I think about this all the time...the way it was prior to managed care and it's invasion into the U.S. system (which has both good and bad elements by the way)and what was easy about it.....deductible, then coinsurance (you 10, 20, 30, 40% after deductible) and coverage for big stuff like hospital, surgery (in and outpatient) major rehabilitative therapy etc.... running to the doctor for a cold, was billed directly to the consumer...that is where the "wraps" came in to place, to cover other stuff like doc visits.
So a layman would say, wouldn't it help if the doctor-visit part of health insurance system were pushed directly to the consumer, wouldn't we save money? Short answer is yes, but we need to incentivize folks to go for annual check-ups, preventative visits, OB/GYN for women etc...so they do not end up in the ER with a $50,000 claim. Education and communication especially between employer's and employees is essential for workers to start becoming more health conscious and proactive about their ongoing illnesses etc...
I happen to think it would not all be bad if we pushed all of the major illness (hospital et al) to health insurance carriers to cover, as they know how to do it effectively, and create an opportunity for more competition in the market for "wrap around" plans to come back...buy exactly what we want, and to cover what we want (like car insurance per say) and have the price be commensurate with what we purchase.
High-deductible health plans are taking a better foothold now with the economic crash of the last 2 years, and they will surely continue to gain marketshare. Will we see the professional services (doc visits other than preventative) style benefits be pushed back to the consumer? If insurance carriers did that, and decreased their bureaucratic staff numbers by 30-40%, we would have no speaking of health insurance problems in the U.S. Thinned out insurance carriers, and unbiased advisors (brokers and consultants) have been working well in financial services and specifically in stock brokerage, life insurance brokerage, etc...so why not in health insurance?
Call a bureaucratic health insurance carrier and try to get a right answer first shot, no way. It is not to say they are all this way, but certainly, there is room to dramatically reduce overhead of internal staff (salaries, bonuses, commissions, employee benefits, worker's compensation, 401k matches, defined benefit plans, long-term disabilities) and push the work to outside brokerages (1099 the commissions they earn and you're done).....food for thought.
Monday, October 25, 2010
Wednesday, September 29, 2010
Consumer-Directed Health Plans
It has been a little while since I have done a brain dump....I will do much more tomorrow, but as both an entrepreneur/business owner, health insurance expert, and card-carrying consumer-directed healthcare BELIEVER, I come back to my same old thoughts. Consumerism is the only thing that will save pricing/affordability in the United States for health insurance. Though Republicans and Democrats mean well, they rarely use all of their HOT AIR on the real topic to discuss - consumerism. We need to stick with high deductible health plans, corporate HRA's, and showing businesses all over the U.S. to take back the control.
All carriers are the same...they will bend you over a barrel to make their shareholders or state/local officials/unions (non-profit plans) happy with the "returns". I am not certain anything will make an impact more than consumerism - no exchanges, no single-payer system (the WORST IDEA in last 100 years)...a universal system where everyone has to be covered (to spread risk) sounds great, but it blew up literally in Hillary Rodham's face almost 20 years ago now...it will never work either.
If businesses en masse moved to consumer directed health plans, and the ridiculous bureaucrats in Washington would push everyone on to the same page, the first impact would be a RADICAL cost reduction in premium, probably a need for another TARP sytem bail-out but this time of health insurance carriers right out of the gate to prop them up for the first 18-36 months of the transition...they would take a "haymaker" to the side of the head upon inception, then would get used to it over time. The immediate impact would be mid 1990s pricing, think about that, wipe out 15 years of increases (just like the 15 yrs of 401k gains and real estate gains you did to us - oh yeah, thanks banks and unscrupulous bankers, CDS/derivative salesman and woman!!) - sounds too good to be true? No it is true.
All carriers are the same...they will bend you over a barrel to make their shareholders or state/local officials/unions (non-profit plans) happy with the "returns". I am not certain anything will make an impact more than consumerism - no exchanges, no single-payer system (the WORST IDEA in last 100 years)...a universal system where everyone has to be covered (to spread risk) sounds great, but it blew up literally in Hillary Rodham's face almost 20 years ago now...it will never work either.
If businesses en masse moved to consumer directed health plans, and the ridiculous bureaucrats in Washington would push everyone on to the same page, the first impact would be a RADICAL cost reduction in premium, probably a need for another TARP sytem bail-out but this time of health insurance carriers right out of the gate to prop them up for the first 18-36 months of the transition...they would take a "haymaker" to the side of the head upon inception, then would get used to it over time. The immediate impact would be mid 1990s pricing, think about that, wipe out 15 years of increases (just like the 15 yrs of 401k gains and real estate gains you did to us - oh yeah, thanks banks and unscrupulous bankers, CDS/derivative salesman and woman!!) - sounds too good to be true? No it is true.
Monday, June 28, 2010
Healthcare Consumerism
So I find it funny...I get called and emailed daily by clients who have just received their 2010 group health plan renewals. The message is the same every time....20%!! or 34%!! or 36%!! Yep, it is here to stay folks and the way carriers will over-increase the plans that they can't keep up with, i.e. copay-based PPO plans...and we will see this every year for the foreseeable future.
