Why are for-profit hospitals acceptable but for-profit insurers aren't?

[Recursion]

Why is financing reform the only thing that people will consider "progressive"?

[Cheese Sandwich]

1. Neither one is acceptable but only one is up for debate in the election right now.

[Recursion]

3. Why is that? (nt)

[Cheese Sandwich]

6. Because the American people want it.

[merrily]

2. After four thousand anti Medicare for All threads, why don't you finally tell us your suggestion?

Otherwise, it could look like you just hate sick people.

[Recursion]

4. Global budgeting and expanding FQHCs. I've posted it dozens of times

Nobody ever seems to comment on those threads, though.

[merrily]

5. I've never seen you advocate for that. I've only seen OPs that look a lot to me like posting games.

Like the OP of this thread, for example.

[Recursion]

7. search my username and FQHC

Or any of my OPs about O'Malley's health care plan.

[merrily]

8. I know what I've seen over and over and over and over.

[Recursion]

25. Here

http://www.democraticunderground.com/10027307942

http://www.democraticunderground.com/1251847319

http://www.democraticunderground.com/10027306302#post174

http://www.democraticunderground.com/10024789647

etc.

[merrily]

32. Thanks. November 2015 and April 2014.

[Recursion]

34. I don't decide the order Google returns stuff in (nt)

[merrily]

35. Read only one of those posts so far. I will read the others.

I do prefer a more straightforward post making your case.

[polly7]

26. Yeah, me too. +1000. nt.

[KittyWampus]

9. For-Profit Insurers find ways to deny payments even when things are covered.

You've paid your premiums that rise steadily.

You have a condition and it should be covered.

Your insurance company refuses to pay and has employees whose main goal is to find ways to deny covering that condition.

Watch Moore's movie Sicko for some examples.

[TheBlackAdder]

11. Bingo! Often, it's the insurance company that acts as what Grassley & Palin call "death panels!" nt

[Ferd Berfel]

78. Exactly. Neither are acceptable BUT - insurers make their money by DENYING not by providing.

What the hell kind of question is this? THIS has to be explained HERE?

WTF? Too many right wingers in here.

[Matariki]

10. One is providing the actual service

the other is standing between you and the necessary service with their hand in your wallet?

[TheBlackAdder]

12. Yep, they just act as an intermediary to manage claims, with profit as a motive. nt

[Recursion]

37. Quite a few insurance providers are not-for-profit. Most Blue Cross organizations, for example.

What's their motive, and why aren't they cheaper than the for-profit plans?

[TheBlackAdder]

42. I used to work for a Non-Profit HMO, years back. That just means liquidating the books before EOY.

.


Some people think that Non-Profits mean that they are good entities. Like many charities who waste the lion's share of their profits on advertising, bonuses, perks, 'educational vacation seminars', etc. That's the reason they are doing it. They can only show a few percentage of profit and they need to drive up their legal expenditures to offset any excessive profits.


These firms have a bunch of different ways to diffuse or reinvest, transfer wealth from one are to another.


Just because a company says they are non-profit doesn't mean they are looking out for the best.


.

[Recursion]

43. Well... right, that was kind of my point (nt)

[TheBlackAdder]

84. You asked their motives--it's to make as much and find ways to spend it down. nt

[GoneFishin]

38. Yep. That about sums it up. One is in the business of providing a service, the other is in the

business of denying it.

[Schema Thing]

13. Because hospitals provide the service of "healthcare". Insurance companies provide actuarial

math, and then use advertising to get people to come into their company - which is essentially at that point operating on the same premises as a casino. Pardon the perverse-but-true-logic here: you might hit the lottery and get cancer, but you'll probably only get a cold. In any case, the house always wins - and by a ridiculous and, for our society, unsustainable margin.

[Recursion]

14. It's 6% of our annual health care spending

I don't get how anybody can look at the numbers and say that's the problem

[Schema Thing]

15. I assume you mean *profits* are 6%?

That's interesting. But to get just-those-profits, insurance companies hire and compensate tens of thousands of mid and high-level executives. They pay billions in advertising. They have real estate all over the place.

All to do actuarial math, negotiate rates, and process payments. All with an eye on their own self-interest, not the patient or country.

So, y'know, argue the full picture.

[Recursion]

17. No, that's literally all private insurance overhead, not just profits

That's the number you get when you subtract how much private insurance took in in premiums (about $980 Billion) and how much they paid out to providers (about $790 Billion).

