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View Diary: Aetna CEO: Game Over for Big-Profit Health Insurance (178 comments)

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  •  standardize health coverage (24+ / 0-)

    I'll never forget - l went into surgery not knowing what was covered - my BC/BS employer policy was head quartered in another state, plus the surgery would generate bills from several independent providers: surgeon, hospital, anesthesiologist, labs, medical tests and more. The medical center I used warned to make sure everybody was covered - that was impossible,  BC/BS could not determine.  The best they could do was say"Well, probably if we cover  it in this state, we'll cover it in your state"  But it seems that every facility and state, has their own way of manipulating the billing codes, so nobody can tell you anything until they can pick apart the bill. RIDICULOUS!

    •  If everybody (0+ / 0-)

      had to buy a SingleVoter-made sandwich by law, the price per SingleVoter-made sandwich could easily be made astronomical.

      What might be done is to require an insurer to offer a policy of its choice in any given state, with say a $200/year cost markup per subscriber, with a minimum cost of say the maximum of $700 or $70/subscriber year of age.

      A 40-year old would have to buy a $2,800/yr or more policy.

      A parent with a five-year old would have to buy a $700/year or more policy for the child.

      Insurer defined coverage forces providers to have to compete for insurance dollars.

      The 40-year old would shop around for the best coverage for his likely needs.

      •  One needs to set the $X/subscriber year of age (0+ / 0-)

        amount to be high enough that all reasonably effective care could be be covered at just under a fair reimbursement rate with small co-pays to make fair reimbursement possible.

      •  That's not the way you do it. (5+ / 0-)

        You have a rational, set price for service x. That price covers y. The price is set by law, is adjusted yearly, and allows for a reasonable profit.

        If your company doesn't think that's enough of a profit, tough. Don't sell service x.

      •  And what happens if you get hit (1+ / 0-)
        Recommended by:
        justintime

        with something you had decided was not important, didn't fit your needs?

        And believe me this "shop around" dream would come to a quick halt if you actually started trying to decide on a policy when you actually knew something.

        The problem becomes real if you actually do it. When the Medicare prescription "benefit" came in each state had about 30 offerings that elders had to choose from. I take about 10 medications and so tried to compare plans. None had all one their formularies and each plan had a different array of cost for the list. Add in I didn't know what new things a doctor would prescribe, what switches would be made — and what if any conditions I would develop in the future. Then too, some come off patent protection and I can get the generic which reduces costs. Then, of course, new drugs are developed all the time. . . .

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Mon Feb 27, 2012 at 03:59:38 AM PST

        [ Parent ]

        •  sam - before Medicare Part D you had nothing (0+ / 0-)

          We all complain about Medicare Part D because it's challenging dealing with what drugs each plan provides, and at what cost. But remember before Part D seniors were completely on their own for drugs an option still available to anyone by not enrolling in part D.

          "let's talk about that"

          by VClib on Mon Feb 27, 2012 at 05:54:09 AM PST

          [ Parent ]

      •  You guys are all re-inventing the wheel (0+ / 0-)

        You start with the blue print of one of the other single payer nations, and adjust as necessary. Citizens don't buy insurance, the pay healthcare taxes.  The government mandates care and provider reimbursement.  It works very well in other countries, making citizens and providers happy.  Plus you don't get religious orgs and employers pissed because they have to buy insurance.  Well, the religious orgs will be pissed anyway, but at least some old Bishop won't be dictating heathcare to women, or deciding that diabetics and Parkinson's sufferers shouldn't benefit from stem cell therapy.

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