So my message is a constant back....HRA with a high-deductible health plan...no not an HSA they are different and the company doesn't "own" them. The HRA I feel is the way employers can actually increase their benefits especially for the somewhat healthy employees, and the sick employees with huge bills, will indeed feel a bit of out-of-pocket in a year, as they should. I have had big bills before, and as a consumer I believe that is right. We can't afford a true socialized system in the U.S., and actually I have had direct experience with an Executive currently cleaning up the NHS in the U.K. which is currently crippled by a socialistic model. Don't believe everything you read is all I can say, and trust the source.
My firm actually makes TONS less in income selling high-deductible health plans with HRAs and does TONS more work on them than selling the easy "dummy" sale of a PPO with a copay plan.....problem is they are the problem. We are not part of the problem, but rather a part of the solution. I can't tell you how many times I have had HR push back on our strategy simply because the idea didn't come from the incument broker, and seems like a bunch of work. When we get the ear of a CEO/CFO our success rate is over 85%. Financial savvy executives flock to us, HR areas worry about the amount of work, which I can understand. Here is my personal take, we are all going to be replaced with outsourcing and computers if we do not do things in the corporate world to stop the inceasing spend on benefits, there will become no other choice but to completely outsource HR and Benefits to private companies. Another reason our clients (HR departments) love us....job preservation. We keep the finances in check, the tools are awesome, and or ideas keep the CEO and CFO happy.
As such, I call to you HR folks, please, please, trust us or someone like us....this is the solution to the never ending price increases which will contine to ramp back up and we are on our side in this revolution.
So my message is a constant back....HRA with a high-deductible health plan...no not an HSA they are different and the company doesn't "own" them. The HRA I feel is the way employers can actually increase their benefits especially for the somewhat healthy employees, and the sick employees with huge bills, will indeed feel a bit of out-of-pocket in a year, as they should. I have had big bills before, and as a consumer I believe that is right. We can't afford a true socialized system in the U.S., and actually I have had direct experience with an Executive currently cleaning up the NHS in the U.K. which is currently crippled by a socialistic model. Don't believe everything you read is all I can say, and trust the source.
My firm actually makes TONS less in income selling high-deductible health plans with HRAs and does TONS more work on them than selling the easy "dummy" sale of a PPO with a copay plan.....problem is they are the problem. We are not part of the problem, but rather a part of the solution. I can't tell you how many times I have had HR push back on our strategy simply because the idea didn't come from the incument broker, and seems like a bunch of work. When we get the ear of a CEO/CFO our success rate is over 85%. Financial savvy executives flock to us, HR areas worry about the amount of work, which I can understand. Here is my personal take, we are all going to be replaced with outsourcing and computers if we do not do things in the corporate world to stop the inceasing spend on benefits, there will become no other choice but to completely outsource HR and Benefits to private companies. Another reason our clients (HR departments) love us....job preservation. We keep the finances in check, the tools are awesome, and or ideas keep the CEO and CFO happy.
As such, I call to you HR folks, please, please, trust us or someone like us....this is the solution to the never ending price increases which will contine to ramp back up and we are on our side in this revolution.
Friday, May 28, 2010
Consumer-Directed Health Plan Thoughts for the day
Well, as an allergy suffered myself, and also the father of 4 young kids, 2 of whom also have allergies, here is my thought for the day. As I started waking up around 2 am this morning sneezing my brains out, I realized I had not taken my OTC CVS brand generic Zyrtec (Up and UP Brand)...45 Bills for 12 bucks folks.
I popped my med, tried to go back to sleep but could not as the med takes a couple of hours to be absorbed. Finally I stop sneezing, too late to fall asleep so I take on my day. I wait until 8:30am and call my family doctor, and get his kind nurse. I tell her my brains are popping out of my nose and that I need my Flonase refilled ASAP...quickly I catch myself, GENERIC Flonase that is, please make sure the doc fills with generic.
This move saved my 30 bucks, as the namebrand is WAY more than the generic and so is my out-of-pocket cost. But most folks would either not know to do this, or maybe get too lazy to even try generics. Well folks, the active ingredient in all generics are the same as namebrands, it can be other things that perhaps cause different side effects (the casing, i.e. makes your stomach upset for example)....I am no physician, but when it comes to "blindly" taking meds that docs write out on their pads, I always opt for generic as the costs are powerfully less. I am also always comparing Wal Mart, CVS, Costco just for starters, as they all have great Rx plans EVEN IF YOU HAVE NO INSURANCE. This in a nutshell is consumerism at its best, as these mega stors know consumer-directed health plans are here to stay, snagging ground, and are the only plans that will be affordable in the years to come for most of us. These mega stores also know the pharmaceutical industry is going to get it's own COLONOSCOPY with reform, and we will probably start seeing less Cialis commercials constantly throughout the day...yes those commercials translate in to costs for you at the CVS counter.
