. We could even run it through the government so the IRS could collect premiums when they collect taxes.
I bet we would save a bundle.
I bet we would save a bundle.
22
Isn't it time to just come out and tell the truth? The commercial health insurers are big crooks. It's a shady industry with astonishing profit margins made at the expense of vulnerable and often poorly informed sick people, as well as of increasingly financially and emotionally squeezed doctors.
Why would anyone think that this oligopoly will save consumers and workers any more than any other ever has? We already know this when it comes to utilities.
We still need to learn it about the shrinking news media. We remain mired in delusion when it comes to medical care. How long will it take to catch up to other Western societies who know that single payer systems are the only way to save our formerly superb health care from avarice and mediocrity?
Why would anyone think that this oligopoly will save consumers and workers any more than any other ever has? We already know this when it comes to utilities.
We still need to learn it about the shrinking news media. We remain mired in delusion when it comes to medical care. How long will it take to catch up to other Western societies who know that single payer systems are the only way to save our formerly superb health care from avarice and mediocrity?
8
The consolidation of the industry can ultimately be a good thing.
I've never really gotten how the 80% rule helps. Yes, it means that a percentage of income must go to healthcare payouts, but what specifically does that 80% consist of? Does it include administration costs. And what about that other 20% where profits are derived? It would seem that to realize increased profits the 80% rule would encourage higher costs to enlarge that 20% margin.
The primary cause of the upward spiraling of medical costs is the profit layer of healthcare insurance. The Affordable Care Act was a necessary stop-gap to slow the upward trend, but we still need to find a way to get to a single-payer system while extricating ourselves from the deep-seated healthcare industry.
Perhaps this consolidation can get us down to a very few health insurance providers which can then be absorbed into a national system.
Wishful thinking...
I've never really gotten how the 80% rule helps. Yes, it means that a percentage of income must go to healthcare payouts, but what specifically does that 80% consist of? Does it include administration costs. And what about that other 20% where profits are derived? It would seem that to realize increased profits the 80% rule would encourage higher costs to enlarge that 20% margin.
The primary cause of the upward spiraling of medical costs is the profit layer of healthcare insurance. The Affordable Care Act was a necessary stop-gap to slow the upward trend, but we still need to find a way to get to a single-payer system while extricating ourselves from the deep-seated healthcare industry.
Perhaps this consolidation can get us down to a very few health insurance providers which can then be absorbed into a national system.
Wishful thinking...
3
From my Econ 101 class (a long time ago, in a galaxy far, far away...) four ideas taught still resonate:
1. Within my lifetime there would be 3-5 participants in every type of business: airline, auto, TV, movie, agriculture, etc. Quality and choice would decline and consumer cost would rise. The über-rich would not be effected and would be catered to
2. Businesses hate competition. Businesses want to avoid competition. Competition is expensive and fraught with danger: One could lose.
3. Businesses like laissez faire, free market capitalism. It can lead to monopoly. Businesses, when left to their own devices, will aggregate to their best advantage, create cartels at best and monopolies at worst. Monopoly is the ultimate goal of any business. A small cartel is not a bad second prize.
4. Businesses like oligarchies and/or plutocracies. They can live with, if they have to, theocracies. Businesses do not like democracies.
1. Within my lifetime there would be 3-5 participants in every type of business: airline, auto, TV, movie, agriculture, etc. Quality and choice would decline and consumer cost would rise. The über-rich would not be effected and would be catered to
2. Businesses hate competition. Businesses want to avoid competition. Competition is expensive and fraught with danger: One could lose.
3. Businesses like laissez faire, free market capitalism. It can lead to monopoly. Businesses, when left to their own devices, will aggregate to their best advantage, create cartels at best and monopolies at worst. Monopoly is the ultimate goal of any business. A small cartel is not a bad second prize.
4. Businesses like oligarchies and/or plutocracies. They can live with, if they have to, theocracies. Businesses do not like democracies.
14
If you want lower costs split up the big providers into at least three pieces.
There would be say three Mercks, three Gileads, three Sutters, and three Partners, etc.
Each drug child would have full patent rights.
Each hospital child would own about 30% to 40% of the space in each hospital over 50,000 square feet, with doctors divided up.
There would be say three Mercks, three Gileads, three Sutters, and three Partners, etc.
Each drug child would have full patent rights.
Each hospital child would own about 30% to 40% of the space in each hospital over 50,000 square feet, with doctors divided up.
1
There could be a silver lining to Aetna's buy out of Humana. Maybe the idiots who dropped Baylor College of Medicine doctors from Humana's plans, will find themselves out of a job. If Aetna covers those doctors, then perhaps it could work out for the patients Humana screwed?
.
Or it could just be wishful thinking. Yeah, probably that.
.
Or it could just be wishful thinking. Yeah, probably that.
1
This is what happens when your elected representatives have been purchased by rich and powerful interests. E.g. HRC and the financial industry.
Bernie Sanders has NOT been purchased by anybody, ever.
Bernie Sanders has NOT been purchased by anybody, ever.
7
Of course these mergers reduce competition - the primary driving force behind them is eliminating competition to improve bargaining power to be able to raise prices to hospitals and other care providers, just as the primary driver for care provider mergers is eliminating competition to improve bargaining power plus raising prices to take advantage of government reimbursement practices. The care providers are already operating in an anti-competitive manner - the solution is to break them up.
Single payer, anyone??
2
Wait a minute. You want single payer, but you don't want mergers because that may reduce choices? That's exactly what a single payer system will do: reducing choices. Ah, I see. You only want a single payer system that is run by the government. And you think that's going to increase choices and maintain quality of care?
2
Well it does a better job than the US for a lot less $$. The MD submits his bills once a month to a single outlet for payment needing no prior permission proscribe, knowing he will be paid in full and no need of staff to navigate various companies for his coverage. The hospitals and insurance entities are non-profit centers, so it all adds up. Unfortunately there were some losses but photo ID has taken care of this problemhttp://independentbloggersalliance.blogspot.ca/2009/11/americans-filchin...
Delivery of health care in the U.S. was long ago turned over to the various profit centers where capital is accumulated and managed for positive return on investment--first to hospitals, then physician-hospital systems, then to the insurers. The "corporate practice of medicine," once deplored and resisted by the (formerly influential) American Medical Association, is now all but universal. The requirement that 80% of insurance premiums be dedicated to clinical services is a joke, producing massive profit. That threshold should be at least 90%, and there should be much stricter surveillance and enforcement of both accounting practices and fraudulent billing, as well as constraints on capital spending. "Competition," when it primarily serves the accumulation of financial power in fewer and fewer players, is a joke, even with the recent thumb-in-the-dyke "triumphs" of the ACA. The essential wrong in the American system is that it serves and preserves the generation of profit, and that institutionalizes waste and uneven distribution of needed care.
4
Editorial Board:
While you are right to shed light on these mergers, you are absolutely wrong about remedies. Divestment of a few small plans here and there are simply a nip and a tuck and do nothing to cure the fundamental problem here. These mini-divestments frankly give DoJ staffers a fig leaf to hide behind, making it appear they have done their jobs all the while allowing the insurance giants to further quash the minimal competition that exists today.
Do New Yorker's have better service and lower prices as a result of seven national cellular carriers collapsing to two super-carriers? Do New York travelers have better service and lower prices as a result of ten national, major carriers collapsing to four?
The only remedy that works for medical insurers' mergers is "just say NO."
While you are right to shed light on these mergers, you are absolutely wrong about remedies. Divestment of a few small plans here and there are simply a nip and a tuck and do nothing to cure the fundamental problem here. These mini-divestments frankly give DoJ staffers a fig leaf to hide behind, making it appear they have done their jobs all the while allowing the insurance giants to further quash the minimal competition that exists today.
Do New Yorker's have better service and lower prices as a result of seven national cellular carriers collapsing to two super-carriers? Do New York travelers have better service and lower prices as a result of ten national, major carriers collapsing to four?
The only remedy that works for medical insurers' mergers is "just say NO."
4
A statement of the obvious: The key to success in the insurance business is not to pay.
The more the insurance companies pay out, the less profit they make.* As a result, their workers are under stress to find ways not to pay. This manifests in all sorts of insidious abuse.
Most people will go away if they're told "no" once or a few times. Most of the few who won't, will take less than they're owed if they can be frustrated enough. This phenomenon is amplified when people are sick and dealing with medical issues and don't have the energy to fight back.
The insurance companies know all of this. They have charts (statistical analysis) on everything. They do not serve the public interest; they are not beneficent. They are for-profit money grabbers.
It is quite shocking how the Republicans were able to dupe the Democrats into passing Obamacare. This is one of the greatest political snookers of all time. In fact, the only way the Democrats can come out of this without looking like complete idiots is to finally admit that they are actually on the same team as the Republican politicians. It is quite a damnable predicament. Admit that you are either an idiot or a crook. It's one or the other.
_________________
* No one should put too much hope into the 80% rule. It would be naive to think that the insurance company accountants could not out smart an overworked government analyst.
The more the insurance companies pay out, the less profit they make.* As a result, their workers are under stress to find ways not to pay. This manifests in all sorts of insidious abuse.
Most people will go away if they're told "no" once or a few times. Most of the few who won't, will take less than they're owed if they can be frustrated enough. This phenomenon is amplified when people are sick and dealing with medical issues and don't have the energy to fight back.
The insurance companies know all of this. They have charts (statistical analysis) on everything. They do not serve the public interest; they are not beneficent. They are for-profit money grabbers.
It is quite shocking how the Republicans were able to dupe the Democrats into passing Obamacare. This is one of the greatest political snookers of all time. In fact, the only way the Democrats can come out of this without looking like complete idiots is to finally admit that they are actually on the same team as the Republican politicians. It is quite a damnable predicament. Admit that you are either an idiot or a crook. It's one or the other.
_________________
* No one should put too much hope into the 80% rule. It would be naive to think that the insurance company accountants could not out smart an overworked government analyst.
2
What about hospitals buying each other up, as well as doctors practice groups?
Just more monopoly to raise prices. (And spend more on advertising. Does that improve anyone's health care...or just the costs?)
And our government does nothing!!
Just more monopoly to raise prices. (And spend more on advertising. Does that improve anyone's health care...or just the costs?)
And our government does nothing!!
5
Actually, the gov't did do something. It passed the ACA; worst legislation in history.
2
What should be looked at far more closely are the doctor and hospital mergers. The Price for service is being allowed to remain unchecked, and as the NY Times has reported in the past - the billing cost code manipulation for higher prices for the same services is bankrupting all of us.
When a monopoly of a health care provider can bill the same service as clinical, or hospital, which are higher prices - instead of at doctor office rates - that's legal theft.
Because of MRL - the insurers do not mind - MLR says what ever the cost is, plus 15% or 20% - sets the new rates for the following year - and federal law says we have to pay those rates.
When a monopoly of a health care provider can bill the same service as clinical, or hospital, which are higher prices - instead of at doctor office rates - that's legal theft.
Because of MRL - the insurers do not mind - MLR says what ever the cost is, plus 15% or 20% - sets the new rates for the following year - and federal law says we have to pay those rates.
2
I now pay more for medical insurance than before the ACA. Reason - prescriptions have been reclassified, choice of Drs are limited and deductibles are higher. I was all for the ACA until the insurance companies found all the loopholes and gamed the system with their drug tiers. First year was great, then the insurance companies changed the game in year two.
3
Did you really think the government was going to completely redesign their insurance products and change the makeup of their customers in terms of healthiness, and you weren't going to suffer any consequences?
I think the DOJ should approve both mergers, and so should any progressive. Look at a 30,000 foot overview: America spends on the order of $2.7T yearly on health care. The MARKET CAP of all five major insurers combined (their collective net worth, not their slice of this massive pie) is around $250 billion. Pfizer alone is roughly as valuable. In fact, if all of America's physicians banded together and pooled their pre-tax salaries for about a year, they could just buy all of them. While insurance companies produce waste in the system, they are overwhelmingly not responsible for the inflated costs in the system. The providers are.
I agree that a single-payer system is much more sensible, especially with respect to the issue of bloated costs, because it can cut prices by fiat, but a confederation of somewhat regulated insurers is probably the best substitute we will have for the foreseeable future. We should be trying to use public policy to make the confederation operate as much like a monopsony as possible.
Ideally, either the states or the federal government would pass a law which would do something like cap the reimbursements private insurers can pay out at 110% of Medicare reimbursement. This would solve the collective action problem insurers face in trying to negotiate lower rates unilaterally, that providers who face little competition will boycott them and devastate their business. With additional pressure, the insurers would remit most of these savings to consumers.
I agree that a single-payer system is much more sensible, especially with respect to the issue of bloated costs, because it can cut prices by fiat, but a confederation of somewhat regulated insurers is probably the best substitute we will have for the foreseeable future. We should be trying to use public policy to make the confederation operate as much like a monopsony as possible.
Ideally, either the states or the federal government would pass a law which would do something like cap the reimbursements private insurers can pay out at 110% of Medicare reimbursement. This would solve the collective action problem insurers face in trying to negotiate lower rates unilaterally, that providers who face little competition will boycott them and devastate their business. With additional pressure, the insurers would remit most of these savings to consumers.
3
Hopefully Bernie will be elected and we can have a single payer system installed in the next few years. Now, with the Medicare and Medicaid people getting all the cost breaks, the real cost is being shifted to 'all others'. In a single payer system a level playing field will be created, with Medicare and Medicaid people paying their 'fair share', which they currently are not. Will cost go down? Of course not. The 'pie' will just be re-disturbed to all the players.
2
Do tell how Bernie Sanders with his meager record of legislation will get single payer past a Congress that was elected in part because of dissatisfaction with the Affordable Care Act?
Single Payer anyone?
1
There is no doubt that less competition is bad for consumers.
So why doesn't the Editorial Board support changing Obamacare so that insurance can be sold across state-lines?
We have a false "shortage" of choices already because of archaic rules like this - yet changing them is never supported. Why?
So why doesn't the Editorial Board support changing Obamacare so that insurance can be sold across state-lines?
We have a false "shortage" of choices already because of archaic rules like this - yet changing them is never supported. Why?
Fewer insurers = higher premiums and poorer service.
Shame on all politicians and regulators if this happens!
Shame on all politicians and regulators if this happens!
The US hasn't policed mergers in any serious way for decades! Consumers are at the mercy of corporations whose profits exceed the GDP of many medium size countries and those corporations wield their power in Congress and the White House. Insurance companies ( as has big pharma) have received a tremendous gift with the ACA and they are taking full advantage. Single payer is the only way to go for health car with complimentary price controls and universal coverage. We need to get profit outof health care now!
Mergers do nothing for consumers or quality products. They do increase profits and the compensation of the corporate higher ups while the workers loose their jobs. No more mergers.
Mergers do nothing for consumers or quality products. They do increase profits and the compensation of the corporate higher ups while the workers loose their jobs. No more mergers.