All to do actuarial math, negotiate rates, and process payments.

Which is a far cry from "nothing"

[Schema Thing]

23. 190 billion is almost 20% of 3 trillion, isn't it?

I'll admit I'm not great with large numbers if I'm wrong.

[Recursion]

24. No, it's 6%

Slightly more, 6.3%

[Schema Thing]

28. ah, yeah... I see where I miscalculated.

[Recursion]

29. I've taken to using Google as a calculator. It's very convenient

Google "190 billion / 3 trillion" and it works. Cool stuff.

[hobbit709]

16. Hospitals should be a public service.

[HuckleB]

18. I'm confused. Neither makes logical sense.

So, I'm not sure where there is a divide.

[cali]

19. Do you mean financial reform?

In any case, false premise. Who is claiming that financial reform is the only thing that is considered progressive? Try no one.

And people here have been criticising for profit hospitals.since before Frist left the Senate.

[Recursion]

21. Financing reform. Single payer is a reform to health care financing that doesn't touch the provider

system.

Who is claiming that financial reform is the only thing that is considered progressive?

People who say anything other than single payer is not progressive. Single payer is financing reform.

[Armstead]

20. You are absolutely correct

One of the unmentioned problems in healthcare is the absorption of so many charitable and/or community-based hospitals by for profit healthcare conglomerates.

It is something that has been ignored byu both parties for far too long. It has similarities to what happened in banking and many otehr sectors.

WE should look for a way to return to not-for-profit healthcare.

But that's step B IMO. First of all we have to develop some rational system for allocating coverage. They're not separate issues, but cost and access is the priority.

[Tanuki]

22. Many people do not realize that Blue Cross/Blue Shield is technically a non-profit.

They certainly don't behave like our better image of a non-profit.
http://www.huffingtonpost.com/wendell-potter/blue-cross-blue-shield-ge_b_856207.html

...Don't think for a minute that the Blues are any more interested in your health and well-being than the companies that at least own up to being in business to make a hefty profit off of insuring the healthy and shunning the sick.

According to a report by Carl McDonald of Citi Investment Research and Analysis, last year was the most profitable year in history for the Blues plans, which enjoy significant tax advantages because of their claim to be nonprofit and terrific community citizens. Collectively, the Blues reported more than $5.5 billion in net income in 2010.

...The company has been building up the reserves for many years, but instead of giving money back to policyholders in the form of rate reductions, it has built itself a veritable palace overlooking downtown Chattanooga.

Under pressure by lawmakers and consumer advocates a few years back to reduce its surplus, BlueCross BlueShield of Tennessee decided instead to spend $300 million on a new 950,000 square-foot headquarters. The building has a scenic view of the Tennessee River and is on historic Cameron Hill, where during the Civil War the Union built a fort and fired cannons at the Confederate army.

When the company's 4,000 employees moved in 2009 to their new digs, they left vacant several buildings in downtown Chattanooga. City officials now realize it will be hard to find new tenants for those buildings, but that didn't stop them from giving BlueCross an unprecedented 16-year, 50 percent tax break back in 2005.

.......

[Recursion]

27. Yep. I think the California BCBS gave up the non-profit fiction

Though for that matter I've usually worked for non-profits and had insurance from non-profits through them, and it's never been noticeably cheaper.

[daleanime]

30. What do insurers add to health care? Nothing, they take resources....

what they call profit, out of the system.

[Recursion]

36. Then why do Medicare and Medicaid use them?

Hell, nowadays nearly all Medicaid insurance is provisioned through Anthem. (Or Cigna. I forget which.)

[daleanime]

39. Well, we have this system of legcalized bribry that we call.....

Lobbying.....

[Recursion]

40. And that's one thing that definitely worries me about single payer

Since we'd be handing the keys to Paul Ryan. For all of the badness of private insurers, they can't be lobbied.

[daleanime]

66. Single payer isn't the only change.....

we need to work on, the only question is will money be able to put up enough of a road block to stop us. That's what scares me. I see the possibly of a future where I don't even brother to vote, and that's something I done for almost 40 years.

[NowSam]

31. Great Question

Why is the welfare of the nation "for profit" anyway?

Why are private corporations allowed to pollute our air?

Why are they allowed to frack our Earth?

Why are they allowed to steal our water and sell it back to us?

Why are they allowed to spew forth their toxic smog into our air from their tax subsidized factories?

Why are they taking the people's resources and not sharing the profits?