I wish I could scream from the rooftops as an entrepreneur, expert in the field of consumer-directed health care as well as industry veteran, and just plain old consumer...This is the only thing that will save the system, is us asking more questions, comparing costs, checking up on our own doctors etc...not OBAMANOMICS, NOT RAISING OUR COPAYS or passing on more of the employer's cost to employees, it is a shift in the buying and using decisions...there will always be folks to lazy to do so, or too adverse to change who will continue to erode healthcare in the U.S. but when CVS pharmacy's start using what is called a HARD EDIT, employees will start learning what I am talking about. A hard edit is when the CVS DENIES your brand name drug because your employer has chosen that option to demand dispensing generic meds, or you pay THE FULL COST OF THE BRAND NAME DRUG!! The are things that have been used for years for the biggest employers with the biggest budgets, and usually the biggest brains behind them...they have been 10 years ahead of what is happening now (or more)....welcome to the new world folks.
I will brain dump again soon -
I popped my med, tried to go back to sleep but could not as the med takes a couple of hours to be absorbed. Finally I stop sneezing, too late to fall asleep so I take on my day. I wait until 8:30am and call my family doctor, and get his kind nurse. I tell her my brains are popping out of my nose and that I need my Flonase refilled ASAP...quickly I catch myself, GENERIC Flonase that is, please make sure the doc fills with generic.
This move saved my 30 bucks, as the namebrand is WAY more than the generic and so is my out-of-pocket cost. But most folks would either not know to do this, or maybe get too lazy to even try generics. Well folks, the active ingredient in all generics are the same as namebrands, it can be other things that perhaps cause different side effects (the casing, i.e. makes your stomach upset for example)....I am no physician, but when it comes to "blindly" taking meds that docs write out on their pads, I always opt for generic as the costs are powerfully less. I am also always comparing Wal Mart, CVS, Costco just for starters, as they all have great Rx plans EVEN IF YOU HAVE NO INSURANCE. This in a nutshell is consumerism at its best, as these mega stors know consumer-directed health plans are here to stay, snagging ground, and are the only plans that will be affordable in the years to come for most of us. These mega stores also know the pharmaceutical industry is going to get it's own COLONOSCOPY with reform, and we will probably start seeing less Cialis commercials constantly throughout the day...yes those commercials translate in to costs for you at the CVS counter.
I wish I could scream from the rooftops as an entrepreneur, expert in the field of consumer-directed health care as well as industry veteran, and just plain old consumer...This is the only thing that will save the system, is us asking more questions, comparing costs, checking up on our own doctors etc...not OBAMANOMICS, NOT RAISING OUR COPAYS or passing on more of the employer's cost to employees, it is a shift in the buying and using decisions...there will always be folks to lazy to do so, or too adverse to change who will continue to erode healthcare in the U.S. but when CVS pharmacy's start using what is called a HARD EDIT, employees will start learning what I am talking about. A hard edit is when the CVS DENIES your brand name drug because your employer has chosen that option to demand dispensing generic meds, or you pay THE FULL COST OF THE BRAND NAME DRUG!! The are things that have been used for years for the biggest employers with the biggest budgets, and usually the biggest brains behind them...they have been 10 years ahead of what is happening now (or more)....welcome to the new world folks.
I will brain dump again soon -
Friday, May 21, 2010
Why HealthInsuranceGeeks Rule - Top 10
This is the beginning of what will become our version of the Top 10 Reasons to become a HealthInsuranceGeeks.com client:
10. We are very, very, very smart
9. Along with smarts, we are both marginally handsome
8. Along with "decent" looks and smiles, we have razor sharp whit and light-hearted personalities
7. Your broker based on our knowledge of our industry is basically a criminal if he/she is not moving you to a consumer-direct health plan strategy
6. Why #4 is so targeted?
5. Because other brokers drive Lexus's, where Rolex's and have beach houses....
4. We drive Toyota's and wear Timex Ironman watches..
3. Can guarantee 15-30% savings with our strategies - your brokers do not want that because it means they take a 15-30% pay cut - ESPECIALLY BIGGER BROKERS!!!
2. We happen to be Health Insurance Geeks - we are experts
1. YOU HAVE NOT GIVEN US A TRY....
10. We are very, very, very smart
9. Along with smarts, we are both marginally handsome
8. Along with "decent" looks and smiles, we have razor sharp whit and light-hearted personalities
7. Your broker based on our knowledge of our industry is basically a criminal if he/she is not moving you to a consumer-direct health plan strategy
6. Why #4 is so targeted?
5. Because other brokers drive Lexus's, where Rolex's and have beach houses....
4. We drive Toyota's and wear Timex Ironman watches..
3. Can guarantee 15-30% savings with our strategies - your brokers do not want that because it means they take a 15-30% pay cut - ESPECIALLY BIGGER BROKERS!!!
2. We happen to be Health Insurance Geeks - we are experts
1. YOU HAVE NOT GIVEN US A TRY....
Tuesday, May 4, 2010
Top Health Plan CEO Pay (2007)
Ron Williams, Aetna, 23+ million
Ed Hanway, Cigna, 25+ million
Dale Wolf, Coventry, 14+ million
Jay Gellert, Health Net, 3+ million
Michael McCallister, Humana, 10+ million
Stephen Hemsley, United Health Group, 13+ million
Angela Braly, Wellpoint, 9+ million
Well, well...............this is substantial evidence to overhaul their pay....should be seeing this from Obamanomics shortly, as it seems to be a conflict of interest to control payments of illnesses that kill, but take home 25 million?
