The Obamacare Bomb Explodes

[Crazedclerkthe2nd]

As good as it sounds. I don't think that's what we'll see. I think realistically, the insurance companies (as they always do) will find ways around the law.

For example:

- Cite $20 000 cost of surgery for patient "John Brown"
- Distribute $20 000 to your top officers, while congress and the law turn a blind eye to the whole thing.

Now I'm sure it won't be that simplistic, but this is a complex framework we're talking about here and from where I sit it appears the opportunities for manipulation are endless.

I think anyone truly expecting wholesale change is deluding themselves.

[Talon]

Fascinating reading, but I'll believe it when I see it.

If you are right, and Obamacare makes a real difference, sure as I'm sitting here the legion of healthcare opponents will try to claim credit. I can already see their press release: "Uh well we were always in favour of better care for working-class Americans, but teh ebil Obama socialist-nazi-commie regulations stood in our way. Our tireless efforts have shown once again that the way to prosperity and health is less regulations and more free market blah blah blah..." I swear it's all becoming routine.

[bara]

Ive said before that health care is an industry that should not be profit driven. I have no qualms about health care professinals or anyone else for that matter being able to make a comfortable living. I mean they can have a nice house, the big screen, all that stuff that to many people use to describe success.
But Ive never been happy with the health insurance industry. They have limited peoples coverage and benefits while increasing costs for years. They use legal loopholes to get out of paying on legitimate claims, they deny insurance and therefore health care to the people who need it most. Ive heard of cases where some one had been getting thierclaims paid, but then becaause of a very silly and minor health issue they had in the past had their benfits cust off and then been sued by the insurance company to make reparations and it was all legal for them to do so.

The movie John Q. pretty much points out many of the misgivings of todays healthcare system.

[FArchivist]

The post below has been taken from a Forbes.com blog written by Rick Ungar

I have long argued that the impact of the Affordable Care Act is not nearly as big of a deal as opponents would have you believe. At the end of the day, the law is – in the main – little more than a successful effort to put an end to some of the more egregious health insurer abuses while creating an environment that should bring more Americans into programs that will give them at least some of the health care coverage they need.

There is, however, one notable exception – and it’s one that should have a long lasting and powerful impact on the future of health care in our country.

That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ration will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

Yesterday, that bomb went off. Yesterday, the Department of Health & Human Services issued the rules of what insurer expenditures will—and will not—qualify as a medical expense for purposes of meeting the requirement.

As it turns out, HHS isn’t screwing around. They actually mean to see to it that the insurance companies spend what they should taking care of their customers.

Here’s an example: For months, health insurance brokers and salespeople have been lobbying to have the commissions they earn for selling an insurer’s program to consumers be included as a ‘medical expense’ for purposes of the rules. HHS yesterday gave them the official thumbs down, as they should have. Selling me a health insurance policy is simply not the same as providing me with the medical care I am entitled to under the policy. Sales is clearly an overhead cost in any business and had HHS included this as a medical cost, it would have signaled that they are not at all serious about enforcing the concept of the medical loss ratio.

So, can private health insurance companies manage to make a profit when they actually have to spend premium receipts taking care of their customers’ health needs as promised?

Not a chance-and they know it. Indeed, we are already seeing the parent companies who own these insurance operations fleeing into other types of investments. They know what we should all know – we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it.

Whether you are a believer in the benefits of single-payer health coverage or an opponent, mark yesterdat down on your calendar because this is the day seismic shifts in our health care system finally get under way. If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone,yesterday is when you begin to understand that the reality is quite the contrary. If you believe that the end of private, for-profit health insurance is some type of nefarious step towards a socialist society, then you might want to attend church this Sunday to mourn the loss of health insurers being able to worm out of covering the bills of a cancer patient because she forgot to write down on her application that she had skin acne for three months when she was a teenager.

Of course, those of you who fear the inevitable arrival of universal health care really shouldn’t be too fretful. There will always be a for-profit health insurance industry for those who want to pay for it. The only difference will be that those who cannot afford private coverage will also have an opportunity to get their families the medical care that they need.

Everyone wins-except the for-profit health insurers.

I can live with that.