1
What we need is no private health insurers. What we need is improved Medicare for all, AKA single payer health care financing. The overhead for traditional Medicare is much lower than the private insurers, less than 3% compared to 15% or worse. No one at the Medicare office has a multi-million dollar salary or stock options. Bernie Sanders has a bill for this in the Senate and John Conyers has had one for years in the House. No, it's not socialism. The hospitals and providers of care are NOT owned by the government, anymore than they are now with traditional Medicare. Let's get some real choice - the freedom to choose any doctor, provider or hospital you want. That will provide true competition on the basis of quality. It's safer for patients not to have to switch medical horses in midstream because of insurance changes at work or elsewhere. Let's use the simplest, most efficient, most humane and the CHEAPEST form of health care financing and gain some real freedom and choice in the bargain. Health insurance companies are scared to death that people are starting to understand this, despite their financial strangle hold on our Senators and Representatives. Everybody in, nobody out!
4
When insurance companies speak about their performance, the term "medical loss ratio" is central to their discussions. That is the percentage difference between their costs (read paying for care) and their bottom line. In other words, they have an inherent conflict of interest with patients, physicians and hospitals. The more care is provided, the less money the company, its CEO and stockholders earn. That's not to say that there are no opportunities to make health care more efficient, but insurance companies are in the business of maximizing quarterly profits, and the provision of better care at affordable cost is a more long term project
Medicare has largely been a phenomenal success. It provides reasonable coverage for millions with low administrative costs and does not have a profit motive built in. And yet the single payer model is viewed as anathema. Go figure
Medicare has largely been a phenomenal success. It provides reasonable coverage for millions with low administrative costs and does not have a profit motive built in. And yet the single payer model is viewed as anathema. Go figure
10
The proper thing to do is to increase the required medical loss ratio.
MLR = amount paid providers/premiums paid
In Germany, the minimum required MLR is over 97%.
In the USA, the minimum required MLR is only 85%, meaning up to 15% of premiums paid can be wasted on sales, administration and profit.
Another possibility is health system offered insurance. Each health system with over 30% of a market in an county, city, built-up region (orange area on a 2015 road atlas) of over 200,000 people in a state could be required to offer a plan on a state/federal exchange by January 2016 or split up by 2017 to less than 30%.
Separating out drug coverage would help health system providers enter the pure health care marketplace.
Separate drug coverage could and should be offered on a national basis.
By 2020, the existing insurers (Aetna, Anthem, independent Blues) might just offer exclusive/expensive drug coverage while the large health care provider systems (Johns Hopkins, Sutter, Kaiser, INOVA, Partners, etc.) providers would just offer health care coverage (sans exclusive/expensive drugs).
MLR = amount paid providers/premiums paid
In Germany, the minimum required MLR is over 97%.
In the USA, the minimum required MLR is only 85%, meaning up to 15% of premiums paid can be wasted on sales, administration and profit.
Another possibility is health system offered insurance. Each health system with over 30% of a market in an county, city, built-up region (orange area on a 2015 road atlas) of over 200,000 people in a state could be required to offer a plan on a state/federal exchange by January 2016 or split up by 2017 to less than 30%.
Separating out drug coverage would help health system providers enter the pure health care marketplace.
Separate drug coverage could and should be offered on a national basis.
By 2020, the existing insurers (Aetna, Anthem, independent Blues) might just offer exclusive/expensive drug coverage while the large health care provider systems (Johns Hopkins, Sutter, Kaiser, INOVA, Partners, etc.) providers would just offer health care coverage (sans exclusive/expensive drugs).
I agree Pat. The solution is to treat insurance companies as much as possible like government insurers. Regulate them like utilities, and pass laws to allow them cut reimbursements and premiums alike.
MLR was set up by ACA as a fixed 20% or 15% depending on the policy type
1
Yes, it is becoming more difficult to pass 'Go' and 'Collect $200 Dollars'. Especially when all the insurers own all of the 'Hospitals on Park Ave'.
2
Health insurance is already an oligopoly with little if any competition for consumer business. The 80% rule is not enough to ensure competition. Neither is state insurance regulation. When and if Democrats control the presidency and Congress, legislation should be passed to require federal government approval of premium, copay and deductible increases.
12
Fed already has premium oversight
Fed set the max out of pocket
Fed set the deductible levels
You can thank the reform law if that does not suit you
Fed set the max out of pocket
Fed set the deductible levels
You can thank the reform law if that does not suit you
The Times wants COMPETITION; they just don't want anyone to make a PROFIT.
Ironically, this is the same attitude "free market" businessmen espouse: "Competition is good for my suppliers, but not for me."
Ironically, this is the same attitude "free market" businessmen espouse: "Competition is good for my suppliers, but not for me."
2
If the Affordable Care Act requires insurance companies to spend at least 80% of health insurance premium on medical care, where is damage to the consumers in allowing more mergers. In fact, if more mergers are completed in the health insurance industry, a private single payer system can be indirectly accomplished. Then nationalize it.
2
There's consumer choice in health insurance when it comes to insurers? I've lived in two states - and in both, BCBS had a near monopoly. ACA has made some changes, but the "market" remains extremely skewed - and not in favor of consumers of health care.
1
If we are to have medical insurance driven by true competition then the only way for this to truly work is to have the insurance companies be non public.
Just like the public companies involved in administering prisons there is a fundamental conflict between the company's responsibility towards its shareholders and being really effective, in these examples, at financing better, less expensive care or be successful in the rehabilitation and integration of convicts back in society? How are you going to make more money if people learn how to take better care of themselves or commit less crimes? Shareholders will suffer. The more sick people and convicts the merrier.
Being non public removes this conflict, there will be more companies, competition will be for real and the quality of the services will go up as a lot of costs associated with running a big enterprise will be no longer necessary.
The mergers proposed will only increase the costs for the population at large, decrease the quality of the care by denying as many medical services as possible, and decrease the amount of rightly earned money by medical providers.
Meanwhile the shareholders will get bigger dividends and the CEO-s bigger salaries. In whichever order.
Just like the public companies involved in administering prisons there is a fundamental conflict between the company's responsibility towards its shareholders and being really effective, in these examples, at financing better, less expensive care or be successful in the rehabilitation and integration of convicts back in society? How are you going to make more money if people learn how to take better care of themselves or commit less crimes? Shareholders will suffer. The more sick people and convicts the merrier.
Being non public removes this conflict, there will be more companies, competition will be for real and the quality of the services will go up as a lot of costs associated with running a big enterprise will be no longer necessary.
The mergers proposed will only increase the costs for the population at large, decrease the quality of the care by denying as many medical services as possible, and decrease the amount of rightly earned money by medical providers.
Meanwhile the shareholders will get bigger dividends and the CEO-s bigger salaries. In whichever order.
1
With the mergers to consolidate any company, one reduces the operating cost of the new merged company, but it does not trickle down to the customers in the form of any relief.
There is no argument that mergers would reduce cost of doing business, but they hardly ever would reduce the premium to the customers.
The mergers would possibly lead to a single payer system that the Federal Government would either take over as essential services or pay them the depreciated value that the companies use to file their tax return. with a single payer system our level of healthcare would be better than the OECD countries.
In healthcare we all know too well that the ACA is just a down payment towards a single payer system in health care delivery. We must look at how the other OECD countries are managing to deliver a better level of care with less cost. Why is it that we are not following the other OECD countries even though we are far ahead in innovation in almost everything else?
Till we change the system of electing our so called representatives who make the laws nothing would change. Our (or should I say the bought and paid for) Representatives work for their constituencies who put them there in the first place and that is almighty dollars. Once we decide to fix this sordid system of elections which last years and now have become a perpetual fund raising operation nothing would change and we keep complaining and trying to fix the symptoms/results but not addressing the cause.
There is no argument that mergers would reduce cost of doing business, but they hardly ever would reduce the premium to the customers.
The mergers would possibly lead to a single payer system that the Federal Government would either take over as essential services or pay them the depreciated value that the companies use to file their tax return. with a single payer system our level of healthcare would be better than the OECD countries.
In healthcare we all know too well that the ACA is just a down payment towards a single payer system in health care delivery. We must look at how the other OECD countries are managing to deliver a better level of care with less cost. Why is it that we are not following the other OECD countries even though we are far ahead in innovation in almost everything else?
Till we change the system of electing our so called representatives who make the laws nothing would change. Our (or should I say the bought and paid for) Representatives work for their constituencies who put them there in the first place and that is almighty dollars. Once we decide to fix this sordid system of elections which last years and now have become a perpetual fund raising operation nothing would change and we keep complaining and trying to fix the symptoms/results but not addressing the cause.
1
'...it does not trickle down to the customers in the form of any relief...'
It also does not trickle down to the workers in wages.
It also does not trickle down to the workers in wages.
our casts are high because limiting which drugs are allowed, limiting treeatments, rationing treatments are not acceptable here in the U S A
if single payer is good, why is industry consolidation bad?
The reason for a shrinking number of health care insurers is excessive regulation coupled with a relatively low profit margin and huge fixed overhead costs. If managing health insurance claims was highly profitable, there would be dozens of companies competing for business.
5
The irony is the SINGLE PAYOR healthcare system, which the overwhelming majority of U.S. citizens expreseed support for during the debate on Obamacare, inexpliciably dropped from consideration by Congress, is being synthetically created as a SINGLE INSURANCE PROVIDER system by the major health care insurance participants. The overarching goal of Obamacare was to permanetly bend the cost curve of healthcare downward to facilitate more access and broader coverage. While broader access to healthcare to millions of Americans who had none, the companion objectives of affordibility and diversity of providers have not.
The affordability provisions of Obamacare were waived or suspended at health insurance provider's request and, as a consequence, the "bad old days" of double digit increases in healthhcare insurance premiums have returned to the detriment of expanding access to basic healthcare services. It is impossible to reconcile the
proposed megrers of large health insurance providers with the goals of grerater competition and diversity of providers essential to reforming the domestic healthcare delivery system. On the basis of these clear, irrefutable and compelling grounds any impartial substative review of the proposed mergers of healthcare insurance providers should conclude they are not in the best interest of the public and should be denied approval by the Dept. of Justice.
The affordability provisions of Obamacare were waived or suspended at health insurance provider's request and, as a consequence, the "bad old days" of double digit increases in healthhcare insurance premiums have returned to the detriment of expanding access to basic healthcare services. It is impossible to reconcile the
proposed megrers of large health insurance providers with the goals of grerater competition and diversity of providers essential to reforming the domestic healthcare delivery system. On the basis of these clear, irrefutable and compelling grounds any impartial substative review of the proposed mergers of healthcare insurance providers should conclude they are not in the best interest of the public and should be denied approval by the Dept. of Justice.
In Britain the traditional "single payer" system was based on regional trusts with national funding based on a formula to adjust for patient demographics. A few systems that correspond to say the Cleveland Clinic, M.D. Anderson and Mayo got non-regional independent funding.
NHS bureaucrats in London never paid a provider on a per patient visit basis.
The hundred plus British trusts paid their local doctors, not the NHS in London.
In US terms, there might be trusts for Westchester County and the Bronx, the NYC part of Long Island and Manhattan, Suffolk and Nassau counties, Northern NJ, etc.
Each trust would get a check for the federal government (HHS) every month.
Expensive drugs might get purchased nationally as is done for hospital drugs in France.
Nowadays, the UK in England is using a system with capitalized payment to doctors. English doctors then "shop" for specialty care and drugs on behalf of their patients. English doctors can buy from the remnants of the old trusts or new for-profit entrants.
NHS bureaucrats in London never paid a provider on a per patient visit basis.
The hundred plus British trusts paid their local doctors, not the NHS in London.
In US terms, there might be trusts for Westchester County and the Bronx, the NYC part of Long Island and Manhattan, Suffolk and Nassau counties, Northern NJ, etc.
Each trust would get a check for the federal government (HHS) every month.
Expensive drugs might get purchased nationally as is done for hospital drugs in France.
Nowadays, the UK in England is using a system with capitalized payment to doctors. English doctors then "shop" for specialty care and drugs on behalf of their patients. English doctors can buy from the remnants of the old trusts or new for-profit entrants.
"The affordability provisions of Obamacare were waived or suspended at health insurance provider's request"
Actually they have not been - the government now decides what is affordable
Actually they have not been - the government now decides what is affordable
Health Care should not be an industry!
4
it should be a hobby instead?
I couldn't agree more. I can't even keep up with the names of the companies. I used to work at Blue Cross/Blue Shield, and I think I've had to change my LinkedIn logo for that company a few times: BC/BS; WellPoint, and now Anthem, which by the way is acquiring our insurance, Cigna.
It reminds me of my dad's company that used to be called Allied Mills then Wayne Feeds then Allied Mills/Wayne Feeds then Continental Grains, then ConAgra. (He was forced into retirement at 50 during the ConAgra takeover.)
I don't get the sense that ConAgra is well regulated.
It reminds me of my dad's company that used to be called Allied Mills then Wayne Feeds then Allied Mills/Wayne Feeds then Continental Grains, then ConAgra. (He was forced into retirement at 50 during the ConAgra takeover.)
I don't get the sense that ConAgra is well regulated.
ACA or AHA or Obama Care.
A perfect example of how holding a health insurance card in America does not ensure access to quality affordable safe health care and medications.
Scam
A perfect example of how holding a health insurance card in America does not ensure access to quality affordable safe health care and medications.
Scam
TOO BIG TO FAIL is the direction in which the healthcare insurance companies looks like increasing the chances of another failure and bailout. We've already seen what results we got by eliminating both competition and oversight in the financial sector. Ultimately, it's the financial people in the healthcare industry who are driving the move. Their goal is to increase the bottom line for stockholders and themselves again, at the expense of the insured. Let's avoid setting up yet another situation where the 1% get to line their pockets while the standard of living for the 99% goes down again.
2
Why does this remind me of J.P. Morgan, Rockefeller, and Vanderbilt in the Gilded Age?
Health care and insurance executives will fatten their already rapacious obnoxious paychecks. Foreign labor (doctors and nurses) will be imported to work for less. Health care will be expensive and ineffective in general ordinary cases as the turnstile whirls away, until a patient gets really sick, at which point ICU/SICU and treatment will skyrocket (for instance look at new treatments for cancer).
Where is a Teddy Roosevelt to take on this monopolistic rush to crush ordinary citizens and to enrich the arrogant, privileged, entitled barons of healthcare?
Health care and insurance executives will fatten their already rapacious obnoxious paychecks. Foreign labor (doctors and nurses) will be imported to work for less. Health care will be expensive and ineffective in general ordinary cases as the turnstile whirls away, until a patient gets really sick, at which point ICU/SICU and treatment will skyrocket (for instance look at new treatments for cancer).
Where is a Teddy Roosevelt to take on this monopolistic rush to crush ordinary citizens and to enrich the arrogant, privileged, entitled barons of healthcare?
