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CBWx2

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« #45 : August 26, 2013, 09:39:37 PM »

For profit insurance providers neither have the power nor the motivation to control costs. They make huge profits either way.

WTF are you talking about?

CBW, if you think private insurers are not motivated to keep healthcare costs down then you have no idea how insurance works. Private health insurers are VERY motivated to have lower healthcare costs. You seem to think that insurers are, essentially, "marking up" health care costs to make a profit? Is that what you think? You understand that is not how insurance works, right?

I've  covered this already. Read below.

In order for a for-profit insurer to make a profit, they have to negotiate with providers in a particular area to accept their product. No person or company is going to purchase insurance that isn't accepted by the health care providers in their area. For this reason, the hospitals and MD's go into negotiations with these companies with most of the leverage. They tend to be fine with this, however, because they can recoup costs by simply raising premiums or lowering coverage by way of raising deductibles. They make money either way, so it's little skin off of their teeth.

Medicare and Medicaid, however, are not for profit, and are generally under scrutiny to keep costs down. They go into negotiations with a completely different amount of leverage, and a substantially lower level of apathy regarding raising service costs. The more people they cover, the more leverage they have.

wow, I can understand having a political point of view, but if that is what you think  its no wonder your view is so **CENSORED**ed up. That description is what you get when you have someone from the medical profession/field looking at things from the outside BUT ONLY FROM THE PERSPECTIVE OF THE CARE PROVIDER .  . and thinking he has figured it out.  Holy crap.

CBW, that is so wrong I have to think about where to start.

This should be good...


VinBucFan

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« #46 : August 26, 2013, 09:56:00 PM »

just added it above and it is "good" if "good" means illustrating that you are talking out of your azz

CBWx2

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« #47 : August 26, 2013, 11:26:19 PM »

Insurers pay for network and out of network coverage precisely because everyone is not in a network (ie negotiate rates). You seem to think everything is negotiated rates when that is not true at all. 

Where do you gather that I think everything is negotiated? Out-of-network billing is generally barely covered by most plans that utilize networks because there is no negtiated contract. Plans that utilize networks usually charge huge co-pays for going out of network, because sans a contract locking them into a price, hospitals generally charge them more for services. I didn't talk about this because it's completely irrelevant. If we are discussing how hospitals and insurance providers contract with one another, what is the significance of talking about what hospitals don't contract with your provider?

You are also leaving off the biggest issue impacting profits, which is CLAIM EXPERIENCE.  Insurers not just tacking on a surcharge, they are collecting premiums from as wide a group as possible and hoping most do NOT have claims. This is why oreventative healthcare and for-profit insurance don't work well.

Your comment has been corrected. It has also illustrates why the for profit insurance model is a sham. They take your money in hopes that the thing that they are taking it for never happens so that they can just keep the money. Worth every penny spent on it, huh Vinny?

but insurer profits are greatly impacted by big care expenses too and contrary to this comment - "they can recoup costs by simply raising premiums or lowering coverage by way of raising deductibles. They make money either way, so it's little skin off of their teeth"  -- insurers are COMPETING with other insurers so "raising premiums" and "lowering coverage" and "raising deductibles" means they lose business to a competitor. 

A competitor that will find itself in the same situation were it negotiating with the same hospital. The provider can only keep costs down if the hospital agrees to lower costs. Competition is irrelevant when prices are set by an outside party. We both know that rising premiums and higher deductables are a real phenomenon. If private insurance companies had the clout to contain this phenomenon, and had the motivation to do so, then why aren't they?



(By the way, who does Medicare compete with?). 

No one. Yet they still police hospitals and negotiate better prices than private insurers do. I could tell you why that is if you care to learn.





Health insurers absolutely care about healthcare costs and do have leverage, that is why you have stuff like this happen:

"Hartford Hospital and UnitedHealth Group, the nation's largest health insurer, are in a hard-fought contract negotiation that could leave thousands of customers facing higher out-of-pocket expenses if the current agreement expires Oct. 28."Hartford Hospital wants consumers to pay 30 percent more over the next three years for services received at their facilities," said Daryl Richard, spokesman for UnitedHealth Group. "In practical terms, that means the average cost for a two-day hospital stay after delivering a baby would increase by as much as $650, and the average cost of outpatient surgery, such as arthroscopic knee surgery, would increase by almost $300."

