tag:blogger.com,1999:blog-9612609.post5522798958400064118..comments2023-09-29T06:58:20.125-07:00Comments on Badtux the Snarky Penguin: Why ObamaCare won't solve denied claims problemBadTuxhttp://www.blogger.com/profile/01345749557330760251noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-9612609.post-14720047667720595172012-03-29T22:10:02.743-07:002012-03-29T22:10:02.743-07:00Neurovore, the first HMO's were created by emp...Neurovore, the first HMO's were created by employers for their employees in order to reduce their labor costs and thus technically violated the anti-trust laws, which prohibit employers from conspiring with each other to reduce their labor costs (thus the little kerfuffle going on here in the Valley where it is alleged that several major employers did just that). Thus the need for an anti-trust exemption to make what they do legal. <br /><br />Regarding what happens if the Supremes *only* void the mandate part: I'm not seeing how they could void the individual mandate without voiding the employer and insurance company mandates also (the mandate that employers provide insurance and the mandates that insurers accept anybody who shows up). Otherwise the entire private health insurance industry collapses in a few years. At that point Medicare for All starts looking like the only thing that might pass muster, since Medicare has already been ruled as being constitutional multiple times and even this right-wing Supreme Court would have trouble creating a plausible ruling that it wasn't. One thing is certain, however: The current system will collapse shortly if something isn't done. Already 51% of the costs are being borne by the government, and that's only going to rise as employers drop coverage for their employees. So we'll see. <br /><br />- Badtux the Healthcare Economics PenguinBadTuxhttps://www.blogger.com/profile/01345749557330760251noreply@blogger.comtag:blogger.com,1999:blog-9612609.post-91898447356190764462012-03-29T19:47:59.897-07:002012-03-29T19:47:59.897-07:00I forgot to thank you for responding to my questio...I forgot to thank you for responding to my questions in your last post on healthcare and insurance. Thank you.<br /><br />One more thing, though...how did HMOs become exempt from antitrust regulations in the US?<br /><br />Also, if the Supreme court decides to void the "mandate" part of the Obomneycare bill that was passed, what would this mean for the future of the rest of the healthcare measure? Since the mandate was such an essential part of the bill, it seems that everything else would fall apart if it was removed. Is there any will or energy left in either Obama or Congress to try and repair the healthcare bill without the mandate or to pass any new legislation dealing with the healthcare problem?<br /><br />I am sorry if I am always asking you these rambling questions, it is just that the nature of medical coverage in the US seems to be needlessly complex, and it does not help the fact that there are many bad actors on all sides of the issue that are either completely ignorant or willfully misleading when they spout off various platitudes about medicine and its associated costs. I am no expert in this either, as my background is in the biological sciences, not in finance or administration. I prefer the rational world of research to the arcane and arbitrary abyss that characterizes political discourse in the US. Unfortunately, the douchebags that run our political structure are the ones that make the decisions and the decisions that they make affect all of us in our daily lives.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9612609.post-34708992976854935562012-03-29T07:58:39.449-07:002012-03-29T07:58:39.449-07:00Joe, the "informational handling" proble...Joe, the "informational handling" problems you've seen are deliberate, and are part of the plan to deny as many claims as they can get away with without being cited by regulators. The insurers have been approached many times about creating a common claims form and common claims information clearinghouse -- indeed, there already is a model for one, the Medicare one, which has all the treatments and diagnoses on it that every other claims form has, because Medicare covers the disabled as well as the elderly and thus must have things on it like pregnancy tests and childbirth and so forth as well as old folks' diseases -- and every single time the medical claims processing folks approached insurers, the insurers acted as if they were cross-wieldin' garlic lovers approaching vampires.<br /><br />About the only thing you can say about Obamacare is that it doesn't make things *worse* than the current situation, where insurers compete for customers (businesses) by how many claims they can deny, but it ain't gonna improve that situation either, that's for sure. The incentives are just all wrong for that.<br /><br />- Badtux the Healthcare Economics PenguinBadTuxhttps://www.blogger.com/profile/01345749557330760251noreply@blogger.comtag:blogger.com,1999:blog-9612609.post-24426219050698502912012-03-29T04:27:05.802-07:002012-03-29T04:27:05.802-07:00An insurance company could get a step up on the co...An insurance company could get a step up on the competition by improving their information handling. My experience is all from the consumer side, but from what I've seen, there's a lot of room for gaining efficiency.<br /><br />They would put the savings into executive salaries, not lower premiums, but that's OK.Joehttps://www.blogger.com/profile/04572777569221103038noreply@blogger.com