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Insurance

July 9, 2008  
McCain Plan to Aid States on Health Could Be Costly

Senator McCain’s desire to maintain a private health insurance system is laudable.  His desire to have a free market approach is also in keeping with mainstream American views which oppose a large, new federal health program.  HOWEVER, his view of how to do this is NOT realistic.  State pools will NOT work to solve the problem.  Only a mandatory acceptance of ALL applicants is a possible solution to save any private health insurance network (see blogitorial and about on this blog).  The article from the New York Times below outlines just some of the flaws.  Come on Senator McCain, health insurance REFORM is the only solution if you really wish to save a market based system in any fashion . . . jomaxx

If Senator John McCain’s radical plan for remaking American health care is to work, he will have to find a way to cover people like Chaim Benamor, 52, a self-employed renovator in this Baltimore suburb. Mr. Benamor never found it necessary to buy insurance before having a mild heart attack last year and now, 13 years shy of Medicare, has little hope of doing so . . . link to entire article

http://www.nytimes.com/2008/07/09/us/politics/09health.html?ref=health

June 22, 2008
Gender can cost you in individual health insurance
Isn’t this sad?  Apparently, being a woman in California means you pay more for health insurance, even though women are more likely to access preventive services, are generally more compliant with medications and overall, have lower usage of drugs, alcohol and tobacco. This is just another reason why state regulation of health insurance is a failure.  Most rating could be eliminated by open enrollment allowing ALL citizens to access private health insurance simply by paying their premiums . . . jomaxx

Some health insurers in California charge men and women differently for individual insurance policies.

See the link below to the column by David Lazarus in the Los Angeles Times‘s (6/22) (Consumer Confidential).  Blue Shield of California charges different individual insurance premiums for men and women starting July 1, with women generally paying more.  This is despite the fact that the plans do not even cover pregnancy and maternity care. A spokesman for Blue Shield said the company was using statistics to base their decisions.  Also, Aetna, Inc. and Anthem Blue Cross are using gender as a factor in individual premium rates.  Kaiser Permanente does not.  The California Department of Insurance said there were no regulations preventing gender-based pricing for individual policies.

Gender can cost you in individual health insurance

http://www.latimes.com/business/la-fi-lazarus22-2008jun22,1,1327960.column?page=1

 

See this excerpt from Consumer Report, which outlines that insurers run overhead in the range of 15-25% PLUS profits based on premiums collected . . . jomaxx

Consumer Confidential

Premiums and profits

Because of the way health insurance works, insurers haven’t been paying much of a penalty for failing to contain costs. Insurers typically keep around 15 to 25 percent of the premiums they collect to cover administrative and marketing costs, plus profit (the exact percentage varies according to state regulations, if any). The rest goes to pay for health care for customers.            

“My insurance company doesn’t care about costs that much because they always get to collect that 15 percent spread,” Arth says. “The more health care costs, the more money they get to keep.”

In 2006, the nation’s six biggest private health insurers collectively earned almost $11 billion in profits.

Mohit M. Ghose, vice president of public affairs at America’s Health Insurance Plans, an industry trade group, says insurers are trying to cope with rising costs with incentives such as tiered drug pricing and giving doctors and hospitals financial incentives to deliver more efficient care. “Our commitment is to improve the affordability and accessibility of health care in America,” Ghose says.

Big businesses have somewhat more leverage over costs because most of them are self-insured. They cover their employees’ health expenses out of their own pockets, paying insurers a percentage of their total expenditure in exchange for handling claims paperwork and gaining access to the insurers’ provider networks. But even a mammoth corporation such as Ford or ExxonMobil is no match for the combined bargaining power of health-care providers.

Comments»

1. Pamela Toll - July 29, 2009

I have 26 years in the insurance industry professionally. No doubt there are discriminating factors against WOMENS HEALTH IN insurance. Birth control pills , Other female oriented birth control is usually NOT covered by Health insurance. If its considering a males sexual health. its ALWAYS covered. Viagra vs birth control pills? whats the difference. Men always have their needs met. Pregnant women find their pregnancy is a time when they LOSE their health insurance and cannot get any at all I went thru an Uninsured C section in 1985 costing me $17,000, my husband was laid off and COBRA BENEFITS did not cover my EXISTING PREGNANCY. I am sure this type of thing occurs often. I was compelled to get less than necessary aftercare due to the cost.
These type of factors are well known. Self insured companies eyeball employees with impending births and schedule the coinsidence of lay off in conjunction with onset medical costs. These factors need to be identified and OUTLAWED and hold employers liable for maternity costs if they fire the employees.. I bet then the employees wont BE FIRED. These types of strategies are well used in FL AND SOUTHERN STATES. Open your eyes. Mammograms are expensive but penile implants are cheap.. SEE THE DISCRIMINATION FACTORS?
Outlaw them ! before you revise the healthcare reforms.

2. Obi Jo - July 30, 2009

Thanks again. We have aggressively commented on this blog about gender discrimination in health insurance and the fact that it should not be allowed. We believe in total subscriber based premium setting so that all are sharing the groups risk, which is in fact the fundamental premise of all insurance pools. No question issues related to pregnancy, childbirth, birth control and other gender specific issues, related to both sexes need to be removed as any basis for exclusion from coverage or as a basis for up-rating premiums.