If your description was right this would never happen. If your description was accurate, UHC would have just accepted the hospitals new rates ("little skin off their teeth" you called it) and raised deductibles, rased premiums and reduced coverage etc.  They didnt do that though because UHC was under competitive pressure from the MANY other insuers that private private coverage to Hartford Hospital:

Aetna
Blue Cross
Cigna
ConnectiCare
Connecticut Health Plan
Franklin Health Plan
Healthcare Compare / Affordable Health / First Health
Health Care Value Management
Health CT
Health Direct
Health Management Center
Health New England
Health Net
Health Strategies
Managed Health Network
Multiplan Managed Care
Northeast Health Direct
Occupational Health Services
Olsten Health Care
One Health Plan of Southern New England
Oxford Health Plan
Private Health Care Systems
United Healthcare
United Payors & United Providers

http://www.harthosp.org/PatientVisitors/PatientFinancialServices/InsuranceManagedCareInformation/InsurancePlansAccepted/default.aspx

Vince, you may want to research how this played out before declaring that I'm wrong. Let me tell you, however, why I know that you're wrong, and I'm right.

The competiton between insurance providers is irrelevant in this case. Want to know why? Because there being multiple providers that service the area does not empower the provider, it empowers the hospital. If they drop UnitedHealth Group, there are many providers to step in and cover those patients. There is, however, only one Hartford Hospital, and people who live in the Hartford area have to use a provider that they accept, or else they can't be seen at the hospital without encurring tremendous out of pocket expenses. See how that works?

you dont have a clue what you are talking about because you are describing your perception instead of reality.

I think you have it a bit confused. Seems to be a trend.


VinBucFan

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« #48 : August 27, 2013, 12:11:07 AM »

Your comment has been corrected. It has also illustrates why the for profit insurance model is a sham. They take your money in hopes that the thing that they are taking it for never happens so that they can just keep the money. Worth every penny spent on it, huh Vinny?

not wasting my time in the black hole beyond highlighting this comment because it shows your true stupidity (or politically-induced blindness). 

CBW,  you say the "for profit insurance model is a sham" and yet nearly everything of value in the world is insured, not because people want things of value constantly serviced (preventative healthcare) but because they want to be indemnified if some UNLIKELY event occurs (catastrophe).  Everyone has the option to self-insure but almost no one does because there is an insurer who will agree to bear ALL the risk for a fraction of the exposure (premium). That insurer is not doing this out of altruism, the insurer is willing to take the risk because it is spread across a broad portfolio that the property owner could never have if they would self-insure. People wouldn't buy insurance UNLESS it was worth every penny you dunce.

he insurer doesn't just keep "the" money either, as you said . .  . . they pay claims, huge claims in many instances.  This is an example:

Sandy, which struck the east coast of the U.S. in October and was the third-most costly natural disaster on record according to Munich Re, cost Lloyd’s $2.2 billion, about 10 percent of the industry’s total loss. Lloyd’s paid 10.1 billion pounds in claims in 2012, down from 12.9 billion pounds in 2011, following earthquakes in Japan and New Zealand, and flooding in Thailand. “The Lloyd’s market has posted a strong result,” Chief Executive Officer Richard Ward said in a statement. The market paid out 91.1 pence in claims and operating expenses for every pound it took in premiums, indicating an underwriting profit, it said. That compares with 107 pence for U.S. property and casualty insurers, 91 pence for Bermudan insurers and 98 pence for European insurers and reinsurers, Lloyd’s said.

after losing hundred of billions the year before,  the market made 0.089 per pound of premium in a year that had a "strong result."  I hardly think you are as stupid as you read, so I am going to go with politically-induced blindness.
« : August 27, 2013, 12:12:49 AM VinBucFan »

Dolorous Jason

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« #49 : August 27, 2013, 07:19:43 AM »

Your comment has been corrected. It has also illustrates why the for profit insurance model is a sham. They take your money in hopes that the thing that they are taking it for never happens so that they can just keep the money. Worth every penny spent on it, huh Vinny?

not wasting my time in the black hole beyond highlighting this comment because it shows your true stupidity (or politically-induced blindness). 

