Reconciliation Bill for FY 2010, p. 24 (Ensuring Lower Premiums)

[Clio the Leo]

Read more here....
http://budget.house.gov/doc-library/FY2010/03.15.2010_reconciliation2010.PDF

[mucifer]

1. If we get someone like cheney as president the Health and Human Service secretary

could really mess this up, right? But, it's something worth doing.

[Clio the Leo]

3. I think the presumption is that by the time that could happen....

.... such a move would be SO unpopular, that no one would do it.

[Oregone]

2. This doesn't ensure lower premiums

It ensures that more of premiums go to medical payouts. Thats it really.

Insurers will manipulate such medical loss amounts if it inteferes with profits. In other words, if you tell them they must take a smaller piece of the pie, they can make sure the pie is simply bigger as a whole (and the medical providers will be gleeful).

Its an experimental measure

[Clio the Leo]

4. and then you'd get a rebate.

per lines 9 & 10

[Oregone]

6. No you wouldn't

Lets say you used to get 1/4th of a pie, and it weighed about 2 lbs of pumpkin goodness (the entire pumpkin pie is 8 lbs)

Well, if I told you that you only get 1/8, and you have control over the size of the pie, you would tell me to pay for a 16 lb pie.

That sucks. I pay more. You get the same.

In this real life situation, you pay more premiums for the same service, and the medical providers get more compensation (which isn't the concern of the insurance industry). The insurance companies protect their per-share-profit ratio and abide by the rules.

Its an experiment. As much as everyone wants "value" to be preserved and see efficiency gains (with costs savings going to consumers), it could just lead to increased premiums to protect shareholders' profits. This is the private market we are talking about.

[Clio the Leo]

8. But technically.....

.... it's sweet potato, not pumpkin.

[Oregone]

9. And I never did get that!

Some guy told me once I tasted sweet potato pie, Id never go back. Im sorry...its pumpkin whenever I get the chance.

[Clio the Leo]

10. Well THAT explains it all.

Doesn't it fellow sweet potato pie fans? :)

It's a ..... well ...... it's a sweet potato pie thing .... ya get me?

I mean, PERSONALLY, I prefer chocolate chess but my community .... well, we're sweet potato pie people.

It's one of the great social divides in this country. :)

[Schema Thing]

11. how does a medical provider getting more compensation

increase or protect an insurance company's per-share-profit?


And is there some reason the definition of MLR can't be written to discourage and even eliminate such abuse?

[Oregone]

12. Read this:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=221735&mesg_id=221752

If the insurers negotiate higher rates, they can collect higher premiums for more revenue). Since they only get 15% to 20% of the total take (minus operation overhead), its in the interests of the shareholders to make sure that the pie is as big as possible.

Its not that tough to figure out. Its a decent idea on how to tame this private beast, but its an experiment that could go bad.

[Schema Thing]

13. uh, yeah.

it's also not that tough to figure out how to stop them from doing this.

[Oregone]

14. How?

Anti-trust exemption repeal would help, for one.

The cost of health care will rise, but what specifically addresses how to control artificial rises?

[eridani]

15. Big whoop. That would have made Mr and Mrs Sarkisian SO happy! n/t

[Schema Thing]

5. there will be regulation of how MLR is calculated.

[Oregone]

7. So?

They don't need tricks here. All they need to do is tell a hospital that the new going rate for a single sutcher is $200 dollars instead of $100. Why compete and race to the bottom as an entire industry if every shareholder in insurance will end up in the poor house? It aint going to happen.

Here is a bit more of a detailed explanation:
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=221735&mesg_id=221752

[eridani]

16. Which will be worthless. 15 states have already tried to control costs by regulating MLR

They have completely failed at it.