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Thread: Pay now, care later

  1. #91
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    Quote Originally Posted by Neomalthusian View Post
    Why do government employees get special privileges that are unavailable to the rest of society?
    If you want the same special privileges, learn to do some shit that nobody can live without, and go command a big fatty policy as part of your compensation. You'll get it. If you aren't in demand like that, don't whine about it. Another option is to join a strong union that can use its collective bargaining power to command that kind of benefits. But since you think unions are evil, I guess you're just going to have to master the intricacies of intellectual property law or something. Or just sit and wallow in bitterness that somebody out there has found a way to negotiate better bennies than you have.

  2. #92
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    Quote Originally Posted by splansing View Post
    How much money are they allowed to keep?
    Best case scenario, 20% of revenue, minus all operating expenses, whatever those are.

    The way they can assure they will get to keep that full 20% (minus whatever their operating expenses are) in the current year is by 1) minimizing the need to pay out claims (i.e. keep the claims paid under or around 80% if at all possible), and 2) minimizing unnecessary operating expenses that eat into that 20%. As soon as they have claims exceeding 80% of revenue, it's coming straight out of any profit margins and risking potentially huge financial losses. They don't make more money by wasting it, or coercing patients and providers to spend money on medically unnecessary care. There is no direct incentive for them to waste money on unnecessary care. That's why your claim that the insurance company forced the doctor and patient to incur medically unnecessary care sounds so strange.

    Theoretically they could run operating losses and use those as leverage against state divisions of insurance to authorize premium hikes, but this means running operating losses. They don't have direct incentives to run big operating losses. In the business world, operating losses are pretty bad things.

    If premiums were continuously variable, floating, unregulated and uncapped pricing, and there were no risk of adverse selection, then yes the 80/20 rule would absolutely create a perverse incentive and runaway train of waste and cost increases. But that's not the case.

    Insurance companies most definitely DO determine what gets covered and how
    That's not what I said. I said they don't determine medical necessity, doctors do, and insurers won't pay for medically unnecessary care.

    and they send out ARMIES of lawyers to make sure people know damn well what the protocols are, and that if their protocols are not followed they will not pay. I completely understand that I sound like I'm making random shit up. Isn't it fucking horrifying that I'm not? I think so, too.
    It still appears you are making it up, in attempt to exaggerate the amount of blame that can be pinned on insurance companies.

    Philosophically, I can (and will) argue that the nature of most types of insurance (including health insurance) are virtually incompatible with free market principles because the ability to profit significantly in the insurance industry involves perfect information for the seller and bad information (exaggerated fears of remote if not phantom risks), which borders on fraudulent.

    But that doesn't mean you sound smart by repeating the anti-insurance propaganda that was being used in 2010 to stir up support for PPACA. Health insurers' hands are very tied now. It's enormously regulated and their ability to profit is austerely controlled. Insurance companies have coverage mandates, benefit mandates, a pre-existing exclusion ban, and a profit cap. The real cost-drivers have to do with dynamics that go a lot deeper than just private sector insurance companies. Especially now.

  3. #93
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    Quote Originally Posted by splansing View Post
    If you want the same special privileges
    I don't. No one should get free-for-all care like this. Ultra-platinum freebie health care like that which government employees and retirees enjoyed back in the 1980s and 1990s (and in numerous places still do today) is bad policy because it encourages waste and over-entitlement to health care. I'm not jealous of government employees because they have ultra-platinum health benefits, I'm pissed because it's bad policy but no one fucking pays attention to what their government is actually doing, and because people like you and labrea make endless excuses for bad policy like this.

    Another option is to join a strong union that can use its collective bargaining power to command that kind of benefits.
    Unions and their dominance in state and local government are a big reason why these ultra-platinum Cadillac policies persist, but these are bad policies. This is why Obama and his ilk supported the Cadillac tax. It was to put pressure on whoever continues offering policies like this to stop doing so. In one respect it seems stupid because it's based strictly on premium cost, not taking into account regional differences, but on the other hand at least it discourages bad policies like this and would put pressure on unions and their lovers in state and local government to axe these things. Benefits like this need to be terminated. They are part of the problem.