4
These merger proposals should be DENIED! There is much evidence that fewer options DO NOT result in lower costs! The telecommunications and cable TV industries are examples. Corporations tend to want a monopoly after which they control the price; which is often higher!
4
Maybe it's time to repeal McCarren Ferguson and apply federal anti-trust laws to the 'business of insurance.'
6
'...Antitrust regulators should make sure that mergers in the health care industry do not reduce choices...'
Because they have done so with all the other hundreds of mergers that reduce choices? (Six huge corporations control 90% of all media in the US, including newspapers.)
The Sherman Antitrust Act had its teeth removed during the Reagan administration which, along with his economic giveaways to the .01%, is responsible for the ongoing destruction of the middle class, the backbone of the US economy.
As goes the middle class goes the country.
Because they have done so with all the other hundreds of mergers that reduce choices? (Six huge corporations control 90% of all media in the US, including newspapers.)
The Sherman Antitrust Act had its teeth removed during the Reagan administration which, along with his economic giveaways to the .01%, is responsible for the ongoing destruction of the middle class, the backbone of the US economy.
As goes the middle class goes the country.
8
Neither antitrust laws nor the ACA protect the public from our current “gotcha!” health insurance plans. Deductibles have ballooned, and there are dozens of loopholes in every plan. These companies are expert gamers; they set the rules, and they always win.
People need access to actual care, not to private health insurance, and until we join the rest of the civilized world in providing national health insurance, we will continue to needlessly suffer, go bankrupt, and die.
People need access to actual care, not to private health insurance, and until we join the rest of the civilized world in providing national health insurance, we will continue to needlessly suffer, go bankrupt, and die.
3
Very surprised to see one topic of these mergers not addressed. Religious affiliated hospitals buying up hospitals and and then not provided many women's healthcare issues because of religious beliefs.
6
And they are tax exempt, while they pass the costs of indigent patients on to the taxpayers.
Great scam.
Great scam.
1
My boss used to say, "there is no bottom to bad taste," but really, it should be, "there is no bottom to bad."
2
Horizon (BC/BS in New Jersey) has just issued its plan for a drastic change in their participating physicians' panel. They have placed some practices into Tier 1 ... which will provide reduced reimbursements to those doctors while minimizing co-payments from subscribers.
Tier 2 physicians will apparently still be reimbursed for services at the current (maybe) rates ... but the subscriber (patient) will have higher co-pays.
I retired as a physician from a Northern New Jersey group practice several years ago ... after 40 years of practice. So I am familiar with many physicians in the area.
Looking at the local listings, it seems that the Tier 1 group appears to be mostly composed of non-US med school graduates (both American and foreign born doctors) ... many of them did their U.S. specialty residencies at lower tiered inner city hospitals ... those with loose medical school affiliations or none ... with training from supervising physicians who themselves had learned their trade at the same second-tier facilities.
There is no doubt in my mind that the health insurance industry's ever changing (profit-seeking) policies will reduce the quality and availability of medical care. Every penny accruing to the health insurers ... through reductions in hospital and physician reimbursements ... will wind up as pure profit for the insurers.
Apparently, my retirement was well-timed. ;-)
Tier 2 physicians will apparently still be reimbursed for services at the current (maybe) rates ... but the subscriber (patient) will have higher co-pays.
I retired as a physician from a Northern New Jersey group practice several years ago ... after 40 years of practice. So I am familiar with many physicians in the area.
Looking at the local listings, it seems that the Tier 1 group appears to be mostly composed of non-US med school graduates (both American and foreign born doctors) ... many of them did their U.S. specialty residencies at lower tiered inner city hospitals ... those with loose medical school affiliations or none ... with training from supervising physicians who themselves had learned their trade at the same second-tier facilities.
There is no doubt in my mind that the health insurance industry's ever changing (profit-seeking) policies will reduce the quality and availability of medical care. Every penny accruing to the health insurers ... through reductions in hospital and physician reimbursements ... will wind up as pure profit for the insurers.
Apparently, my retirement was well-timed. ;-)
3
Insurers are very limited on profit, and have been for over 5 years - review the ACA MLR regulations, and you will see the adjustments are driven to keep premiums lower owith all of the added mandated services
I'm less worried about health insurance mergers than I am about mergers of health providers. Here in Columbus we went from 7 independent hospitals to 3 hospital groups (all tax exempt) in just a few years with nary a peep from any antitrust agency. This wasn't for some altruistic reason, but to increase their negotiating power with insurance companies. Of course, the insurance companies aren't going to lose money so increased costs will be passed on the consumer.
8
It the Times Editorial Board was really interested in health care competition, it would call for the end of the McCarran–Ferguson Act which exempts insurance companies from most anti-trust regulation.
Indeed, many people believe that if the was true competition in insurance, that Obamacare and its large government bureaucracy would not be needed.
Indeed, many people believe that if the was true competition in insurance, that Obamacare and its large government bureaucracy would not be needed.
6
You are right to raise alarms about these mergers, higher prices often come from greater control in a market place. The insurers might get lower provider prices but will they pass it along to consumers?
You might also consider pushing to allow patients to access insurers from any state and not merely one state... that is a much greater problem and one surer to gain benefits for consumers.
You might also consider pushing to allow patients to access insurers from any state and not merely one state... that is a much greater problem and one surer to gain benefits for consumers.
the prices are controlled by the providers - the insuurrers are locked into a cost plus 15% or 20%, depending on the policy - costing structure
Monopolies should be forbidden. They used to be against the law before the corruption began.
There is nothing about health care that remotely resembles a free market. The idea that it is "competitive" is ridiculous.
3
With Health insurance companies exempt from all Federal Regulations due to McCarron Ferguson Act and ERISA isn't this a Quixote like effort by the Feds to quell the dying masses?
We don't have a free market and capitalism .... we have monopolies strangling competition and holding people's health hostage. The " too big to fail banks " operating in America are a prime example of what can go wrong in our deteriorating democracy. We need to expand Medicare for all, it has dramatically lower administrative costs compared to private insurance. Private insurance isn't really in the best interests of people's healthcare, it's totally in the business of profit. Monopolistic healthcare is making people even sicker and probably in some cases dying. If we don't have affordable healthcare ... We can't be a great democracy and a world leader. We need a leader to put a stop to this life killing monopolistic predatory move, I know Bernie a Sanders will not play dumb like the rest of our two party representatives on this issue. The two party machine has been ineffective in stopping the monopolistic takeover of our capitalistic system. We need Bernie now more than ever, Bernie '16 !
3
Is the paper starting to wake up to the dirty little US secret that virtually every sector of the US economy has little or no competition. From media and airlines to healthcare and health insurance, our capitalist economy has transitioned into an oligopoly economy. Without this corporate consolidation, the current Gilded Age could not exist.
9
I gather there's a well-known bottom line in all of this, one that I'm guessing has little to do with health care. Am I too cynical in suggesting that a two-word description of that line is "maximizing profit"?
Just another side effect from that disaster of a law, Obamacare. Unless you are someone getting Medicaid or a free subsidized ride you will be paying more and having less choice due to Obamacare. Shame on the Democrats for pushing this bad law through without even knowing what was in it.
and so long as legislators are addicted to the money, and there remains a revolving door between regulators and industry executive suites, NOTHING will emerge to benefit citizens, either in health care arenas or elsewhere, as all involved are perfectly and profitably aware
3
By continuing the merger game, the insurers are admitting that a single payer is best.
2
They will reduce choices & raise prices. Based on their Johnny-come-lately surprise that airline mergers did the same, don't expect the Justice Dept to try to do anything here until the horses have left the barn. It's all part of the income inequality that is savaging this nation.
3
It seems to me there is a crisis on the horizon with the cost of health insurance premiums and no one seems to be sounding the alarm.
Many States have had to raise the rates 25% or more and hundreds of thousands have stopped paying premiums on their AHA health plans because they're UNaffordable.
Many States have had to raise the rates 25% or more and hundreds of thousands have stopped paying premiums on their AHA health plans because they're UNaffordable.
2
whatever it takes to prevent my medications from being tampered w/again. Thats is why you dont let women become privy to inside information or let them run important details. My medications have been tampered w/twice the past 2yrs.
Its comical to believe that increasing 'competition in an important industry' will provide the kind of reform needed. Breaking up the telecommunication and the railroads did nothing to 'increase' competition. Slave armies still toiled across the american west and telephone companies still charge whatever they want. The justice department is following tradition by getting involved after its already much too late.
3
I fear larger health insurance companies. They are bad enough as-is. Getting Anthem Blue Cross to acknowledge and eventually pay a valid claim has taken hours of frustration. When I sent a message of complaint about ABC's failure to even list the claim, I was referred to their grievance on-line form. That requires an explanation in "92 characters" or less; won't accept more. When I tried to explain in 92 characters, I got another message saying the explanation wasn't adequate. Truly Kafka-esque. DOJ, please stop the mergers!
46
Very funny. That horse already escaped the barn. There's very little competition left in the insurance healthcare business. And if the insurance carriers had any interest in negotiating enormous hospital charges, they already would have done it.
22
It's actually better for an insurer to get 15% of a $50,000 bill than 15% of a $40,000 bill.
The medical loss ratio should have a negative feedback in the face of higher provider prices to ensure insurers want to get lower provider prices. The lack of a strong insurer incentive to minimize provider costs is a major flaw of the PPACA.
And, instead of a ratio like MLR, the insurer monthly margin might be say $1 per year of age of insured less a percentage (say 3%) of submitted claims less a percentage (say 10%) of claims not properly paid within 30 days for any reason including insured error.
For a 50-year old, this margin would be say $50/month minus say $12/month on average (3% of $400/month on average), for an insurer margin of about $38/month.
The medical loss ratio should have a negative feedback in the face of higher provider prices to ensure insurers want to get lower provider prices. The lack of a strong insurer incentive to minimize provider costs is a major flaw of the PPACA.
And, instead of a ratio like MLR, the insurer monthly margin might be say $1 per year of age of insured less a percentage (say 3%) of submitted claims less a percentage (say 10%) of claims not properly paid within 30 days for any reason including insured error.
For a 50-year old, this margin would be say $50/month minus say $12/month on average (3% of $400/month on average), for an insurer margin of about $38/month.
The fatal flaw in the argument presented here is that healthcare is a market. It is not. Markets have consumers that make choices. They chose what to buy or if to buy at anything at all. Healthcare doesn't work that way. The consumers makes few if any choices. They just show up and say I don't feel well and its off to a billing race of insurance codes and charges that can easily hit four figures each day in the hospital.
Al the ACA has done to reduce prices is to introduce a modicum of competition to how healthcare is paid for through insurance companies, not to restrain how healthcare is billed. Negotiation are just that. Both sides end up getting most of what they want.
These mega mergers will reduce what little price competition the ACA brought to healthcare. They represent further monopolization of the industry. They will swamp out new insurers from entering their territories. Smaller companies will not be able to capture enough business to gain a foothold and survive.
The system is still broken and these mergers will break it some more. So long as we have a fee for service with inelastic demand and no consumer choice driving those fees, costs will continue to spiral up.
Al the ACA has done to reduce prices is to introduce a modicum of competition to how healthcare is paid for through insurance companies, not to restrain how healthcare is billed. Negotiation are just that. Both sides end up getting most of what they want.
These mega mergers will reduce what little price competition the ACA brought to healthcare. They represent further monopolization of the industry. They will swamp out new insurers from entering their territories. Smaller companies will not be able to capture enough business to gain a foothold and survive.
The system is still broken and these mergers will break it some more. So long as we have a fee for service with inelastic demand and no consumer choice driving those fees, costs will continue to spiral up.
39
I am so happy the NY Times decided to speak out on the proposed consolidation of the health insurance industry. Given their druthers it doesn't take much imagination to figure out what the insurance industry was up to in planning these mergers. In a few years the American people in the affected markets would have been faced with a behemoth national sized insurer against which individuals would not stand a chance at equitable treatment. So called insurance exchanges would become monopoly geographies for these insurers, thereby killing competition.
Of course these mergers reduce competition! And it always means higher premiums to appease "shareholders" while paying off the costs of a leveraged buyout, not to mention paying for the bonuses to the executives who engineered the deal in the first place.
And since 1985 (suggestions by the Greenspan Commission at the request of Reagan) we can thank the libertarian ex-Fed chairman, Alan Greenspan, and the ever-compliant congress, the countless lobbyists, lawyers, and several occupants of the Oval Office for killing competition in several business sectors.
Did mergers in telecommunications bring improvements for the consumers? No. How about the airline industry? How about the financial industry (banking, insurance and brokerage houses all included)? Another big NO.A big NO on that one two. How about Big Pharma? NO!!! Big Ag? NO!! And the list goes on. In every single case where mergers & acquisitions and hostile takeovers reduced competition, the consumers took a nasty hit while the executives and investment bankers made out like, well, bandits. (No surprise there.)
All of the promises of better services, better products and better value for consumers have been nothing less than a pant-load of lies.
For more than 30 years, since the Greenspan era began, mergers and the resulting reduction of competition has not only put our democracy up for sale to the highest bidders, it hasendangered the American workforce as jobs evaporated with each merger.
And since 1985 (suggestions by the Greenspan Commission at the request of Reagan) we can thank the libertarian ex-Fed chairman, Alan Greenspan, and the ever-compliant congress, the countless lobbyists, lawyers, and several occupants of the Oval Office for killing competition in several business sectors.
Did mergers in telecommunications bring improvements for the consumers? No. How about the airline industry? How about the financial industry (banking, insurance and brokerage houses all included)? Another big NO.A big NO on that one two. How about Big Pharma? NO!!! Big Ag? NO!! And the list goes on. In every single case where mergers & acquisitions and hostile takeovers reduced competition, the consumers took a nasty hit while the executives and investment bankers made out like, well, bandits. (No surprise there.)
All of the promises of better services, better products and better value for consumers have been nothing less than a pant-load of lies.
For more than 30 years, since the Greenspan era began, mergers and the resulting reduction of competition has not only put our democracy up for sale to the highest bidders, it hasendangered the American workforce as jobs evaporated with each merger.
Telecom service has improved in terms of quality.
In 1984 there were 300 bit per second modems.
My local ISP providers are greedy, but their speeds are much, much better by factors often well over 10,000.
In 1984 there were 300 bit per second modems.
My local ISP providers are greedy, but their speeds are much, much better by factors often well over 10,000.
What regulators really need to do is to examine preventative, medical, surgical and palliative outcomes among health insurance companies.
Few will argue that publicly subsidized and private health insurance companies make their profits for their shareholders, bondholders, executives, bureaucrats and patron politicians by financially or physically rationing access to preventive care, diagnostics, treatments, physicians, hospitals and hospice care. The results of that rationing will be revealed in different costs and clinical outcomes for patients on different insurance plans. How would it be for business if Humana or Aetna patients were dying or more sick than age and disease matched United patients?
