For or against Obamacare, at least be informed and ask the tough questions. Here are the questions you should ask about claims for Obamacare

Healthcare 10 comments

2013

From an article on Californian.com

By Don Kusler, executive director of Americans for Democratic Action. Write to him at ADA, 1625 K St. NW, Suite 102, Washington, D.C. 20006.

Children with pre-existing conditions can now get coverage. Young adults can now stay on their parents’ insurance up to age 26. Seniors are now paying less for prescriptions. Insurance companies are now required to spend their ample incomes primarily on patient care, not advertising or lobbying — and if they spend too much on self-promotion, they have to send refunds to their policyholders — the first checks went out last summer.

In the coming months and years, more benefits will kick in: Adults with pre-existing conditions will be covered; prescription drug prices will go down even more for seniors; Americans will be able to compare insurance options online as easily as they shop for airline tickets now, increasing the quality and driving down the cost of coverage.

The Affordable Care Act is a comprehensive approach with a big goal: expanding and improving health care for all Americans. While detractors do everything in their power to tear it down — most recently by blaming it for the doctor shortage — the ACA will increasingly serve the health-care needs of the American people, guided by the simple but powerful principle that everyone has the right to a healthy life.

Whoopee do! we have achieved nirvana … problems solved. I love these types of blind faith, naive articles which ignore the realities of cost and the interaction of the various moving parts of a complex problem.

Here are a couple of my favorites:

  • Insurance companies are now required to spend their ample incomes primarily on patient care, not advertising or lobbying — and if they spend too much on self-promotion, they have to send refunds to their policyholders

    • The fact is most insurers were already spending at least 15% of premiums on all administration and were for years. The fact is health insurance company profit margins are well in line with general business and often less than that allowed regulated utilities. And hey, what about that $236 million California is spending on “advertising” the new insurance exchanges. I guess that doesn’t matter because no one is paying in premiums.

  • prescription drug prices will go down even more for seniors;

    • True, but to offset the growing savings somebody else will pay and besides a relatively few seniors reached the so-called donut hole and even fewer reached the 95% reimbursement level.

  • Americans will be able to compare insurance options online as easily as they shop for airline tickets now, increasing the quality and driving down the cost of coverage.

    • Exactly how does shopping on line have anything to do with quality or driving down costs? Insurance companies compete now, you can go to healthcare.gov and compare the insurers in your area right now and have been able to do so for years … try it and see how easy it is! Then look at the “improved” application process for exchange coverage and see how easy that is.

    Proponents and opponents of Obamacare mislead, misinform, and charge ahead with idealistic and questionable assumptions. Before you accept the ideas of anyone left or right about health care and health care reform (including me) be prepared to ask questions. For example:

  • How will that be accomplished?
  • Exactly what does that cost and how is it paid for?
  • What are the unintended consequences?
  • If we do this, won’t (doctors, hospitals, patients, insurers, etc.) do that in response?
  • How exactly is that measured, especially the claims for higher quality?
  • Doesn’t that somehow cause cost shifting to other groups?
  • What has fundamentally changed that affects the delivery of health care in America?
  • Does the federal government saving money on Medicare impact costs for the non-Medicare population?
  • What, if any, are the adverse consequences of squeezing more and more in taxes and fees from employers, insurance companies and the pharmaceutical and health device industries?
  • Exactly what will make competition work now?
  • Can I ever be an informed, dispassionate consumer of health care where cost is the prime consideration in obtaining care for my family?
  • Please define “affordable.” Does that mean the true cost or just that something is more affordable to one party because another party is paying more?

    • 10 comments

    1. Pingback: New commercials opposing Obamacare | quinnscommentary

    2. What the O-pologist forgets to mention is that all of the things he just touted aren’t free. You have to pay for them, and now, they’re mandatory.

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    4. The fact is most insurers were already spending at least 15% of premiums on claims and were for years. The fact is health insurance company profit margins are well in line with general business and often less than that allowed regulated utilities.
      Am I missing something? 15% of premiums go to claims, so 85% profit is the standard. Minus salaries, parties and the BIGGY, amazing corporate office campuses they have to have to pay those 15% of our medical bills?

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      1. Hey Charlie. Believe you’ve the figures reversed? Think you meant 85 % for claims and 15% for retention including admin, taxes( where appropriate), risk/profit. These are ballpark figures depending on size of the account and coverges..Larger the account the lower the admin as a general rule.

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        1. I copied right from the original write-up! I didn’t reverse the statement made! That is why I asked if I missed something?

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    5. My main concern is the financial impact of this law.What does it do to our budget short term and long term? My gut tells me the financial impact will be worse than we expect as govt(CBO) cost projections are usually too optimistic based on bogus assumptions. If true and emergings costs re higher than expected how do we deal with growing deficits ? Even higher taxes? Many unanswered questions still.I will be very curious to see how the law is rolled out in the upcoming months.Will it be a piece of cake or a nightmare or somewhere in the middle? I am leaning towards a nightmare scenario but I hope I am wrong on that.

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