Goldman analysis: Thumbs Up for Health Insurance Companies

Maybe the fact that it came from Goldman will motivate some people to take a second look at where we are on health care. Goldman likes the two biggest health insurance companies because it says profits are going up due to lack of competition and lack of regulation. Like the foreclosure mess, the fact that this is further damaging what was once a healthy middle class doesn’t seem to enter the equation probably because Goldman has a proprietary interest in those companies.

The net result, if Goldman is right about the failure of health-care reform, is that premiums will continue to rise thus further reducing median income which in turn will further reduce housing prices. Fewer and fewer people will be able to afford anything close to reasonable coverage which now costs as much as $30,00 per year for a middle-aged couple. Bankruptcies resulting from medical bills — already at 50% of all bankruptcies — will continue to rise, as will defaults and foreclosures putting further pressure on housing prices. And, as we already know, a decrease in housing prices results in a failing economy. In the courtroom, we say that intent is determined by the result if it was reasonably foreseeable.

Don’t get me wrong. reasonable people can disagree on the issue. But the fact is that while companies in other countries have national health-care plans, some with private insurance companies that are strictly regulated, and some without any insurance companies, some with a mix of public and private, the U.S. has the worst of both worlds — unregulated insurance companies that do not provide a national system under which everyone is covered. The worst consequence is that we have the worst health outcomes and death rate compared to 36 other countries. So the cost factor of providing insurance keeps going up while the benefits are decreased here. Each U.S. company is subject either to lower profits because it does provide insurance to its workers or lower productivity because the good workers are going elsewhere. Only in America.

Between the insurance industry and banking flooding the state and national capitals with lobbyists there isn’t enough hotel space to put lobbyists for us ordinary folk.

March 6, 2010

Obama Wields Analysis of Insurers in Health Battle

By DAVID M. HERSZENHORN

WASHINGTON — To bolster the case for a far-reaching overhaul of the health care system, the Obama administration is seizing on a new analysis by Goldman Sachs, the New York investment bank, recommending that investors buy shares in two big insurance companies, the UnitedHealth Group and Cigna, because insurance rates are up sharply and competition is down.

White House officials on Saturday said that the Goldman Sachs analysis would be a “centerpiece” of their closing argument in the push for major health care legislation. The president and Democratic Congressional leaders are hoping to win passage of the legislation before the Easter recess. Republicans remain fiercely opposed to the bill.

The Goldman Sachs analysis shows that while insurers can be aggressive in raising prices, they also walk away from clients because competition in the industry is so weak, the White House said. And officials will point to a finding that rate increases ran as high as 50 percent, with most in “the low- to mid-teens” — far higher than overall inflation.

The analysis could be a powerful weapon for the White House because it offers evidence that an overhaul of the health care system is needed not only to help cover the millions of uninsured but to prevent soaring health care expenses from undermining the coverage that the majority of Americans already have through employers.

Republicans, however, could also point to the analysis as bolstering their contention that Democrats should be focused more on controlling costs and less on broadly expanding coverage to the uninsured.

The research brief is largely based on a recent conference call with Steve Lewis, an industry expert with Willis, a major insurance broker.

In the call, Mr. Lewis noted that “price competition is down from a year ago” and explained that his clients — mostly midsize employers seeking to buy health coverage for their employees — were facing a tough market, in which insurance carriers are increasingly willing to abandon existing customers to improve their profit margins.

“We feel this is the most challenging environment for us and our clients in my 20 years in the business,” Mr. Lewis said, according to a transcript included in the Goldman brief. “Not only is price competition down from a year ago,” he added, “but trend or (health care) inflation is also up and appears to be rising. The incumbent carriers seem more willing than ever to walk away from existing business resulting in some carrier changes.”

The report also indicated that employers are reducing benefit levels, in some cases by adding deductibles for prescription drug coverage in addition to co-payments, and raising other out-of-pocket costs for employees as a way of lowering the cost of insurance without increasing annual premiums and employee contributions to them.

Kathleen Sebelius, the secretary of health and human services, is expected to discuss the Goldman analysis on two Sunday television talk shows, “Meet the Press” on NBC and “This Week” on ABC.

In his call with Goldman, Mr. Lewis said beneficiaries were feeling the brunt of the changes to existing policies. “Visually to employees, they’re fairly significant,” he said.

But the report also sounded cautionary notes that the administration will probably not want to highlight.

Asked by Goldman analysts about the effort to pass major health care legislation, Mr. Lewis said many employers experiencing increases in their insurance costs were nonetheless apprehensive about the president’s proposal.

“They’re very mixed in their reaction, quite candidly consistent with what we’re seeing in the polling numbers by party lines,” Mr. Lewis said. “I think most people would acknowledge that there’s a need for health care reform; employers continue to be very frustrated. So when they look at what the Obama administration and the Democratic majority state as their goals to increase access and lower cost and rail at what may be termed oligopolistic behavior of carriers in certain markets, I think employers really buy in to that message and have much of that frustration and anger at our lack of solutions.”

