Part II of my take on the new AHIP road trip. Yesterday we started reporting on the AHIP Campaign for an American Solution, the new road trip planned by health insurance companies to persuade Americans that we're all in it together and they've got a plan. First we noted that you cannot forget the agenda of AHIP, they are a lobby group for insurance companies and seek profits for the same. Second, the fact that their suggestions omitted a discussion of what health insurers might do to effectively monitor themselves and reduce the billions of dollars spent by health insurance companies on salaries, lawsuits with governments and insureds, and settlement payments, in addition to the cost of fraud, is noteworthy as the single most important thing for consumers whose premium dollars help cover the cost of these health insurance company expenses. Third, the quality of "listening to America" as an impossibility since the plan is already in place, in other words, health insurance companies solidify their place as health policy makers instead of insurers, helping consumers pay for needed health services.
Today we assess the first part of the five part recommended plan: "Overuse, underuse, and misuse of health services inconsistent with medical evidence" or our title, Poor Stupid Consumer, Health insurance companies and the government will fix things for you.
This section approaches the Consumer as an uneducated nitwit, who unwittingly has helped create the health services crisis because "many consumers, having little information to rely on, tend to equate higher costs with better quality." The answer from health insurance companies? "actionable consumer information and payment incentives to drive outcomes and competition could produce substantial savings to the health care system." What? Okay, here's the insurance company plan.
1) Tiering: Different levels of reimbursement such as is used under the new prescription drug plan. Please note, tiering is another way of saying health insurers pay less for different drugs assigned to tiers, levels of reimbursement by...health insurers. The expansion of this tiering to medical services means health insurers will pay less for different treatments based on a level assigned by health insurers. Apparently we're too stupid to notice that "tiering" is another name for less reimbursement. This is the old trick by health insurers, we'll cover you up to a certain amount, and the large divergence in that amount and the amount you are charged comes out of your pocket. Medicare recipients have already started living the tiering dream as more and more medications are moved into lower reimbursement tiers. Any time health insurers cut reimbursement rates or increase co-payments for anything under their plans, savings should be passed onto consumers but they are not. Without this mandate, tiering is just a way of selling the same or worse coverage for the same or greater price.
2) Remember this is called the campaign for an "AMERICAN" solution? It's not the America of free competition but the America of GOVERNMENTAL support through money and legislation that health insurers support. "American" is a good use of a word that appeals to all those free market guys. While consumers rah rah the competitive market, perhaps they will forget to read HOW that "free market" is being implemented by health insurance companies.
Watch carefully...in order to implement their TIER approach, the health insurance companies note that they have to get the medical services providers on board. (This has already passed as federal law for Medicare which is addressed in earlier blogs. Those provisions REWARD doctors through federal dollars for exhibiting their use of certain "practices.") In order to get consumers and providers on board health insurers seek GOVERNMENT to enact laws to enable them. The health insurers recommend that "...policymakers (government) need to ensure consumers are given actionable information...." and "policymakers (government) need to establish an environment that encourages innovation by promoting competition that will drive value-based decision making throughout the health community." We've been here before, remember the early days of HMO's? Faster doctor visits to promote volume, more medication rather than referral because it's cheaper. Health insurers seek governmental support for them becoming the GATEKEEPERS of health services for a new generation and if doctors work with them, they want governmental financial awards given to doctors instead of the old time health insurance company bonuses for increasing insurance company profits. Let's see, the stakeholders are government, medical services providers, health insurers and consumers...notice any group who is NOT being consulted? That would be us.
3) It's about Money: Something for nothing: The health insurers have tapped into a great motivator, fear. If you don't support us and do everything we say we will raise your premiums. Like all threats, giving into health insurer threats just buys us time until their next demand...well, time to keep paying the piper. AHIP announces that "inadequate payment rates in public programs are contributing to the erosion of private coverage," silly us, and we thought it was greed by health insurers and medical services providers. In other words, they want bigger governmental payments to those covered under Medicare, Medicaid, and SCHIP...now that's a good one. Let's have government pay bigger portions of expenses not covered by Medicare, Medicaid and SCHIP to take the pressure off health insurers...so we, the consumer can shift our payments from private health insurers as premiums to higher taxes so that governments can pay higher rates to those receiving public health insurance and relieve health insurers from this burden.
Without a guarantee return to consumers of any dollars saved by health insurers squeezing government and consumers for more money, we are again giving into health insurers. This health terrorism, doesn't work any more than giving into any other extortioner. Health insurers must be reminded that they are not paying their own bills, their money comes from consumers. If they are wasting so much money that they can no longer provide INSURANCE, assistance in paying for needed medical services, then they are no longer feasible as a business.
