Skip to main content

View Diary: How to make improving the health care law a reality (66 comments)

Comment Preferences

  •  As long as purchasers have a choice (0+ / 0-)

    then the insurance companies selling the coverage have an incentive to keep the cost down.  Insurance is a big-ticket item, close to 20% of payroll at my company.  I look at price and coverage to determine what to purchase.  The carriers compete to get our business.

    Of course they are looking out for their own interest, but their interest is to get me to buy their policy instead of the competition.  Your profit margin on a sale you don't make is meaningless.

    •  But price and coverage don't tell you anything (0+ / 0-)

      The dirty secret is that the allegedly independent firms that tell insurance companies what is reasonable and customary to charge are, in fact, owned by the insurance companies.

      In essence health insurance contracts are opaque and include (even under the PPACA) enough clauses that an insurer who doesn't want to pay can simply refuse and invoke some clause or another in the contract.  And since you are buying it for your employees, you probably don't get a lot of feedback when this happens.  I have heard of this happening more times than I can count.

      When my second child was born, I went back the next year and figured out how much we paid out of pocket for tax purposes.  Note there was nothing unusually complicated about the pregnancy or delivery....  We paid out of pocket $11k even after insurance largely because of clauses like these.  We cancelled our insurance at that point and have been uninsured since.  I fully plan, under the PPACA to pay the penalty rather than give it to an insurance company, and only buy insurance if/when we need it.  If they can play that game, I can play it too.

      This would be different if the insurance company was owned and operated by the insured.  Then the insurance union would represent me.  That's not the system we have though, and what they say they cover doesn't always reflect what they actually cover.

    •  In case you are wondering (0+ / 0-)

      My third child was born in Indonesia.  Total cost without insurance?  $3000.  Including plane tickets?  about $8k.  Prenatal care?  Not significant expense-wise.

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site