READY OR NOT, BIG CHANGE IS COMING: THE IMPENDING DEATH OF PRIVATE HEALTH INSURANCE

Most of us have by now heard many indictments of private health
insurance, from its inefficiencies and unaffordable costs to its
profiteering, cherry picking, and avoiding coverage of those who most
need insurance. What’s new and may be surprising to many people is
this: despite its size and political power, it is a dying industry.

 



The industry’s track record speaks for itself. It is an imploding
industry on a death march. The costs of insurance premiums alone have
become unaffordable for tens of millions of Americans, and are
increasing several times faster than costs-of-living and family
incomes. As the attached graphic shows, premiums will consume almost
one-third of average household income by 2010, and all of it by 2025!
Moreover, insurance covers less and less of total health care costs.

Access to affordable health care has become a major concern affecting
all middle class Americans, with no relief on the horizon. Private
insurers go to great lengths to avoid coverage of sick individuals and
even high-risk groups. As their employer-based market shrinks, they
desperately seek out new lucrative markets with near-worthless
limited-benefit policies. Their overall private markets are shrinking,
and they now turn to generously subsidized public programs, especially
Medicare and Medicaid, for revenue growth.

The health insurance industry is unsustainable, as some of its insiders
fear. Bernard Tresnowski, President of Blue Cross/ Blue Shield, issued
this warning in 1994: “The good old days, when nobody really paid a
lot of attention are gone. We’re now front and center in the public policy
sphere... What our future holds depends in many ways on our ability to
continue to control the rate of increase of health care costs...
It will be a real test over the next five to eight years as to whether
the private sector indeed can produce the kind of results that would
make health care more affordable.”

Even Wall Street analysts are seeing dark clouds on the horizon for the
health insurance industry. Commenting on precipitous drops in share
value of Wellpoint, the nation’s largest insurer, Sheryl Skolnick,
health care analyst and senior vice president at CRT Capital Group,
observed in April, 2008 “that it took Wellpoint imploding for us to
figure out that current prices of health plans do not account for
growth in medical costs,” and that in order to reverse their downturn
insurers must “create affordable health insurance plans that consumers
really want to buy instead of affordable-but-barebones plans that do
not offer consumers a compelling value.”

The industry’s 60-year report card is in, and it has failed the public
interest. It is now time to require an efficient, equitable and
sustainable financing system that can enable universal coverage for all
Americans of necessary health care by spreading risk across our entire
population. Subsequent posts will focus on the many ways in which
private health insurance cannot meet that challenge.

Adapted from Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, forthcoming, August 2008 by John Geyman. With permission of the publisher, Common Courage Press.

Order link http://commoncouragepress.com/index.cfm?action=book&bookid=396

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Insurance

I am worried that no candidates really get it, they talk about guaranteed health INSURANCE for all.......I want guaranteed health CARE for all. I have one question that no one has answered, what VALUE do the insurance companies add to the health care delivery system? The answer is of course, nothing, they are only a drain of dollars away from actual patient care. Every dollar of insurance executive pay and profits is a dollar NOT spent on actual patient care for some one. It is fairly simple if you look at it this way, yet few seem to get beyond the threat of the big boogie man, "socialized" medicine.

Insurance

I am familiar with this industry both as a former employee and as a "victim". I worked for 5 years for a health insurer before being laid off during a reorganization. During that time, I witnessed the typical shell game involving cherry picking and denials of coverage. A few years ago, the company began losing members and as a result, a massive reorganization of the staff and the processes occurred. I realized that this was a dead end field and decided to change carreers. I am now working part time and am studying to become an R.N.
Now, my wife and I are battling our insurer to pay the claims on a laparoscopic surgery that she had in August, 2006-- almost 2 years ago!!! The group policy under which she and I are covered is supposed to be a very good plan but they only have covered $700 out of a total of $3800. Since this is a self-insured plan, the state department of insurance has no authority to intervene. Our only recourse is to sue the insurer if they don't pay the claims.
My experiences with this industry lead me to believe that their days are numbered. According to numerous recent surveys, the majority of people in the U.S. dislike the current system and favor a single payer approach. Doctors and nurses also favor a complete restructuring of the health care system. I have also ordered this book "The Impending Death of Private Health Insurance" to get more insight into this issue.

Good for you Gregg!

Now if we can get the rest of America to see what you see! And good luck with your RN career. We are proud to have you among us. Keep insisting that your insurer uphold their end of the contract--you paid your premiums. They need to pay your claim.

Health care for all. NOW! No excuses.
www.nurseconscience.blogspot.com