[Kip Humphrey]

33. I don't find for-profit hospitals acceptable at all.

[backtomn]

41. In both cases, private citizens started them.

The government didn't build the hospitals or start the insurance companies, so you would have to advocate a government take-over of private business. It seems to me that if the government wants to control the system, it needs to provide the people something better. I believe that means single-payer and private hospitals. It would probably be the only option that was legal.

[kristopher]

44. It isn't "financing reform"

[Recursion]

45. It's a reform of how we finance healthcare (rather than provider reform)

Of course it's financing reform.

[kristopher]

47. No it is far broader than financing reform - it is fundamental system reform.

But you know that.

[Recursion]

48. No, it's not. You may intend it to be, but it's just a change in how the money gets from people

to doctors and hospitals. Or, as it's called, "financing".

Systemic reform would mean making hospitals adopt global budgeting and rates, or making medical school debt-free, or putting a cap on physician salaries, or abandoning fee for service in favor of capitation. None of which is being talked about.

[kristopher]

50. Bullshit

[Recursion]

51. Cogent as always (nt)

[kristopher]

55. Unlike you I call a spade a spade.

You know full well that the primary intent behind adoption of single payer is creating cost control mechanisms where none presently exist. That is fundamental system restructuring.

[Ron Green]

72. All those are being talked about in any health-care advocacy organization.

Additionally, the long term has got to be based on building a healthier country. Extractive capitalism has created, and depends upon, the kind of addiction and slavery that drives much of our health care costs.

[Vinca]

46. Hospitals actually deliver medical care. Insurance companies are pencil pushers.

[kristopher]

49. Actually the reason is that insurance companies can't create competition.

The present system allows unfettered price setting by the medical industry. The insurance companies are fractured and can be frozen out by the medIndustry. With single payer, the medical industry can't play control pricing, they become price takers instead of price setters.

That means that hospital administration on a for profit basis is limited as to how much gouging it can get away with.

Recursion knows all of this, but chooses to try and stir up a bunch of shit rather than have a real discussion to help educate less informed DUers.

[HassleCat]

52. It would be OK

If insurance companies were regulated in a meaningful way.

[Recursion]

54. I agree. I like Switzerland's set-up

You provide a basic care plan at actuarial cost, and then can provide a supplementary plan for profit. It's not actually that far from where we are now. It also wouldn't address the bigger problem of provider costs increasing without bound, but then again neither does single payer...

[Romulox]

53. We are mandated to supply insurers' profits by Federal Law, for starters.

But then you knew that, you free-marketeer, you.

[Recursion]

56. No you're not. Every state has a not-for-profit provider (nt)

[Romulox]

57. I don't believe that to be true. Citation, please?

[Recursion]

59. And yet. Here's CMS's page on the program

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Insurance-Programs/Consumer-Operated-and-Oriented-Plan-Program.html

The Affordable Care Act calls for the establishment of the Consumer Operated and Oriented Plan (CO-OP) Program, which will foster the creation of qualified nonprofit health insurance issuers to offer competitive health plans in the individual and small group markets.

Every exchange or marketplace must offer them. I think it was Baucus, of all people, who got that language put in (he wanted just all insurance to be done by statewide co-ops, which honestly is sounding better and better every day).

[Romulox]

62. You said not-for-profit insurance providers exist in all 50 states. Where is the list?

[Recursion]

64. Right there. Enjoy! (nt)

[Romulox]

65. lol. And Recursion punts after being unable to prove his naked assertion! nt

[Recursion]

68. Well, if clicking through is difficult, here's a list of all the non-profit providers in the country

http://www.nonprofithealthcare.org/resources/basicfactsandfigures-nonprofithealthplans9.9.08.pdf

64% of all large health insurance companies are actually not-for-profit, it turns out.

[Romulox]

69. If citing your claims is difficult, I suggest you obfuscate. Oh wait! nt

[Recursion]

70. That's literally a PDF of the list of the 84 largest non-profit providers

Who among them offer plans in every single state and DC.

So, you're welcome.

