The highlights of Parts I and II of the AHIP roadtrip campaign of town hall meetings to sell the American people on the AHIP plan for health insurance companies are first, that all changes continue the trend of empowering health insurance companies as POLICYMAKERS and EDUCATORS regarding health instead of demanding they fulfill their role as INSURERS, covering the risk of the EXPENSE of illness for the price of an affordable premium. Here we expand on AHIP's recommendations to make them representative of consumer goals Access Affordability Quality Tactics: If insurance companies do not INSURE, provide assistance in paying for needed medical care, then they are not fulfilling their role. All issues involve how much assistance in paying for the RISK of needed medical services vs. Insurance company desire for profits.
1) Remember who we're dealing with: AHIP is the largest lobby of health insurance companies that we have: American Health Insurance Plans. While consumers use health insurance as the current MEANS of obtaining assistance in paying for needed medical services IF the need arises, AHIP, the health insurance companies have dangerously shifted away from being INSURERS covering such risk of expense from illness to policy makers and educators...not their role.
2) Consumers CANNOT be squeezed for every dollar without some adjustments from health insurance companies in terms of monitoring themselves better to reduce EXPENSE. AHIP's pages long plan does not address the COST to CONSUMERS from health insurance company expenses: Salaries to CEOs in the tens of millions, lawsuit settlements in the tens of millions (people suing insurance companies for illegal or unethical actions), and corporate waste and fraud. The failure by health insurance companies to reduce their expenses by examining these millions to billions of dollars of expenses means that the only way health insurers seek to maintain and increase their profits is to squeeze the consumer. Consumers cannot singlehandedly cover the billions of dollars in expense by health insurance companies that come from tens of millions of dollars paid to CEO's, tens of millions of dollars paid out in settlements to people, governments and classes of individuals who are victims of crooked or unfair business practices, hundreds of millions of dollars that represent the cost of fraud, including fraud within health insurance companies. These costs are discussed elsewhere in this blog in addition to yesterday's blog. Health insurance company search for profits must reflect increased liability for their own waste, fraud, and liabilities for wrongful actions, consumers cannot continue to pay for these costs through higher premiums, increased co-payments and deductibles, and less coverage. Further, any money saved because of the provision of less coverage to the consumer by way of higher premiums, increased co-payments and deductibles, and less coverage should be returned directly to the consumer in the form of premium credits, including, sums for underutilization for a period of years where consumers do not "cost" the insurance company because of their good health. A system that punishes the sick through higher costs and increased exclusions MUST include a retroactive reimbursement to all those who have paid premiums and NOT cost the health insurance company money for years of good health. Punishment without reward is not an economically sound system. If a 50 year old man gets sick with cancer, and has not done more than have a physical and an eye exam for the prior thirty years of premium payments, he should be entitled to a refund of premium dollars for all prior years (REWARD) for all his good health now that he is uninsurable or only insurable at 140% premium cost or higher for the rest of his life (punishment).
3) While AHIP purports to support the free market place, all of their "solutions" involve government mandates forcing consumer dollars in the form of tax dollars and increased premium rates, government involvement. Obviously as a LOBBY group, influencing favorable legislation is their primary raison d'etre. Similar mandates requiring the development and implementation of corporate policies that reduce expenses from fraud, lawsuits, settlements, and salaries are not in place. Nor are minimum levels of insurance coverage mandates discussed. In other words, AHIP supports all government actions that further its agenda of strengthening health insurance company profits without partner legislation that supports mandates to protect consumers.
The next "problem" identified after yesterday's "the stupid consumer" problem is another version of the "stupid consumer." In the section that discusses the problem of the "Explosion of new technologies without a national entity to compare the clinical and cost-effectiveness of these new technologies to existing ones," in other words, what are the ODDS that you'll be better off with a particular treatment or medication.
First, AHIP puts on its policy hat and advocates the establishment of a CEB, a Comparative Effectiveness Board. This newly created insurance company idea would assign their new Board with the job of comparing cost effectiveness of new and EXISTING drugs, devices, procedures and therapies. Then this new insurance devised board would ASSESS alternative uses of treatments currently in practice and finally, once their policy-making role of establishing a board and giving the board a job was in place, they would assign the board to DISTRIBUTE information to patients and doctors...the EDUCATOR hat. The cost? Described by the health insurance companies as "RELATIVELY MODEST" would be $5 BILLION a year up to at least 2015.
Understand one thing very clearly, comparative effectiveness means only one thing, more health services will NOT be covered. The "tiered" system of health services will be rich v. poor not sick v. well. As more things are excluded only those of us who are poor will suffer, the rich won't care what is covered or not.
How AHIP imagines its CEB (comparative effectiveness board) will determine your health care: first, "expedited approval for generic drugs"...less oversight more cheap drugs, it's logical but then again how 'bout all the people dying from bad meds especially since health insurers don't want any lawsuits allowed by patients who are victims of malpractice? Developing and strengthening scientific evidence for emerging products....just because your doctor says something might work is not enough for health insurers, it will probably still be excluded. And third, FDA oversight of already approved drugs...you know, maybe check and see whether the drugs work. This one actually coincides with a consumer goal...unsafe drugs hurt consumers, duh.
