[Winona] FW: qotd: Medical-loss ratios oflargestfor-profitinsurers

[Dwayne and Denine Voegeli]

[Winona Online Democracy]

We don't just have a sick health care system.   More importantly, we have a sick political system.   Fix the political system, and democracy will heal itself.   Linda Fort made the good point about health insurance for the baby boomers.  That is a real fear and an important point.   But the people who should really be afraid are the Generation X'ers and today's young people.    Social Security, health care system, nursing homes, national debt...you name it, we're going to have to be living with it and paying for it. :-<   We need elected leaders who are brave enough to be honest.  We have to raise taxes AND cut programs.   I wish it wasn't so but it's reality.   Dwayne Voegeli   March 21, 2006   ========= I am sure I not the only one of the baby boomers who are worried/concerned what the cost of health care and insurance is going to be in the next 25+ years.  Our rates already went up this year and neither of us have turned 50 yet.  Being self employed we already have a $2000.00 deductable just to make rates somewhat affordable monthly.   Are we going to have to spend all our savings just to buy medications and pay for dr apppointments?  I just don't see how the health care problems in this country are ever going to change, no one besides the consumer seems to care. Not all of us will retire with a pension that covers health care coverage.   Linda Fort [Winona Online Democracy] Well, there would still be a need for insurance companies that would be responsible for processing claims and providing "supplemental" plans as they do for medicare, I suppose.   My recollection, though, is that even though the government doesn't processs medicare, the system has lot of flaws. It might be very frustrating for both providers and consumers if there aren't good information processing systems in place. Maybe Dick or Bill can comment on their experiences with medicare (part D and otherwise) and the relative ease of their claims processing to, say, MMIS II which is used for MA claims?   I, personally, believe that a single payor system is in the best interest of all, but I'm not sure how we will be able to transition.   Kathy Seifert ----- Original Message ----- From: LindaF To: winona@mnforum.org Sent: Tuesday, March 21, 2006 8:38 AM Subject: Re: [Winona] FW: qotd: Medical-loss ratios oflargestfor-profitinsurers [Winona Online Democracy]    I agree, but how are we going to do this when the insurance companies are so powerful with their lobbying?  Also would the drug companies want this type of coverage? I have been told they are only out to make a buck.  Someone I know is in Mexico right now getting cancer treatments that are not available here.  Her dr in LaCrosse told her if she went to Mexico not to come back to him.    Linda Fort [Winona Online Democracy] We clearly need universal coverage and a single payer.  Think "Medicare for all" without hundreds of HMOs involved like the Part D mess.  We must take the middle man out from between the doctor and the patient.  We must simplify the reimbusment process.  We must remove the administrative waste.    Craig Brooks check http://muhcc.org/ and  http://www.pnhp.org/ Duane Peterson <[EMAIL PROTECTED]> wrote: [Winona Online Democracy] Over the years I have heard insurance company statistics that attribute 15 to 25% of the premium dollars to the cost of underwriting and issuing the policy. The cost of claim processing has to be added to that. Health insurance has traditionally cost less than casualty insurance probably because of group coverage and less complicated claim procedures. ----- Original Message ----- From: "Davis, William MD" <[EMAIL PROTECTED]> To: Sent: Monday, March 20, 2006 2:28 PM Subject: [Winona] FW: qotd: Medical-loss ratios of largest for-profitinsurers [Winona Online Democracy] This is related to our discussion of medical fees and the impact of insurance. While it looks pretty good that they are spending 76 to 83% of premium dollars on health care, they are including the cost of processing claims and selling insurance as though it was being spent on patients. If you add in the cost of processing the insurance in hospitals and doctor's offices, the burden for patients is even higher. What is also unknown is whether companies include the cost of processing claims and selling insurance in the amount they spend on patient care. Bill William Davis MD [EMAIL PROTECTED] 507.454.5050 ext 623 825 Mankato Ave Winona MN 55987 American Medical News March 6, 2006 Health plans make more, spend less in 2005 By Jonathan G. Bethely If physicians needed any more indication of tightening reimbursement, how about this - not only did profits for the biggest health plans go up last year, but those plans also continued to cut the percentage of revenue they spend on care. The medical-cost ratio - also called the medical-loss ratio or medical-care ratio - is the key number for health plans in terms of their level of profitability. That ratio, simply, is the percentage of dollars the companies spend on health care. Whereas 10 years ago many plans had medical-cost ratios in the high 80s or 90s, now the highest percentage among large, publicly traded health insurers is Health Net, at 83.9%. Aetna, which had a medical-cost ratio well into the 90s when CEO John Rowe, MD, took over in 2000, recorded a ratio of 76.9% in 2005, Dr. Rowe's final full year before his retirement. That was the lowest medical-cost ratio for the nation's largest publicly traded plans. Medical-loss ratios for 2005 (Source: Company 10-K, year-end filings with the Securities and Exchange Commission): 76.9% - Aetna 82.3% - Cigna 83.9% - Health Net 83.2% - Humana 78.6% - UnitedHealth Group 80.6% - WellPoint http://www.ama-assn.org/amednews/2006/03/06/bisd0306.htm Comment: Clearly, one-fifth of health insurance premium dollars are not being spent on health care, but are consumed by the insurers. What does not show up in these numbers is the cost of the administrative burden that these insurers place on the health care delivery system. The billing and insurance related functions for physicians and hospitals burn up another 12 percent or so of the premium dollar (Kahn et al, Health Affairs, Nov/Dec 2005). Add these together, and that is about one-third of the premium dollar. We are very concerned about the continued escalation of health care costs. New technology and pharmaceuticals are adding to the spending on physicians, hospitals, laboratories and other health care services. We fret about these expenditures within the two-thirds of the insurance premium that actually makes it down to the health care system, yet we are ignoring the one-third that is wasted on administrative services that provide no health benefit for the patient. We are enriching this industry for providing coverage for the healthy workforce and their young, healthy families, and for covering the healthy sub-sector of the individual insurance market. We taxpayers are footing the bill for the population subgroups with greater health care needs. We certainly are not receiving much value from the insurers - letting them have the easy stuff at a very high cost. Wouldn't it be more logical to target their waste, rather than slowing spending growth by making health care unaffordable for those who do have needs? Why do we keep hearing that eliminating this industry isn't feasible? You would think that anyone with a modicum of business sense would believe that keeping them in charge is no longer feasible. _______________________________________________ Quote-of-the-day mailing list [EMAIL PROTECTED] http://two.pairlist.net/mailman/listinfo/quote-of-the-day _______________________________________________ This message was posted to Winona Online Democracy All messages must be signed by the senders actual name. No commercial solicitations are allowed on this list. 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