Insurance companies do not want the clinical outcomes of their patients revealed. These insurance companies don't want to compete capitalistically based on the quality or the cost of the clinical outcomes of their patients.
Few will argue that publicly subsidized and private health insurance companies make their profits for their shareholders, bondholders, executives, bureaucrats and patron politicians by financially or physically rationing access to preventive care, diagnostics, treatments, physicians, hospitals and hospice care. The results of that rationing will be revealed in different costs and clinical outcomes for patients on different insurance plans. How would it be for business if Humana or Aetna patients were dying or more sick than age and disease matched United patients?
Insurance companies do not want the clinical outcomes of their patients revealed. These insurance companies don't want to compete capitalistically based on the quality or the cost of the clinical outcomes of their patients.
Better idea is to go to a single payer health system for all, including the Congress, and get the profit motive out of the equation thereby closing private insurers. We'll never have health care as a right, which it is, in this country until this happens.
1
There is one reason for the mergers: to increase shareholder value. Any nonsense about increasing bargaining power is cover for that goal. And if the insurers can collect higher and higher government subsidies at the expense of the American taxpayer, all the better. After all, they can blame it on "Obamacare". Shareholders & CEO's reap windfalls while consumers & taxpayers once again take a hit to their pocketbook. This charade is all too common in the "unregulated" marketplace.
Yes, I'd say regulators need to take a VERY close look at the mergers - not just in insurers but in health care providers as well. Unregulated capitalism always gravitates toward oligopoly and then monopoly - it's the nature of the beast. Vigilant and efficient regulation are essential to the proper functioning of capitalism.
Yes, I'd say regulators need to take a VERY close look at the mergers - not just in insurers but in health care providers as well. Unregulated capitalism always gravitates toward oligopoly and then monopoly - it's the nature of the beast. Vigilant and efficient regulation are essential to the proper functioning of capitalism.
The best strategy is a single payer system with which assures universal coverage and providing the best care, whether that system ultimately relies upon private or public sources of funding. We have a big problem with monopolies in this country. They are designed and reliably act to dominate markets, leaving buyers without any leverage, then they provide predictable sales and assurance of success for sellers. They provide the best publically sold stock with the best returns upon investments. The problem is that they lead to government regulations because nobody running monopolies has any regard for the effects of dominating whole segments of the economy have generally. The ruin economic growth by bearing down so against effective competition and buyers choices that everybody suffers, eventually. So the spin doctors pretend that markets eliminate monopolies on their own and continue to claim that government interference is the real threat to economic expansion.
Insurance corporations are protected from anti-trust and medical malpractice via the McCarron Ferguson Act and ERISA. Most importantly, Fed regulators should examine clinical outcomes (preventative, medical, surgical and palliative) among and between insurance plans. Outcomes are the only products manufactured by the doctors and patients who are employed and customers of the rationing insurance corporations.
Few will argue that publicly subsidized and private health insurance companies make their profits for their shareholders, bondholders, executives, bureaucrats and patron politicians by financially or physically rationing access to preventive care, diagnostics, treatments, physicians, hospitals and hospice care. The results of that rationing will be revealed in different costs and clinical outcomes for patients on different insurance plans. How would it be for business if Humana or Aetna patients were dying or more sick than age and disease matched United or Blue Shield Blue Cross patients?
Insurance companies do not want the clinical outcomes of their patients revealed. These insurance companies don't want to compete capitalistically based on the quality or the cost of the clinical outcomes of their patients.
Few will argue that publicly subsidized and private health insurance companies make their profits for their shareholders, bondholders, executives, bureaucrats and patron politicians by financially or physically rationing access to preventive care, diagnostics, treatments, physicians, hospitals and hospice care. The results of that rationing will be revealed in different costs and clinical outcomes for patients on different insurance plans. How would it be for business if Humana or Aetna patients were dying or more sick than age and disease matched United or Blue Shield Blue Cross patients?
Insurance companies do not want the clinical outcomes of their patients revealed. These insurance companies don't want to compete capitalistically based on the quality or the cost of the clinical outcomes of their patients.
Nearly 50 years ago, I figured out that fascism and communism were two sides of the same coin. In communism, government owned business; in fascism, business owns government.
This paradigm should be considered when considering health insurance mergers. The advantages touted by capitalism--competition lowering prices--become empty when there is NO competition, either by trusts, price-fixing agreements, or few competitors. In that case, government-run health insurance would by default deliver on the Constitutional promise of "life, liberty, and the pursuit of happiness" without making a small class of people rich, not to mention curbing some of the abuses of privatize healthcare, such as Medicare fraud.
This paradigm should be considered when considering health insurance mergers. The advantages touted by capitalism--competition lowering prices--become empty when there is NO competition, either by trusts, price-fixing agreements, or few competitors. In that case, government-run health insurance would by default deliver on the Constitutional promise of "life, liberty, and the pursuit of happiness" without making a small class of people rich, not to mention curbing some of the abuses of privatize healthcare, such as Medicare fraud.
Of course these mergers will result in higher costs and less choice. They reduce competition, a cornerstone of the free market. Mergers are never done with the benefit going to the consumer, but to the companies and their shareholders. Let's be realistic here. Allowing these kinds of mergers would be a travesty. If they do go through, we will then all be reading the inevitable stories about individual consumers priced out of the market, unable to afford insurance and then penalized for not having insurance. We are already suffering from less attention and absurd pricing from our physicians and hospitals because of insurance companies dictating the terms under which doctors and hospitals can function. Office visits are timed, medical practices are increasingly huge and impersonal because doctors are driven to merge with other practices, and hospital costs and the subsequent bills and insurance claims defy common sense translation.
The other day I received 2016 Part D insurance info from AARP which is underwritten by United Healthcare. I was surprised. Premiums were increase about 20% and prescription copays about 50%. Whether these increases are result of proposed mergers, less competition in the prescription management business, or manipulation by the lessening of competition among the pharmaceutical companies I cannot say. I would guess its a combination of all the above. It seems that the large health insurers and Big Pharma are out to undermine the Affordable Care Act. Single Payer and the ability for Medicare to negotiate drug costs is the only solution to the industry's monopolistic tendencies.
1
The intended purpose of ACA was to give insurance companies and Wall Strret complete control of health care which enables them to fleece poor sick people. My insurance company has requested a %50 rate increase for next year with additional increases to follow. Health care providers grossly overbill in their ongoing battle with the newly all powerful insurance companies. Yes, mergers are an issue but the underlying issue is ACA which has given corporations the legislated power to plunder poor sick people and increase the numbers of poor people by governmental fiat. Yep, Republicans have done nothing to improve health care, but Democrats took things a step further and made things worse. Insurance is not health care. Medical treatment is health care. If indeed insurance is health care then logic would dictate that we should have insurance for groceries, fuel, clothing and any other item needed for life.
1
The government has lots of rules about what insurance companies can do. Insurance companies and providers are at economic war. The public that chooses its insurer has a limited understanding of what they're getting. They can read a 100 page brochure or speak to a company rep in India if they don't understand something important. The public is also limited in the providers they can use. Most of the big shot providers won't accept their insurance, A lot of the providers who do are foreigners, many of whom don't practice the way your family doctor did when you were a kid. Reducing the number of insurers by 5 to 3 gets rid of 2 companies that don't serve the public interest, leaving 3 companies that will serve it even less. This is what they call health care reform. It isn't working for me.
1
The editorial board is on the mark here, or perhaps better to say on the money.
Federal regulators were very much asleep at the wheel when it came to regulating recent merger mayhem in the airline industry. The DOJ foolishly permitted several mergers of major airlines. The resulting industry consolidation has produced oligopolies or monopolies in many markets; airfares have gone up (especially when surcharges are included), and probably more importantly, there are fewer flights.
The stakes in the health care industry are high, and medical costs are great. We need competition, both among providers and insurers. Federal regulators need to pay close attention both to the medical insurance industry, and providers, especially large hospital firms. Federal regulations are endowing both providers and insurers with great power to set prices, and to regulate the very availability of medical services. Competition is essential to product the consumer - meaning all of us.
The feds should be very leery of allowing consolidation in either the provider or insurance domains, and need to evaluate the potential effects of proposed mergers on both a national level, and in the multitude of regional markets.
Federal regulators were very much asleep at the wheel when it came to regulating recent merger mayhem in the airline industry. The DOJ foolishly permitted several mergers of major airlines. The resulting industry consolidation has produced oligopolies or monopolies in many markets; airfares have gone up (especially when surcharges are included), and probably more importantly, there are fewer flights.
The stakes in the health care industry are high, and medical costs are great. We need competition, both among providers and insurers. Federal regulators need to pay close attention both to the medical insurance industry, and providers, especially large hospital firms. Federal regulations are endowing both providers and insurers with great power to set prices, and to regulate the very availability of medical services. Competition is essential to product the consumer - meaning all of us.
The feds should be very leery of allowing consolidation in either the provider or insurance domains, and need to evaluate the potential effects of proposed mergers on both a national level, and in the multitude of regional markets.
1
Regulators are putting high quality carriers who are offering good networks out of the business by denying needed increases in premiums.
My carrier, Assurant Health who has one of the best networks in the country is leaving the health insurance business at the end of this year. They are going broke allowing sick patients to go to quality providers. Blue Cross of NM and Texas are no longer offering individuals the ability to buy PPO plans which gives customers access to the best providers because they were denied increases and are going broke providing high quality providers to their sick customers.
The administration is pushing low premium, high deductible, limited network insurance so they can say they have kept the price of premiums down. The ACA is removing competition not creating it. The cost of premiums is one part of the puzzle, access, the actual product we are buying is the other part of it. Regulators need to take both into account when scrutinizing these mergers and premium increases.
The mergers don't matter, managed care, high premiums, large deductibles are baked into the ACA.
My carrier, Assurant Health who has one of the best networks in the country is leaving the health insurance business at the end of this year. They are going broke allowing sick patients to go to quality providers. Blue Cross of NM and Texas are no longer offering individuals the ability to buy PPO plans which gives customers access to the best providers because they were denied increases and are going broke providing high quality providers to their sick customers.
The administration is pushing low premium, high deductible, limited network insurance so they can say they have kept the price of premiums down. The ACA is removing competition not creating it. The cost of premiums is one part of the puzzle, access, the actual product we are buying is the other part of it. Regulators need to take both into account when scrutinizing these mergers and premium increases.
The mergers don't matter, managed care, high premiums, large deductibles are baked into the ACA.
2
Insurance companies consolidating and multi billion dollar mergers all to put the squeeze on hospitals and doctors and do nothing about real problems rampant in the medical Industry. Since when is that new news?
Of course the ADA was Medicare-ultrlite. No mention of single payer was brought up by the quasi Democratic Senator Max Baucus who headed the committee then got promoted to the cushy position of Ambassador to China.
Or the fact the W Bush era Plan D which denies the government the right to get competitive quotes on drugs, a payoff to the nearly trillion dollar drug industry. The congressman who wrote that bill, along with big Pharma quit and went to work for Big Pharma for $2.5 million per year, not as a scientist but as a spokesman!
No mention of the billions wasted in replicated lab studies as there is no central data center to accumulate our health records hence each doc does duplicates of the same tests and labs blame it on the security laws, again blaming govt. when the cause is their own.
Not to mention there are not nearly enough doctors being educated as you must be a member of elite society to afford that education and most of the elite would rather join hedge firms where they can rip off the middle class for billions.
Our medical system is totally in the hands of private enterprise and it is a disgrace, despite the efforts of thousands of dedicated clinicians.
Of course the ADA was Medicare-ultrlite. No mention of single payer was brought up by the quasi Democratic Senator Max Baucus who headed the committee then got promoted to the cushy position of Ambassador to China.
Or the fact the W Bush era Plan D which denies the government the right to get competitive quotes on drugs, a payoff to the nearly trillion dollar drug industry. The congressman who wrote that bill, along with big Pharma quit and went to work for Big Pharma for $2.5 million per year, not as a scientist but as a spokesman!
No mention of the billions wasted in replicated lab studies as there is no central data center to accumulate our health records hence each doc does duplicates of the same tests and labs blame it on the security laws, again blaming govt. when the cause is their own.
Not to mention there are not nearly enough doctors being educated as you must be a member of elite society to afford that education and most of the elite would rather join hedge firms where they can rip off the middle class for billions.
Our medical system is totally in the hands of private enterprise and it is a disgrace, despite the efforts of thousands of dedicated clinicians.
2
I would like to make two points:
1. How many times must we watch this merger scenario unfold--two telecoms, two airlines, two supermarket chains--and what does the public get? Nothing!
The new, larger company can then lay-off redundant overhead staff, economies to scale enable it to combine logistics and communications networks. The merged company lowers its prices at first; but, then they start to creep up and up, and never stop again. Oh, and the public now has less alternatives to choose from. Sound familiar?
2. When it comes to the Insurance Industry--which includes Health Care--it is regulated individually by each state, for activities within its borders. Thus, the large national health insurance providers operate through separate subsidiaries in each of the states in which they do business. So, wouldn't it be interesting as to how these corporate combinations will work-out if a few of the states disallow the merger? HMMM.
http://thetruthoncommonsense.com
1. How many times must we watch this merger scenario unfold--two telecoms, two airlines, two supermarket chains--and what does the public get? Nothing!
The new, larger company can then lay-off redundant overhead staff, economies to scale enable it to combine logistics and communications networks. The merged company lowers its prices at first; but, then they start to creep up and up, and never stop again. Oh, and the public now has less alternatives to choose from. Sound familiar?
2. When it comes to the Insurance Industry--which includes Health Care--it is regulated individually by each state, for activities within its borders. Thus, the large national health insurance providers operate through separate subsidiaries in each of the states in which they do business. So, wouldn't it be interesting as to how these corporate combinations will work-out if a few of the states disallow the merger? HMMM.
http://thetruthoncommonsense.com
2
Increasing market power for insurance companies will likely lower overall healthcare costs as these companies will have better negotiating power with hospitals. Healthcare costs are currently high because there is little pressure on doctors to be deliberate and resourceful in the way they administer care. Physicians have enough power that they are able to bill in a completely opaque way that would not fly in any other area. Anything that puts pressure on physicians to be cost conscious is good in my book.
1
Mergers and acquisitions in healthcare only lower costs when they reach the inevitable conclusion. That conclusion is a "Single Payer". Indeed everywhere else in the world, a single payer system exists, it provides better care at a much lower cost.
The faster we get it done, the less painful and expensive the transition will be.
The faster we get it done, the less painful and expensive the transition will be.
8
While the argument for "socialized medicine" is well known, so are the drawbacks. Resources are allocated in a prioritized system. This is often why Canadians come to the states to seek treatment for certain diagnosis, regardless of the cost.