And yet, he said, there is little enthusiastic support from employers for the Democrats’ proposals.

“Many of them still view the legislation and the partisanship coming out of Washington as possibly the medicine worse than the disease,” he said. “So many employer groups that we’re talking to feel like it would be a shame to lose an opportunity to do something with respect to health care reform. But many are starting to feel like maybe nothing is better than something in this current environment.”

Clinton’s Healthcare Sell-Out: Watch Out for this Lady — She wants to be President more than she wants to be a great president

THE PROBLEM WITH AMERICAN HEALTHCARE

AN UNAVOIDABLE TRUTH — IT DOESN’T WORK

When Marianne Falacienski’s husband started a new job, the family could not afford the health plan. Ms. Falacienski, 32, found individual coverage only for him and their daughter, Gabrielle.

WHY OBAMA HAS THE RIGHT APPROACH:

INCREMENTAL STEPS TO ELIMINATING MIDDLEMEN WHO ADD COST BUT NO VALUE

THE REASON WHY HEALTHCARE COSTS ARE SO HIGH: We let it get that way because we thought we were not paying for it. We were lulled into this fraudulent situation by the presence of “insurance” which was just a hidden tax which we call “PRIVATE TAXATION.” This opened the door for the profit motive to dominate healthcare.  The inevitable result was cutting costs by delivering less care, increasing revenues by increasing premiums, and avoiding delivery by small print. 

THE EFFECT ON AMERICAN HEALTH: Americans are dying younger, with higher infant mortality than 40 other countries, and living lives of quiet desperation and stress locked in by a system that requires us to choose between life and death, between quality of life or suffering, and between being overmedicated into virtual stupor or becoming our own physicians and deciding what medications we need.

WHO CONTROLS OUR OPTIONS: The presence of insurance along with government complicity has interfered with the normal market forces found in every other country on the planet. Examples abound where the cost of a medication is $120 per month here whereas it could be as little as 5 cents elsewhere. 

The pharmaceutical industry dictates medical protocol: the profit motive requires them to present protocols that require long-term constant daily medications which now average 8-10 pills per day for many people. 

The pharmaceutical industry controls the FDA (virtually all FDA employees have worked for Pharma, are working for Pharma or will work for Pharma and Pharma literally pays most of the budget of the FDA). 

Any protocol that is preventative is opposed by Pharma and opposed by the insurance companies because revenues would decline, costs would decline and thus the need for expensive insurance premiums would also decline. 

Any intervention protocol is likewise not covered by insurance and declared “placebo” or “experimental” unless it is accompanied by a protocol of 53 pills per day for life as in the case of a lung transplant. 

The inescapable conclusion is that the insertion of insurance into our lives has increased our effective rate of taxation without us realizing it was a tax, it has reduced the level, quantity, availability and quality of care, and is responsible for half of all bankruptcies filed.

Obama’s plan, while it continues to include the insurance infrastructure, loosens the death grip of the insurance-Pharma cartel. It can lead to continued enhancements of the system and eventually to a single payer system which is what everyone else in the world has. 

Mandatory insurance is a sell-out for continuation of the current system regardless of what sound bites are attached to it. Obama is once again taking the courageous position of recognizing the nuance and complexity oft he situation and taking hits for not “mandating” insurance for everyone. The Clinton-Edwards “mandatory” plan is good politics, bad economics and unworkable.

Mandatory health insurance is a tax pure and simple. Except by inserting private insurance companies into the mix it adds between 100% to 500% to the costs of healthcare. Mandatory insurance is a wealth transfer system and anyone who promotes it is either purposefully or inadvertently playing into the hands of the few people who benefit financially from this corrupt system while the rest of us continue our lives of quiet desperation and stress.

 

May 4, 2008

Even the Insured Feel the Strain of Health Costs

By REED ABELSON and MILT FREUDENHEIM

The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.

With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline.

“It just keeps eating into people’s income,” said James Corbin, a former union official who works for the local utility in Tucson.

Mr. Corbin said that under their employer’s health plan, he and his co-workers are now obliged to pay up to $4,000 of their families’ annual medical bills, on top of about $1,600 a year in premiums. Five years ago, they paid no premiums and were responsible for only about $2,000 of their families’ medical bills.

“That’s a big jump,” Mr. Corbin said. “You’ve just lost a month’s pay.”

Already, many doctors say, the soft economy is making some insured people hesitant to get care they need, reluctant to spend a $50 co-payment for an office visit. Parents “are waiting longer to bring in their children,” said Dr. Richard Lander, a pediatrician in Livingston, N.J. “They say, ‘The kid isn’t that sick; her temperature is only 102.’ ”

The problem of affording health care is most acute for people with no insurance, a group expected to soon exceed 48 million, but those with insurance say they too are feeling the pain.

