is the fact that health insurance companies must pay 80% of what they take in on medical services. If they don't, they have to refund that money to policy holders. I understand that they are currently not in compliance with this provision and they they will be sending out the first refund checks to policy holders (I've heard the average refund is 500.00 in one state) in the near future.

And several states already have exemptions to that requirement.

Facts are unpatriotic here.

So 80% is pretty shitty by comparison. And there is NO cost control effect.

okay, got it.

--because of the lack of cost controls.

though this is the first year my health insurance had a small rather than large increase.

--that all increases averaged almost exactly 9.9%, by sheerest coincidence just under the 10% that triggers review under ACA? Why not do the math and see how yearly 9.9% increases add up over a period of 5-10 years?

It is the insurance cartel not service providers and they set the reimbursement rates below what providers want to charge so under this system, assuming it works as intended, if the cartel wants more profits they just push up the allowable charges and there is NOTHING to stop them from doing just that.

The insurance profit margin is and always has been what I call a river dipper situation, they get a piece of the pass through. This is there business model and the MLR is essentially set exactly where the industry self reports. They will be cutting some checks but the reality is we are looking at a small percentage being kicked back (1.1 billion out of almost 700 billion in revenue) and that mostly on the strength of the definitions of medical expenses which logically will correct over the next few years and when the dust settles, if they want to increase their bottom lines they will be forced to put more money into care and again that is easy and unrestricted.

If I was them, I'd consider further pool fragmentation to reduce volume discounting and I'd look seriously at crippling or eliminating internal cost controls like preferred drug lists, network providers, and preferred vendors.

The only real cost control in this set up is the tax on benefits (which obviously will erode care over time) and the upward pressure of inflation which will force more and more stripped down coverage and increased cost sharing to keep premiums down and I consider that approach wrongheaded and counter to the goal of quality affordable care for all Americans.

The rebates are a good sales pitch and we can pretend we are getting tough but it is a token at the most, we aren't even talking 1% here. I'm not saying the money is meaningless to the few (by percentage) that will get checks but it is very, very, very small potatoes in the big picture.
I believe the inducement to increase costs is far and away greater than the most optimistic realistic estimates of benefit, you may not and I'm interested in some well reasoned counters but so far I haven't seen them other than shit like "We'll have to fix that" and "I disagree (minus why) and changing the subject.

Where an MLR makes hay (if hay is there to be made, sometimes shit is just costly and cost cutting runs the risk of decreasing value) is on the producer/provider end and see if you can push prices below or hold the line the best you can on present day allowables. Then the MLR on the cartel creates a check on them and you have some restraint on the system rather than building in a fairly unbounded perverse, reverse incentive to increase systemic costs to pad your own pockets.

No matter how well intentioned a solution is, if it is focused on false root causes or misses critical variables it plain won't work and when you get too far of course then you make matters worse.
This was a 11th hour throw in response to the very valid and important criticisms about the lack of cost controls and I don't think it is very well thought out or if so built on some less than rock solid assumptions or driven by ideological concerns.

It's going to help some people in the short run and that's a positive outcome. Congress is inevitably going to have to go back and actually deal with the skyrocketing costs of health care. And probably the only solution for that will be a single payer system. But there simply isn't the political will for that right now.

which can only tamp down the fire on the drivers to force a change in political will utilizing a plan built ground up to suppress broad systemic reform.

The dumbest thing was to pass this sucker's bet without any TeaPubliKlan votes because when it fails and it will fail, is that there will be the usual arguments for Reich Wing non-solutions and it will be neigh onto impossible to pin the particular Reich Wing solution on them after running all the victory laps, tears of joy, and full bore opposition of the current crop of TeaPubliKlans.

Now, we can't do anything really. Two years to implementation, several more in phase in, a good five to six in shakedown (gotta give it a chance to work will be the rallying cry), then around five years of evaluation and debate, then a round or two of tepid and/or counter-productive "fixes" and "adjustments", more time to break in and evaluate them. Only then can it be admitted that the effort wasn't corrective enough to be a broad benefit that seriously addressed our systemic problems and then we will have carry the weight of the failure into that next debate which means we will yet again do the wrong thing or more importantly avoid going in the direction of the right thing and stop marching toward destruction.

Meanwhile, all along one of the major problems is a too big to fail and is sucking the people and the treasury dry for a couple of decades or more and the cartel's influence in the halls of power will only be magnified in a future where the influence of money is likely to be greater than it is today.
A poorer people and a far more indebted country will have more political will, when?

We are further from where we need to be than we were when we started if for no other reason than we have the distraction of playing out this charade over the next decades, which means all we did was extend the grip of the cartel at a high cost while the liberal ideology takes a black eye for a right wing plan that got zero votes from right wingers.

And quite a few people will.

because if that is the goal the benefit comes at the cost of bolstering what you claim to be in pursuit of eliminating.

Self interest doesn't change the system in place and short term benefit does not mean long term benefit for the individual or the society.

Someone who opposed all reform because they benefit from the status quo would have been fucking crucified for putting their needs above the greater good and I see nothing different now, it is a nothing defense.

You tell me the goal(s) and then we can discuss if the goal(s) are being seriously pursued but I don't see how it is supposed to be argued that bolstering something is the path to being rid of it.

The fact is that some people who would've previously died under the old system will be able to get life saving treatments under the ACA. It's also true that the ACA will likely not save some people.