    But since you think unions are evil, I guess you're just going to have to master the intricacies of intellectual property law or something. Or just sit and wallow in bitterness that somebody out there has found a way to negotiate better bennies than you have.
    In the past you acknowledged the problems with public sector unions, and look at you now, bragging about the fact they've successfully extorted special privileges for government employees from taxpayers and rate payers. Which is it? Are you really this boastful and proud of public sector unions?

    Ultra-Cadillac health benefits are bad policies that no one should have, because it promotes the very type of entitlement and irresponsibility that has created our problem with health care costs. Union-enabling legislation is also bad policy for a host of reasons I've discussed in other threads. It is only through the apathy and ignorance of taxpayers themselves, along with excuse-makers for special privileges for government employees, that this continues. I'll continue advocating against it, and provide specific policy recommendations that will eventually eliminate these Cadillac health plans as well as public sector unionism in general.
    Last edited by Neomalthusian; 19th April 2017 at 12:18 PM.

  4. #94
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    Quote Originally Posted by Neomalthusian View Post
    Best case scenario, 20% of revenue, minus all operating expenses, whatever those are.

    The way they can assure they will get to keep that full 20% (minus whatever their operating expenses are) in the current year is by 1) minimizing the need to pay out claims (i.e. keep the claims paid under or around 80% if at all possible), and 2) minimizing unnecessary operating expenses that eat into that 20%. As soon as they have claims exceeding 80% of revenue, it's coming straight out of any profit margins and risking potentially huge financial losses. They don't make more money by wasting it, or coercing patients and providers to spend money on medically unnecessary care. There is no direct incentive for them to waste money on unnecessary care. That's why your claim that the insurance company forced the doctor and patient to incur medically unnecessary care sounds so strange.

    Theoretically they could run operating losses and use those as leverage against state divisions of insurance to authorize premium hikes, but this means running operating losses. They don't have direct incentives to run big operating losses. In the business world, operating losses are pretty bad things.
    That last bit is what I like to call horseshit. You see, all they have to do is pay off a handful of regulators, and that only if they intend to raise their premiums by more than 10%, at least in this state. They are granted a TEN PERCENT INCREASE EVERY YEAR without having to prove anything. So if their gross goes up by 10%, that makes their slice bigger. And if they can convince those regulators that they really need to raise it more than that, they can. But even if they don't, my rates will double in less than 10 years. And their profits will soar MASSIVELY. They never have to operate at a fucking loss, because if they go over that 20% they just send out a few bucks to their customers to get it under. They ALWAYS keep ALL of the profit they are allowed to keep. Not to mention that they can move the needle on those operating expenses a million different ways, including just paying themselves more.

    If premiums were continuously variable, floating, unregulated and uncapped pricing, and there were no risk of adverse selection, then yes the 80/20 rule would absolutely create a perverse incentive and runaway train of waste and cost increases. But that's not the case.
    No, it's not. But it's close enough. So you can see the perverse incentive now.

    That's not what I said. I said they don't determine medical necessity, doctors do, and insurers won't pay for medically unnecessary care.
    No, what you said is they don't cover medically unnecessary treatment. But they do, according to my doctor. They fund studies and pay doctors a shit load of money to provide their opinions on what is medically necessary, and lawyers to write up how those medical necessities will be covered. If patients don't want to be bankrupted when the insurance company refuses to pay, they won't leave AMA. And if the doctors argue too much about what is necessary, they'll wind up in court against a mountain of paper and an army of lawyers and millions of dollars.

    It still appears you are making it up, in attempt to exaggerate the amount of blame that can be pinned on insurance companies.
    It appears to me you are intentionally muddying the waters, in an attempt to confuse exactly how powerful insurance companies are in this arena.

    Philosophically, I can (and will) argue that the nature of most types of insurance (including health insurance) are virtually incompatible with free market principles because the ability to profit significantly in the insurance industry involves perfect information for the seller and bad information (exaggerated fears of remote if not phantom risks), which borders on fraudulent.
    Sounds like an apt description to me.

