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View Diary: Good WaPo editorial on "Keep Your Own Doctor" (153 comments)

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  •  The issue is "degree" and "imact" (1+ / 0-)
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    FG

    "Decades ago" insurance companies competed ... to the extent that they DID "compete" ... on the perceived value of their coverage --  having large approved networks and covering as many conditions as possible was a competitive advantage.

    On The Exchanges ... the lowest premium with the lowest delectable is the most persuasive argument.  THAT, at least,  is transparent and comparable.  Who and how many are in-Network PPs -- much less so.

    So, the insurance companies are shrinking their networks and squeezing their providers "as never before."

    Something you might consider ... the WalMart business model:   "keep costs and (some/many) prices low -- make it up in volume".  A small margin on a huge number of sales pays better than a modest margin on a smaller  volume.

    And, that, frankly, is an issue the PACA doesn't engage nearly as well as it should.

    Yes ... the margin is now regulated by law ...  80% of premium income must be spent on patient services. To make up for thinner margins ... the obvious counter-move is "increase the volume."   MORE care is STILL "better care" from everyone's point of view -- except of course that of employers and government budget guardians,  who have to find the funds to pay the premium-support subsidies.

    For this, the potential of 45 million new customers --  (:nudged" by the threat of a small fine, and incentivized by the possibility of significant government subsidies)  -- IS of course, a great help.  But putting helpful health hints into the self-promotional "newsletters"  ande calling it "patient lifestyle education" works too, as does maintaining the existing a-la-carte,  fee-for-service care model.

    •  Given that price of healthcare has been going (0+ / 0-)

      up like crazy it's good for insurance companies to squeeze their providers. Narrow networks have been used quite a bit in the past especially on individual market and for dental insurance. Group market is not particularly price sensitive. Possibility to increase volume for insurance companies is limited since the majority of the people have insurance already. ACA tries to change the existing care model but it's difficult.

      •  It's a PAYMENT model, not a "care" model (0+ / 0-)

        And  the ACA does NOT try to change it much.

        Rather, it seeks to perpetuate the existing   pay-for-service, for-profit, employer-provided,  private insurance model.  ... "making it sustainable" ...  by providing subsidies and some regulatory reforms so that people who previously could not afford, or had been excluded from the existing model, could now participate in it.

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