Blue Mass Group

Reality-based commentary on politics.

Health Care: Connector swings and misses

By

No, no, no, this is not going to work:

At today’s meeting, the Policy Committee members and the public who attended learned that the average premium for MCC [Minimum Creditable Coverage, the “cheap” option] plans submitted by the State’s insurance carriers will require premiums in the range of $379 per month for individual coverage; the plans will carry deductibles as high as $2000 for individuals and $4000 for families, with total out-of-pocket maximums of $5K and $10K. One of many alarming aspects of this is that the MCC plans will set the minimum standard for what individuals are expected to purchase to comply with the individual mandate. [my emphasis]

And $379/month is the “Minimum Creditable Coverage”! Wow, expensive and crappy coverage. Great work, guys!

Look, if this is the kind of stuff the insurance companies are going to try to foist on the public, we need to see absolutely everything on which they’re basing their proposals — their costs, their administrative overhead, their risk assumptions, profit margins, everything. And these days, we need to be ready to regulate the heck out of the industry to assure that the public is not getting screwed over, buying “mandatory” crap.

John McDonough posits a motive by the insurers who put forth these plans:

Is it possible there’s a game afoot here? The insurance plans are being asked to participate in the new Connector-sponsored market, at the same time they continue to offer plans in the non-Connector market, plans which have been pretty profitable for them. Are they acting to comply with the requirement to offer plans through the Connector, and deliberately making them as unattractive as possible so as not to undercut their non-Connector portfolios? Who knows?

In other words, they didn’t want their state-mandated business digging into their non-state business. But if that’s the case, the state should at least demand, in effect, a volume discount, if not regulate the price outright, or even create its own product to compete with the insurers.

Furthermore, this just shows how big a hole the new health care law left for working folks that don’t get insurance from their jobs, and don’t make tons of money. This proposed “coverage” will leave working families that much closer to the poorhouse, closer to missing their rent payments, closer to skipping out on food, even — and still not adequately cover health costs! What garbage. What a disgrace. What a waste of effort on the part of the Connector.

And let’s not forget the either-fanciful or flat-out dishonest claims by ex-Gov. Romney that these plans would cost around $200 a month. What a bait and switch — and he knew it was coming, he just knew he wouldn’t be around to deal with the consequences.

I fully expect Gov. Patrick and a slew of legislators to take an intense interest in this. The fight is on.

You might want to call your legislators at 617-722-2000 and tell them if you think the proposed “Minimum Creditable Coverage” plan is affordable to people of modest incomes, and whether it’s a good deal for anyone — and that you expect insurers to be accountable and transparent to the public if they’re going to get their business through the state.

(Oh, and I shouldn’t neglect to ask: Why do we have to deal with insurers at all? Why not just knock down this whole industry that holds hostage human beings and our economy as a whole, and go single-payer, with the state as the only insurer? Insurers should know that the public has options.)

Please share widely!
fb-share-icon
Tweet
0

Comments

  1. Fixed

    <

    p>

    I fully expect Gov. Patrick and a slew of legislators to take an intense interest in this. The fight flight is on.

    <

    p>
    Seriously, if the Connector Coverage craters, everyone will run for cover.

    <

    p>
    Romney: Patrick broke it.
    Patrick: Romney broke it.
    Leg: Road Trip!  … Gazebos.

    <

    p>
    I don’t think it’ll crater. Not yet. Too soon. All underwriters don’t have their policies built yet.  More pricing will come out and time will tell if the percent coverage is out there.  If not, then tough choice to i) ignore enforcement ii) subsidize the uninsured even more.

    • You can’t “break” what was never there to begin with.

      <

      p>
      I hope you’re right about the pricing. In any event, I fully expect that we’ll see the lege carve out exceptions to the mandate before spending more $$.

  2. Ignoring the problems that Charley brings up on the connector for just a moment, will the $295 (or whatever it is) charge on businesses for the uninsured result in those businesses increasing coverage at all?

    <

    p>
    My point is this: even if the answer is no enforcement on the mandatory because the connector coverage is too expensive, will this whole ordeal result in some more people insured anyway?  If so, do we have any sense for how many?

    <

    p>
    Furthermore, is it possible that these new people added to the risk pool, plus any progress the Dems in Congress make on medicare/other pharma negotiations, plus anything I’ve forgotten result in decreased cost for insurance (if only by a little bit), thereby helping yet a few more people get coverage who wouldn’t have gotten it otherwise?