As a Doctor and a cancer survivor, twice, had we had such a system, my cancer would have been deemed as "less critical" than other more aggressive cancers and I would have had to wait for my surgery and treatment. As an American I want the ability to remove the cancer NOW and not "roll the dice" on metastatic disease whereby my treatable cancer with a 95% cure rate becomes terminal.
Democracy and free market is all about choice. Sadly, neither is a panacea. In theory social medicine can work. In reality, preference is not always based on pure medical needs. Money talks. It does now, it would not change for the 1% or the new 0.1%, but under a social program of "one pay", the 90% have no choice.
As a Doctor and a cancer survivor, twice, had we had such a system, my cancer would have been deemed as "less critical" than other more aggressive cancers and I would have had to wait for my surgery and treatment. As an American I want the ability to remove the cancer NOW and not "roll the dice" on metastatic disease whereby my treatable cancer with a 95% cure rate becomes terminal.
Democracy and free market is all about choice. Sadly, neither is a panacea. In theory social medicine can work. In reality, preference is not always based on pure medical needs. Money talks. It does now, it would not change for the 1% or the new 0.1%, but under a social program of "one pay", the 90% have no choice.
The nightmare is that "single payer" will come AND it will be a for-profit payer. Customers, clients, guests, patients--whatever the term of the day--will be getting the worst of all possibilities: The US will have a million small insurance plans with clever names all backed by the same monopoly which only the cynical and ignorant believe could deliver better outcomes.
The current system which allows a patchwork of state regulators and the pretense of minimum national standards within the false idolatry of competition does have serious flaws, but it satisfies those who believe the name of a system, legislative act or political compromise matters more than the reality of how the system functions and what the act or compromise does when implemented. Sorry to burst the bubble of wishful thinking, but doctors, clinic groups and hospitals are big business not selfless entities, no health insurer is legitimately "non-profit"and state regulators are a useless drain on fair competition and good outcomes for Americans.
Distraction with the "shiny objects" of meaningless mergers and corrupt state by state regulation prevents the development of a national system of health care access and delivery which could result in a healthier, more productive American society fit to compete with those countries who have given their residents tools for a better life.
The current system which allows a patchwork of state regulators and the pretense of minimum national standards within the false idolatry of competition does have serious flaws, but it satisfies those who believe the name of a system, legislative act or political compromise matters more than the reality of how the system functions and what the act or compromise does when implemented. Sorry to burst the bubble of wishful thinking, but doctors, clinic groups and hospitals are big business not selfless entities, no health insurer is legitimately "non-profit"and state regulators are a useless drain on fair competition and good outcomes for Americans.
Distraction with the "shiny objects" of meaningless mergers and corrupt state by state regulation prevents the development of a national system of health care access and delivery which could result in a healthier, more productive American society fit to compete with those countries who have given their residents tools for a better life.
1
The monopolies are inevitable. Statistically, the only way to avoid random concentration of sick people in cohort of patients is for as many people to be included as is possible. The smaller insurers are more vulnerable to finding a disproportionate number of claimants and a dwindling of resources needed to remain profitable with competitive premiums. This alone will cause companies to merge over time, let alone the opportunities for short term gains from merging firms just to manipulate stock prices. The only way to address this problem is a single payer system, with insurance companies assigned policies by some bidding process that spreads the risks and uses private funding along with government guarantees to hedge against unforeseeable circumstances.
16
It's probably too late to close the barn door. The five insurers we have today - soon likely to be three - purchased the health care business of many other insurers. In 1963, 506 insurance companies sold both group and individual health insurance policies and another 315 insurance companies sold only individual policies. http://www.ssa.gov/policy/docs/ssb/v28n12/v28n12p3.pdf
Since the 1980's there has been a relentless effort to roll-back regulations and under fund U.S. regulatory agencies, especially by Regan and the Bushes, by big business employing armies of lobbyists and purchasing favorable decisions from Congress with millions in campaign funds, by regulators like Alan Greenspan who did not believe in regulation, by messianic pundits like Ayn Rand, by a conservative Supreme Court and by hundreds of conservative talk media personalities and outlets.
There is no going back. For industries like airlines, cable, telephone, etc. we may suffer monopsony pricing for many years. But healthcare is different. There has been a lot of consolidation in the provider market. Providers will not be happy with a few insurers making a lot of profit from their work. We are likely to see more provider-based plans both selling through but also competing with insurers. But that will probably be insufficient to hold down prices. So, we are probably headed for national health insurance - ironically because conservatives went too far and killed competition.
Since the 1980's there has been a relentless effort to roll-back regulations and under fund U.S. regulatory agencies, especially by Regan and the Bushes, by big business employing armies of lobbyists and purchasing favorable decisions from Congress with millions in campaign funds, by regulators like Alan Greenspan who did not believe in regulation, by messianic pundits like Ayn Rand, by a conservative Supreme Court and by hundreds of conservative talk media personalities and outlets.
There is no going back. For industries like airlines, cable, telephone, etc. we may suffer monopsony pricing for many years. But healthcare is different. There has been a lot of consolidation in the provider market. Providers will not be happy with a few insurers making a lot of profit from their work. We are likely to see more provider-based plans both selling through but also competing with insurers. But that will probably be insufficient to hold down prices. So, we are probably headed for national health insurance - ironically because conservatives went too far and killed competition.
29
Nope. I'm in healthcare and have worked in regulatory with various agencies in DC. This was the plan all along. That's why the Dems implemented it.
Sadly, everyone thinks they'll get Medicare. They won't. Even those on Medicare no longer get Medicare. Obama and HHS have been cutting that for the last few years via numerous mechanisms.
The Dems have destroyed healthcare and all we citizens were looking for was a decrease in costs. But Obama didn't care, he drove a bill to subsidize costs for those that either could afford it, but didn't want to buy it or for those that couldn't afford it. We could all have afforded it if he did his job.
The Dems have increased the costs of healthcare and now pretend it's the evil insurance companies. Those very companies they helped create. Not that Congress cares - most of their healthcare is on us, the tax payer.
Sadly, everyone thinks they'll get Medicare. They won't. Even those on Medicare no longer get Medicare. Obama and HHS have been cutting that for the last few years via numerous mechanisms.
The Dems have destroyed healthcare and all we citizens were looking for was a decrease in costs. But Obama didn't care, he drove a bill to subsidize costs for those that either could afford it, but didn't want to buy it or for those that couldn't afford it. We could all have afforded it if he did his job.
The Dems have increased the costs of healthcare and now pretend it's the evil insurance companies. Those very companies they helped create. Not that Congress cares - most of their healthcare is on us, the tax payer.
Too late.
The same power to negotiate better prices from suppliers is power to extract higher premiums from consumers. Over the years our choices in Maryland have dwindled to two and neither BCBS nor United Healthcare have lowered costs to their clients. Fewer of my doctors accept my health insurance.
Health costs in the US are the higherst in the world and health outcomes rank us well behind dozens of other countries. At last shareholder value is up.
The same power to negotiate better prices from suppliers is power to extract higher premiums from consumers. Over the years our choices in Maryland have dwindled to two and neither BCBS nor United Healthcare have lowered costs to their clients. Fewer of my doctors accept my health insurance.
Health costs in the US are the higherst in the world and health outcomes rank us well behind dozens of other countries. At last shareholder value is up.
5
Look, the CEO's wives need new yachts and new castles in several countries around the world. How can you deny them such entitled items just because you, oh, I don't know, have some boring disease like cancer or something?
Wake up. You lose, they win, period. The goal is that those who are entitled get health care and the rest of us can die. Time to invest in the funeral industry, right? I mean, Del Vecchio (Luxottica) owns all the makers of eyeglass frames, all the makers of lenses, all the retail sellers of eyeglasses, and all the insurance companies that sell useless eye care insurance. Why shouldn't ALL health care providers--hospitals, clinics, doctors, nurses, pharmacies, drug manufacturers, health insurance companies, etc., be owned by one person? It works for Luxottica--they are rich, and what else matters? Your health? Ha, ha--very funny. Hurry up and die, please. As Elvis Costello sang in Senior Service,
"I want your company car
I want your girlfriend and love
I want your place at the bar"
Now get out of here, but give me all your money and possessions first, of course. You owe me since I own all health care.
Wake up. You lose, they win, period. The goal is that those who are entitled get health care and the rest of us can die. Time to invest in the funeral industry, right? I mean, Del Vecchio (Luxottica) owns all the makers of eyeglass frames, all the makers of lenses, all the retail sellers of eyeglasses, and all the insurance companies that sell useless eye care insurance. Why shouldn't ALL health care providers--hospitals, clinics, doctors, nurses, pharmacies, drug manufacturers, health insurance companies, etc., be owned by one person? It works for Luxottica--they are rich, and what else matters? Your health? Ha, ha--very funny. Hurry up and die, please. As Elvis Costello sang in Senior Service,
"I want your company car
I want your girlfriend and love
I want your place at the bar"
Now get out of here, but give me all your money and possessions first, of course. You owe me since I own all health care.
2
Allow medicare to fight for business of healthy and working as in a free market and this problem will solve on its own!!
2
To the Editorial Board:
Thank you for this editorial but your verb phrase "need to" is much much weaker than the imperative MUST that you use so often when writing about other nations, such as the editorial re Ireland today.
I sincerely hope this difference is simply the result of less precise writings by the younger generation of staff ( that readers see everywhere now) and not a true representation of editorial opinion.
Thank you for this editorial but your verb phrase "need to" is much much weaker than the imperative MUST that you use so often when writing about other nations, such as the editorial re Ireland today.
I sincerely hope this difference is simply the result of less precise writings by the younger generation of staff ( that readers see everywhere now) and not a true representation of editorial opinion.
1
There is a pernicious trend in healthcare, in addition to the insurers consolidating. Hospital groups are buying physicians practices. When incorporated into the hospital group, the same practice might TRIPLE the cost, or more, of care and visits to the same doctor for the same service.
I recently attempted to make an appointment for a basic examination for one of these acquired groups. The cost quoted was nearly $1200 for a simple physical examination, that included no laboratory or imaging. A cost that was greatly increased from the pre-aquisition rate.
I think the breakdown was something like $750 for the examination, and $450 for a charge that was effecitively made up out of whole cloth - a 'facilities fee' that did not exist previously at all. This is an abhorrent practice, and it takes away choice, by unjustifiably escalating cost, from those seeking medical services.
After a great number of calls, and talking to a network of folks for referrals, I found a practice that had not been acquired by a hospital group. This is in Beverly Hills, CA. The charge for that 20 minute visit/examination was $250, at the rate for my insurance plan.
This insidious trend of acquisition of local and regional medical practices, and raising of cost for the same services, sometimes by many multiples, by hospital groups should be investigated, understood, and mitigated as necessary.
I recently attempted to make an appointment for a basic examination for one of these acquired groups. The cost quoted was nearly $1200 for a simple physical examination, that included no laboratory or imaging. A cost that was greatly increased from the pre-aquisition rate.
I think the breakdown was something like $750 for the examination, and $450 for a charge that was effecitively made up out of whole cloth - a 'facilities fee' that did not exist previously at all. This is an abhorrent practice, and it takes away choice, by unjustifiably escalating cost, from those seeking medical services.
After a great number of calls, and talking to a network of folks for referrals, I found a practice that had not been acquired by a hospital group. This is in Beverly Hills, CA. The charge for that 20 minute visit/examination was $250, at the rate for my insurance plan.
This insidious trend of acquisition of local and regional medical practices, and raising of cost for the same services, sometimes by many multiples, by hospital groups should be investigated, understood, and mitigated as necessary.
14
Many of your readers have advocated Single Payer systems or nationalized medicine. The health care system is a mammoth industrial enterprise. It depends on ever greater demand for medical services. Insurance and Medicare pay for most of it. The cost of treating Blood Pressure or Pneumonia costs less than treating Low-T (Testosterone for elderly men). So where does the research go? To seek profits? There are few new antibiotics being developed by big Pharma, Insurance doesn't care much; Doctors are loosing influence. (Not that doctors are innocent here). Every aspect of Medical Care in the US is based on profit, which is based on ever increasing use of medical services. Much of what is being sold is good, but we spend twice what other nations spend. I think it is because of increased demand for medical services. If we have ever larger medical businesses, only profitable services will survive, Doctors will give way to Nurse practitioners and Physician Assistants to cut costs and more and more efforts to increase demand for services will lead to ever increasing worry about our health. I frankly don't think that worrying about your health is actually healthy. If we had a Nationalized system, perhaps we could balance Supply and Demand.
4
The stupid American electorate deserves these mergers. They seem to be ok when insurance companies deny claims, but they lose there collective minds if the government wants to logically ration health care. My retirement and long range health care plan is a 45 caliber bullet.
...what this really says is that this shouldn't be an unregulated market, but a government-run industry. Take the middlemen out and figure out true costs - they are like HFTs on Wallstreet; wonderful for lining the pockets of unscrupulous traders who add no value to the market but who drive costs substantially higher....
9
Do not trust the Anti-Trust Division of the Justice Department nor any state anti-trust regulators to do the right thing in a country where corporations are people and money is speech.
Instead of directly protecting competitors or consumers, the anti-trust laws are supposed to protect the competitive process which indirectly should aid fair competitors and informed consumers. But by politically bipartisan malevolent malfeasance, America has devolved into a chronically cynical corrupt criminal crony capitalist corporate plutocrat oligarch welfare state.
The alleged Patient Protection and Affordable Care Act began as a conservative Republican free market capitalist private solution to providing health insurance for more Americans. There was no promised "robust" public option to counter the greedy private profit driven bureaucrats standing between the people and their health care providers trying to deliver them quality effective health care. Consolidation in all parts of the health care industry is inevitable. Consumers will bear the primary costs of their plush conspicuous consumption.
I say single payer today. Single payer tomorrow. Single payer forever.
Instead of directly protecting competitors or consumers, the anti-trust laws are supposed to protect the competitive process which indirectly should aid fair competitors and informed consumers. But by politically bipartisan malevolent malfeasance, America has devolved into a chronically cynical corrupt criminal crony capitalist corporate plutocrat oligarch welfare state.
The alleged Patient Protection and Affordable Care Act began as a conservative Republican free market capitalist private solution to providing health insurance for more Americans. There was no promised "robust" public option to counter the greedy private profit driven bureaucrats standing between the people and their health care providers trying to deliver them quality effective health care. Consolidation in all parts of the health care industry is inevitable. Consumers will bear the primary costs of their plush conspicuous consumption.
I say single payer today. Single payer tomorrow. Single payer forever.
11
Choice will be only one of the negative aspects of these large mergers to patients. Additionally costs will rise and the quality of care will deminish.
2
Eventually it will all be one "socialized medicine." No need to worry and you will be taxed to death to pay for it all.
1
Janis, I would much rather pay taxes for a non profit health care system at more than half the cost than a for profit system so a few can get rich. This big business good, government bad thinking makes absolutely no sense especially when it comes to health care.
