The idea is to take the mind-boggling process of shopping for insurance and make it a little more like buying an iPod. Customers are greeted by a concierge. There are work stations for do-it-yourselfers and private rooms for meeting with salespeople.
Now that college is over, you may have noticed that many of you and your pals are suddenly uninsured. According to a report by the Commonwealth Fund, young adults are disproportionately represented among people who lack health insurance, accounting for nearly 30 percent of the 45 million uninsured people younger than 65, even though they comprise just 15 percent of the population.
Once you organize and take a head count, go price group health-care coverage. And after you calculate the rate at which the larger the group the cheaper the insurance, go out and gather up everyone else you can–through your massive social networks–who might be interested in the cheapest health insurance. It will only be a matter of time before your organization is so large that you can become your own underwriters. Then you can really throw some weight around.
And if you can remember that you started this venture not to make a buck but to obtain affordable health insurance–if you can stay on the nonprofit side of things and avoid antitrust laws–you might just have the motivation and support that corporations and the government are lacking to provide universal health-care coverage.
Hadn’t seen that before. But, for the reason above (and several more), it is striking how much business wants to continue to involve itself in the provision of health care insurance coverage. It feels like more of a “the way we’ve always done it” sort of conclusion as opposed to a distrust of government, taxes will increase argument. But health care expenditures go up, up, up and will continue to do so even with yesterday’s announcement.
Insurance coverage that follows people as they job hop/strike out on their own would boost American productivity. Short-term plans are annoying. COBRA too expensive. And individual insurance purchasing not rewarded by employers.
Jane Sarasohn-Khan at Health Populi writes, “a new survey from the International Foundation of Employee Benefit Plans finds that most employers do not want to move away from an employer-based system of health insurance.”
More than a few business people have had a tough-go of things lately; it seems obvious, then, that businesses would want to unload an ever-increasing expense line item from their budgets.
Not so fast.
As one of those who’ve watched the slow-cooking past efforts toward changing the structure of health care financing and delivery in the U.S. — and given the current sorry state of the macroeconomy — employers who “can” will continue to sponsor health plans for the next couple of years.
“Employers who can” depends on company profitability per employee, and clearly many companies whose good fortunes are based on consumer purchases could become compromised in their ability to provide health insurance. Milliman, the actuarial firm, calculates that the average cost of health care for a family of four in 2009 will be $17,310. This will over-burden companies in many consumer-facing industries — beyond automakers, consumer goods companies, retailers, home appliance manufacturers, and others from a large number of SIC codes.
It is baffling to read that “64% of employers believe that employer-based health care should continue to be the primary mechanism for benefits delivery,” even if that number has been decreasing over the past ten years.
No doubt that any health care reform in the near term will require employers to pick up some of the tab, but do employers fear that employees no longer needing the one benefit that keeps them on the job will up and leave en masse?
The era of one company, one career has long been dead. The final frontier in overcoming job lock is the health care benefit and the now defunct John McCain health care plan at least had the redeeming quality of separating health insurance from employment.
Not only is divorcing health care insurance from employment the right thing to do, it also makes business sense from a financial perspective. Or so I thought.
Read this article in The Wall Street Journal about fighting health insurers when they deny coverage. It’s tough:
In any case, appealing an insurer’s decision is often complex and tricky, and the deck can seem stacked against you. It is often hard for consumers to know what is covered and what isn’t in an insurance plan. Indeed, insurers have been winning a majority of the cases reviewed by state regulators in recent years, with victories for insurers at 59% in 2006.
Here is what you need to know: get help.
The WSJ article provides several examples of patients doing just that.
Another option: get help from the start. Today’s health care world almost necessitates it.
Health advocates are the answer. From Marketplace:
Navigating that system — and, increasingly, fighting it — can be expensive. With coverage shrinking, people are looking for help in dealing with the details. There are doctors’ appointments to book, insurance companies to pay, medications to monitor. But there are companies that’ll shoulder that burden for you. For a price, of course.
The story highlights health advocate company Guardian Nurses.
Here’s what such a company can do for the patient:
Health advocacy companies make up a tiny fraction of the health-care field. But experts say the market is growing as people feel squeezed between full-time work and full-time management of their family’s health care. Advocates can search for specialists, book doctors appointments, and keep track of medications. They’ll also manage electronic health records, and provide a second set of ears during a consultation.
On a side note, according to the article, there is only one college that offers a health advocacy degree. Not that a specific degree is necessary to perform the functions of a health care advocate, expect more universities to offer similar programs.
Some have scoffed at the idea of traveling to India or Thailand for medical care. How about New Zealand for the same reason? They speak English and have such American necessities as McDonalds and Starbucks. Rumor is the scenery is beautiful, too.