CBW,  you say the "for profit insurance model is a sham" and yet nearly everything of value in the world is insured, not because people want things of value constantly serviced (preventative healthcare) but because they want to be indemnified if some UNLIKELY event occurs (catastrophe).  Everyone has the option to self-insure but almost no one does because there is an insurer who will agree to bear ALL the risk for a fraction of the exposure (premium). That insurer is not doing this out of altruism, the insurer is willing to take the risk because it is spread across a broad portfolio that the property owner could never have if they would self-insure. People wouldn't buy insurance UNLESS it was worth every penny you dunce.



In short , it sounds like you are saying that Insurance provides a wonderful service.


...and as the Comrade himself said :

Profit earned by people providing a service is one thing.

What is your point? I was wrong? Ok. You win. I was wrong.

           

spartan

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« #50 : August 27, 2013, 08:39:45 AM »


Your comment has been corrected. It has also illustrates why the for profit insurance model is a sham. They take your money in hopes that the thing that they are taking it for never happens so that they can just keep the money. Worth every penny spent on it, huh Vinny?


Insurance
From Wikipedia, the free encyclopedia

Insurance is the equitable transfer of the risk of a loss, from one entity to another in exchange for payment. It is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss.

An insurer, or insurance carrier, is a company selling the insurance; the insured, or policyholder, is the person or entity buying the insurance policy. The amount of money to be charged for a certain amount of insurance coverage is called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.

The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a financial (personal) loss. The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insured will be financially compensated.

Dolorous Jason

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« #51 : August 27, 2013, 08:59:05 AM »

Robber Barrons !!

Why cant insurance be more like the government - entrap us all in a ponzi scheme by force , squander the majority of the funds on bureaucracy , and then borrow the shortfall from China ?

Damn you Robber Barrons!!
« : August 27, 2013, 09:03:13 AM Fire Mark Dummynik »

What is your point? I was wrong? Ok. You win. I was wrong.

           

Bucfucious

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« #52 : August 27, 2013, 09:12:03 AM »

By force? That sounds monopolistic.

VinBucFan

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« #53 : August 27, 2013, 01:42:10 PM »

CBW . .   you've some "esplaining" to do . . . seems no one is buying your "for profit insurance is a sham" nonsense . . .  and considering that is the entire premise of your position . . . . well . .  I guess it looks like we have a new low from your performance in the Trayvon Martin thread.  "For profit insurance is a sham"  like George Zimmerman called Trayvon Martin a "**CENSORED**".  Haha

CBWx2

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« #54 : August 27, 2013, 03:07:48 PM »

CBW . .   you've some "esplaining" to do . . . seems no one is buying your "for profit insurance is a sham" nonsense . . .  and considering that is the entire premise of your position . . . . well . .  I guess it looks like we have a new low from your performance in the Trayvon Martin thread.  "For profit insurance is a sham"  like George Zimmerman called Trayvon Martin a "**CENSORED**".  Haha

LOL, look at Vinny getting all uppity because people with a similar worldview agree with him! You do realize that if Cove consensus = being right about something then everything you've said about gun control would be 100% incorrect, right? Stop jocking people for agreeing with you. It makes you look like a pathetic lapdog.

Your comment has been corrected. It has also illustrates why the for profit insurance model is a sham. They take your money in hopes that the thing that they are taking it for never happens so that they can just keep the money. Worth every penny spent on it, huh Vinny?

not wasting my time in the black hole beyond highlighting this comment because it shows your true stupidity (or politically-induced blindness). 

In other words, you have no leg to stand on with anything else debated, so you will focus on the one thing that you think that you do have a leg to stand on.

CBW,  you say the "for profit insurance model is a sham" and yet nearly everything of value in the world is insured, not because people want things of value constantly serviced (preventative healthcare) but because they want to be indemnified if some UNLIKELY event occurs (catastrophe).

Two things:

1 The fact that people want things of value insured isn't proof that the for profit model of insurance isn't a sham, you moron. It's proof that insurance as a concept has social value, independent of the profit motive. You seem to be taking my comments and suggesting that they mean that insurance in general is a sham. Maybe this is because you are incapable of viewing insurance in any other way that as a for profit entity, which brings me to...