  3. A few years back I read a book called “About Face” by Col. David Hackworth.  Now deceased, Col. Hackworth was the most decorated member of the US Armed Forces, and was one of the few very-successful commanders in Viet Nam.  He later went on “Meet the Press” to denounce that war, and then resigned from duty.

    <

    p>
    In the book, I recall Col. Hackworth relating how he knew the military was in big trouble in the 1960s when he observed that, during war games, a group of troops could “take” a hill simply by charging up it en masse.  Of course in a real war they’d all be slaughtered by enemy fire.  And when the real war came – they [u]were[/u] all slaughtered.

    <

    p>
    The odd history of the Chapter 58 health care mandate has always reminded me of the faux hill-takings Hackworth described.  A bunch of elected officials simply made up a plan, proclaimed victory over healthcare, shook hands, and went home. Huzzah! Huzzah! Huzzah! 

    <

    p>
    Ladies and gentlemen: simply proclaiming that a new and never-tried plan will be better than the status quo doesn’t actually make it so.  Mathematics is a harsh and immutable thing, and it won’t listen to your legislation.  Even if you threaten it with fines, and get the Boston Globe to write condescending articles about how politically unrealistic Math is, Math won’t budge.

    <

    p>
    Perhaps now we can get down to the reality-based work of implementing single-payer halthcare, which costs far less, and produces better medical outcomes, in every industrialized country where it’s been tried.

    <

    p>
    I’m sure that I’m not the only one who’s disturbed by paying the highest health care costs (by far!) for health care that yields a life expectancy that’s only 48th in the world, and infant survival that’s only 43rd.

    <

    p>
    C’mon people – let’s get real.

    • If my memory serves me right, the whole health-care “plan” was ginned up so we wouldn’t lose a large chunk of federal funding.  I don’t really see how anyone could be disappointed by a plan that was scribbled on the back of an envelope in order to service federal grant rules and Romney’s campaign aspirations.  It would be ridiculous to expect better.

  4. that everyone expected, from advocates of universal healthcare to the cynics.

    <

    p>
    Last year’s health-care victory was never anything more than an opening–a path to this moment, when everyone is supposedly on board for healthcare and the plan isn’t working

    <

    p>
    The question is, what do we do? Depending on the answer this is either the begining of really getting serious, or proof that the problem is really intractable.

    • we’ve got to wise up and expose the fact that “everyone” involved in health reform does not have altruistic, humanitarian, or ecomnomic stewardship motives as their primary motives for being involved.

      <

      p>
      The reality is as Kuttner states simply and accurately in his op-ed today: “Reformers seeking universal coverage should recognize that the private insurance industry is less a credible partner than the prime obstacle”.

      <

      p>
      It also needs to be pointed out that this is most certainly NOT “the moment that everyone expected”.  in fact, quite a few tens of thousands of voters who signed a certain initiative petition expected to have, at this moment, firm legal standards in place to guide ongoing health reform, established by a health care constitutional amendment that had either been passed already (approved by the voters on the Nov 2007 ballot)or would be heading to the 2008 ballot.  this issue ain’t dead yet, and might not be until it’s on the ballot eventually, one way or another…

      <

      p>
      The public has not weighed in on THE MOST important health reform questions that must be posed and discussed thru public dialogue directly and honestly – ha! that’s impossible with legislators and congress letting insurers push/buy their way into the drivers seat on reform plans.

      <

      p>
      Kuttner acknowledges the good done by expanding subsidized coverage for the poor but then explores implications of the larger scope of the MA reform law when he asks
      “…But is it the right door?”

      <

      p>
      The fundamental direction of the new health plan takes us through the door of manadating the purchase of private insurance. This was shrewdly brought to us by none other than the state’s largest insurer, MA BCBS, in what clearly appears to be a strategic move to slam shut another door, the door leading to a public sector role for providing affordable coverage. Background on this conclusion here.

      <

      p>
      select excerpts from today’s op-ed expand on these points and relates them to national level reform plans

      Health insurance dilemma, by Robert Kuttner, Boston Glob, Jan 20, 2007

      …But is it the right door?…It’s commendable that more people will be covered, though the current funding is inadequate to meet the promises. But the Massachusetts approach builds on, and reinforces, an inefficient and fragmented system — one where private insurers divert too much money from medical care and have too large a political role. In that respect, the strategy takes us further away from efficient, universal health insurance.

