The End of Health Insurance Companies

[RyanPsych]

Here’s a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients. Already, most insurance companies barely function as insurers. Most non-elderly Americans — or 60 percent of Americans with employer-provided health insurance — work for companies that are self-insured. In these cases it is the employer, not the insurance company, that assumes most of the risk of paying for the medical care of employees and their families. All that insurance companies do is process billing claims.

For individuals and small businesses, health insurance companies usually do provide insurance; they take a premium and assume financial responsibility for paying the bills. But the amount of risk sharing that is accomplished is limited because the insurers charge premiums that vary, depending on the health of an individual or a group of employees, and use their data and market power to identify healthy people to cover and unhealthy people to exclude from coverage. (The health care law’s total ban on exclusions for pre-existing conditions will begin in 2014.)

A new system is on its way, one that will make insurance companies unnecessary.
.Many health insurance companies also impose barriers — like requiring prior authorization for tests and treatments and denying payment for covered services, which forces patients to appeal — to discourage patients from using the medical services for which they are insured and to attempt to avoid paying for those services. While these barriers can reduce waste by preventing unnecessary care, they can also discourage patients from receiving care they need, as well as impose administrative burdens on doctors and patients.

But thanks to the accountable care organizations provided for by the health care reform act, a new system is on its way, one that will make insurance companies unnecessary. Accountable care organizations will increase coordination of patient’s care and shift the focus of medicine away from treating sickness and toward keeping people healthy.

continue reading: http://opinionator.blogs.nytimes.com/2012/01/30/the-end-of-health-insurance-companies/?partner=rss&emc=rss

[fadedrose]

1. I'd rather see a public option replace the insurance companies...but....

getting rid of them in any fashion would make me happy...

Car insurance is another racket...no hope there...every state being different...

[gopiscrap]

2. HOW ABOUT A SINGLE PAYER SYSTEM

until we get that, we're fucked as a nation!

[Uncle Joe]

6. I agree, that would be the best most logical solution, the OP is just more corporate shell game.

A pig with lipstick.

[TBF]

14. Agree - that bit about the companies processing insurance claims

is wrong right off the bat. They don't "process" claims - they DENY claims.

The only solution to this nonsense is single payer.

[Cleita]

3. I hope so.

Insurance is about catastrophes. You get fire insurance on your house just in case, not because you know there will be a fire. You will always need health care at various times of your life. It's not that you might need health care one day. Insurance has no place in a health care plan that covers every one and is available at the time they need it.

[KatyMan]

4. I think they will change, not go away

Medicaid in Texas, while run by the state, is administered by several large insurance companies (United, Molina and one other I don't remember) or 'managed healthcare providers'. I suspect that even under single payor this system will still exist.

[northoftheborder]

5. Health Care Insurers need to find another scam to promote, other than the health of the public.

As far as I'm concerned they should start buying up real estate on Mars, now, and begin development, as soon as possible. They serve no useful purpose for the public. They are only a mechanism for a few people to gain zillions of dollars. Single payer by the government, coops, non-profits like we used to have are the way to go, and hopefully will get there in my lifetime.

[uponit7771]

7. Naw....naw....Obama didn't do shit...give Obama credit for anything even passively you get attacked

[zipplewrath]

8. Rather rosy take

There will be a shift in the health insurance industry, but I think it is foolish to presume that it will play out as the author describes. Yes, they will get more into health care delivery, because they can make more profits on health care. But they will be the same companies as before. Their intent will be to maximize profits, and a large way to accomplish that will be to push costs back onto the consumer however they can.

They will have "coordinated" groups of health care providers and insurance companies. The result will tend to be that the insurance companies will be the organizations who are primarily "steer" patients to certain providers. The providers profits aren't limited by the 85% rule, and the insurers won't be particular incentivized to keep the health care costs down, because they make larger gross profits on higher costs (but still at the 85% margin).

Regulation of course can help temper all of this, but that exposes the regulators to the same lobbying pressures that all regulators over industry experience.

Until the consumers (the US citizens) get control of the costs of health CARE, we are all in trouble. Leaving that to the profit/greed system to regulate will just end up resulting in the same situation we are already in.

[Old and In the Way]

9. Eliminating the no-value added middleman is a start.

If ACO's operate as an extension of the healthcare providers, this ought to be a far better system than what's in place now. Ultimately, I still think the consumer needs a single payer entity to keep the ACO's honest and consistent in the cost and level of services they provide.

[Initech]

10. Reverse Citizens United and dump big pharma/health care lobbyists now!!

[TreasonousBastard]

11. Payig bills is not all they do, but why bother throwing a few facts in the...

way of a good rant.

Also in the Times today was mention of how "Board Certified"plastic surgeons have been causing vast amounts of pain and bad plastic surgery because they're certified in another specialty but do tummy tucks and Botox on the side. This hardly ever happens with insured people because the company generally checks out the doctor.

The sorry truth of the matter is that no matter who pays or how they do it the real problem is the overly expensive and inefficient care here. It's not that there aren't great doctors and hospitals here, it's just that there is no control over costs like there is in other countries.

Germany, France, Spain, Italy and Japan, for instance, do NOT have single payer, but they do have universal health care. And the overall care is better than ours for less money. What they don't have is the constant stream of overpriced chits for every peek, poke, and procedure. They don't have doctors paying off a half million or so in student loans, or working 60 hours a week and taking home less than the receptionist after the bills are paid.

"Accountable care" sounds like a nice buzzword, but it will probably mean no more than the rest of the rote reciting of "single payer" "insurance companies are useless" and the rest of it.

Unless, of course, we make major changes to health care delivery.

[zipplewrath]

13. You can't control delivery

You can't control the delivery if you don't control the care. The government is going to have to get into the health CARE business.

[Hoyt]

12. I support the idea behind Accountable Care Organizations. But health insurers are forming them too.

Hospitals, that make most of their money from acute care and endless diagnotic tests and treatment are forming them.

In any event, better coordination of care will help us down-the-road.

While I would like single payer, it alone will not change the yearly increase in the cost of health care and the bad outcomes.

Until the system changes, single payer still won't be affordable for most people. Also, consumers need to change their expectations of the system.