Ed Hanway, Cigna, 25+ million
Dale Wolf, Coventry, 14+ million
Jay Gellert, Health Net, 3+ million
Michael McCallister, Humana, 10+ million
Stephen Hemsley, United Health Group, 13+ million
Angela Braly, Wellpoint, 9+ million
Well, well...............this is substantial evidence to overhaul their pay....should be seeing this from Obamanomics shortly, as it seems to be a conflict of interest to control payments of illnesses that kill, but take home 25 million?
High Deductible Health Plans
These go waaaaaay back. We were discussing the need for consumer-directed health plans (CDHPs)and consumerism in general as it pertains to health insurance 15 years ago....it is like Malcolm Gladwell's book "Outliers", these CDHPs have been hanging arond waiting for an implosion to then take root.
Now is that time, between Obamacare, which from my perspective will not do much more than open up more individual health plan purchasing, (canabalize the group market)and CDHPs, I think those coupled will develop the new market. We will get used to plans that do not pay first dollar (the copay) yet have deductibles and coinsurance for everything except preventive care. It is about time....if you step back and look at the copay, it is absurd and I am not sure how we got to expect them as a physician visit really should not cost 5, 10 or 20 dollars. With a structure that way (let's not even get in to the 100% inpatient benefit, that has CRIPPLED our healthcare economy) as we have been saying for years, we will end up with $2,000 single employee or personal purchaser rate in the coming years....so bye, bye copay, hello deductible and coinsurance. Couple that with health savings accounts (which can help from a taxation perspective, long-term savings) and network based care, and welcome to the new healthcare landscape. We will be penalized much more for going out of network, and we may also end up with the old referral system we so loved to hate in the 1990s....so basically we will end up Back to the Future, with plan designs like they were before managed care, but the network based care of managed care.
Hate to admit that I along with other colleagues predicted this 10 plus years ago, but that's the truth. I welcome any alternatives to this model, but as I see employers do away with group plans, set a monthly flat stipend per employee to go purchase their own health insurance, I know we are well under way.
Once Obamacare tax incentives take hold, and the greedy health insurance carriers are forced to give FREE preventive visits, un-do medical underwriting and pre-existing condition exclusions, I think we will end up with an a la carte menu much like GEICO auto-insurance, but if we have too much government, here we go:
"Welcome to McDonald's may I take your order please? Uh, yes, I would like a number 2 super-sized (5,000/person deductible, 80/20% coinsurance thereafter up to an additional $5,000 out of pocket) and I live in Charlotte so I would like that from, ummm, Aetna. No problem sir, and when you have any questions, just call our 800 number, we have the wait time down to an hour and 15 minutes. If you have a non-life threatening emergency (like a hip replacement that has kept you out of work) we will put you in our treatment wait-que, but don't worry, we can get that hip fixed in 30-40 MONTHS!!"
I don't know about you, but I do not want the government telling me when and how I can get treatment for a critically ill child or parent, PERIOD. I understand Obamacare et al need to pressure these GREEDY insurance companies (hello Ron Williams, CEO of Aetna, and your 165 million in stock options waiting to be exercised on a good earnings report, so you can buy another house) in to offering a more leveled playing field....yeah, yeah, I get that as well as anybody, we need REFORM, but go away Obamanomics, the government in this country is starting to be a George Orwell 1984 fulfilling prophecy....
Blow up Ron Williams,
Now is that time, between Obamacare, which from my perspective will not do much more than open up more individual health plan purchasing, (canabalize the group market)and CDHPs, I think those coupled will develop the new market. We will get used to plans that do not pay first dollar (the copay) yet have deductibles and coinsurance for everything except preventive care. It is about time....if you step back and look at the copay, it is absurd and I am not sure how we got to expect them as a physician visit really should not cost 5, 10 or 20 dollars. With a structure that way (let's not even get in to the 100% inpatient benefit, that has CRIPPLED our healthcare economy) as we have been saying for years, we will end up with $2,000 single employee or personal purchaser rate in the coming years....so bye, bye copay, hello deductible and coinsurance. Couple that with health savings accounts (which can help from a taxation perspective, long-term savings) and network based care, and welcome to the new healthcare landscape. We will be penalized much more for going out of network, and we may also end up with the old referral system we so loved to hate in the 1990s....so basically we will end up Back to the Future, with plan designs like they were before managed care, but the network based care of managed care.
Hate to admit that I along with other colleagues predicted this 10 plus years ago, but that's the truth. I welcome any alternatives to this model, but as I see employers do away with group plans, set a monthly flat stipend per employee to go purchase their own health insurance, I know we are well under way.
Once Obamacare tax incentives take hold, and the greedy health insurance carriers are forced to give FREE preventive visits, un-do medical underwriting and pre-existing condition exclusions, I think we will end up with an a la carte menu much like GEICO auto-insurance, but if we have too much government, here we go:
"Welcome to McDonald's may I take your order please? Uh, yes, I would like a number 2 super-sized (5,000/person deductible, 80/20% coinsurance thereafter up to an additional $5,000 out of pocket) and I live in Charlotte so I would like that from, ummm, Aetna. No problem sir, and when you have any questions, just call our 800 number, we have the wait time down to an hour and 15 minutes. If you have a non-life threatening emergency (like a hip replacement that has kept you out of work) we will put you in our treatment wait-que, but don't worry, we can get that hip fixed in 30-40 MONTHS!!"
