Thursday, January 7, 2010

Misdirection and Slight of Hand - Health Care Reform

Just a quick post to provide you information on the health care reform trends.Click below to read what United Health Care has summarized as what they believe will be the final version of the coming changes to health care over the next few years.

Specifically, in the next 6 months, insurers will need to adjust their treatment of the following;

1) Get rid of any waiting periods of greater than 90 days to begin insurance that is approved.
2) Stop rejecting children under 19 for pre-existing conditions.
3) Stop canceling insurance policies except in the case of fraud (this is overdone - in 7 years I have never seen a policy dropped for someone making valid claims.)
4) Provide preventative care (wellness visits) without cost sharing. - Many insurers only pay $300 or $400 a year, but require a client to pay 25% of the cost. For example they pay 75% of wellness visits up to $300 out of the insurance company's pocket.

All of these changes are good and right, however they will raise rates, so hold on to your hat!

UHC also highlights other changes they expect in 2011 and 2014 so read away.Here is my take on the entire deal.

You must know how the structure is set up to understand the fraud that is being put in place.
A) Taxes begin immediately.
B) Cuts in Medicare coverage begin (After mid-term elections)
C) In six months, the changes above are effective
D) 2014 - The big reform is schedule to hit - Individuals are required to have coverage or pay a penalty of the greater of $750 or .5% of their income if they don't purchase insurance.


As I mentioned, the impact of these changes will be immediate. Insurers now are required to take children that have pre-existing conditions in the near term and these "sick" kids will be an immediate drain on profitability and an increase in cost. Is there any doubt that kids that are very sick will hurry to buy insurance? Is there any doubt that insurers will adjust rates on all new policies sold and also on all existing policies when they have a chance?

Ok, so here is the real deal. The administration's efforts here are to begin paying for this plan with increased taxes today. In addition they begin cutting Medicare benefits, require insurance companies to make changes immediately add sick folks to the insured roles (read as decrease profits and increase costs - or simply put hurt their businesses significantly). Finally in 2014 we have everyone come on the plan. Kind of strange timing isn't it?

A) Oh yes, please look at the 2014 stipulations as well. Employers will ultimately drop their coverage and stop offering it if they employ more than 50 employees. Think about it, they will cut costs significantly in the form of premiums (they will have to pay a $750 fee per employee fee when not offering a plan) and will be able to tell their employees that they have health care available through the government exchange plan. -- You don't think they'll do it? Right now, most employers pay 1/2 of the health plan costs per employee, just assume that that is $200 a month of a total of $400 a month. The break-even is just at 4 months. Cash strapped employers will absolutely push their employees off into the new plan.

B) Over the course of the next 3 years, people will sue the federal government and it WILL be declared unconstitutional to require a person to enter into a contract with a third party to obtain insurance.B) In that 3 year period, private insurers will have had their business margins slashed and profitability will have been destroyed. With the high court ruling that the health reform act is unconstitutional, we will see a final destruction of these firms as the trend to buy insurance will be broken and good healthy clients will drop policies, while sick folks will retain them.

C) As a result of the court action, the federal government will step in with the only solution - a national health plan that is a one payer system (GOVERNMENT HEALTH PLAN). This will be the only fix as the collapse of private insurance plans will be complete.

It sounds ominous and sounds like a conspiracy doesn't it? The answer is clearly "YES" it does and guess what, it is all planned. Remember, the administration says they don't care what gets passed, just as long as it is passed. This is the gateway for the end goal of national health care. The first step is only a first step.

Do I think the system needs an overhaul? Yes, of course. I speak with people every single day that are declined by insurers.

Do I think this is the answer? No way.

Long term, you as a patient and consumer will pay more, have less choice, and ultimately wait much longer for medical services. Government is inefficient and is never the answer. In addition, all of the assumptions by the CBO and the administration don't account for the massive exodus from employer plans to the new government plan. This will be the major reason for massive cost overruns.

We have been told that the model for these plans are the VA system and Medicare.Remember two or three years ago when President Bush was blasted for the conditions and treatment of soldiers in the VA system during the Iraq conflict? Remember how the Democrats told us how terrible things were and how bad the hospitals were maintained? Ask a veteran that goes to the VA how quickly treatment is provided? This is the model?

Finally, if you think that government can run things well why is Medicare absolutely broke? Why would we model anything after this plan. The system is filled with fraud and costs are out of control. The government almost creates an environment where over billing is the norm because they reimburse providers at less than 50%. If you owned a practice wouldn't you do an extra procedure, lab, or other test simply to cover the cost of the haircut you'd receive?

Bookmark this post, I'm certain of only a few things in life, but I am sure this is a disaster waiting to happen. In the meantime, I'll rejoice as I'll sell a lot more policies and insure many of the kids that I've had declined previously. I better save my money though because the future is certainly dim over the long term unless the government allows for the sale of supplemental coverage to sit on top of the government run plan we are sure to have.