      …By partnering with the insurance industry, state policies could end up improving the statistics on people insured — and worsening the broader problem of under insurance.

      …A better alternative was recently proposed by Yale professor Jacob Hacker and the Economic Policy Institute. Employers would either have to provide good insurance or pay a tax of 6 percent of payroll. People without insurance could buy into a public program much like Medicare, on a sliding scale. That same program would enroll people whose employers elected to pay the tax instead of providing insurance.

      Hacker estimates about half of all Americans would soon be in the universal pool. Over time, the superior efficiencies of the public program would attract more people. The private health insurance industry, as a superfluous and inefficient middleman, would dwindle. Eventually there would be universal and public coverage without the fragmentation.

      …Reformers seeking universal coverage should recognize that the private insurance industry is less a credible partner than the prime obstacle.

      <

      p>
      If this stuff interests and/or motivates you to learn more and maybe get involved in health reform in your community check out their website resources and contact the nice folks here at Mass-Care.

      • It is clear that the only real value, if any, of the health-care agreement last year was as a kind of placeholder for when this moment came. It was clear at the time.

        <

        p>
        Since then, a number of things have happened:

        <

        p>
        California has put a more-muscular version of the plan on the table, which has raised expectations nationally.

        <

        p>
        Mass. legislators unconstitutionally blocked a final vote on the proposed Health Care Amendment, also raising expectations by making last year’s agreeement the only game in town (rhetorically if not in fact).

        <

        p>
        I do not endorse either of these developments but clearly health-care advocates should use them to the fullest on Beacon Hill in the months ahead.

  5. I love John’s line:

    <

    p>

    Is it possible there’s a game afoot here?

    <

    p>
    Oh, gosh, d’ya think?  And I was expecting the insurance companies to do their gosh-diddly-darndest to make sure that even the least well-off among us would have access to quality, affordable health care.

    <

    p>
    And in case you were thinking that the insurers are happy with just charging exorbitant premiums for a crappy product that everyone in the state has to buy — they’re not.

    <

    p>

    A spokesman for insurers said the requirements were too prescriptive and could undermine the goal of universal coverage.

    <

    p>
    Folks, this plan — and the hare-brained individual mandate that accompanies it — is now officially a joke. 

    • There’s a big group who really wants to trash this before it starts, but be realistic.  I think it’ll fail because a more free market solution is in order.  You may think it’ll fail and favor single payer.

      <

      p>
      The one certainty is that it will fail if not tried.  Upthread, I pointed out that these aren’t final products, also:

      <

      p>

      At today’s meeting, the Policy Committee members and the public who attended learned that the average premium for MCC plans submitted by the State’s insurance carriers will require premiums in the range of $379 per month for individual coverage

      <

      p>
      Average of $379.  That’s too high?

      <

      p>
      Could that be two policies, each costing $200 and $558 per month? or 10 different products ranging from $1.59 to $1000, or … but no, let’s jump to criticize the product now cause later facts will only cloud the discussion. 

      <

      p>
      And I’m at least as skeptical as you on the likely success of the Connector, but Mr. McDonough over reacted. 

      <

      p>

  6. Don’t let it go unnoticed that these soon to be mandated insurance policy price decisons were announced on a Friday and are due to be voted on the following Monday (see article below).  Gee, “interesting” timeframe.

    <

    p>

    Sticker shock for state care plan: Average premium of $380 outlined By Alice Dembner, Boston Glob, Jan 20, 2007

    “A state panel yesterday outlined for the first time the minimum requirements for coverage under the state’s new health insurance law, a package estimated to cost $380 a month on average for an individual, more than $100 above recent estimates.

    …After the 10-member board votes on the requirements Monday, there will be a public hearing on Feb. 16, and then the rules could be revised. However, the board needs to move quickly if new health plans are to be ready for the public by July.

    …Until Monday’s meeting, groups representing residents, insurers, hospitals, and others will be lobbying board members.

    <

    p>
    I wonder how many health care advocates have contact information needed to effectively “be lobbying [Connector] board members” over the weekend!!

