One of the most frustrating aspects of the Affordable Care Act is that those earning over 133% of the poverty line -- who are under 65 -- will be forced to purchase -- some with government money -- flawed insurance policies from mega-profit companies like Aetna, Cigna or WellPoint. Those earning under 133% or below the poverty line will be lucky enough to receive Medicaid, which as Paul Krugman recently argued, is actually a pretty good program.
Basically, health insurance lobbyists armed with a fancy iPad app (how many doctor's visits would these lobbyist iPads pay for?) will go to Congress to paint themselves as Romney-style victims of out-of-control health care costs instead of evildoers who punish acne-afflicted teenagers with retroactive rescissions of their insurance policies when they get cancer.
In those discussions, health insurers rarely come across in a positive light. One survey back in the late 1990s had people say whether various industries do “good jobs.” Health insurers came in third-last, with 48 percent of Americans thinking they did a good job. Even oil companies came across as better, although insurers did beat out tobacco manufacturers.The problem is that if indeed health insurers are not to blame for rising health care costs -- and it's certainly arguable that the bureaucracy that the multi-payer system demands does cost a lot of money (just ask the person at your doctor's office whose entire job exists to call 1-800 numbers to get claims paid) -- then private health insurers are actually unilaterally failing at their jobs. Let's borrow from this article describing Aetna hospital negotiations:
During the health reform debate, insurers often found their premium increases playing foil to the president’s call to pass the Affordable Care Act.
Moving into a potential debate over deficit reduction, health insurers want to carve out a different role in Washington. Namely, they don’t want to be the bad guys anymore. To that end, they’ll soon start arming their lobbyists with data that argues that other health care sectors are actually the ones to blame.
“For a number of years, when people talk about health care costs the debate has focused exclusively on premiums,” said Association of Health Insurance Plans president Karen Ignagni. “If you’re going to have a debate and discussion about what’s driving health care costs, you have to get under the hood.”
Walt Cherniak, a spokesman for Aetna, said the company is duty-bound to hold down costs, and could not meet UNC Health Care's demand for a double-digit increase in the rates the insurer pays on behalf of its customers.So, OK, AHIP morons, your entire lobbying strategy is to admit that you are absolutely incapable of meeting your core obligation for patients and the broader health care system? Say what?!
"As a health insurer, we have dual obligations," Cherniak said. "One is to provide broad access to quality hospitals and doctors for our customers. We also have an obligation to try to contain rising health care costs, which have been a major problem to employers and patients."
“When our lobbyists go up to the Hill, this is going to be at their finger tips in an easy to use format,” said Robert Zirkelbach, AHIP vice president for strategic communications.Right, so what is the purpose of any private 'insurance administration' if those very corporate administrators are absolutely incapable of achieving lower systemwide costs?
They also will have charts that show how much other sectors account for health care costs. That’s what this chart is all about: It charts the cost of insurance administration (the orange section) against all the other actors in the system. This includes hospitals, physicians and spending on prescription drugs.
Could it be that the reason America pays more for health care as percentage of GDP than any other nation on Earth is because it is the only nation on Earth that allows a role for hundreds of different corporations to use tens of thousands of different health insurance policies to finance basic patient care? Hell yes.
And, with an Affordable Care Act-mandated turn to paying for outcomes over paying for care on a fee-for-service basis, insurers in an ObamaCare America will have less risk than ever before, but lousy administrative costs will remain constant.
One suggestion the AHIP lobbyists will propose is that all hospitals charge the same price -- to all insurers -- for the same procedure. Good idea -- I agree. But, again, if hospital prices are regulated as such, then what is the point of having hundreds of private insurers existing with the mission of 'negotiating' lower prices? Then their administrative costs -- as minimal as AHIP likes to boast they are (and they're a heckuva lot higher than Medicare) -- have absolutely no reason to exist at all, because, again, the private insurers themselves should not exist at all for financing basic care.
So, to review, private health insurance lobbyists are planning to descend on Congress like locusts in order to argue that they deserve to be admired and respected because they have failed at doing that which is the only reason for their existence: supposedly making health care cheaper for patients.
Single payer advocates should be thanking AHIP for the free support.
I have two words for AHIP: please proceed.