I don't know about you, but I do not want the government telling me when and how I can get treatment for a critically ill child or parent, PERIOD. I understand Obamacare et al need to pressure these GREEDY insurance companies (hello Ron Williams, CEO of Aetna, and your 165 million in stock options waiting to be exercised on a good earnings report, so you can buy another house) in to offering a more leveled playing field....yeah, yeah, I get that as well as anybody, we need REFORM, but go away Obamanomics, the government in this country is starting to be a George Orwell 1984 fulfilling prophecy....
Blow up Ron Williams,
Monday, April 26, 2010
Advertising & Branding Companies
We specialize in helping smart creative companies, get smart and creative with their benefits portfolio. Just like I would ask questions of an insurance brokerage walking in to my office in a starched white shirt, tie, and suit (get with the times it is Gen X and Y coming in to the workforce fast, we like work-life balance!) I would also question anyone not understanding high-deductible health plans, with an HRA (company controlled) HSA (employee owned accounts that can be funded by employee and employer) combination..... take control of your cash flow, give BETTER benefits to your employees and stabalize premium increases. Insurance carriers that are pricing against this structure are going to be left in the dust, this is the wave of the future. To have one of our Geeks help you, visit www.healthinsurancegeeks.com or call 1-866-976-3977....it costs nothing to learn from the Geeks, but we want your business, believe me!
Wednesday, April 21, 2010
Health Reform - What happens in 2010?
Children up to the age of 26, can remain covered under parents medical plan...to me implemented in 2010. Also, no annual limits/lifetime limits on medical services, also in 2010. Most of the other items are coming in 2011 and beyond, also quickly, i.e. Jan 1, 2011, copays will not be allowed for preventive services even if you have a high-deductible health plan.
Tuesday, March 23, 2010
Health Reform Passes - So Now What?
Well, let's get to what appears to be stuff to happen in 2010....uninsured now, and with medical problems, folks will be able to buy insurance in 2010 through high-risk pools later in the year. How it is funded, what the cost structure is like and plan design remains to be seen (probably medicaid model).
Starting this year health insurance companies will not be able to exclude coverage for pre-existing conditions, and can't drop you suddenly from a policy for that reason too. Cost structure, how they rate, presumably more information to follow.
Young, college student aged kids on parent's polilcies, to be covered to age 26.
Employers with 25 or less employees will get up to a 35% tax credit towards the cost of providing health insurance to employees, again presumably on top of the deduction as business expense too.
Other milestones will be 2011, 2012 and ultimately 2014 when it will be required to carry health insurance in the U.S. Exceptions will be for severe financial hardship, elsewise folks will pay what has been published recently (in 2010 anyway) as up to a $695 dollar fine.
Starting this year health insurance companies will not be able to exclude coverage for pre-existing conditions, and can't drop you suddenly from a policy for that reason too. Cost structure, how they rate, presumably more information to follow.
Young, college student aged kids on parent's polilcies, to be covered to age 26.
Employers with 25 or less employees will get up to a 35% tax credit towards the cost of providing health insurance to employees, again presumably on top of the deduction as business expense too.
Other milestones will be 2011, 2012 and ultimately 2014 when it will be required to carry health insurance in the U.S. Exceptions will be for severe financial hardship, elsewise folks will pay what has been published recently (in 2010 anyway) as up to a $695 dollar fine.
Wednesday, March 17, 2010
The Flaw in What Obamacare DOES NOT Discuss Enough
Well, as an expert in this field for close to 20 years now, and having spent a considerable amount of my career in NYC, helping middle market companies combat health insurance premium increases, and "smart" benefit designs to prompt utilization that hopefully "slows" these carriers from ratcheting up premiums, I focus my attention on NYC specifically. There are some good intentions in Obamacare, honestly, but as an expert and listening to the often useless and almost nonsensical political jousting I get back to a place where the theme behind Obamacare has been in place, has not worked, and has pushed pricing to the SKY!!! NYC folks.... in NYC we have guaranteed-issue individual/family health insurance offered normally by just a few carriers (as they get forced to because they do tons of commercial business too) but in 2010 for example Empire Blue Cross Blue Shield, and Oxford Health Plans to name 2. We get calls daily of people looking for alternatives to their SINGLE rate of 985/mos to get an HMO plan, yes folks, almost $1,000/mos or a mortgage payment to have coverage that limits him/her to network only coverage. Well, that is exactly what Obamacare will deliver unless the young, healthy folks in this country are also forced to carry health insurance. The problem in NYC, is they can't deny coverage, and they charge the same rate whether you are deathly ill or healthy as a horse. The only catch for them to be able to apply pre-exisiting condition language is if you go beyond the 63 day "uncovered" HIPAA window (if you do not have coverage for greater than 63 days, you open yourself up to having pre-X language). So, when you get sick, you can jump in and buy, and not get denied, sounds great right? Wrong, that is how you end up with $1,000/month rate for a single 25 year old.