    <

    p>
    I only wish this was a joke.  It’s not.  Maybe a farce. The amount of money in play here is staggering.  And it’s largely OUR MONEY, isn’t it?  So whaddya say, as Charley puts it: “Why do we have to deal with insurers at all? Why not just knock down this whole industry that holds hostage human beings and our economy as a whole, and go single-payer, with the state as the only insurer? Insurers should know that the public has options”

    <

    p>
    Maybe you’ll get fired up looking over the alarming analysis of health spending in Mass. – $62Bil in 2006 – by Sager and Socolar to better understand how much of a tragic farce this situation really is.  And to know why we’ve got to demand a just remedy to it.

    <

    p>
    (p.s. to David the opera guy: is there such a thing as tragic farce?)

    • I read the entire Sager and Socolar white paper, and it summarizes in detail the current health care spending patterns and cost structures in MA.

      <

      p>
      But besides demanding, page after page, that costs be reduced, they DO NOT provide workable solutions … well, except for one general theme: government should take over this sector of the MA economy in a centralized state-run single-payer system.

      <

      p>
      This, it appears, is what AnnEM believes is the only way costs can be controlled.  And so, we must have a single payer system.

      <

      p>
      The current mandatory-insurance experiment was always, in AnnEM’s world, simply a stepping stone to full government takeover of our health insurance industry.  Ergo, the Connector must fail!

      <

      p>
      To begin the debate by demanding cost control is deceptive and dishonest.  Stop demonizing insurance companies and the pharmaceutical industry (both huge employers in MA, by the way,) stop whinning about “our money” (my premiums are mine, not Beacon Hill’s) and start asking for what you really want – socialized medicine in MA.

      <

      p>
      PS … health care is not a right however many times you claim it is.

      • Ann can certainly speak (write) for herself, but I think that she wants universal single-payer healthcare (i.e., Medicare for everyone) rather than socialized medicine (as practiced in the UK, for example).  That being said, compared to US “private” helathcare, either single payer or socialized medicine costs far less, and produces measurably-better outcomes, in every industrialized nation where it’s been implemented.

        <

        p>
        You seem to dislike the idea of moving to a system that costs less and gets better results every time it’s used.  Why?

      • Well, duh.

        <

        p>
        That’s why I and so many others have worked for four years to establish it as a legal right, as was referenced in an above comment.

        <

        p>
        Tens of thousands of Mass. voters signed a certain initiative petition and we rightly expected to have, at this moment, firm legal standards in place to guide ongoing health reform.  These standards were to be established by a health care constitutional amendment making “comprehensive, affordable, equitably financed health insurance” A CONSTITUTIONAL RIGHT for all state residents.

        <

        p>
        It is reasonable to have the expectation that that amendment would have either been passed already (approved by the voters on the Nov 2007 ballot)or would be heading to the 2008 ballot.  Of course I’m an optimist in expecting it would pass, and I know that polls were showing 80% support for it. 

        <

        p>
        Instead, on Jan 2, 2007, 101 legislators chose to break the law, expose themselves as hypocrites, and not vote on the citizens health care amendment.  Stay tuned.

        <

        p>
        p.s. I do not wish for socialized helath care delivery; I do wish for streamlined and equitable healthcare financing that is administered by the government.  Quality health care is guided by clinical needs, science and compassion, not by corporate greed and fortune-seeking. (Manny’s comments are on the mark).

        • health care should never be a constitutional right.  It’s a legislative matter, not a constitutional one.  Enshrining every social good as a constitutional right requires the state to protect that right.  Doesn’t that means providing that social good to people cannot afford it?

          <

          p>
          What’s next?  A right to home insurance?  Auto coverage? The right to low-cost gasoline?  Right to ride the T for free?

          <

          p>
          Why health insurance and not 50 other crucial conomic benefits?  How about a right to housing?  “Everybody, regardless of economic means, should have a right to housing.  I have no money, so the state has to give me the money to get one because it’s my right!”

          <

          p>
          Where’s it stop?

          <

          p>
          Reminds me of the so-called EU constitution … 800 pages trying to proscribe a laundry list of rights.  An impossible task, and a blueprint for economic disaster.