2. You seem to constantly echo this asinine assertion that consistently serviced things, such as preventative care and office visits, are incompatible with the concept of insurance. They are not. What they are incompatible with, is for-profit insurance. The reason that catastrophic or unlikely occurrences are more friendly to the for profit model than frequent care is because that's where the most money can be made. They make their profits by people NOT making claims, therefor, the best logical bets on how money can be made with this concept is to charge to cover the rare incidents so that you can most always be in a position to collect more than you are paying out.

Everyone has the option to self-insure but almost no one does because there is an insurer who will agree to bear ALL the risk for a fraction of the exposure (premium). That insurer is not doing this out of altruism, the insurer is willing to take the risk because it is spread across a broad portfolio that the property owner could never have if they would self-insure. People wouldn't buy insurance UNLESS it was worth every penny you dunce.

You do realize that this statement is contradictory, right? Everyone has the option to self-insure, but they don't because they don't have access to the "broad portfolio" than an insurer does? If they don't have access to the "broad portfolio", then they don't have the option to self insure.

And what is this "broad portfolio" that you speak of? That's just a fancy way of saying "other people's money", right? The insurer takes on this risk, because they are backed by other people's money. The money that they take in with the hopes that they never have to pay it out. Everything that the insurer does is with other people's money. The people who are really incurring the risk are the people who pay in monthly and never file a claim, or that file a claim that amounts to less than what they've paid in. They are the one's who absorb the risk, not the insurer. Very rarely is there ever an instance where the insurer actually does take in less than he pays out, and when that even looks like it's close to occurring, premiums typically rise to ensure that it doesn't.

The insurer doesn't just keep "the" money either, as you said . .  . . they pay claims, huge claims in many instances.  This is an example:

Sandy, which struck the east coast of the U.S. in October and was the third-most costly natural disaster on record according to Munich Re, cost Lloyd’s $2.2 billion, about 10 percent of the industry’s total loss. Lloyd’s paid 10.1 billion pounds in claims in 2012, down from 12.9 billion pounds in 2011, following earthquakes in Japan and New Zealand, and flooding in Thailand. “The Lloyd’s market has posted a strong result,” Chief Executive Officer Richard Ward said in a statement. The market paid out 91.1 pence in claims and operating expenses for every pound it took in premiums, indicating an underwriting profit, it said. That compares with 107 pence for U.S. property and casualty insurers, 91 pence for Bermudan insurers and 98 pence for European insurers and reinsurers, Lloyd’s said.

after losing hundred of billions the year before,  the market made 0.089 per pound of premium in a year that had a "strong result."  I hardly think you are as stupid as you read, so I am going to go with politically-induced blindness.

So they lost 802 million in 2011, and then turned around and made a 4.2 billion dollar profit a year later? Sounds like risky business to me. And since they don't keep the money, as you say, I wonder what they will do with that 4.2 billion dollar profit? Should Lloyd's customers be expecting refund checks any time soon?

I'm hoping that you simply misspoke, and are not idiotic enough to actually have meant to say that they don't keep the money, because if they didn't keep their profits then they wouldn't be a for profit business. There would be no incentive for them to "take on all the risk", correct?


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« #55 : August 27, 2013, 03:14:19 PM »

CBW . .   you've some "esplaining" to do . . . seems no one is buying your "for profit insurance is a sham" nonsense . . .  and considering that is the entire premise of your position . . . . well . .  I guess it looks like we have a new low from your performance in the Trayvon Martin thread.  "For profit insurance is a sham"  like George Zimmerman called Trayvon Martin a "**CENSORED**".  Haha

LOL, look at Vinny getting all uppity because people with a similar worldview agree with him!

CBW, the issue being discussed is not an opinion, its fact. You apparently think "for profit insurance is a sham." On that issue it is not a couple "people with a similar world view" who agree with me .  . its neatly the entire world as almost all items of monetary value in the world are insured.  On this issue, you are  like the president of the Flat Earth Society.

Now, because you would never admit that . . . spin, spin, spin, spin

CBWx2

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« #56 : August 27, 2013, 03:19:27 PM »

Your comment has been corrected. It has also illustrates why the for profit insurance model is a sham. They take your money in hopes that the thing that they are taking it for never happens so that they can just keep the money. Worth every penny spent on it, huh Vinny?

not wasting my time in the black hole beyond highlighting this comment because it shows your true stupidity (or politically-induced blindness). 