[Romulox]

71. That's not evidence for your claim in your #56. I suspect you simply fabricated it. nt

[Recursion]

73. Page 124, Section 1321

https://www.congress.gov/bill/111th-congress/house-bill/3590/text

(a) Establishment of Program.--
(1) In general.--The Secretary shall establish a program to
carry out the purposes of this section to be known as the
Consumer Operated and Oriented Plan (CO-OP) program.
(2) Purpose.--It is the purpose of the CO-OP program to
foster the creation of qualified nonprofit health insurance
issuers to offer qualified health plans in the individual and
small group markets in the States in which the issuers are
licensed to offer such plans.
(b) Loans and Grants Under the CO-OP Program.--
(1) In general.--The Secretary shall provide through the CO-
OP program for the awarding to persons applying to become
qualified nonprofit health insurance issuers of--
(A) loans to provide assistance to such person in
meeting its start-up costs; and
(B) grants to provide assistance to such person in
meeting any solvency requirements of States in which the
person seeks to be licensed to issue qualified health
plans.
(2) Requirements for awarding loans and grants.--
(A) In general.--In awarding loans and grants under
the CO-OP program, the Secretary shall--
(i) take into account the recommendations of
the advisory board established under paragraph
(3);
(ii) give priority to applicants that will
offer qualified health plans on a Statewide basis,
will utilize integrated care models, and have
significant private support; and
(iii) ensure that there is sufficient funding
to establish at least 1 qualified nonprofit health
insurance
issuer in each State, except that nothing in this
clause shall prohibit the Secretary from funding
the establishment of multiple qualified nonprofit
health insurance issuers in any State if the
funding is sufficient to do so.
(B) States without issuers in program.--If no health
insurance issuer applies to be a qualified nonprofit
health insurance issuer within a State, the Secretary
may use amounts appropriated under this section for the
awarding of grants to encourage the establishment of a
qualified nonprofit health insurance issuer within the
State or the expansion of a qualified nonprofit health
insurance issuer from another State to the State.

If your state does not have a not-for-profit provider, HHS will lend somebody money to start one. Like I said, Baucus put it in the bill.

[Romulox]

74. You claimed such providers *actually exist* in all 50 states. I'll take your post as a concession

of your error.

[Recursion]

75. They do actually exist in all 50 states. I listed them for you above

This is the language that made sure that happened.

[Romulox]

76. No, you didn't. You obviously cannot, either. So, more obfuscation. nt

[Recursion]

77. Post #68

http://www.nonprofithealthcare.org/resources/basicfactsandfigures-nonprofithealthplans9.9.08.pdf

Since links clearly aren't your strong suit:

1 Health Care Service Corporation* 12,410,915
2 Kaiser Permanente 8,846,616
3 Highmark, Inc. 4,832,863
4 Blue Cross Blue Shield of Michigan* 4,629,097
5 HIP Health Plan of New York 4,002,227
6 Blue Cross and Blue Shield of Alabama* 3,637,063
7 Independence Blue Cross 3,420,610
8 Horizon Blue Cross Blue Shield 3,377,000
9 Blue Cross and Blue Shield of Florida, Inc.* 3,183,375
10 Medical Mutual of Ohio 3,056,234
11 The Regence Group* 2,914,142
12 Blue Cross Blue Shield of Minnesota 2,900,515
13 BlueCross BlueShield of Tennessee 2,802,119
14 Blue Cross Blue Shield of North Carolina 2,716,359
15 Blue Shield of California 2,597,823
16 Wellmark, Inc. 2,062,450
17 Lifetime Healthcare Companies 1,967,550
18 Premera, Inc. 1,706,387
19 Medica Health Plans 1,354,000
20 Blue Cross Blue Shield of Arizona 1,192,837
21 CareFirst, Inc. 1,180,853
22 Harvard Pilgrim Health Care, Inc. 1,073,399
23 Blue Cross and Blue Shield of Louisiana 1,070,453
24 Blue Cross Blue Shield of Massachusetts 1,020,601
25 Capital Blue Cross 1,000,000
26 LA Care Health Plan 790,035
27 Blue Cross and Blue Shield of Nebraska* 780,931
28 BlueCross BlueShield of South Carolina 731,046
29 Hawaii Medical Service Association 699,806
30 Blue Cross and Blue Shield of Kansas 699,457
31 Providence Health Plan 692,808
32 HealthPartners, Inc. 657,762
33 MVP Health Care Preferred Care 602,998
34 CareSource, Inc. 601,688
35 Blue Cross & Blue Shield of Rhode Island 591,542
36 Group Health Cooperative 573,217
37 BlueCross BlueShield of Western New York and
BlueCross BlueShield of Northeastern New York
555,282
38 Blue Cross and Blue Shield of Kansas City 541,900
39 Health Alliance Plan of Michigan 540,705
40 SelectHealth 508,925
41 Healthfirst, Inc. 479,718
42 UPMC Health Plan, Inc. 469,898
43 Priority Health 448,694
44 Blue Cross Blue Shield of North Dakota 439,908
45 Bluegrass Family Health, Inc. 337,244
46 CalOPTIMA 336,314
47 Inland Empire Health Plan 324,119
48 Blue Cross of Idaho 309,344
49 Mercy Care Plan 296,304
50 Fidelis Care, Inc. 287,741
51 Blue Cross and Blue Shield of Montana 285,958
52 Capital District Physicians Health Plan, Inc. 280,169
53 MetroPlus Health Plan, Inc. 272,299
54 Independent Health Association, Inc. 254,485
55 Blue Cross of Northeastern Pennsylvania 234,860
56 Community Health Plan of Washington 232,579
57 AultCare Health Plans* 225,000
58 AvMed, Inc. 213,251
59 Boston Medical Center HealthNet Plan 212,000
60 Geisinger Health Plan 206,811
61 Health Plus (PHSP), Inc. 195,680
62 Rocky Mountain Health Plans 183,655
63 Texas Children's Health Plan 177,512
64 Scott and White Health Plan 174,427
65 MaineCare 170,227
66 Blue Cross and Blue Shield of Vermont 166,153
67 McLaren Health Plan 165,546
68 Neighborhood Health Plan, Inc. 164,056
69 Fallon Community Health Plan 159,168
70 The M-Plan, Inc. 154,352
71 Mercy Health Plans, Inc. 153,023
72 HealthPlus of Michigan, Inc. 152,198
73 Family Health Partners 150,240
74 Health Partners of Philadelphia 138,322
75 Security Health Plan of Wisconsin, Inc. 137,603
76 Community First Health Plans, Inc. 128,854
77 Parkland Community Health Plan 125,000
78 Community Health Choice, Inc. 117,681
79 UCare Minnesota 112,304
80 Capital Health Plan, Inc. 112,155
81 Priority Partners 111,641
82 Kern Health Systems, Inc. 103,751
83 SCAN Health Plan 102,974
84 CareOregon 100,536

