Michael Olenick over at nakedcapitalism.com decided to aggregate all the insurance plans being offered to him on the Exchanes, and the results are disturbing.
He really shouldn't have needed to do this in the first place; all this information should be easily accessible. The fact that it isn't is a huge red flag. Here's Olenick discussing this issue:
Transparency when buying healthcare insurance was seen as a raison d’etre of the insurance exchanges. Healthcare.gov fails miserably. I could neither export nor print the plans or plan information. I could not even view them all on one page: there is no option to change the number displayed on a page, a standard website feature. Intuitively I could see the plans looked terrible but, without the ability to analyze them as a whole, I didn’t realize how terrible. Finally I decided it was worth the time to throw open the blinds on this fiasco and type it all into a spreadsheet. Political partisans cherry-pick scenarios to support their narrative but, in much the same way that a picture quickly conveys a story, data itself defeats spin doctors.Now, bronze, silver, gold, and platinum plans are supposed to pay out 60, 70, 80, and 90% of costs respectively. But digging into the data, Olenick found a much different story:
Healthy baby delivery is projected to cost $7,540 in my area. Bronze plans, which are supposed to pay 60% of out-of-pocket healthcare expenses, cover only 27% leaving families to pay $5,516 of $7,540. Silver, gold, and platinum plans are supposed to pay 60%, 80%, and 90% respectively but pay 47%, 64%, and 85%.This is a massive problem, but a predictable one. Insurance companies make their money by leeching as many of your premium dollars as they can. It is their reason for being. There was no rational reason to assume they'd change just because we smiled at them and asked them to nicely.
Type II diabetes is projected to cost $5,400 per year to treat. Plans pay 47%, 62%, 78%, and 94% on average, for bronze, silver, gold, and platinum, of the cost. Although the bronze plans average better for diabetes seven bronze plans pay less than $100 towards the $5,400 yearly expense.
Using this relatively large real-world sample we see there is only one category – Type II diabetes insured by a platinum plan – that is projected to pay out at the mandatory actuarial level. At 27% bronze plan payouts for routine births are abysmal, especially considering deliveries are one of the primary conditions the subsidized bronze plans should cover. If a family put aside $500 per month they’d leave the hospital with a $1,540 bill. Instead, by buying insurance, they start out with a $5,516 bill. Maternity coverage is not useful if it never pays.
Yes, there are supposed to be limits on insurance profit margins under the ACA, but this data shows the companies aren't worried about them. After all, why gouge the consumer like this if you're just going to have to send them a check at the end of the year? Either they anticipate not being audited (not a bad assumption, given the state of regulation in this country) or they've figured out how to game the system (again, not surprising). Yves over at naked capitalism points out they could just buy some medical device companies and overcharge themselves since the law puts no limits on that side of the cost equation. Or they could displace as much of their profit onto the spending side of the 80/20 spending/overhead ratio as they can; advertising becomes "patient education" for example.
Either way, Olenick's data proves what many on the left were saying: reform of the system is impossible if you leave for-profit-insurers in place.
NOTE: Yes this my first diary. No I am not a right wing troll. I care about health care reform, I just recognize that the ACA ain't it. And I'm worried that unless we wake up to that fact, and soon, we'll lose our chance to really fix the problem. We should start pushing for single payer as a replacement to this gamed system and its broken website.