If you've been paying attention for, oh, the last twenty years, it is the "socialized medicine" nations that have been getting better health care at lower cost.
There is no free ride. It's either taxes or premiums. I find the former less abhorrent and certainly less fickle than the latter.
There is no free ride. It's either taxes or premiums. I find the former less abhorrent and certainly less fickle than the latter.
Currently, medical care is the #1 cause of personal bankruptcy in the USA (http://www.cnbc.com/id/100840148). At least taxes only take a portion of your income.
These mergers are good news and are the inevitable consequence of the ACA, whose main effect has been to destabilize this massive, inefficient sector of our economy.
As several point out, the distance between the status quo and a single-payer system grows shorter with each merger. As insurers, doctors, hospitals, and drug companies continue to merge, it will become easier for the federal government to negotiate to that final step.
Imagine what our country could do with $800 billion that would rapidly come out of healthcare administrative costs when we move to a single payer (e.g Canada) or nearly single-payer (e.g. UK) system.
All we need now is a functional government to carry it off.
As several point out, the distance between the status quo and a single-payer system grows shorter with each merger. As insurers, doctors, hospitals, and drug companies continue to merge, it will become easier for the federal government to negotiate to that final step.
Imagine what our country could do with $800 billion that would rapidly come out of healthcare administrative costs when we move to a single payer (e.g Canada) or nearly single-payer (e.g. UK) system.
All we need now is a functional government to carry it off.
48
Except it will not save 800 Billion
ACA is a prime example - uncompensated care cost, as reported by the NY Times in 2012, was 46 Billion per year
Post ACA, the cost was projected to be just 24 Billion per year, BUT ACA costs 100 Billion per year to manage and operate
Net savings = an increased annual cost of 78 Billion.
But the general masses do not pay attention - so another bloatation of costs is added to the taxpayer's backs
ACA is a prime example - uncompensated care cost, as reported by the NY Times in 2012, was 46 Billion per year
Post ACA, the cost was projected to be just 24 Billion per year, BUT ACA costs 100 Billion per year to manage and operate
Net savings = an increased annual cost of 78 Billion.
But the general masses do not pay attention - so another bloatation of costs is added to the taxpayer's backs
"All we need now is a functional government to carry it off."
Well, that, world peace, and a perpetual motion machine.
Well, that, world peace, and a perpetual motion machine.
Was this comment a joke? Do you understand the administrative costs that are currently going to the government agencies tied to healthcare? Billions are wasted every single year due to the ineptitude of government agencies - including the VA System (receiving over 75% increase in budget in <5 years yet cannot even set up appointments), the CDC (can't pass an audit, ever), the NIH (wastes over 2 billion in administrative meetings in 5 years - 2 billion!), and HHS that just insisted on new ICD 10 codes that have cost us over a billion so far and it's not even implemented yet?
Seriously, are you kidding?
Seriously, are you kidding?
When we said "single payer", this is not what we had in mind.
36
AHA a perfect example of how holding a health insurance card in America does not ensure access to quality affordable health care or medications.
True, but perhaps that is he only way we will ever get one.
Mergers are beneficial to only the companies that merge and the company's stock holders. The USA has long ignored the trend toward monopoly, and not only in the health insurance arena. Hospitals are charging enormous amounts of money for their services and this is most definitely a problem; however the ability of health insurance to negotiate a lower price will alwyas have a negative impact on the patient. Why? Because when the cost is lowered through negotiation with a payer the hospital attempts to reduce its' costs. Who suffers- the patient.
47
Hello Old School,
Couldn't agree with you more Old School,
The patient has been left out of the health care discussion for a long time. Patients have to accept a poor quality of physician discussion,now only addressing the computer in the room, and mine recently complained vigorously about having to learn the new coding system. The physician lost the battle 30 years ago when the insurance industry began practicing medicine.
Couldn't agree with you more Old School,
The patient has been left out of the health care discussion for a long time. Patients have to accept a poor quality of physician discussion,now only addressing the computer in the room, and mine recently complained vigorously about having to learn the new coding system. The physician lost the battle 30 years ago when the insurance industry began practicing medicine.
"The Affordable Care Act has demonstrated that competition is good for consumers and taxpayers."
This is a statement that requires far more evidence to back up. I know this is the "opinion" section of the paper, but one would think the NYT editorial board would form it's opinions based on facts. Please show them.
This is a statement that requires far more evidence to back up. I know this is the "opinion" section of the paper, but one would think the NYT editorial board would form it's opinions based on facts. Please show them.
1
The editorial board seems to go to pains to avoid assigning blame for these mergers to the ACA. The ACA rewards large insurers and creates pressures toward monopoly conditions. With these mergers, we're seeing the fruits of that law.
Hidden in this editorial, however, is a statistic that offers a brilliant solution to rising health care costs. The ACA requires 80 percent of insurance premiums to go toward health care costs? Gee, why don't we arrange a system in which insurance is insurance (i.e., protection against large, unexpected events) rather than a payment system for routine care? Let people pay out-of-pocket for all of the low-cost, routine care they need. Instead of 80 percent of payments going to health care, 100 percent of those payments will go to health care. We can slash up to 20 percent of costs on routine care just like that. For expensive, non-routine care, insurers deserve to be paid for the service of covering for those events. Using them as an all-covering payment system as the ACA does, however, simply drives up costs.
Hidden in this editorial, however, is a statistic that offers a brilliant solution to rising health care costs. The ACA requires 80 percent of insurance premiums to go toward health care costs? Gee, why don't we arrange a system in which insurance is insurance (i.e., protection against large, unexpected events) rather than a payment system for routine care? Let people pay out-of-pocket for all of the low-cost, routine care they need. Instead of 80 percent of payments going to health care, 100 percent of those payments will go to health care. We can slash up to 20 percent of costs on routine care just like that. For expensive, non-routine care, insurers deserve to be paid for the service of covering for those events. Using them as an all-covering payment system as the ACA does, however, simply drives up costs.
3
You mean, insurance should provide for catastrophes, not every day events? What a novel concept! Any expense that would be funded by universally mandated insurance would cause price increases. Fundamental economics.
"Our politicians, most well funded by the healthcare lobbyists..." Indeed. While everyone has been scrutinizing healthcare providers and casting them as the primary greedy villains in healthcare for quite some time, health insurers have been doing whatever they please with little oversight. And raking in even more in profits under the guise of consumer cost containment under ACA. Who regulates this industry and why have their activities gone unchecked for so long?
I like the idea mentioned by a commentator that mergers mean there will be fewer companies to replace when we move to single payer.
I also think that after the merger, Anthem/CIGNA should change its name to Moloch. Or maybe Leviathan.
I also think that after the merger, Anthem/CIGNA should change its name to Moloch. Or maybe Leviathan.
Not exactly true. Many countries (Switzerland, Netherlands, Germany) use private insurance companies to administrate their single payer systems. These companies are highly regulated, like public utilities, but are still private companies.
They are limited in that they must pay out 90% of revenues out as medical benefits, as opposed to the current 80% that US companies have to pay out under Obamacare, which is up from the approximately 70% the American companies used to pay out before Obamacare.
However I do like the "Moloch" idea.
They are limited in that they must pay out 90% of revenues out as medical benefits, as opposed to the current 80% that US companies have to pay out under Obamacare, which is up from the approximately 70% the American companies used to pay out before Obamacare.
However I do like the "Moloch" idea.
Can we please stop pretending choice has anything to do with health care? A tiny minority of those receiving care have much in the way of choice. Those of us, like my employees and myself, have the conditions of our care dictated by what we can afford out of pocket, who we see by the insurance companies and how much we will ultimately pay, by the providers and insurers that use an arcane system of calculation they themselves can't explain. We are encouraged to be "educated consumers" when in reality that education requires a degree in contract law, to read the policy, the statistical analysis of an actuarial, to calculate risk and the training of a physician to understand the best and appropriate therapies. The whole idea of a market approach has stood the admonition to first do no harm on its head. Maybe if we stop pretending things like "competition" and "choice" will ever have a significant impact on what we spend, how we spend it and how all that spending does or does not improve outcomes, we can have an honest conversation about where the next steps after the ACA should go. From my perspective who buys who, won't change much on the continuum of escalating cost and diminishing expectations.
101
And, what happens when organized crime families merge or kill each other off, and a fewer bosses take over larger shares of the market?
Speaking of mergers and competition in health care: Our local newspaper had an article a few months ago, which reported that the medical costs for our area are somewhat lower than other areas. Why?
Towns with fewer hospitals and competition for health care have higher medical costs. We have relatively more hospitals & competition for health care in this town.
However, one hospital was just bought up by Trinity Health, which most of take as not a good sign. According to the newspaper, Trinity Health is one of the largest systems of health care in the U.S., has "operating revenue of about $13.6 billion, and employs about 89,000 people." Then the article said: "The hospital and Trinity are identifying opportunities to leverage shared services...." Whoops! Have a problem with health care at this local hospital? Try going up against a multi-billion dollar corporation to redress the grievance.
Quiz: Who are the beneficiaries when big corporate mergers occur and there are fewer competitors?
a. the big surviving corporations; or
b. the consumers, workers, and local communities
Think the cable industry, the airline industry--two of the most despised industries for customer service and satisfaction!
Good editorial!
Speaking of mergers and competition in health care: Our local newspaper had an article a few months ago, which reported that the medical costs for our area are somewhat lower than other areas. Why?
Towns with fewer hospitals and competition for health care have higher medical costs. We have relatively more hospitals & competition for health care in this town.
However, one hospital was just bought up by Trinity Health, which most of take as not a good sign. According to the newspaper, Trinity Health is one of the largest systems of health care in the U.S., has "operating revenue of about $13.6 billion, and employs about 89,000 people." Then the article said: "The hospital and Trinity are identifying opportunities to leverage shared services...." Whoops! Have a problem with health care at this local hospital? Try going up against a multi-billion dollar corporation to redress the grievance.
Quiz: Who are the beneficiaries when big corporate mergers occur and there are fewer competitors?
a. the big surviving corporations; or
b. the consumers, workers, and local communities
Think the cable industry, the airline industry--two of the most despised industries for customer service and satisfaction!
Good editorial!
75
The Justice Department should block these mergers. Otherwise, eventually the 3 insurance companies will merge into one, and there will be single-payer healthcare, which means higher prices and NO choices for consumers. But I sincerely doubt that the president's justice department will block these mergers because it is the unstated goal of Obama to create one provider.
Not so rhetorically, has there ever been a mega-merger that has really reduced costs as advertised for the consumer? Watch for the words '...in order to be more effective and efficient...', or something similar, and one's first move should be to protect their wallet, at least in the short run. Ultimately the consumer will have to dig ever deeper into an ever shorter pocket.
Also, surprise, surprise, the newly merged company will find job redundancies galore, and job cuts will be forthcoming by the thousands.
Make no mistake, Wall Street likes this stuff, ergo the Justice Dept. [and by default the political party beholding to the industry] will undergo severe pressure to make these two mergers happen.
At some point in all this pseudo too big to fail company merger mania, the public will need to find the next Theodore Roosevelt. Any candidates?
Also, surprise, surprise, the newly merged company will find job redundancies galore, and job cuts will be forthcoming by the thousands.
Make no mistake, Wall Street likes this stuff, ergo the Justice Dept. [and by default the political party beholding to the industry] will undergo severe pressure to make these two mergers happen.
At some point in all this pseudo too big to fail company merger mania, the public will need to find the next Theodore Roosevelt. Any candidates?
96
"ntitrust regulators have to do a detailed geographic and product-by-product analysis for each deal and for both mergers taken together."
Health insurers are not subject to antitrust rules. In 1948, in order for insurance companies to start offering health insurance, they recived this provision so they could be "profitable". The ACA never took care of this, among other things. That is why insurance is still regulated at the state level and why premiums vary by zip code, in some cases. It cost 20% more for health insurance where I live, than in Denver.
Thus, the mergers cannot be blocked over antitrust rules.
Health insurers are not subject to antitrust rules. In 1948, in order for insurance companies to start offering health insurance, they recived this provision so they could be "profitable". The ACA never took care of this, among other things. That is why insurance is still regulated at the state level and why premiums vary by zip code, in some cases. It cost 20% more for health insurance where I live, than in Denver.
Thus, the mergers cannot be blocked over antitrust rules.
2
"Plus ca change, plus ca reste le meme." When has a merger ever resulted in better service and lower prices for consumers? Just look at telecom or airlines. The American-US Air merger has really been a bummer for travelers, and according to articles published here, constitutes a monopoly in certain markets.
And healthcare is even worse, because of the local impact and the disparate costs in different regions of the country. Here in Boston we're facing our own market grab, as hospitals and providers merge to form huge healthcare blocks: Partners, Steward Health, and a merger in the works between Lahey and Beth Israel. While I'm on Medicare and my costs are somewhat contained, I know for a fact that private plan premiums are rising in our state.
I used to have Humana as my Medicare Part D and was considering returning. With this news, I wouldn't touch the company. But as everyone knows full well, despite the ACA, we still have the most costly, confusing, fractured and unfair health system in the world.
I'm a raging "socialist" when it comes to saying we'd be better off with single payer and price setting, turning parasitic insurance companies into claims processors. The Medicare system serves its membership well, and could do the same for all Americans.
It's one thing for consumers to pay more for an airline ticket. Quite another to be at the mercy of the "market" when you need a transplant or chemo treatment.
And healthcare is even worse, because of the local impact and the disparate costs in different regions of the country. Here in Boston we're facing our own market grab, as hospitals and providers merge to form huge healthcare blocks: Partners, Steward Health, and a merger in the works between Lahey and Beth Israel. While I'm on Medicare and my costs are somewhat contained, I know for a fact that private plan premiums are rising in our state.
I used to have Humana as my Medicare Part D and was considering returning. With this news, I wouldn't touch the company. But as everyone knows full well, despite the ACA, we still have the most costly, confusing, fractured and unfair health system in the world.
I'm a raging "socialist" when it comes to saying we'd be better off with single payer and price setting, turning parasitic insurance companies into claims processors. The Medicare system serves its membership well, and could do the same for all Americans.
It's one thing for consumers to pay more for an airline ticket. Quite another to be at the mercy of the "market" when you need a transplant or chemo treatment.
115
Unexpectedly! The ACA passes, and suddenly we get a string of mergers as insurance companies react to the altered landscape under the new law. Who (besides opponents of the law) could have predicted this?
As for Medicare for everyone, do you really think Medicare serves people well? Medicare is rife with fraud, to the tune of billions of dollars siphoned from the system. Medicare payments are so poor that many doctors are refusing to see new Medicare patients because doing so would bankrupt them, a problem that will only get worse with an aging population. The promised Medicare outlays over the next few decades are completely unsustainable and will require massive tax hikes to keep the system afloat.
But, hey, I suppose if you're on Medicare now, already settled with a provider, and don't expect to be alive in 30 or so years, then, yeah, Medicare is great.