Since the recession of 2001, the employee’s average cost of an annual health care premium for family coverage has nearly doubled — to $3,300, up from $1,800 — while incomes have come nowhere close to keeping up. Factor in other out-of-pocket medical costs, and the portion of the average American household’s income that goes toward health care has risen about 12 percent, according to the consulting and accounting firm Deloitte, and is now approaching one-fifth of the average household’s spending.

In a recent survey by Deloitte’s health research center, only 7 percent of people said they felt financially prepared for their future health care needs.

Shirley Giarde of Walla Walla, Wash., was not prepared when her husband, Raymond, suddenly developed congestive heart failure last year and needed a pacemaker and defibrillator. Because his job did not provide health benefits, she has covered them both through a policy for the self-employed, which she obtained as the proprietor of a bridal and formal-wear store, the Purple Parasol.

But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband’s heart medicines, which cost some $400 a month.

Experts say that too often for the underinsured, coverage can seem like health insurance in name only — adequate only as long as they have no medical problems.

“There’s a real shift in the burden of health care to people who happen to be sick,” said Paul B. Ginsburg, the president of the Center for Studying Health System Change, a research group in Washington.

Companies and policy makers have yet to focus on what the faltering economy means for employees’ medical care, said Helen Darling, president of the National Business Group on Health, a Washington association of about 200 large employers.

“It’s a bad-news situation when an individual or household has to pay out-of-pocket three, four or five times as much for their health plan as they would have at the time of the last recession,” she said. “Americans have been giving their pay raise to the health care system.”

Sage Holben, a 62-year-old library technician with diabetes who is active in her local union in St. Paul, says that in 2003 union members agreed to a two-year freeze on wages to protect their health care coverage. But for the union, which will begin talks on the next contract this fall, it may be difficult to continue that trade-off, Ms. Holben said. “It’s at the point where we’re losing, anyway,” she said.

“I live paycheck to paycheck,” said Ms. Holben, who makes close to $40,000 a year at Metropolitan State University.

When she took the job in 1999, she says, the health benefits required no co-payments for doctor visits. Now, her out-of-pocket cost per visit is $25, and she pays $38 a month for her diabetes medicine. She has not been to the eye doctor in two years, even though eye exams are crucial for people with diabetes and she knows she needs new glasses. Nor does she monitor her blood sugar as regularly as she should because of the cost of the supplies.

“It’s not an extravagant expense,” she said. “It just adds up.” And it comes atop the increasing cost of utilities, gasoline and food — and the few hundred dollars of repairs her 1994 Chevrolet Cavalier needs.

Many employers do recognize that their workers are struggling financially even as they are asking them to pick up more of their health-care bills.

“It makes the work we have to do even more challenging,” said Anne Silverman, the vice president in charge of benefits in North America for the publishing company Reed Elsevier. “Employees are being stretched in terms of their disposable income.”

Even so, more companies may see themselves as having little choice but to require employees to pay even more of their health expenses, said Ted Nussbaum, a benefits consultant at the firm Watson Wyatt Worldwide. And when a weak economy undermines job security, he said, workers may simply have to accept reduced benefits.

While Mr. Nussbaum and other consultants say it is unlikely that significant numbers of employers will simply drop coverage for their workers, the weak economy could prompt more of them to push for so-called consumer-driven plans. Such plans tend to offset lower premiums with higher annual deductibles.

And while these plans often allow employees to put pre-tax savings into special health care accounts, they typically end up forcing the worker to assume a bigger share of overall medical costs. About six million people are now enrolled in these medical plans.

Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.

Health costs are “burying small business,” said Mike Roach, who owns a small clothing store in Portland, Ore. He recently testified on health coverage at a Senate hearing led by Ron Wyden, Democrat of Oregon.

Last year, Mr. Roach paid about $27,000 in health premiums for his eight employees. “It’s a huge chunk of change,” he said, noting that he was forced to raise his employees’ yearly deductible by 50 percent, to $750.

Around the nation, some workers are simply priced out of their employee health plans.

After Brian Falacienski of Milton, Fla., was laid off last year from his job as a surveyor for a construction company, he found another position. But the cost of his new health plan — $800 a month for coverage with a $1,000 annual deductible — was beyond the means of Mr. Falacienski, 38, who is married and has a 2-year-old daughter.

His wife, Marianne, started researching individual insurance policies and was able to find policies for her husband and daughter offering basic, if minimal, coverage, costing $161 a month for father and daughter. But Ms. Falacienski, 32, who has arthritis and the severe digestive disorder Crohn’s disease, is now uninsured. Because of her conditions, she said, four major insurers rejected her.

“I even applied for Medicaid,” she said, “but I wasn’t low-income enough.”

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