    But that doesn't mean you sound smart by repeating the anti-insurance propaganda that was being used in 2010 to stir up support for PPACA. Health insurers' hands are very tied now. It's enormously regulated and their ability to profit is austerely controlled. Insurance companies have coverage mandates, benefit mandates, a pre-existing exclusion ban, and a profit cap. The real cost-drivers have to do with dynamics that go a lot deeper than just private sector insurance companies. Especially now.
    The insurance companies DO profit. ENORMOUSLY. Their lobby is among the most powerful in Washington, and their wealth is nearly boundless. Especially now.

    Wall Street bankers claimed they were enormously regulated in 2005, too. That was also a lie. The regulation you speak of is mountains of legalese horseshit that only serves to camouflage the realities of what is going on in that industry. It is, quite simply, a fucking racket.

  5. #95
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    Quote Originally Posted by splansing View Post
    That last bit is what I like to call horseshit. You see, all they have to do is pay off a handful of regulators,
    More conspiracy theory crap. You're resorting to baseless accusations of outright corruption to try to salvage your theory that insurance companies are making the costs go up so that they can rake in the big bucks all for themselves.

    They are granted a TEN PERCENT INCREASE EVERY YEAR without having to prove anything.
    Citation?

    So if their gross goes up by 10%, that makes their slice bigger.
    But only if their claims that year don't exceed 80%, which calls into question your claim that insurance companies are compelling patients and providers to incur medically unnecessary care.

    But even if they don't, my rates will double in less than 10 years. And their profits will soar MASSIVELY.
    Citation needed.

    They never have to operate at a fucking loss, because if they go over that 20% they just send out a few bucks to their customers to get it under.
    You don't even know what you're saying. You're making an inaccurate reference to their requirement to rebate customers the difference between 80% and the amount actually paid out in claims. I.e., if in a given year claims are 75% of revenue, they must issue rebates to customers for that other 5%. They would operate at a loss if their claims paid plus operating expenses exceed their premium revenue.

    They ALWAYS keep ALL of the profit they are allowed to keep. Not to mention that they can move the needle on those operating expenses a million different ways, including just paying themselves more.
    None of this supports your argument that insurance companies want to shell out more in claims.

    No, it's not. But it's close enough.
    You're on a war path against insurance companies, facts and finance be damned.

    No, what you said is they don't cover medically unnecessary treatment. But they do, according to my doctor.
    So I'm supposed to take your doctor's word for it?

    Here's what my insurance policy states regarding medical necessity, and this is verbatim, and you should be able to find language like this in your own policy, and in every policy: "Evidence Of Medical Necessity: We have the right to require proof of medical necessity for any services or supplies you receive before benefits are provided under this plan. Members or providers must provide evidence of medical necessity when requested. If this evidence is not provided when required, benefits will not be available."

    They fund studies and pay doctors a shit load of money to provide their opinions on what is medically necessary, and lawyers to write up how those medical necessities will be covered. If patients don't want to be bankrupted when the insurance company refuses to pay, they won't leave AMA. And if the doctors argue too much about what is necessary, they'll wind up in court against a mountain of paper and an army of lawyers and millions of dollars.
    None of this supports your argument that insurance companies want to blow money on unnecessary claims. There might be reasons why an insurance company won't cover care for someone leaving a facility against medical advice, but that's not the scenario you outlined previously.

    It appears to me you are intentionally muddying the waters, in an attempt to confuse exactly how powerful insurance companies are in this arena.
    There's no reason for anyone to muddy the waters, it's just that the shit you're saying about insurance companies are conspiratorial and not supported. They don't have incentives to blow money on medically unnecessary care, nor do they rake in big profits by doing so.

    The insurance companies DO profit. ENORMOUSLY. Their lobby is among the most powerful in Washington, and their wealth is nearly boundless. Especially now.
    This isn't supported. But for entertainment, if you think Obamacare's 80/20 rule doesn't go far enough to limit their ability to profit, what should the rule have been? 90/10? 98/2?

