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Tuesday, October 06, 2009

And herein lies the problem with the private insurance model
Posted by Jill | 4:42 AM
The New York Times reports that the goals of coverage and affordability in health insurance may be mutually exclusive (in other news, sun expected to rise in east today):
As Democrats prepare to take up health care legislation on the floor of the Senate and the House, they are facing tough choices about two competing priorities. They want people to pay affordable prices for health insurance policies, but they want those policies to offer comprehensive health benefits.

These goals collide in the bills moving through Congress. The different versions of the legislation would all require insurance companies to provide coverage more generous than many policies sold in the individual market today. That is good for consumers, Democrats say.

But Republicans say the new requirements would mean added costs for some consumers and for the government, which would help pay premiums for millions of low- and middle-income people.

That tension between keeping costs low and improving coverage is just one of many challenges facing Congress and the Obama administration as they head toward the final stages of the effort to pass health care legislation.

Under the legislation, the government would not only require insurers to accept all applicants. It would also define the acceptable levels of coverage.

Senator Jeff Bingaman, Democrat of New Mexico, said the federal government had to specify coverage levels because the benefits under many existing insurance policies were inadequate.

“We have more than 46 million people who are uninsured,” Mr. Bingaman said. “We also have a substantial number who are underinsured. Although they have coverage, it is so bad or so inadequate that if they really get sick, they find they cannot afford the health care they need.”

But the No. 2 Republican in the Senate, Jon Kyl of Arizona, said it was “an act of hubris” for Congress to prescribe the permissible coverage.

“For the life of me,” Mr. Kyl said, “I don’t see why Washington has to dictate what kind of insurance you get to buy. Why not let the consumer decide?”

Perhaps because more often than not, the policies the consumer buys are worth about as much for providing health care as the products sold by Ryan O'Neal's door-to-door bible salesman in Paper Moon, as Dawn Smith found out:



Is everyone who is denied payment of claims going to be able to get his or her story in front of people the way Dawn Smith has? Of course not. And that's what the insurance companies are relying on -- the millions of people who fight with these companies every day in order to get medical care that is supposed to be covered under their plans paid.

This is why when I hear talk of "coverage" in the context of health care reform I cringe. Because "coverage" is what's on paper. But absolutely nothing is being said on Capitol Hill about actually paying claims. And that's why I'm desperately afraid that what comes out of Congress is going to be far worse than what we have now. At least now those who cannot afford "market-based" insurance aren't paying up to $15,000/year for family coverage that covers very little. What Congress is talking about is forcing them to buy "coverage" -- and doing nothing to address the hoops that these companies make people jump through in order to actually get their care paid.

The answer, of course, is not to do nothing, or to stand on a street corner holding a picture of Barack Obama with a Hitler mustache. The answer is not "government-run health care." The answer is a single-payer plan in which everyone receives REAL coverage for health care, not promises from for-profit companies which they have no intention to fulfill.

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Anonymous Anonymous said...
Oops! looks like Medicare is actually the biggest claim denier in the country: http://biggovernment.com/2009/10/05/ama-endorses-largest-denier-of-health-care-claims/

But they pay doctors fast and accurately!
10/6/09, 9:53 AM  
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