[Romulox]

79. That list doesn't prove the assertion you made in your #56. This becomes embarrassing. nt

[Recursion]

80. Find me a state without a provider on that list

(Though for that matter these are just the huge fish; there are hundreds of smaller not-for-profit providers.)

[Romulox]

81. That's not how debate works. I'm not disproving your naked assertions.

[Recursion]

82. Got it. You'd rather make baseless assertions about enforced profit

Rather than take the time to actually learn what the not-for-profit options are.

[Romulox]

83. You've confused yourself. You were supposed to be defending *your* naked assertion in #56.

You are not a serious poster.

[Romulox]

60. Nice self delete of a non-responsive post!

I've quoted your post in its entirety to document your failure to provide any citation for your assertion:

Recursion
58. Here's a good postmortem on why so many of them keep failing
View profile
http://www.democracynow.org/2015/11/3/the_co_ops_collapse_how_gop

[Recursion]

61. Well, that was a good post-mortem, but then it struck me you might be sincere

And actually not know that the ACA mandated that, so I gave you the link to CMS's page about the program.

[Romulox]

63. Where's the list, Recursion? Provide it, or admit you've been less than truthful.

[Nanjeanne]

67. Hospital provide CARE. Insurance companies provide money exchange.

Even still - we should have more nonprofit hospitals. And we should have insurance companies provide additional health services for profit beyond basic healthcare.

[rhett o rick]

85. Why don't you give us your opinion in lieu of asking insinuating questions? nm

[Recursion]

86. Well, I have several times, but

I would prefer to see capitation budgeting for hospitals and a significant expansion of the FQHC program. Actually bring down provider costs directly rather than trust in the magical power of financing to do so.

[rhett o rick]

87. I do not like hospitals for profit either. In my area the Francisons are buying up

the hospital and all the other businesses that service the patients like CT scans and even the doctors clinics. Soon you will be out of luck if you don't use their doctors, their CT/MIR companies etc.

[Recursion]

88. And single payer lets that continue. This is my point

For about 5 years now a large part of the party has been convinced that

1. Single payer is the only possible solution for health care, and
2. By itself it will solve our health care problems

There are probably better financing models for us, and financing isn't really even the big problem.

[rhett o rick]

89. "There are probably better financing models for us, and financing isn't really even the big problem.

That's not very convincing.