Under my definition of "greater good", you help those people that you can right now and then once you have, you do everything you can to help the rest. You don't force everybody to continue suffering until you're able to help them all at once.

while diminishing national and individual resources to do so and expect such action to magically result in an outcome that eliminates the predatory system. It is the predatory system that is driving the misery and propping it up spreads and fosters the misery. The short term agony that is feverishly being avoided didn't go a damn place, it is not eliminated but rather redistributed around the poor and working classes more evenly in exchange for a key to the nation's treasury and an exclusive franchise to step on our necks in perpetuity as a captured customer base.

Not only that but in order to achieve this redistribution of suffering, it was necessary to surrender to the Reich Wing on a fundamental level and push a solution that asserts that health care is a market commodity and perhaps a social obligation to other folk's pocketbooks but certainly not a right.

I believe your short term/immediate solution allows for broader pain to be felt for a longer time and because of the resource drain we will always be less able to do any better. The plan with this deal is to prop up the cartel long enough for it to matter very little what happens next.
The march of time shrinks our available resources, this plan accelerates the burn.

You don't build systems with the short term as the focus and do anything but make a fucking mess. This is why we can ALWAYS be kettles by the wealthy and powerful, we are easily bought and are very hand to mouth. We are prone to eating our seed corn in the belief that some "good old days" are back and motivated by fear that tomorrows crumb allotment will be decreased should we ask for a meal.

Desperate to do any small good, we will trade significant future evil in exchange for immediate term relief of any amount because we are optimistic that we will "fix it later".

It makes me kind of ill to think this is where we spent our political capital.

When one identifies a source of pain, what is the more cruel view? To remove it or failing that an orderly movement from that source or to feed the source and insure its viability in return for immediate but limited relief by essentially being permitted to redistribute the pain around the afflicted in a more balanced fashion.

As far as I'm concerned the greater cruelty is in strengthening a parasitic entity's grip on our people and our economy, no matter how laudable the intentions.

very simple.

if you will not, then you are asking other, vulnerable populations to be sacrificed.

other people, not you.

We have an economic disaster in this country! Congress hasn't done a damn thing except to put some band-aids on it. Because the politicians are not beholden to us, Congress does not have to fix anything. Now or ever. Those who benefit from the skyrocketing costs of health care will continue to make campaign contributions which will greatly exceed anything that we can ever give.

We already have more than 100,000 different plans, and that very fact causes expenses to be high. How would your city like to fund capital equipment for three different fire departments just so they can "compete"? If another cardiac center opens in your town, will people start having twice as many heart attacks.

In fact, in my county there are only about 4 companies offering Medicare Advantage plans, and some do not offer all the standardized plans.

Then the insurance companies can drive down their costs by squeezing the medical services providers. This is easy to do with GP and other types of individual practicioners, but harder to do with hospitals and testing labs, which have already consolidated as well into large hospital groups.

But it's the flaws that we will use to our advantage and fix over time. When enough people get screwed by Flaw A or Flaw B then they will clamor for the law to be tweaked. Enough tweaking over time and we will have Medicare for All.

They just can't single people out, and why would they when they can charge everyone without having to answer for it.

the maximum permissable amount every year without fail. They are going to take advantage of every little bit of this llaw they can. And when they abuse people enough, the clamor for Single Payer will be too great to ignore.

I just hope I live to see it happen. I'm 55 and not holding my breath.

They cannot, however, set discriminatory rates against people with pre-existing conditions or people with a history of filing medical claims.

Having said that, 10% is a gigantic margin on which insurance companies can gouge consumers.

... that they can only charge one person more than another based on those factors.

They can still charge everybody more, and indeed they will, if health care costs keep going up.

They can increase your rates as much as they bloody well want. That's how it's been explained to me by someone who supports this thing.

Thanks. We already pay nearly $15K/yr to BC/BS.

Health care expenses are about the very sickest people only. 5% of the population in every age demographic accounts for fully half of all costs. 15% accounts for 85% of costs. Woo does not patch you up after a disastrous wreck, or deal with complex chronic conditiions

The clean living of the 85% of the populationa accounting for only 15% of all health care expenses doesn't do jackshit to lower costs.

A laundry list of echo-chamber scare-slogans. I'm surprised that you didn't mention death panels.

There's no basis for believing that any of what you described is going to come to pass, not even with progressives all atwitter about the SCOTUS ruling.


Though I'll admit that I support the regulation of "alternative" "treatments," a multi-billion dollar industry almost wholly unaccountable for its actions and operating with close to zero transparency.

It's a new recipe.

$819 to $893 per month. Blue Cross is not discouraged from raising rates. And this is just HMO.

SINGLE PAYER. Premiums will be raised and raised and raised in collusion with hospitals and other corporations that have their dirty fingers in healthcare, who will raise and raise and raise their fees. See? And everybody gets richer. Well, except for the insured, who will get screwed again.

and the govt won't so much as review it.
(Look up the Rule of 72 and logarithmic progressions, if you doubt that 9.9% increases could lead to doubling in such a short time.)

Oh, and remember that Wellpoint VP, Liz Fowler, who disguised herself as a Senate staffer, and wrote the health care "reform" bill as chief counsel of the Senate Finance Committee?


Obama put her in at Health and Human Services as an Asst. Director to oversee implementation of the insurance mafia Enabling Act.
http://billingsgazette.com/news/state-and-regional/montana/article_4a5924b4-8ed7-11df-93ce-001cc4c03286.html
You are SO fucked, America.