Pat Oliphant for September 09, 2009

I’d be happy too, if the gd cartoon would show up

After a certain age (I think it’s 75), the actuarial tables don’t work so well anymore – they can’t predict who will die reliably.

motive, they can if the insurance companies get to institute their death squads.

M_Mag, do you really want to begin at 75???? Besides, I know one quitter from Alaska who has already out lived her significance to society. Her 15 mins have been over soooooooo long ago!!!!!

Let’s talk about qualitative, rather than quantitative significance.

Ms. Alaska is the one who brought up her own baby as a prop for her politics!!! What kind of mother does that????????

CD, the insurance companies already have them in place but their calculation has nothing to do with the age of the insured, just the profit margin of the company. The company that withholds the most care and broadcasts it loudly gets the biggest reward from Wall Street.

cdward, Bob, ray – right on. I was just commenting on why old people make insurance companies nervous.

For private insurance companies and Medicare, something like 80% of total medical expenditures occur in the last year of life. Doesn’t seem much of a death squad there.

Hard to believe that you supposedly “educated” people actually think that un-elected government employees can manage medical care efficiently, cost-effectively and cover every citizen in the nation. Is ‘THE ONE” capable of magic now? How does one increase demand for service from doctors (dramatically) when the supply of doctors cannot be increased by an appropriate amount? And, BOB HASTY, good grief, man, Palin-bashing is soooooooo last year!

bikemaster, 555,

Medicare operates at a 3 percent administrative cost. Private health insurance commonly operates a a 25 to 33 percent over head cost, including CEO bonuses, shareholder profits, as well as the cost of running their business. (You can find this information on many independent research sites.)

Every dollar paid to a healthcare provider is called a medical loss and private insurers keep constant track of their “medical loss ratio” to profits. Caring for patients is second, or maybe third to making profits and forcing doctors to accept reduced payment schedules.

Physicians complain more about the intrusion of private insurers in their medical care for patients than about the “intrusion” of medicare administration.

Private insurers create their own medical protocols for when they will authorize treatments and when they will deny. Insurance accountants and executives determine what you will be covered for …. and the right screams about government takeover. Ahh, in case you didn’t notice the private insurers took over a long time ago and we the people are NOT their primary customer.

“If this is true of insurance companies who have to worry about suits and PR; just wait ‘til healthcare is handled by an entity that cannot be sued or need worry about PR.”

charlie, is this another reference to “Catholic healthcare in the golden age” that you brought up in another thread? Remember, “Christians don’t sue someone for making a mistake.”

BCS

Don’t know where you live but in my practice Medicare is run by BC/BS. Exact same people who run private non-profit BC/BS. Many BC have become for profit but some have not. Kaiser et al are non-profit. Your figures just don’t add up.

For perspective

http://www.desmoinesregister.com/article/20090830/NEWS/908300352/-1/archive

churchill, I simply do not believe that profit margin. Cite sources, please. I may go check some annual reports. What I have seen (repeatedly) is the same number bcs cited. I have also seen numbers that indicate that a higher percentage of people are happy with Medicare than with private insurers – I’d have to look up the numbers, but I seem to recall it is something like 80% versus 50%. As for “faceless government bureaucrats,” as it stands the Insurance industry spends $1.4 million per day on lobbyists to make sure they can protect their faceless bureaucracy. A government agency wouldn’t have that option. They might be (gasp) more accountable, since every Senator and Congressperson would have a motive to protect the votes of their constituents…

Tell Bill McGuire that his administrative cost was 3% and he’ll happily give back that 1.56 BILLION DOLLAR payday he had back in June.

http://money.cnn.com/magazines/fortune/fortune_archive/2007/04/30/8405485/index.htm

Although the article says $2 billion, put that in your peace pipe and smoke it!

Surely you understand the difference between salary and stock market appreciation. He started a company and got stock. It was wildly successful so his stock appreciated. the article says paper profit so maybe he didn’t sell.

MM I read the same numbers as Churchill 4% profit margin.

I also read where 80% of the insured were satisfied. But that is misleading. Over 80% of our population spend less than $3000/year in total health expenditures. So if they don’t utilize the health insurance of course they are going to be happy. That is the same problem when asking UK, Canada etc about satisfaction. If you aren’t ill and don’t use the product of course you are satisfied.