Medtral is hoping that an experience similar to that found in the United States will be the reason American health care travelers choose New Zealand for their next hip replacement. From The Washington Post: “The company says it can offer procedures at boutique hospitals with follow-up personal nursing care at a fraction of the cost of the same surgery in the United States.”
Only 30 North Americans have registered with the company in ten months of existance. The article also says that cost comparisons are difficult because of the variability in pricing across the U.S. Medtral is focusing on a market they estimate at 75 million uninsured and underinsured Americans.
Here is the most important point, however:
“If my insurance company will cover the major share of the cost of the procedure, then I’m inclined to have it done here in California, since my biggest concern is what if something goes wrong,” says Shaw, an eighth-grade teacher from Mountain View, Calif. “I really don’t want to have to travel back to New Zealand for the sole purpose of doctor visits. That’s a bit expensive on a teacher’s salary.” If his insurer balks at the U.S. expenses, he is ready to make the case for traveling to New Zealand.
It always comes back to what patients will have to spend out of pocket. Cost savings must be equivalent to the extra effort required to receive care in New Zealand (or any other country, for that matter). Getting a knee replaced requires significant rehab time and a few follow-up visits. Turns out those tasks are easier to accomplish when the services are provided a few miles from the home rather than around the world.
“Will my insurance cover it?” and “How much is it going to cost me?” have been, and will continue to be, more important questions than “Who is doing my procedure?” and “Where is my procedure being done?”
That doesn’t seem right.
This is just too good to pass up. If you watch any amount of TV you know who Billy Mays is. If not, here’s a quick refresher:
Well now he’s pushing health insurance—calling it the most important product he has ever endorsed. I present:
The non-verbals, moving charts, and great promises are superb.
However, it is complete underinsurance. And it’s too bad because the market they are targeting probably has no idea how far $1000 of annual surgical coverage goes (the cheapest plan). The most expensive option covers up to $6,000. Anyone checked the cost of a bypass surgery lately?
When he says affordable, he means health insurance you can actually afford.
Capitalism at its best.
Our employer based health insurance system distorts the real cost of health care. Some (rightfully so) attribute our current consumption activities to this distortion.
A classmate was relaying a conversation last week that she had had with a group of law students. She asked, “How much do you think open heart surgery costs?” One response, “a couple of thousand bucks.”
The WSJ Health Blog wrote a couple of weeks ago about San Francisco restaurants reacting to a local mandate to provide health insurance to employees.
Since the beginning of the year, San Francisco businesses have been required to offer health insurance to employees or pay a fee to the city to fund health care.
Some restaurants are passing the fee on to consumers in the form of a health surcharge, which shows up on the bill as a flat fee ($1 per person, or so) or as a percentage (like sales tax).
Interesting thought. A surcharge at the bottom of a Wal-Mart receipt? Or a hotel bill?
Can you imagine GM placing a line item at the bottom of the sticker on a new car detailing a $1,500 surcharge for health insurance (back when they offered it to retirees). Not that it would change the bottom line price. But do you think that would make someone think twice about purchasing the vehicle?
From the Akron Beacon Journal, “Alliance Community Hospital wants to pay you $100 or more to find out how much your health insurer paid for care you received at rival hospitals.”
Hospital’s stated motivation:
Alliance Community Hospital Chief Executive Stan Jonas said the offer is part of the hospital’s attempt to provide consumers with more information about the true cost of medical services.
The hospital plans to share the information eventually on a new Web site.
”We feel that consumers should be able to compare prices before they buy health-care services,” Jonas said. ”We are doing this because we want to prove our value in the marketplace and to provide meaningful comparisons with our own pricing, as well. So in order to help inform consumers, we are seeking information about procedures performed at other hospitals.”
Typical insurer response:
”To the best of my knowledge, this appears to be a new type of initiative,” said Richard Waldron, director of provider networks for Medical Mutual of Ohio. ”While we support the concept of transparency, this initiative seems problematic. Looking through EOBs from unrelated facilities poses issues of data collection, interpretation and validity. Moreover, there may be numerous legal issues inherent in such an effort.”
It would be terrific if transparency is the true motivation. But a hospital isn’t going to shell out that kind of money just so patients can compare prices between hospitals. I have a feeling a competitive market is at least a factor in the decision…
This gem also from the article, “In recent years, ”transparency” has become a buzzword in the medical industry as patients are being forced to foot a higher percentage of the bill.”
Ahh, shouldn’t high quality care be reason number one for transparency?
Last night’s winning numbers for “Win for Life,” a game of the Oregon Lottery: 8, 20, 73, 77.
But that website doesn’t have is the results for a lottery’s importance not measured in a dollar sign and zeros…
Covered widely by big media, and for good reason, the state of Oregon is offering a few of its luckiest citizens not eligible for Medicaid the opportunity to win health insurance.
Really? Are they serious?
The article reports that only a few thousand out of more than 80,000 applicants will get lucky. It seems like a rather shameful situation to me.