Your plan's biggest flaw, however, is the payment structure. Medicare works by having young, current workers pay for the already retired. When all of those younger people in the workforce, along with all their children and everyone else, are on your nationalized Medicare, who is paying for it? Medicare is a trust system--pay now, get benefits later. When people pay now for benefits received now, the more realistic model we're dealing with is Medicaid. And given that the Oregon experiment exposed how people on Medicaid actually had worse health outcomes than people with no insurance at all, I'm not sure we want this.
As for Medicare for everyone, do you really think Medicare serves people well? Medicare is rife with fraud, to the tune of billions of dollars siphoned from the system. Medicare payments are so poor that many doctors are refusing to see new Medicare patients because doing so would bankrupt them, a problem that will only get worse with an aging population. The promised Medicare outlays over the next few decades are completely unsustainable and will require massive tax hikes to keep the system afloat.
But, hey, I suppose if you're on Medicare now, already settled with a provider, and don't expect to be alive in 30 or so years, then, yeah, Medicare is great.
Your plan's biggest flaw, however, is the payment structure. Medicare works by having young, current workers pay for the already retired. When all of those younger people in the workforce, along with all their children and everyone else, are on your nationalized Medicare, who is paying for it? Medicare is a trust system--pay now, get benefits later. When people pay now for benefits received now, the more realistic model we're dealing with is Medicaid. And given that the Oregon experiment exposed how people on Medicaid actually had worse health outcomes than people with no insurance at all, I'm not sure we want this.
I agree with you. However, if everyone had access to healthcare, there would be a shortage of doctors. The way it is now, the poor don't go to the doctor and they usually die. I moved from Chestnut Hill, MA to Florida in 2000 and Blue Cross cancelled my health insurance when I got here because of my depression and medication for it. They did not want anyone with pre existing conditions. I lived without insurance until 2014 and paid most of my salary for my healthcare, which meant I could not afford rent and had to live with my family. I still have to wait a few months to see a specialist with Obamacare and if FL had expanded Medicaid, I would have to wait even longer for a doctor appointment...and if I make less than 11,770, the government eliminates my subsidy and I have to pay full price (about $400) per month for the same plan that I now pay $65 for with the subsidy. What makes America different is that all the people with money can jump to the front of the line and get the best care -- unlike in Canada where socialized medicine requires that the rich wait their turn or come to Florida for winter vacation to get their MRIs on demand at full price. A single payer system works well for rich countries, like parts of Europe. It does not work for poor countries. It could work for America if there were no Republicans who hate subsidizing the poor and middle class.
@Blert: you say, "But, hey, I suppose if you're on Medicare now, already settled with a provider, and don't expect to be alive in 30 or so years, then, yeah, Medicare is great." Your sarcasm aside, Medicare works very well and would work even better for the entire country. If everyone paid into the system and the entire population, young and old were on the plan instead of over 65 folks like me whose consumption of health services is high, the costs would come down and providers could be paid what they're worth (not what they charge, mind you, Medicare fee "ratcheting up" is well known.
It's called national health insurance and it's used in every single country in the developed world, except our "exceptional" US that pays more for less, doesn't even cover everybody, rewards rapacious insurance plans, and has far worse health outcomes on just about any health parameter you can measure. Sure we have top notch healthcare: for those with money or on Cadillac plans like Ted Cruz who coasts on his wife's insurance plan.
It's called national health insurance and it's used in every single country in the developed world, except our "exceptional" US that pays more for less, doesn't even cover everybody, rewards rapacious insurance plans, and has far worse health outcomes on just about any health parameter you can measure. Sure we have top notch healthcare: for those with money or on Cadillac plans like Ted Cruz who coasts on his wife's insurance plan.
Such scrutiny should extend to long-term care insurers as well. My husband and I have had policies with the largest provider (Genworth, which currently controls over a third of the market) since 2002. We recently were discouraged to learn of an abrupt 60% rise in our premiums. The hike has caused us to accept far lower benefits in order to continue our coverage.
Why? According to Genworth's letter announcing the increase: "...the expected claims over the life of your policy are significantly higher today than was anticipated when your policy form was originally priced." Translation: 'Our actuaries made a mistake, causing us to present what in effect was bait-and-switch pricing in our ads in 2002. Now you're going to have to pay for our mistake.'
Our provider presumably applied to New York State's Department of Financial Services and received its approval for the outsized increase. So clearly, scrutiny needs to include an investigation into what, if any, improper influence is being exerted by mega-companies to gain rate-hike approvals from that department.
Why? According to Genworth's letter announcing the increase: "...the expected claims over the life of your policy are significantly higher today than was anticipated when your policy form was originally priced." Translation: 'Our actuaries made a mistake, causing us to present what in effect was bait-and-switch pricing in our ads in 2002. Now you're going to have to pay for our mistake.'
Our provider presumably applied to New York State's Department of Financial Services and received its approval for the outsized increase. So clearly, scrutiny needs to include an investigation into what, if any, improper influence is being exerted by mega-companies to gain rate-hike approvals from that department.
34
At the very least, you should have been given the option of getting your premiums back, plus interest, if Genworth decides to change the policy so drastically.
It is a shame that a "occupy health care" movement has not taken shape in this country to battle the for profit health care industry. The best course of action for all of us that are captive to this system is to deny it the fodder on which it lives; do not pay premiums, do not pay hospital bills and do not pay doctors. Only when the public has the attention of the powers that be will any reasonable reforms be made. It is the only way to tame this immoral beast.
10
The "Occupy" movement in response to banks and Wall Street having accomplished so much?
Be afraid. Be very afraid!
The insurance companies want to make profits. They have no conscience. They will find any excuse to either hammer the Doctors and Hospitals to extract dollars or they will keep premiums higher than necessary to increase profits. since we have chosen a capitalist model for most of our healthcare, we need to understand that capitalism is a weed that will grow without consideration of any other plants. It will deplete the nutrients in the soil and block out the Sun from other plants. Unless you weed the Garden and prune the excessive growth or have competing weeds to fight back, the dominant weed will crush all around it. The same for insurance companies. Competition is key. Remember what happened ( is happening) when the "Banks" became "Too Big to Fail"? Let's not duplicate the same mistake with Health Care.
The insurance companies want to make profits. They have no conscience. They will find any excuse to either hammer the Doctors and Hospitals to extract dollars or they will keep premiums higher than necessary to increase profits. since we have chosen a capitalist model for most of our healthcare, we need to understand that capitalism is a weed that will grow without consideration of any other plants. It will deplete the nutrients in the soil and block out the Sun from other plants. Unless you weed the Garden and prune the excessive growth or have competing weeds to fight back, the dominant weed will crush all around it. The same for insurance companies. Competition is key. Remember what happened ( is happening) when the "Banks" became "Too Big to Fail"? Let's not duplicate the same mistake with Health Care.
38
Break them up into tiny little pieces and gives us a Single Payer System.
45
In this publication, a lot of ink has been spilled--and rightfully--on the effects of a super-low effective tax rate for the wealthy, and the ballooning costs of necessities such as housing, healthcare, and education due to "privatized Keynesianism;" when private companies step-in to fill the role once played by the state.
However not nearly enough time has been spent on the ridiculous rise of monopoly power, and the historical amnesia that seems to have set-in regarding that power. When did we just magically forget that a monopoly is one of the fundamental contradictions in a capitalist system? When did we just stop caring about the pernicious effects of monopoly on consumer choice and cost-control? Obviously, our crisis of capitalism is so bad--and our corruption so thick--that those in power need to look the other way. Look at the telecoms for a premonition of what's to come.
Of course, it's not life or death--or abject poverty--if you can't watch 'Game of Thrones.' But it will be when looming, corporate health wardens can more easily get in the way of you and your doctor. Regulators shouldn't be skeptical about these companies' ability to monopolize. They should be skeptical about their very existence. They should put the fear of nationalization deep into their black, corporate hearts.
However not nearly enough time has been spent on the ridiculous rise of monopoly power, and the historical amnesia that seems to have set-in regarding that power. When did we just magically forget that a monopoly is one of the fundamental contradictions in a capitalist system? When did we just stop caring about the pernicious effects of monopoly on consumer choice and cost-control? Obviously, our crisis of capitalism is so bad--and our corruption so thick--that those in power need to look the other way. Look at the telecoms for a premonition of what's to come.
Of course, it's not life or death--or abject poverty--if you can't watch 'Game of Thrones.' But it will be when looming, corporate health wardens can more easily get in the way of you and your doctor. Regulators shouldn't be skeptical about these companies' ability to monopolize. They should be skeptical about their very existence. They should put the fear of nationalization deep into their black, corporate hearts.
30
"The companies say that being bigger will give them the ability to negotiate lower prices with hospitals, physicians and drug makers and make health care more efficient...." Yes, because every time industries consolidate, what we see are lower prices and better efficiency. Maybe if we insisted on regulating CEO income, or if we tied insurance profits with their performance....or, just get rid of them altogether. Other countries have, and they seem to be doing ok.
19
The only benefit from these mergers is that it will be eventually easier to convert to single payer, with fewer companies to subsume.
For an fuller analysis of our health care mess, you might rerun the series by your own Elizabeth Rosenthal.
For an fuller analysis of our health care mess, you might rerun the series by your own Elizabeth Rosenthal.
8
Isn't that the purpose of the ACA in the first place? The goal from the start with the ACA increasingly appears to have been to screw up the health insurance industry and health care system even worse than it already was. The problem up until now with passing a single-payer system is that 80 percent or more of Americans were happy with their health insurance and with their doctors. It's hard to foist a single-payer system on the public when people are happy with what they have. It's necessary first to have most people discontent with their own insurance coverage and health care. When the insurance and medical industries near collapse under the weight of the flawed ACA regulatory structure, a single-payer system will be much easier to sell to the American people.
Won't happen. There are so many people working in this field - mostly profitable by negotiating and paying lower claims - that it will become "too big to convert"....
It's pretty much Econ 101 here. It's a rare monopoly that doesn't set prices at the tipping point of what the market will bear, and then work constantly to push that point higher. Competition almost always lowers prices to the consumer. In the insurance industry that should translate to lower premiums, more benefits per buck, and better service to the consumer/patient and to the providers.
The health insurance industry giants are locked in a battle, not to cut costs, improve benefits, or adequately compensate the health providers fairly, but to increase profits for themselves. And they will wage this battle until the last phrase of the previous sentence reads: "but to increase profits for itself."
This is not what those of us who believe single-payer health insurance want. As long as Profit is supreme, private industry will work toward that goal and that goal only.
If we must have private insurance for health care, we must not allow it to concentrate into a single private source. A governmental agency, despite all the real and genuine, spurious and asinine objections to having government take over, would still work more to the benefit of the public and the healthcare providers, not to the bank accounts of the executive suite of AnthignaAetmana Megahealth.
I worked at Cigna a decade ago. The running joke in the office was that the script for answering a client's call was : Hello. Thank you for calling Cigna. My name is (------). How may I deny your claim today?
The health insurance industry giants are locked in a battle, not to cut costs, improve benefits, or adequately compensate the health providers fairly, but to increase profits for themselves. And they will wage this battle until the last phrase of the previous sentence reads: "but to increase profits for itself."
This is not what those of us who believe single-payer health insurance want. As long as Profit is supreme, private industry will work toward that goal and that goal only.
If we must have private insurance for health care, we must not allow it to concentrate into a single private source. A governmental agency, despite all the real and genuine, spurious and asinine objections to having government take over, would still work more to the benefit of the public and the healthcare providers, not to the bank accounts of the executive suite of AnthignaAetmana Megahealth.
I worked at Cigna a decade ago. The running joke in the office was that the script for answering a client's call was : Hello. Thank you for calling Cigna. My name is (------). How may I deny your claim today?
56
Get the rate of crooks and lobbyists. Single-payer system is the only way to go.
14
America needs to implement national healthcare and eliminate the health insurance industry. Period.
25
According to these companies, removing competition among pharmaceutical buyers actually increases pressure on those companies to offer lower prices.
In the general population's experience, and in the anti-regulatory crowd's rhetoric, the pressure exerted by fewer sellers actually raises prices. The Justice Department should ask these companies to submit forecasts of the degree to which prices are estimated to diminish over each of the next 5 years.
This is an interesting moment. Does the public want the supposedly self-regulatory benefits of a monopoly, or does it want government regulation to curb the abuses of a monopoly?
In the general population's experience, and in the anti-regulatory crowd's rhetoric, the pressure exerted by fewer sellers actually raises prices. The Justice Department should ask these companies to submit forecasts of the degree to which prices are estimated to diminish over each of the next 5 years.
This is an interesting moment. Does the public want the supposedly self-regulatory benefits of a monopoly, or does it want government regulation to curb the abuses of a monopoly?
8
Without competition, there will be nothing the least bit affordable about our care. And when patients don't feel they can pay for their care, they don't see their healthcare providers until it's often too late.
We learned from the days of Ma Bell that a lack of competition is bad for consumers. Unlike our phone bills, access to affordable healthcare can be a matter of life or death for American patients.
Our politicians, most well funded by the healthcare lobbyists, need to take swift and decisive action to protect us.
We learned from the days of Ma Bell that a lack of competition is bad for consumers. Unlike our phone bills, access to affordable healthcare can be a matter of life or death for American patients.
Our politicians, most well funded by the healthcare lobbyists, need to take swift and decisive action to protect us.
37
The problem with using Bell Telephone as an example of monopolistic terrorism is that it was, compared to the resulting mess we know as phone service today, probably the closest thing to a benign monopoly that the planet has known.
What about mergers of health care PROVIDERS?
Hospitals buying each other up.
Well, the executives get big pay raises.
Hospitals buying each other up.
Well, the executives get big pay raises.
30
Well this is Obamacare. It is not just an expansion of health insurance. It also seeks to stimulate these mergers into large health care systems and it has made it extremely difficult to have a small practice.
Also it is about transferring cost to patients so they do not "overuse care". However, for those with limited income the shift is substantial and has discouraged chronically ill patients to have regular followup.
Also it is about transferring cost to patients so they do not "overuse care". However, for those with limited income the shift is substantial and has discouraged chronically ill patients to have regular followup.
4
Nadia, you may call it obamacare if it pleases you, but it is actually romneycare. This is exactly what one might expect from a vulture capitalist system.
1
Single-payer, medicare-for-all. It's the only way forward.
If Big Insurance agrees to shut itself down, I'll agree not to press charges for crimes against humanity.
The CEOs can live very well for many years, from their ill-gotten gains. The other employees can similar positions with Medicare, after a year-long course in honesty and service to the public to counteract the nasty tricks they learned in their former jobs.
If Big Insurance agrees to shut itself down, I'll agree not to press charges for crimes against humanity.
The CEOs can live very well for many years, from their ill-gotten gains. The other employees can similar positions with Medicare, after a year-long course in honesty and service to the public to counteract the nasty tricks they learned in their former jobs.