As such, we must have mandatory coverage like auto coverage, with a la carte plan designs, so if we want to buy hospital coverage and pharmacy coverage, but pay our own physician office visits, speech therapy, physical therapy and mental health visits, carriers should be forced to offer them....state and federal benefit mandates also kill the system(again another problem in NYC, where they mandate EVERYTHING to be covered in every offered policy - another way to DRIVE UP COSTS!).
So, let me lay this out again, a la carte plan designs, cheaper plan designs for higher deductible (my up front risk) and lesser benefits (no mental health, office visits, physical therapy, chiropractic care) and conversely, higher costs for folks who wish to have that coverage, AS IT SHOULD BE. We need to be paying a portion of the underlying benefits we consume, and others in our "risk pool" within insurance carriers need to be rated accordingly. Same thing for the "risk pools" of consumers with different product/plan designs.
I am not an actuary but have spent lots of my career around them and in HUGE institutions in which I used to work early on....smart people, who can figure out how to still get us what we need and make a profit, or perhaps not....maybe health insurance carriers should all be forced to be non-profit? Not sure on that, but strong arguement for it.
I hope this has given some insight in to the bigger problem with Health Care Reform...we do not need another NYC, nor Massachusetts (their mandatory system has absolutely imploded, for similar reasons to NYC)....
Let's go the route of how be must carry car insurance, and pay for what we actually have in benefits.
As such, we must have mandatory coverage like auto coverage, with a la carte plan designs, so if we want to buy hospital coverage and pharmacy coverage, but pay our own physician office visits, speech therapy, physical therapy and mental health visits, carriers should be forced to offer them....state and federal benefit mandates also kill the system(again another problem in NYC, where they mandate EVERYTHING to be covered in every offered policy - another way to DRIVE UP COSTS!).
So, let me lay this out again, a la carte plan designs, cheaper plan designs for higher deductible (my up front risk) and lesser benefits (no mental health, office visits, physical therapy, chiropractic care) and conversely, higher costs for folks who wish to have that coverage, AS IT SHOULD BE. We need to be paying a portion of the underlying benefits we consume, and others in our "risk pool" within insurance carriers need to be rated accordingly. Same thing for the "risk pools" of consumers with different product/plan designs.
I am not an actuary but have spent lots of my career around them and in HUGE institutions in which I used to work early on....smart people, who can figure out how to still get us what we need and make a profit, or perhaps not....maybe health insurance carriers should all be forced to be non-profit? Not sure on that, but strong arguement for it.
I hope this has given some insight in to the bigger problem with Health Care Reform...we do not need another NYC, nor Massachusetts (their mandatory system has absolutely imploded, for similar reasons to NYC)....
Let's go the route of how be must carry car insurance, and pay for what we actually have in benefits.
Friday, March 5, 2010
Thanks for so much Feedback
First, I want to thank all of our fans, and followers for so much great feedback on our blog, and what we say about health care reform, as well as the health care system including health insurance plans/coverage etc...so THANKS, it has been great to read, learn, and also be able to reflect on what assumptions some folks make based on their readings.
A few points of clarity, I as a specialist in this business for quite a long time have worked on and with some of the largest most complex businesses with their insurance woes (Like JPMorganChase, Scudder Kemper,even some of these mega-banks before they all merged)....I have also helped thousands of small businesses with their problems. So with that as a back-drop let me please clarify, my opinions and comments are based on lots of experiences, many years, things that have frustrated my clients and me, and also watching hours of debates from folks that I would deem to be way off "center" whether on one side of the political isle or the other. So with that said, I do not support what is on the table right now regarding Reform in its entirety as they are not talking incessantly and focusing on the real problem....THE WHOLE SYSTEM. Again as i blogged last time, I do believe we need to be accountable for researching our health care options, but we also need all of the stats to make informed choices...that is where technology is severely lacking from insurance carriers and providers (who need to get hooked up) - if I have ready data regarding the physicians that have performed thousands of ACL reconstructions (knee injury) have great rehab and success rates, low infection rates, and low recurrance of injury, and charge a fee that is reasonable (as it would be great to compare his/hers with a few other docs stats, and fees) than why in the world would I go to the "goon" down the road who charges double, screws me back together terribly with rapidly approaching arthritic symptoms and chronic pain, and ba-bing, I blow it back out running up steps to catch a train....SOMETHING IS WRONG HERE FOLKS. That is the "corner of the mouth" statement Obama says about "evidence-based medicine." That is the problem with health care, and rising health insurance premiums. Billions of waste in the system.
Somewhere we have "learned" that a person with a Harvard medical degree or Harvard Business School degree (or Stanford, Duke, Michigan, Columbia - so we do not just pick on Harvard here) is practically a law-abiding "God" who can't have criminal intent....I have read now for 2 years in the WSJ and other papers about what I would basically call criminal as far as the crap banks swapped with each other under the covers, so all parties could make repeated fees on the same crap and almost cripple the entire world economy.
I could talk for hours, and hours on this, and as someone educated in this field, who supports a capitalistic society, happens to own and operate a business, has four children of his own with his wife, has friends, parents, in-laws, nephews and nieces, likes the outdoors, is active, tells a funny story here and there, is not a staunch "anything political", and just basically thinks we need to get the healthcare system updated with good technology that supports paying for things that "work", I rest my case.