    The regulation you speak of is mountains of legalese horseshit that only serves to camouflage the realities of what is going on in that industry. It is, quite simply, a fucking racket.
    Maybe moreso prior to Obamacare, but now it's becoming very difficult for you to maintain this conspiratorial argument that these companies are so evil. I have long acknowledged the system doesn't work very well, but what Obamacare literally does should be very much calling into question your angry feelings about insurance companies, and your attempts to use them as the scapegoat are no longer supported. And even prior to Obamacare, the net amount of American money spent on the administration of health insurance, both private and public added together, has been small and still is. They are not where all our money is going, and their slice of the wedge is not the slice that's really grown over the last 10-20 years.

  6. #96
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    Quote Originally Posted by Neomalthusian View Post
    This isn't supported. But for entertainment, if you think Obamacare's 80/20 rule doesn't go far enough to limit their ability to profit, what should the rule have been? 90/10? 98/2?
    NOOOO!!!! That's an idiotic stupid way to "regulate" the industry. They are INCENTIVIZED to increase the GROSS as much as possible. How can you possibly deny that? It's not possible that you don't understand it. You have to be shilling for them. There is simply no other explanation.

    We need to install a proper, civilized healthcare system and join the fucking TWENTIETH century already.

    True to form, you've parsed my words into smaller and smaller chunks and bled all meaning out of the posts. Go cite yourself. You deny obvious realities and attempt to deconstruct me to death. I never should have taken that bait for even one post. My apologies to you, myself, and anyone who attempted to read that last pile of shit you put up here.

  7. #97
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    Quote Originally Posted by splansing View Post
    NOOOO!!!! That's an idiotic stupid way to "regulate" the industry. They are INCENTIVIZED to increase the GROSS as much as possible. How can you possibly deny that? It's not possible that you don't understand it. You have to be shilling for them. There is simply no other explanation.
    You are the one that seems to continue to be concerned about their "enormous profits" (your words) even under the current system. Their premium hikes have to be approved by divisions of insurance, there's a very real threat of adverse selection if rates go too high, and insurance companies can't compel providers to increase what they charge. What evidence is there that they want costs and claims to go up? It doesn't work like a government cost-plus contract, they don't just get 20% on top of whatever they can figure out how to spend. They know how much they'll start with in a given year, and the absolute best case scenario for them is that actual claims submitted to them that year will be equal to or less than 80% or less of that premium revenue. They don't benefit any differently from spending exactly 80% of the revenue on claims than they do if they spend 70% of it on claims and then issue 10% in rebates. However, they do have major, major financial incentives to not have to spend more than 80% of their revenue in claims, because it demolishes their profit margins and starts putting them in the red almost immediately. But there isn't all that much they can do to just turn the spigot off when they near 80% of claims. They're contractually obligated to cover claims pursuant to the policy contract terms. And they are not trying to incur losses so that they can beg states for premium hikes the following year.

    I provided a link to information on national health expenditures which, if you were curious, you could go there and see that the amount of money being absorbed by the administrators of insurance is very small overall, including historically. The skyrocketing amounts of money we've spent on health has ended up in the pockets of providers and their organizations, not insurers.

    True to form, you've parsed my words into smaller and smaller chunks and bled all meaning out of the posts. Go cite yourself. You deny obvious realities and attempt to deconstruct me to death. I never should have taken that bait for even one post. My apologies to you, myself, and anyone who attempted to read that last pile of shit you put up here.
    You have accused the health insurance industry, even under Obamacare rules, of (1) paying off regulators to agree to unnecessary price hikes, (2) collusion with other insurers, (3) forcing providers to hike prices (4) forcing doctors and patients to incur medically unnecessary care even when doctor said the care was medically unnecessary, (5) wanting to pay out more in claims so that they can "keep" more money (refusing to acknowledge the risk and reality of current year losses), and you have also said they're making "ENORMOUS" profits (compared to what and when?). I've seen no evidence that any of these things is occurring.

    Remember, I am the guy that started a thread arguing insurance has some fundamental incompatibilities with free market principles. I've somewhat advocated single payer, including that Republicans should flip-flop and push for it (thereby depriving Democrats of a coherent platform). An insurance industry shill does not argue things like that. But that doesn't mean I will sit by idly and nod along to conspiracy theories and falsehoods and misdirected anger at an industry that is already basically bound and gagged by the most recent health insurance reform law.
    Last edited by Neomalthusian; 19th April 2017 at 03:29 PM.

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