Re: NEWS: Co-payments for expensive drugs soar


Like I said, if we go down that road the insurance companies will
eventually find a way to deny coverage to almost everyone: Alcohol,
cigarettes, drugs, no seat belts, no helmet, no money, war veteran,
traveled abroad.... (they will add more as the need arises)

Certain companies will, others won't. It will depend on the premium
one wants to pay. In your scenario I could see a Smokers Policy let's
say. At my last Organization the HR Director was constantly pushing
for a "Smoke Free" workplace. Since the majority of our workers were
Blue Collar & Smoked I thought it would hurt retention & attraction.
Therefore, I personally saw no upside then fulfilling his personal
agenda. However, I agreed that if our Group Insurer would lower our
premiums because of it, then it would be a "good" business decision to
move forward with his idea. He never did approach the insurance
company.



I think one of the things that you are not grasping in your analysis
is how group coverage, especially through an employer works. Their
are all sorts of Tiers of Products & Services that are offered. The
more the coverage offered, the higher the premium. What is happening
is in order to control costs more & more employers are electing for
Higher Co-Pay Policies with greater deductibles & decreased services.
It is much more complex then just blaming it on the Insurance Company.


Yes I realize that a lot of factors go into calculating premiums:
Group size, age and past experience come in to play as well as
regional differences. That is why we need one group: American
Citizens. We already overpay for crappy insurance fraught with
exclusions, denials and effectively waiting lists for procedures.

What we need are American plans with single payer. This will actually
make America a more attractive place have a manufacturing plant.
Single payer does not necessarily mean socialized medicine, it means
that employers are relieved of the responsibility of providing
healthcare insurance and everyone is covered, no exclusions, at the
same rate negotiated with the government. Make it a quasi-private
non-profit entity if you like. Providers will be forced to modernize
and reform in order to make a profit. Those that cannot do this will
go away.

Once all the basics are covered there will be plenty of room for
higher tier benefits as options. This is happening in the UK already.
A former employer of mine offered its Canadian employees all kinds if
insurance upgrades since they did not have to cover basic coverage for
them.

The healthcare industry as a whole is not moved or motivated to reduce
cost because demand allows them to simply raise prices. There is no
competition either. In other businesses, supply and demand and
competition reign in price increases and keep product quality and
services as high as possible because just raising prices doesn't keep
the customers coming back. With healthcare, people have no choice;
they must come back. The supply/demand model predicts that health
insurance costs will continue to climb until demand falls off. In the
absence of any real competition falling demand means fewer patients.
How do you get fewer patients?

Insurance companies used to offer services directly but now they
really only cover catastrophic illness and contract the rest out to
doctor groups and hospitals. Now with tier 4, catastrophic no longer
applies so why do we pay them? They are just another profit sponge
right under insurance brokers. It is part of our healthcare
overpayment.

Few companies I have worked for ever offered more than three plans:
PPO, HMO and Indemnity as a way of giving workers out of pocket
choices. The state of California,however, offers a cafeteria plan with
many choices. My wife's employer used to offer an indemnity plan a PPO
and an HMO but now only offers a PPO with high co pays and auth still
required for most procedures. The indemnity and PPO plans are just too
expensive now. My wife's employee monthly premium portion is $800/mo
or more. Only 3 employees out of 5,000 chose that option.

Smaller employers only offer an HMO and Kaiser.

You are right, the insurance companies are offering tier 4 as a way of
reducing premiums. There has been a steady erosion of benefits
starting in the early 2000's. Unfortunately, it is also a way of
saying that only mainstream illnesses will be covered and the burden
of expense will no longer be spread over a large group. I foresee an
expansion of this tactic to other diseases. For instance, why not
charge more for diabetic, asthma and allergy medications. In a sense
they are specialty drugs with the difference that their groups sizes
are larger.


I know I said I would not continue this but I thought I needed to
explain what I am really trying to say.


I currently offer ZW's "Gold Standard" Medical Insurance. Everything
is offered, there are no denials, deductibles, co-pays or maximum
annual benefits. You can have any type of drug you want, whenever you
want & as much as you want. All your children are covered for life as
well. Want to take a guess at how much the daily premium is though?

We already pay more for less than at least 36 other nations.

Mike
.

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