A few points of clarity, I as a specialist in this business for quite a long time have worked on and with some of the largest most complex businesses with their insurance woes (Like JPMorganChase, Scudder Kemper,even some of these mega-banks before they all merged)....I have also helped thousands of small businesses with their problems. So with that as a back-drop let me please clarify, my opinions and comments are based on lots of experiences, many years, things that have frustrated my clients and me, and also watching hours of debates from folks that I would deem to be way off "center" whether on one side of the political isle or the other. So with that said, I do not support what is on the table right now regarding Reform in its entirety as they are not talking incessantly and focusing on the real problem....THE WHOLE SYSTEM. Again as i blogged last time, I do believe we need to be accountable for researching our health care options, but we also need all of the stats to make informed choices...that is where technology is severely lacking from insurance carriers and providers (who need to get hooked up) - if I have ready data regarding the physicians that have performed thousands of ACL reconstructions (knee injury) have great rehab and success rates, low infection rates, and low recurrance of injury, and charge a fee that is reasonable (as it would be great to compare his/hers with a few other docs stats, and fees) than why in the world would I go to the "goon" down the road who charges double, screws me back together terribly with rapidly approaching arthritic symptoms and chronic pain, and ba-bing, I blow it back out running up steps to catch a train....SOMETHING IS WRONG HERE FOLKS. That is the "corner of the mouth" statement Obama says about "evidence-based medicine." That is the problem with health care, and rising health insurance premiums. Billions of waste in the system.
Somewhere we have "learned" that a person with a Harvard medical degree or Harvard Business School degree (or Stanford, Duke, Michigan, Columbia - so we do not just pick on Harvard here) is practically a law-abiding "God" who can't have criminal intent....I have read now for 2 years in the WSJ and other papers about what I would basically call criminal as far as the crap banks swapped with each other under the covers, so all parties could make repeated fees on the same crap and almost cripple the entire world economy.
I could talk for hours, and hours on this, and as someone educated in this field, who supports a capitalistic society, happens to own and operate a business, has four children of his own with his wife, has friends, parents, in-laws, nephews and nieces, likes the outdoors, is active, tells a funny story here and there, is not a staunch "anything political", and just basically thinks we need to get the healthcare system updated with good technology that supports paying for things that "work", I rest my case.
Wednesday, February 24, 2010
Health Insurance Premium Increases as bad as ever in 2010
I have been a professional in this business for close to 20 years now, and with all of the talks of health reform, I am pretty appalled at what health insurance carriers and their leadership has done rolling in to 2010. Small businesses are getting killed with some of the biggest premium increases I have seen in close to 20 years....we have had recent clients, SMALL BUSINESSES, getting hammered with 22-35% increases for the same benefits rolling in to a new year. It is obvious carriers are offsetting their lobbyists, the large companies in this country, by pushing costs over to individuals and small businesses - let's face it, from Aetna, to Cigna, to United Healthcare, depending on what part of the U.S. that you survey, they are in and out of the business of insuring small businesses year in and year out. It is also interesting that the highest paid CEOs in all of health insurance land, also happen to be the leaders of those carriers, United Healthcare, Aetna, and Cigna. They sure now how to enrich themselves, but perhaps it is time for the "pay czar" to step in and cap compensation for the leaders of health insurance carriers? As brokers for small business health insurance, www.healthinsurancegeeks.com, we spend time on each client each year, finding ways to lower their premium from past years' levels, or at least to remain level, which also by the way keeps our compensation level, or decreasing as well. Many brokers who enjoy the luxury of working less and less as years go on, and enjoying the fishing boat in the Hamptons, are the ones with concern. For folks like us, we work hard, it is our ethic as we are dedicated to a cause, rather than dedicated to the search of a less-than-hard earned buck, like many brokers of small and medium sized companies have enjoyed for years. The do their best to keep their clients at the same carrier year in and year out, to reduce the amount of work they do, because let's face it, public companies or large companies that are in the health insurance brokerage business are more focused on their shareholders, and profit models, than HELPING their clients. We have enjoyed such rapid growth at HealthInsuranceGeeks.com because we go above and beyond for all clients, whether they have 2, 20 or 200 employees. Clients can tell when you have passion to help, trust the Geeks.
Let's see what this Thursday, February 25th, 2010 does in the Blair House with all of the Goons from our Government continuing to "debate" on health care reform...remember, it is more than health INSURANCE reform, it is health CARE reform, so let's get all of the parties straight - doctors, hospitals, insurance carriers, governments both federal and state, medical device makers, pharmaceutical companies, insurance brokers, lawyers, I could go on and on, but those are some of the biggees -
Let's see what this Thursday, February 25th, 2010 does in the Blair House with all of the Goons from our Government continuing to "debate" on health care reform...remember, it is more than health INSURANCE reform, it is health CARE reform, so let's get all of the parties straight - doctors, hospitals, insurance carriers, governments both federal and state, medical device makers, pharmaceutical companies, insurance brokers, lawyers, I could go on and on, but those are some of the biggees -
Monday, January 25, 2010
Small Group Health Insurance
Well, where is reform? More than ever small employers needs a change in the continually rising premium structure alongside benefit buydowns. We are still seeing 15-25% renewal increases for our book of business which could not be more frustrating given all of the talk of fixing this broken system.
