It’s the 21st Century, Stupid!

The New York Times reports on an investigation by New York state AG Andrew Cuomo that has uncovered what appears to be a rigged system to determine the “reasonable and customary” rates charged by health care providers. The determination is made by a company named Ingenix and is used by insurers to determine payments made by insurance companies when customers have to see doctors outside of the insurers’ networks. The problem is that Ingenix is owned wholely by UnitedHealth Group. Golly gee, there’s no room for a possibility of abuse, is there? Cuomo not only thinks there is but has done investigations that seem to show that abuse has been taking place. What a shock.

I like the essence of Senator Obama’s health care ideas but I think we just need to go farther. Comparisons to the system in Canada and Great Britain are always made by conservatives but they ignore other countries that have more government involvement than we do, including single payer systems that work much better than those two countries. This of course includes the rest of Europe. But in the real world it is questionable whether even any of those variations would be politically achievable in the United States. So I tried to think of something else. If anyone stumbles across this blog opinions and input are something I’d love to read.

First, nothing beyond current regulations except for consumer protection legislation would be passed limiting private insurance companies. But they’re still going to have to adapt to the existence of a new type of insurance organization. This organization would have a closer relationship to the government than the Post Office, but like it not be an actual agency of the government. It would be a purely non-profit health care organization like no other.

Read more »

Why does anyone believe anything that George W. Bush or anyone who represents him or allies themselves with him says anymore? Remember the good old days when he was saying that he hadn’t made up his mind about going to war with Iraq?  And that thinking that it might cost $50 billion was dismissed as speculation? When Mitch Daniels said that Larry Lindsey’s estimate of $200 billion was the upper end of a hypothetical?

Now there are estimates that the combined total of Iraq and Afghanistan could reach $2.4 trillion before it’s all said and done. What’s the White House reaction?

The Bush administration has declined to make long-term projections because “the war is ever-changing” and costs are difficult to predict, said Sean Kevelighan, press secretary for the White House budget office.

“Congress got a predictable answer to its leading question, which was clearly intended to artificially inflate war costs (by) politicians in Washington trying to manage our military commanders,” Kevelighan said.

“Budgets follow military decisions, not vice versa,” he said.

What do Bush’s allies in the Republican Party have to say about it?

Rep. Paul Ryan of Wisconsin, the ranking Republican on the committee, said the estimates fail to show that as a percentage of gross domestic product, the nation is better equipped to pay for these conflicts than previous wars.

Of course I want to know what the percentage of GDP has to do with it? Government revenues and debt are what matter if you’re going to discuss an enterprise that the government is paying for and these same people want Bush’s tax cuts to stay the course. They want the estate tax eliminated. Many of them want capital gains taxes eliminated or at least reduced even further than where they are already at. Look at these numbers and realize that President Bush is once again threatening to veto SCHIP, claiming that part of the reason is the expense, $35 billion over 5 years.

As I said to begin this post, why does anyone still believe this man or his minions?

David Broder writes about a plan to fix our health care problems with a “publicly subsidized individual health insurance”. Of course this concept is somewhat useless. OK, it’s lots of “thought” about a proposal that will do nothing to help improve our system. Why won’t it? The key lies in this paragraph.

Instead, the report calls on government to restructure the private insurance market in less rigid form than Hillary Clinton proposed 14 years ago — and then step back and let competitive market forces do their invaluable work of forcing recalcitrant insurers, doctors and hospitals to bid against each other on the basis of price and quality.

Competitive market forces do not simply function magically in a vacuum. The primary concept behind the ability of the market to accomplish what these people expect it to is the rational choice theory, which is also used in other social sciences. Rational choice in turn relies on a rational actor. The assumption of the existence of a rational actor is one where the people taking part in the economy are willing and able to make a choice based purely on their knowledge of their needs, the product being purchased and their ability to pay for it. It does not account for irrational fears, emotions or choices based on incomplete information or lack of understanding. The plain truth is that the vast majority of the American populace does not have any information base for making these choices and the plans that hope to use the magic of the free markets do not address that fact. There are economists and social scientists addressing the limitations of this part of neoclassical economic theory, as shown by this article in Harvard Magazine but apparently those who are proposing that the market will solve the problems in the American health care system don’t acknowledge them. They also don’t acknowledge the desire of those in the health care industry to distort rational choice with advertising, small print, legalese and the ability to in effect change the terms of any agreement unilaterally much as their compatriots in other industries do. Look at this article from SmartMoney and realize that those who propose that the current system, largely unchanged, is what we need to stick with believe it is perfectly acceptable that consumers go through this routine. I disagree.

At least I think that this doctor writing an op-ed for the Washington Post does. He calls the Republicans for their constant refrain of socialism, socialist and socialized when ranting against their political opponents proposals. There’s just no way it can be called a discussion when this rhetorical overkill and inaccuracy is used.

That’s what David Ignatius writes about in the Washington Post. What it comes down to is a variation on my criticism of what motivates much of the current American business world. It’s not enough to make a profit. There’s never enough profit, apparently. The search is always on for a greater margin or rate of return no matter how risky or how questionable it might be for the long term good of the company or our society. It doesn’t matter what happens to those thousands of people you fire from their jobs so that Wall Street will approve of you enough to up the stock value and the incomes of those executives who receive a significant part of their income from stock options. There is no other value that matters. Now keep in mind that many would have this environment and set of values determine everything about our health care system.

MSNBC also informs you of 9 Things the Insurers Don’t Want You to Know. Among them is that if you become expensive to them they’ll go over your records to see if there is absolutely anything that they can use against you as a reason to drop your coverage retroactively. They call it recission.

You know how the insurance companies tell you that you should get things pre-approved? Look at this little gem.

 “Preapproval is often what triggers the rescission review,” says Shernoff. “If it’s for hip surgery, that’s an expensive item that they’ll look at and see if you’re a candidate for rescission.

Catch-22, anyone?