Tuesday, September 04, 2012


In matters of health insurance, I have come to understand the public is mostly uninformed about the mechanics of health care and health insurance. It seems they are content to remain that way and are satisfied to devote more time to reality TV than reality education.

This is an election year and voters, informed and otherwise, will show support for a candidate of their choice on or before November 6. Sadly, many will cast their vote based on nothing more than the "likability" of the candidate vs. qualifications or ability to lead.

I suspect this is why we are in the mess we are in.

As a veteran of the health insurance industry, I expect more of those who work in our market, and especially those who are part of the editorial staff of an industry periodical.

It appears my expectations are too high.

This became quite evident when the National Underwriter, Life and Health edition arrived in my mailbox a few weeks ago. The new Editor in Chief (Bill Coffin) is much improved over his predecessor. At least in areas where he is unfamiliar he makes very good attempts to balance one side against the other and present the "full" picture.

Not so for at least some of his staff.

A recent article "Sticker Shock" penned by an obviously young and misinformed man disappointed me greatly.

Not only does this person fail to understand the workings of the health care system, he proposes a solution where carriers adopt a baseball type collective bargaining agreement with hospitals and medical providers as a way of lowering the cost of health care.

Mr. Stanley was watching a baseball game when his girlfriend developed abdominal pains that were severe enough to prompt a 9 PM trip to the local ER. The middle of the night ordeal included a 7 hour stay and culminated in a CT scan and a hospital bill for $16,448.

No word if the bill includes additional P.A.R.E. charges for services performed by outside contractors and non-par providers.

As Mr. Stanley observed, one could have purchased a Ford Fiesta for a comparable amount.

Thanks to negotiations by Aetna (and perhaps some par providers) the net bill was reduced to $12,724 with Aetna paying 80% of that amount.

His girlfriend is covered under her mothers health insurance due to a provision in Obamacare that considers adults under the age of 26 to still be children for insurance purposes. Long before turning 26 you can legally drive a car, serve in the military, order and consume an alcoholic beverage, enter in to financial arrangements that obligate you to pay back borrowed funds but you do not have to buy health insurance if you don't want as long as mommy and daddy will buy it for you.

My first reaction to the article was to say "grow up" but it soon became clear the comments were posted by someone who had no clue about the health care system or health insurance. Apparently that is not a qualification for an associate editor.

His rant about the cost of health care includes comments about the cost of a CT scan in which he wonders if the machine is powered by liquid gold. He does admit one of the reasons why health care, especially in an ER, is expensive is due in part to uncompensated care and admits his girlfriend would be one of those if not for Obamacare and the goodness of her mother who pays the premium.

Mr. Stanley comes up with the idea that, had the illness happened at 9 AM it could have been diagnosed and treated by her PCP with simple antibiotics and the CT scan (as well as the $16k bill) would have been mostly unnecessary.

I suppose Mr. Stanley, or his girlfriend, possess the uncanny ability to diagnose ailments after the fact and arrive at the conclusion that the level of care was overkill in addition to being overly expensive.

His solution is an MLR for hospitals and a baseball type collective bargaining between carriers and medical providers as a way to hold down costs.

Apparently Mr. Stanley believes the health insurance MLR is or will actually work to "bend the health care cost curve" and make health insurance more affordable for everyone.

Regular readers of InsureBlog will know that MLR is not only a total failure but is actually responsible for higher premiums, higher costs for carriers and employers,  and fewer consumer choices.

Perhaps Mr. Stanley should spend some time here where when he is not watching the Mets lose.

Better yet, his skills and expertise would be better suited to seek employment as a sports writer and leave matters of health insurance to those who really have a clue.
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