Should i respond to my Republican Congressman about Obamacare?

[patrice]

7. I'd want to know what CareFirst/BC/BS's Medical Loss Ratio averages for 10-20 years. & compare to

Medicare/Medicaid, which operates with a 3-4% overhead, making a Medical Loss Ratio (MLR) for Medicare of something over 95% compared to the 85% mandated by the Patient Protection and Affordable Care Act, a.k.a. Obamacare.

"Health" "care" mid-level business managers (some with one or another medical degree) called Risk Managers define a lot about how care is delivered by being part of what delivers operational mandates that protect and enhance profits, i.e. to "Do more with less".

For example, there are networks of PREFERRED vendors, preferred staffing agencies, preferred health care service groups for imaging and such, preferred data processors and many others who seek business with "health" "care" providers/institutions and, hence, with HC insurance companies.

Each and every level in all of the complex systems and sub-systems that add up to "health" "care" has a stake in how an MLR is achieved or not and, hence, in the operational efficiencies and/or dysfunctions that result in how much of your premium is spent on your care, compared to how much goes into, more or less, avoidable sources of overhead, much of which overhead has little or nothing to do with DIRECT CARE but which does indeed affect direct care because it's all part of the same set of systems that deliver "health" "care" according to specifications limited by business managers in all of the different levels of systems.

Health care professionals see the dysfunctions up close and personal, as do the families too, but health care professionals can lose their positions within the various delivery networks if they make too much noise about how much money is going to people and stuff that don't contribute to cures for care receivers. Mid-level and upper-mid-level managers' positions are, thus, protected by the silence and they can, therefore, continue to build these PREFERRED networks, thusly insuring the perpetuity of their jobs, which jobs are essentially to create their own jobs by means of the economic relationships that they control.

Like health care professionals, families can see the effects of these sets of arrangements on the output "end" of all of that, i.e. in what happens to their patients in these systems. Families can have their own impetus for silence about certain things, especially when, if they complain, they too can be identified as trouble makers and shunted into tracks that will take them out of certain contexts to become someone else's problems.

Elders in particular are very obvious canaries who manifest all of the inefficiencies that precede the point at which we encounter them. And understand too how heavily ALL systems are invested in claiming that "this was/is the best treatment for this person" or "there wasn't anything else that could be done for your loved one" for elders and such who have had a lifetime of (plausibly deniable) trial-and-error "care" by systems that are designed NOT to invest "too much" in individuals.

In short, costs going up or down are in part the effect of HC providers and not all providers DO DIRECT CARE, so market competition causes everything from second tier "care" up to the top to protect itself (whether that fits your particular loved one or not) in certain ways specified and, thus, controlled by the very MANAGEMENT & ADMINISTRATIVE systems that create all of this stuff.

Anyone internal to the institutions, i.e. receiving a paycheck or profits from it, has LOW incentive to change anything for the better, because that can cause you to be black-balled. Direct care givers are particularly vulnerable in that regard, since, if they did lose their jobs by whistleblowing, they'd just be re-cycled right back into the same set of systems through a different provider, because this is the way it's done almost everywhere, and, because they broke the taboo against public light, their recycling into a different job will probably come along with some loss of professional power to respond appropriately to the needs of those in their care.

Nurses will say, when it comes down to that possibility of losing their jobs for telling the truth, for them, the questions about systemic inefficiencies and dysfunctions also include that someone(s) who really NEED them will lose them, will lose that particular nurse (or CNA/CMA, or doctor, or med tech, or ...) if a care-giver tells the truth about delivery systems, so many direct-care givers will keep their mouths shut, not so much for a paycheck (which they can get practically anywhere in the country, btw, due to staffing shortages) but BECAUSE THEY KNOW how much care-receivers NEED them personally to be there to do what they can to move toward a positive result for those in their care.

HC institutions know this about relationships between direct care givers and receivers and they depend upon that personal responsibility to cover WHY CARE COSTS are so high. The relationship between care givers and receivers can be used to cover what "health" "care" institutions are charging for it and to cover their own corporate asses in re the precise details of the costs of "care" by using the personal sacrifices that nurses and such give practically every day to do the best for those in their care inside extremely top-heavy systems that protect paychecks and profits at all levels and thus control the prices that are part of the MLR.