One this is very clear, we need plan designs for small employers that keep premium stable, as such high deductible health plans are selling much more often, as consumer are starting to realize paying a substantially lower premium for say a 1500 deductible plan still allows that person to benefit from negotiated rates between physicians and insurance carriers, even though a "sick" visit in office may go "towards the deductible." So for example, your child gets sick, you have a 1500 deductible, and you take him to the pediatrician. The visit is 110 dollars, but the negotiated rate between, let's say Aetna, is 58.50...well, you pay the 58.50 at the point of service from the doctor, not the 110. That is good news as those of us with families, and that are in good health but each of us perhaps go to the doctor 1-2 times per year, a high deductible plan is perfect.
We need carriers to radically reduce premium structure on high deductible health plans - they have not yet, because they have not been forced by the government, YET...they are still GOUGING the consumers.
I am a married father of 4, and just bought an individual plan (though i own a small business myself!!) for my family for 288/mos from Humana with a 7500 deductible. It is better than not being covered, and also has preventive care and a good Rx card, which takes care of most of our normal charges. I look at buying my own health insurance just like car insurance now. I am willing to take on a big charge if something "catastrophic" occurs, but would rather pay a substantially lower premium that offsets our yearly charges for the care we have received on average for the last 10 years.
I hope more people continue to come to the Geeks so we can help you make the same kind of choices. It is obvious the government is not going to help us.
One this is very clear, we need plan designs for small employers that keep premium stable, as such high deductible health plans are selling much more often, as consumer are starting to realize paying a substantially lower premium for say a 1500 deductible plan still allows that person to benefit from negotiated rates between physicians and insurance carriers, even though a "sick" visit in office may go "towards the deductible." So for example, your child gets sick, you have a 1500 deductible, and you take him to the pediatrician. The visit is 110 dollars, but the negotiated rate between, let's say Aetna, is 58.50...well, you pay the 58.50 at the point of service from the doctor, not the 110. That is good news as those of us with families, and that are in good health but each of us perhaps go to the doctor 1-2 times per year, a high deductible plan is perfect.
We need carriers to radically reduce premium structure on high deductible health plans - they have not yet, because they have not been forced by the government, YET...they are still GOUGING the consumers.
I am a married father of 4, and just bought an individual plan (though i own a small business myself!!) for my family for 288/mos from Humana with a 7500 deductible. It is better than not being covered, and also has preventive care and a good Rx card, which takes care of most of our normal charges. I look at buying my own health insurance just like car insurance now. I am willing to take on a big charge if something "catastrophic" occurs, but would rather pay a substantially lower premium that offsets our yearly charges for the care we have received on average for the last 10 years.
I hope more people continue to come to the Geeks so we can help you make the same kind of choices. It is obvious the government is not going to help us.
Tuesday, January 5, 2010
Financing of Health Reform
Well, not sure on this one....everything I read points towards a new tax on the wealthy, and surcharges on very "rich" plan designs or "cadillac" type insurance plans.
I wish the republicans and democrats could work out a truce, but that seems highly unlikely. We sell individual health plans, and small group plans all day long, and the same things are discussed with consumers of ours on the phone every day. We need a system where the healthy and the sick are insured all together, therefor providing affordable benchmark plans. The problem is the healthly folks who do not want to pay for insurance plans (who can blame them, they feel they do not "need" it right now) are not in the bigger pool, as such, the sick are left with high claims and not enough overall "premium" to fund the expenses. Then if the healthy become "sick" they then want to be able to jump in to the "pool" because now they need it...that's the GOTCHA, then any carrier in it's right mind "net's" those folks with medical underwriting to prevent folks adversely selecting against them. I have heard and seen this as long as I have been in this business, and that has been quite some time now. I think we need to have a mandate of coverage, similar to driving car without insurance coverage, and penalties alike, to get everyone sick or healthy in the "boat" together, as well as disbanding many of the federal and state mandated benefits, so we have a la carte coverage. If I want no Rx, no doc visits, just hospital (not even mental health) for myself and my family, give it to me - but do not charge me more than 200/mos for it, because that is really what this stuff should cost.
I wish the republicans and democrats could work out a truce, but that seems highly unlikely. We sell individual health plans, and small group plans all day long, and the same things are discussed with consumers of ours on the phone every day. We need a system where the healthy and the sick are insured all together, therefor providing affordable benchmark plans. The problem is the healthly folks who do not want to pay for insurance plans (who can blame them, they feel they do not "need" it right now) are not in the bigger pool, as such, the sick are left with high claims and not enough overall "premium" to fund the expenses. Then if the healthy become "sick" they then want to be able to jump in to the "pool" because now they need it...that's the GOTCHA, then any carrier in it's right mind "net's" those folks with medical underwriting to prevent folks adversely selecting against them. I have heard and seen this as long as I have been in this business, and that has been quite some time now. I think we need to have a mandate of coverage, similar to driving car without insurance coverage, and penalties alike, to get everyone sick or healthy in the "boat" together, as well as disbanding many of the federal and state mandated benefits, so we have a la carte coverage. If I want no Rx, no doc visits, just hospital (not even mental health) for myself and my family, give it to me - but do not charge me more than 200/mos for it, because that is really what this stuff should cost.
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