GNW, what figures are you disputing specifically?

Medicare is not run by BC/BS, which you well know. I assume you’re referring to Medicare Advantage, which is different, as you also well know. Many major insurers offer Medicare Advantage plans, so what is your point.

Not going there with you about BC/BS being for profit .. think beyond your own little world.

I think you’re having fun again …. you can have it by yourself …

My Medicare carrier for my private practice was BC/BS. Not the Federal Government. BC/BS managed the insurance/administrative/payments/denials etc. Whenever I had a question I sent it in to BC/BS.

Your paragraph above is very confusing. Who exactly do you think manages Medicare?

Churchill

Your figures are the ones I read elsewhere. I don’t know where BCS gets her numbers but 3.3%/4% return is the correct answer.

re private insurance profit: different numbers are cited by different sources … here’s another source

Private insurance overhead and profit, on average, fluctuates between 12% and 14% nationally.

This figure is somewhat lower than the 16-20% at many of the big insurers because it includes self-insured plans of many big employers that have overhead of about 6-7%. On the other hand, overhead in the individual market is often substantially higher than 20%, and in some cases above 30%.

The estimate that total administrative costs consume 31% of U.S. health spending is from research by Drs. David Himmelstein and Steffie Woolhandler and published in the New England Journal of Medicine in 2003. The figure would undoubtedly be higher today.

Note how individual insurance policies have the very highest overhead/profit percentages, the very type of policies the GOP wants the uninsured, self-employed and others to buy, rather than a more affordable public option or insurance exchange.

GNW suggest you answer your question first:

Who exactly do you think manages Medicare?

BCS

Manage is a nebulous term.

Who sets policy? National Medicare/Federal.

Who handles administration, forms, payments, requests for appeals and grievances, pre-authorization and all other day to day operations- in my case BC/BS of Pennsylvania. I never once had any contact whatsoever with DC. They “manage” through state insurance companies.

Medicare is administered by the federal govt., more specifically, the Center for Medicare and Medicaid Services (CMS). The govt. determines eligibility and sets reimbursement schedules through complex formulas. CMS contracts with private cos., including insurance cos., to handle claims and payment processing, member services and fraud investigation. These contracted cos. serve as a third-party administrator, an intermediary between the govt. and the Medicare member.

Traditional Medicare plan beneficiaries often choose to purchase a “medigap” or supplemental private insurance plan, but the supplemental plan’s purpose is not one of management, they pay they 20 percent of costs members would otherwise have to pay. I have a Blue Cross Medicare supplement plan.

Medicare Advantage plans are somewhat different, since they operate like other non-medicare HMOs. Traditional Medicare plans do not require pre-authorizations, for example, as Medicare Advantage plans do. The Medicare Advantage insurer has more management function.

You wrote in a previous post that you have Medicare and Medicare Advantage. I don’t understand how that is possible, since Medicare Advantage plans are an alternative to traditional, or fee-for-service medicare plans.

If you care to clearly explain how you can have both Medicare and Medicare Advantage, you can do so here. If you’re intent on more fun and games, don’t bother.

In order to be able to purchase a Medicare Advantage policy you must first have paid for traditional Medicare $100/month (?). You then leave Medicare and replace it with the HMO called Medicare Advantage. All my personal Medicare related payments/questions etc go through Oxford Medicare Advantage. I do not understand your pre-authorization comment. I have never used it and there hasn’t been any need. All routine doctor visits, lab tests, Rx are selected by me. For my accident I had an MRI (paid for) without ever contacting Oxford.

You may be confusing my personal situation with my private practice. I use BC/BS of Pa for my private practice and my billing for patient visits. They are the ones who wouldn’t allow me to inject cortisone in my patient and get paid on the same day she had a visit.

Don’t get snarky. We had a disagreement about the meaning of a word not a policy disagreement and I said debating word meanings and usage was for me fun and games. Not serious as policy discussions are.

If you read this please let me know.

Regarding HMO profitability, take another look at your table. Health care information systems, Health care REITs, Drug Delivery, etc. etc are all the places where the profits of these firms can get hidden to ensure the regulators don’t see the “HMO” making very much money, and so they can quote the statistics you’ve so helpfully repeated.