81
This is an absurd proposition. The government does not know all. There are no government efficiencies - if you think the defense budget promulgates waste and inefficiencies, just picture health care, a much bigger boondoggle in waiting. Also, keep in mind that Medicare exists at its current funding levels because private payers (read: those covered by the dastardly health insurance companies) make up the shortfalls resulting from Medicare and Medicaid's unrealistically low payments that would bankrupt providers if they didn't get revenue from the private payers. So the private system has to charge more to keep government funding low. Horror stories about people getting released from the hospital too early, or being kept there 3 days for "observation" but never actually "admitted"? That's because everyone (including the dastardly private system) follows Medicare rules. VA system horror stories? Who do you think runs that? Aetna? One size first all? Bigger is better? Let Washington run everything? Great....
2
One payer system
26
Simple, huh?
Now... How're we gonna fund it?
Now... How're we gonna fund it?
In a civilized country, there is no place for a profit motive in health care or in education. The United States is not a civilized country; it is increasingly a jungle ruled by amoral apes.
146
I agree, educators and health care providers should not be paid.
Please name the industries where you feel competition IS appropriate. I'm sure you will get plenty of arguments against EVERY ONE you list.
Yeah that'll sure attract the best people to enter those fields..
1
The effect of Obamacare also deserves scrutiny.
If the Insurance companies cannot get premiums from say 5-10 of members because they belong to Obamacare then the rates for the paying members will go up 10-12 percent!!!
You cant have your cake and eat it too. Barack, you need two cakes for that.
If the Insurance companies cannot get premiums from say 5-10 of members because they belong to Obamacare then the rates for the paying members will go up 10-12 percent!!!
You cant have your cake and eat it too. Barack, you need two cakes for that.
3
All the easier to nationalize them when reality sets in.
14
Anthem just bumped small business group renewal rates in California and Nevada by 23% over the prior year, with age-weighted pricing increasing rates for younger workers from 75 to >100%, albeit w/ a drop in rates for older (45+) workers.
Competing companies seem to offer + or – equivalent coverage @ about a 12% increase overall.
Conclusion... Anthem's profits are capped if they overcharge - they'd have to refund premiums if they don't spend 80% on providing medical service..so it appears that they are trying to drive the small groups away to other carriers. The personal disruption for employees of being forced into other carriers networks could be substantial - especially if Primary Care Physicians and certain specialists become out-of-network providers.
Competing companies seem to offer + or – equivalent coverage @ about a 12% increase overall.
Conclusion... Anthem's profits are capped if they overcharge - they'd have to refund premiums if they don't spend 80% on providing medical service..so it appears that they are trying to drive the small groups away to other carriers. The personal disruption for employees of being forced into other carriers networks could be substantial - especially if Primary Care Physicians and certain specialists become out-of-network providers.
1
Others have wisely said elsewhere that the government should let them (and urge them to) ALL merge, then immediately take over the resulting corporate chimeral horror. Et voilà, single payer for all.
13
One of the biggest disappointments of the ACA is the lack of oversight of the commercial private insurance companies, many of whom have been emboldened to raise premiums and their deductible amounts while limiting access to providers. The rationale that many have used is that by asking patients and their providers to "share costs," you are reducing the cost of healthcare. This approach and attitude has in fact raised the cost of healthcare for many people not only in premiums but out of pocket costs while increasing profit margins for the commercial insurance companies. These merger will obviously worsen this "cost sharing" for a population that can least afford to assume this cost. I sincerely wish that we move beyond the ACA and move toward a public single payer system that truly has an equitable way of sharing cost.
12
Since anti-trust is arbitrary, all mergers are dangerous - to the people who make up the businesses attempting to merge. Because bureaucrats and lawyers make things up as they go.
If you want competition - and the lower prices that result - anti-trust is the wrong way to go. Remove regulations, remove unelected irrational politically-appointed and politically-motivated regulators - and let freedom in business reign.
Because no one - including members of the NYT editorial board - ever came to work in the morning and said, "Hey, you know what? My work would be SO much easier if only there were MORE rules for me to follow to get my job done!"
If you want competition - and the lower prices that result - anti-trust is the wrong way to go. Remove regulations, remove unelected irrational politically-appointed and politically-motivated regulators - and let freedom in business reign.
Because no one - including members of the NYT editorial board - ever came to work in the morning and said, "Hey, you know what? My work would be SO much easier if only there were MORE rules for me to follow to get my job done!"
2
NO. NO, NO!
Haven't we been through this before in so many industries? Especially in health care, this is not the way to go!
As a small business owner (3 people), I pay very close attention to our health care plan. Every year they increase premiums (this year they're threatening 40% due to costs of AFA) by double digits and there's always something not covered (3-D mammograms not covered, only regular for example). It's very clear that merging these companies will lead to more of this. Health care providers should never have been allowed to merge and should serve as an example that we should do NONE of this!!!!
Haven't we been through this before in so many industries? Especially in health care, this is not the way to go!
As a small business owner (3 people), I pay very close attention to our health care plan. Every year they increase premiums (this year they're threatening 40% due to costs of AFA) by double digits and there's always something not covered (3-D mammograms not covered, only regular for example). It's very clear that merging these companies will lead to more of this. Health care providers should never have been allowed to merge and should serve as an example that we should do NONE of this!!!!
32
Three major insurers for the entire country? Aren't we getting close to single payer? If we are to have a single payer, let it be the government and Medicare. At least there would be accountability.
105
It's all a set up designed to eliminate private enterprise from the health care business.
First, the Government legislates the amount of money Insurance companies may profit from their hard work, AKA Obamacare. Then Government regulators question, and try to limit, the amount of money that insurance companies can save by merging, and reducing their overhead.
All the while the Government places no limit whatsoever on how much money health care providers can charge for their services.
Eventually squeezing the insurance business out of the insurance business.
Caught between the rock and the hard place, with the approval of the Times Editorial Board.
Enter the single payer option. In other words, Medicaid for everyone not on Medicare.
As to rising medical costs? Just more zeros added to the deficit, and the national debt.
Until the, soon to be, omnipotent government decides to cut costs and transform the entire health care profession into, what else, government bureaucrats.
The future of US health care under a single payer system? Think: DMV on steroids.
First, the Government legislates the amount of money Insurance companies may profit from their hard work, AKA Obamacare. Then Government regulators question, and try to limit, the amount of money that insurance companies can save by merging, and reducing their overhead.
All the while the Government places no limit whatsoever on how much money health care providers can charge for their services.
Eventually squeezing the insurance business out of the insurance business.
Caught between the rock and the hard place, with the approval of the Times Editorial Board.
Enter the single payer option. In other words, Medicaid for everyone not on Medicare.
As to rising medical costs? Just more zeros added to the deficit, and the national debt.
Until the, soon to be, omnipotent government decides to cut costs and transform the entire health care profession into, what else, government bureaucrats.
The future of US health care under a single payer system? Think: DMV on steroids.
4
"The future of US health care under a single payer system? Think: DMV on steroids."
And the for-profit health insurance industry isn't? Try getting past voicemail with your insurer, or just try to find out how much a procedure will cost at a major hospital BEFORE you get the bill!
As one who has had first-hand experience with the National Health Service in the UK, where the only paperwork included my name, address, mobile number, and medical information relevant to the condition at hand - 90 seconds or maybe two minutes at most, I found that particular single-payer system FAR simpler, and I might add, FAR less expensive when the bill finally came to me as a foreign national. My friends tell me it is much the same in Germany. No process or money devoted to limiting care to maximize profit - Conversely, no pointless test or procedures by providers to maximize revenue..
You might want to inform yourself before making predictions like this.
And the for-profit health insurance industry isn't? Try getting past voicemail with your insurer, or just try to find out how much a procedure will cost at a major hospital BEFORE you get the bill!
As one who has had first-hand experience with the National Health Service in the UK, where the only paperwork included my name, address, mobile number, and medical information relevant to the condition at hand - 90 seconds or maybe two minutes at most, I found that particular single-payer system FAR simpler, and I might add, FAR less expensive when the bill finally came to me as a foreign national. My friends tell me it is much the same in Germany. No process or money devoted to limiting care to maximize profit - Conversely, no pointless test or procedures by providers to maximize revenue..
You might want to inform yourself before making predictions like this.
6
"The companies say that being bigger will give them the ability to negotiate lower prices with hospitals, physicians and drug makers and make health care more efficient." More efficient, not more affordable, translation - more profit and nothing else matters more than profit. For profit health care will never work for anybody but the health insurance companies, companies that are completely unnecessary and add zero value, in other words parasites who eventually will kill the host.
25
If we're going to move to a quasi-single payer system, it should not be rooted in a competition-free, for-profit system in which denial of healthcare enhances shareholder value.
92
During the last economic downturn we suffered form a condition known as 'too big to fail'. By all means, let's repeat that experience with the health insurance industry.
69
I confess -- I am a health insurance idiot. I bought into my plan years ago and I seldom compare it with others. I don't understand why my premiums are so different than those down the road. I don't know why prices go up year to year as much as they do. I don't much understand my benefits and I don't know how much my insurance saves me on my annual costs. When changes in coverage are made, I read the explanations which I don't understand. My principal provider doesn't accept any insurance but provides me a lot for my money, which he says is partly attributable to the fact that insurance regulations would make it difficult for him to provide services as needed among his patients. My pharmacy sometimes runs into insurance problems with my medication that they can generally override. So those who give me health care services seem not much to like my insurer. And I have come to believe that the problem is a lot more complicated than 3 or 5.
5
Holy Smoke Batman!
The NYT is just a bit late on this issue regarding health insurers, let's say at best, 20 years late.
Anti competitive and restraint of trade practices have run rampant in the U.S. since Bill Clinton was in office, starting with oil company mergers where
we ended up with Shell occupying three corners of an intersection after a merger approval. Then there are the airline mergers, CATV mergers, hospital mergers, acquisition of competing companies like car dealers (brands) in major metro areas by folks like autonation, carmax, etc. are another obvious restraint of trade issue, you know like NY banks taking out every other bank, grocery store mergers, how about Lowes and Home Depot ( have you noticed that the price of copper wire hasn't dropped a penny even though copper is at cyclical lows?) Do the price of imported cars here drop when the $$ get's stronger? Nope....... and neither do wine and imported food items. Its rigged. Most recently an article in BB pointed out that the price of 20-40 count shrimp paid shrimpers has dropped to $3.50/lb. Has this been passed on by the major grocers? Forget it. When two chains dominate a market like Houston, good luck!
Just another Clinton legacy followed on by Bush and Obama. Monopolistic practices are everywhere. The way companies compete today is by matching the prices of their higher priced competition. Grocery stores are the worst. And you can only do this where monopolistic freedom exists.
The NYT is just a bit late on this issue regarding health insurers, let's say at best, 20 years late.
Anti competitive and restraint of trade practices have run rampant in the U.S. since Bill Clinton was in office, starting with oil company mergers where
we ended up with Shell occupying three corners of an intersection after a merger approval. Then there are the airline mergers, CATV mergers, hospital mergers, acquisition of competing companies like car dealers (brands) in major metro areas by folks like autonation, carmax, etc. are another obvious restraint of trade issue, you know like NY banks taking out every other bank, grocery store mergers, how about Lowes and Home Depot ( have you noticed that the price of copper wire hasn't dropped a penny even though copper is at cyclical lows?) Do the price of imported cars here drop when the $$ get's stronger? Nope....... and neither do wine and imported food items. Its rigged. Most recently an article in BB pointed out that the price of 20-40 count shrimp paid shrimpers has dropped to $3.50/lb. Has this been passed on by the major grocers? Forget it. When two chains dominate a market like Houston, good luck!
Just another Clinton legacy followed on by Bush and Obama. Monopolistic practices are everywhere. The way companies compete today is by matching the prices of their higher priced competition. Grocery stores are the worst. And you can only do this where monopolistic freedom exists.
51
Corporate capitalism is the terminal metastasis of amoral greed. It kills every civilization that tolerates it.
14
This editorial is exactly why we need to move to single payer. One of the arguments against single payer has been the loss of jobs in the insurance sector. Who thinks the point of these mergers is not the elimination of jobs, one argument against single payer down.
152
Unfortunately, this editorial indicates that the trajectory IS toward a single payer, that is, to single private payers dominating areas. It is important to clarify that what is required is a public payer.
2
Another option is to open the group program open to all federal employees and to the families of congress member to the public at large -- with all premiums fully deductible to policy holders on the federal income tax. The insurance companies then can compete for the contracts to service that group policy -- as they already do.
3
I don't really know what happened to government oversight. Mergers, acquisitions, takeovers have become routine. Multi-billion dollar health care and hospital systems, social media platforms, airlines and now health insurance companies have been allowed to merge at will, greatly eroding the customers power of choice.
When was the last time an airline merger dropped ticket prices? The steep rise in gas prices in the last decade led almost immediately to higher airplane ticket prices and new baggage restrictions and fees. Now that gas prices plummeted, why are we still paying these high prices? The answer is plain, there are fewer major national airlines; passengers simply do not have the clout to do anything, except pay up.
Similarly, allowing these giant insurance companies to merge will prove catastrophic for the public, and unlike plane travel, health insurance affordability is vital for the nation's overall health.
When was the last time an airline merger dropped ticket prices? The steep rise in gas prices in the last decade led almost immediately to higher airplane ticket prices and new baggage restrictions and fees. Now that gas prices plummeted, why are we still paying these high prices? The answer is plain, there are fewer major national airlines; passengers simply do not have the clout to do anything, except pay up.
Similarly, allowing these giant insurance companies to merge will prove catastrophic for the public, and unlike plane travel, health insurance affordability is vital for the nation's overall health.
138
Reagan stopped doing anti-trust and that has become a republican and corporatist democrat tradition since. Carter's Justice department was the last to really pursue anti-trust by breaking up Ma Bell which has since been allowed to re assemble itself. To his credit Clinton's justice went after Microsoft but Bush dropped it and was that.
This also accounts for a lot of lost middle class jobs and occupations as these monsters drive everyone else out of business. Instead of reading Ayn Rand I wish a few republicans would read Adam Smith who clearly lays out the capitalist's desire to consolidate to eliminate competition especially regarding quality and price.
This also accounts for a lot of lost middle class jobs and occupations as these monsters drive everyone else out of business. Instead of reading Ayn Rand I wish a few republicans would read Adam Smith who clearly lays out the capitalist's desire to consolidate to eliminate competition especially regarding quality and price.
5
Or, at the very least, after reading Ayn Rand, remember that the anti-Medicare zealot changed her colors and signed up for the coverage once she became old and sick.
1
Yet, the mergers in healthcare post-Obamacare have been astounding. They should be blocked, but are not even questioned. Is that because the government wants a small playing field, where the consumer has no choices, and they step in to 'save us' with universal care handled by the most inept player of all - the Federal government?!