CBW,  you say the "for profit insurance model is a sham" and yet nearly everything of value in the world is insured, not because people want things of value constantly serviced (preventative healthcare) but because they want to be indemnified if some UNLIKELY event occurs (catastrophe).  Everyone has the option to self-insure but almost no one does because there is an insurer who will agree to bear ALL the risk for a fraction of the exposure (premium). That insurer is not doing this out of altruism, the insurer is willing to take the risk because it is spread across a broad portfolio that the property owner could never have if they would self-insure. People wouldn't buy insurance UNLESS it was worth every penny you dunce.



In short , it sounds like you are saying that Insurance provides a wonderful service.


...and as the Comrade himself said :

Profit earned by people providing a service is one thing.

You know who else provides this service? The government. You know, that entity that used tax dollars (or premiums, if it makes you feel better) to rebuild all of the property damage that was left to be rebuilt after State Farm, All State, and their buddies cried "no mas!"?

Funny how it's a wonderful service when done by a private company that is looking to make a profit from it, but is a ponzi scheme when done by the public sector, who makes no profit from it.


CBWx2

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« #57 : August 27, 2013, 03:28:32 PM »

CBW . .   you've some "esplaining" to do . . . seems no one is buying your "for profit insurance is a sham" nonsense . . .  and considering that is the entire premise of your position . . . . well . .  I guess it looks like we have a new low from your performance in the Trayvon Martin thread.  "For profit insurance is a sham"  like George Zimmerman called Trayvon Martin a "**CENSORED**".  Haha

LOL, look at Vinny getting all uppity because people with a similar worldview agree with him!

CBW, the issue being discussed is not an opinion, its fact. You apparently think "for profit insurance is a sham." On that issue it is not a couple "people with a similar world view" who agree with me .  . its neatly the entire world as almost all items of monetary value in the world are insured.  On this issue, you are  like the president of the Flat Earth Society.

Now, because you would never admit that . . . spin, spin, spin, spin

What is the difference, Vince, in theory and implementation, between BCBS and Medicare?

If BCBS is a superior model to Medicare, then why did they and companies like them spend billions of dollars to kill a public option?

What you are proving, Vince, is that insurance as a concept has social value, The fact that people buy for profit insurance isn't because it is a superior concept to true non-profit models. It is because in most cases there is not a non-profit alternative.
« : August 27, 2013, 03:33:59 PM CBWx2 »


Bucfucious

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« #58 : August 27, 2013, 03:35:04 PM »

BCBS steals all the money they go to prison. Politicians do it they get reelected. But the real difference between the two is in the quality of the shareholders.

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« #59 : August 27, 2013, 03:37:11 PM »

The reason that catastrophic or unlikely occurrences are more friendly to the for profit model than frequent care is because that's where the most money can be made. They make their profits by people NOT making claims, therefor, the best logical bets on how money can be made with this concept is to charge to cover the rare incidents so that you can most always be in a position to collect more than you are paying out.

You just make things worse everytime you type. Two things:

1. Even NOT-FOR-PROFIT entities cannot always lose money UNLESS they have some other source such as charitable contributions or taxes.  The business venture still has to make sense economincally even if there is  no profit motive (except for governments builkding massive debts or rasing taxes) Not for Profit insurers still have people to pay and mortgages to pay and benenfits and other costs that have to come from operating profit, so the busines model has to make sense contant preventative care is not compatibale with traditrional insurance BECAUSE the "claim experience" is too high.  Look no further than the federal debt and Medicare for proof of that.  THAT IS THE PROBLEM.

2. using property insurance as an example, property insurers insure against events that are not wholly infrequent (fire, hurricane, rain, wind, collapse, collisions etc.) but they are able to provide the coverage that an insured could not provide for itself because the LOSSES are infrequent when spread over a large, diverse portfolio.  There are a lot of wildfires in CA, but not in New England. There are hurricanes here, but not in Wyoming.  Property insurers do NOT simply cover events that are unlikely to happen.  A car crash is not unlikley to happen, they happen all the time, insurers are able to provide the coverage because the pool is so large, not because the event is a "rare incident." 
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