          <

          p>
          By the way, if “streamlined and equitable healthcare financing that is administered by the government” isn’t socialized medicine (and an oxymoron, too), I don’t what is.  If the government is paying for it, then it is they who will determine the level of health care services and “clinical needs,” not me and my doctor.  This has been the experience for all socialized medicine worldwide.

          <

          p>
          I, for one, would rather take my chances in a free and open marketplace for health services and medical insurance than let the solons on Beacon Hill tell me what statin is best for me.  (In Canada I would not be able to get the only statin which has lowered my chloresterol.  It’s not availble in their national health system’s formulary.)

          <

          p>
          AnnEm, here’s your plan as I see it: Step One, make health care a constitutional right.  Step Two, let the government run it.

          <

          p>
          No thanks.

  7. I am currently paying $388/month, with no prescription coverage.  I expect the rates to go up in March for the annual renewal.  Every year they have gone up quite a bit.  $379 may be the best deal I can get.

    <

    p>
    But I knew it.  I laughed when I heard the $200/month estimate.  That was certainly created by people smoking crack.  If I may quote myself, from April, here at BMG:

    Absolutely a draw for entrepreneurs

    I started my own business a few years back.  And I talk to a lot of people who would like to start businesses at entrepreneurs groups–they are high energy folks with great ideas.  But the first question they always ask me is: how do you get health insurance?

    Also, I talked with someone who I would consider hiring.  But flat out she said she can’t leave her corporate job that she hates because she can’t risk losing the good insurance for her family.  Her husband is a landscape/lawn care type, self-employed, and so she carries the insurance.

    I’d like to know where you can get the BC/BS for $250.  I’m paying $388/month for my plan, with no prescription coverage.

    If you want to see my rate options, they are here:
    http://i4.photobucke…

    • People in their fifties pay $1,500/mo for similar coverage.

      <

      p>
      Before ANY of you go on about the outrageous cost of $379, call your employer/health care provider and find out what the cost of your COBRA would be.  THAT is the actual cost of your plan.  For years, when I did health plans, and people quit and signed up for COBRA, they did not BELIEVE that their employer wasn’t ‘sticking it to them’ and that they had really been paying that much all along.  That was my single biggest gripe about HMO’s – it conditioned people to think that a doctor’s office visit really DID cost $10 instead of the $75 paid by the company!

      <

      p>
      Another thing to think about – I always enouraged people to take the very highest deductible they could, and set up a medical savings account (in Mass., you still can’t have a tax-free MSA, but you can at least have a savings account!)  TREAT HEALTH INSURANCE LIKE INSURANCE!  Do you submit a claim every time the paint is scratched on your car?  What do you think homeowner’s insurance would cost with a zero decutable for every time you broke a dish?  TAKE a $2,000 or $5,000 decuctable, and EXPECT to pay for a routine doctor visit or strep throat prescription.  I spent ten years in the industry, and I will tell you what I told every customer I ever had – a dollar paid in premium is a dollar lost to you forwever.  MINIMIZE that by assuming the maximum feasible risk – enough so you don’t lose your house in the event of a serious illness – and keep your own money, because usually, you don’t GET sick.

  8. My question, to echo PP, is: what do you think would be cheap and good coverage. Let’s have some numbers. Absent any point of comparison, aren’t we just arguing in a vacuum.

    • Great coverage: $500 per month.  Reasonable co-pays say ($5,5,50/drug, visits,emergency) with no cap on lifetime coverage.

      <

      p>
      Middle: $350.  Different depending on situation:  family coverage, coverage of those with high prescription needs,

      <

      p>
      Low end: $200.  High co-pays say ($15, 15, 50/drug visits, emergency). For the healthier, or less wealthy or less risk adverse.

  9. …the entire health care financing system in the United States of America is so f_cked up (pardon my french) and so larded with special interest fat that it will never ever be fixed.  I’ve gone on and on about this elsewhere, from the universities who make medical instruction so expensive that their graduates are in debt to them to the tune of the price of a house in Weston when they graduate, to the pharmaceutical companies who are only interested in selling “life-style drugs” because the people they get hooked on them are buying them for a “life-time.” 

    <

    p>
    And the insurance companies do nothing more than process claims for this sham of a health care system (to try to deny claims, of course) and they take their cut.  But they aren’t the cause of the problem, merely a symptom.

    <

    p>
    Other countries really do do it better.  Try Germany, for example.

Archives