Now go back to the beginning and read your thread again
Useful idiots one and all
Itâs funny because itâs true
Instead of having an army of nit-wits tell you over the phone âour policyâŠâ
They should just have the people who come up with these ideas receive a knee or hip transplant sans anesthesia.
THEN ask them if its âworth itâ.
The broader picture is a different story than âinsurance bad and greedyâ however.
âAnthem Blue Cross Blue Shield said Thursday it was not going ahead with a policy change that would limit reimbursements for anesthesia during surgery and medical procedures. The new policy would have reimbursed doctors based on time limits set by the insurer.â
The reimbursement limitations are a method of cost control, but this is because insurance companies are required by law to maintain a certain revenue/expense ratio, and they have to control costs as they manage the pot of money they have. Itâs actually an effort to manage budget in order to steward care so they donât come up dry. Literally budgeting, in the most basic sense of the definition.
From a high level view insurance finances look like this:
You have to have a shitload of money to even start a company. Not just money for operations and overhead typical of any company, but a pool of money you cannot touch to pay claims from.
Your growth is also limited by how much money you have in reserve, if you take on too many clients too fast, you risk not being able to cover them appropriately. A money in/money out ratio must be maintained. By law.
Enter risk bands. This is one way they justify dollars to donuts. âWe have x% of clients who are healthy and low risk, or not likely to dig in to our reserve, so we can now extend coverage to higher risk people, but with limitations because if we take on too much risk, we lose our ratioâ. Then govt regulators show up and they are the real Darth Vaders.
So we also enter coverage limitations and premium cost.
âWe donât have enough money, by law, to cover more people or unhealthy people and the premiums we are bringing in arenât enough to increase risk tolerance. So we will have to either raise rates or be a little more exclusionary in our coverageâ.
Now enter Obama and ACA. âNobody can be deniedâ. But he didnât alter the ratio rule. So now what? We see the insane rate increases and coverage limitations that @Alrightmiami19c âs meme pointed out above. And he made all the healthy people start paying $600 a month vs the $100-$150 per month prior, as an open market premium vs employer subsidized, to pay for poor people too. To maintain the money in, money out ratio.
Now insurance does have another option, which is to negotiate provider costs in their networks. From hospital stays to treatment and consultations and even pharmaceuticals. And they do.
This is where the healthcare industry enters the fray and says that the insurance industry is a bunch of stingy bullies trying to beat up doctors who then have to pass on loss costs to others. Bullshit. The doctors set costs. Insurance negotiates them down. They donât do it to be nice, they are managing their own bottom line, but we as consumers get to hide behind them while they do it, and ultimately theyâre trying to reduce costs in the aforementioned ratio so they can
A) cover more people, aka take in more premium
B) Offer excellent coverage benefits because it is a private industry and they compete for clients, so being a âgoodâ company is also profitable.
And, as the article someone posted earlier mentions, they average a 2% profit margin. All that money everyone uses to point out greed is going towards paying claims, not fattening pockets. And itâs all regulated heavily.
So the BlueCross decision takes care of optics, and can unfortunately validate misguided talking points, but unless the anasthesia itself sees a reduction in price, theyâre either going to raise rates or rob Peter to pay Paul from elsewhere in their benefit approval analysis as they manage the in/out ratio under incredibly thin profit margin lines.
So, to revisit the list of people to kill first:
- Healthcare execs themselves (not to be confused with insurance execs)
- Providers themselves charging an arm and a leg literally because they know youâll pay it while bent over the health barrel
- Poor people
- Politicians enacting policy to subsidize poor people in a way that aggravates the bigger financial picture vs assuaging it.
The issue really is much more complicated than the green hair dialogue.
Mangione didnât kill the bad guy. Not by a long shot.
3 Likes
Was that a deliberate joke? Because if so, Iâm impressed.
All the information above is very objective, can be researched further and was discussed in greater detail with graphs, charts and links for illustration in a linked article earlier in the thread for reference. I believe it even offered citations for ease of confirmation but could be remembering wrong.
Youâve chosen to follow a false narrative by any analysis, and one that will keep kicking the bullshit can youâre mad at down the road in ever increasing cost perpetuity. Because it doesnât address root cause, or understand the broader picture.
Your prerogative, but not very GT of you. The ball pit can be more fun than building indestructible egg carriers, Iâll give you that.
1 Like
What does this acronym mean?
I was trying to make a pun about âlong shot,â since it was at close range.
When you have bean counters determining surgical procedures, its wrong.
It just is. This isnât an affront to you or business in general, its just dumb. And arrogant.
If I need a money guy, I call you.
If you need a welder, you call me.
If Either of us need heart surgery, we arenât calling an accountant.
1 Like
If you have ghosts, you callâŠ
It was a good post. You coherently explained why the whole notion of âhealthcare is a rightâ requires fundamentally flawed thinking that ignores the entire concept of cost accounting.
Emotional rhetoric cannot eliminate costs, as much as we wish they werenât present. They are always there, and they must always be accounted for.
1 Like
GHOST BUSTERS!
Cue music 
1 Like
Hand waving away legitimate points and concerns doesnât account for the ridiculous profits theyâve been posting either. I mean, seriously dude. Theyâre not even modest.
They knew what they were getting into with the ACA. Hell, they wrote it.
To try to frame it as somebody (Obama, poor people) somehow monkeyed with their formulas is just disingenuous.
As is ignoring their massive profits, quarter after quarter, year after year.
1 Like
I get it. I donât take offense to it. Iâm not an actuary or an insurance executive. They beat me up too in market delivery compensation.
But, I understand why. Itâs very hard for me to call a 2% profit margin greedy, especially when the penalty for going negative isnât an investor slap on the wrist with some cash to get over the hump with, but government receivership or even forced closure.
Which would be an absolute train wreck.
Our healthcare system sucks. Itâs a patchwork developed over time with many interests involved. Itâs also very complicated, especially when you get granular, and if we want to affect real, productive change I think itâs important to understand the moving parts.
Right now the dialogue is so off itâs dangerous. Sincerely. From a rising cost standpoint that hits all of us significantly.
Thank you. And yes, with the addition of legal force behind accounting and financial management practices being the curbing factor.
1 Like
Most corporations today are run by finance ( bean counters)âŠand there lies the problem
2 Likes
Not even with the egg reference?
We just had a discussion about thisâŠ