How much does health insurance cost in the US?

[Aimless]

Bullshit. 84% of Americans are covered by insurance, and the co-pays for doctor visits are minuscule.

Another present for "I don't need statistics"-Loki who apparently does need statistics after all:

http://www.commonwealthfund.org/~/me...010_ITL_v2.pdf

http://www.ama-assn.org/ama/pub/news...port-card.page

http://www.kff.org/kaiserpolls/upload/7591.pdf

http://www.commonwealthfund.org/~/me...Excl%20pdf.pdf

http://www.pnhp.org/new_bankruptcy_s...uptcy-2009.pdf

http://www.commonwealthfund.org/~/me...rket_ib_v2.pdf

http://www.kff.org/insurance/upload/...-June-2001.pdf

http://democrats.energycommerce.hous...pplemental.pdf


As if it weren't bad enough already to be black or to lose your job. Maybe these people can buy your brand of rose-coloured glasses

[Aimless]

GGT don't you realise that when you're talking about the NHS one individual matters, while when you're talking about the US tens of millions of individuals do not matter? The value of a person is clearly relative and depends on the point that needs to be scored.

[GGT]

GGT don't you realise that when you're talking about the NHS one individual matters, while when you're talking about the US tens of millions of individuals do not matter? The value of a person is clearly relative and depends on the point that needs to be scored.

Of course. And a national budget reflects the values of that nation. Where does the US spend its money? Definitely not on the health, education, or 'welfare' of our own citizens, or building our own nation. We're too busy building other nations, after we've sent our military's destructive forces.

[Loki]

Another present for "I don't need statistics"-Loki who apparently does need statistics after all:

http://www.commonwealthfund.org/~/me...010_ITL_v2.pdf

http://www.ama-assn.org/ama/pub/news...port-card.page

http://www.kff.org/kaiserpolls/upload/7591.pdf

http://www.commonwealthfund.org/~/me...Excl%20pdf.pdf

http://www.pnhp.org/new_bankruptcy_s...uptcy-2009.pdf

http://www.commonwealthfund.org/~/me...rket_ib_v2.pdf

http://www.kff.org/insurance/upload/...-June-2001.pdf

http://democrats.energycommerce.hous...pplemental.pdf


As if it weren't bad enough already to be black or to lose your job. Maybe these people can buy your brand of rose-coloured glasses

How are any of these links relevant to 84% of Americans being insured?

[Veldan Rath]

I'm still wrapping my head around the fact that, according to GGT, we don't fund education or welfare or health. (Or would it be not to GGT's desired amounts?)

[Aimless]

Key Findings
• One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or
failed to fill prescriptions because of costs, compared with as few as 5 percent of adults in the United
Kingdom and 6 percent in the Netherlands.
• One-fifth (20%) of U.S. adults had major problems paying medical bills, compared with 9 percent or
less in all other countries.
• Thirty-one percent ofU.S. adults reported spending a lot of time dealing with insurance paperwork,
disputes, having a claim denied by their insurer, or receiving less payment than expected. Only 13
percent of adults in Switzerland, 20 percent in the Netherlands, and 23 percent in Germany—all
countries with competitive insurance markets that allow consumers a choice of health plan—reported
these concerns.
• The study found persistent and wide disparities by income within the U.S.—even for those with
insurance coverage. Nearly half (46%) of working-age U.S. adults with below-average incomes who
were insured all year went without needed care, double the rate reported by above-average-income
U.S. adults with insurance.
• The U.S. lags behind many countries in access to primary care when sick. Only 57 percent of adults in the
U.S. saw their doctor the same or next day when they were sick, compared with 70 percent of U.K.
adults, 72 percent of Dutch adults, 78 percent of New Zealand adults, and 93 percent of Swiss adults.
• U.S., German, and Swiss adults reported the most rapid access to specialists. Eighty percent of U.S.
adults, 83 percent of German adults, and 82 percent of Swiss adults waited less than four weeks for a
specialist appointment. U.K. (72%) and Dutch (70%) adults also reported prompt specialist access.

New AMA Health Insurer Report Card Finds Increasing Inaccuracy in Claims Payment

For immediate release:
June 20, 2011

Chicago – The overall rate of inaccurate claims payments increased since last year among leading commercial health insurers, according to American Medical Association’s (AMA) fourth annual National Health Insurer Report Card. Claims-processing errors by health insurance companies waste billions of dollars and frustrate patients and physicians.

According to the AMA’s latest findings, commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of two percent compared last year. The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the health system. The AMA estimates that eliminating health insurer claim payment errors would save $17 billion.

“A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually,” said AMA Board Member Barbara L. McAneny, M.D. “Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care.”

Most of the health insurers measured by the AMA failed to improved their accuracy rating since last year. UnitedHealthcare was the only commercial health insurer included in this year’s report card to demonstrate an improvement in claims-processing accuracy. UnitedHealthcare came out on top of seven leading commercial health insurers with a accuracy rating of 90.23 percent. Anthem Blue Cross Blue Shield had scored the worst of those measured with an accuracy rating of 61.05 percent.

To encourage a more efficient claims payment system, the AMA’s National Health Insurer Report Card provides an annual check-up for the nation’s largest health insurers and benchmarks the systems they use to manage, process and pay claims. Key findings from this year’s report card include:

Insurer Non-payment. Physicians received no payment at all from commercial health insurers on nearly 23 percent of claims they submitted. There are many reasons a legitimate claim may go unpaid by an insurer. Claims may be denied, edited or deferred to patients. During Feb. and March of this year, the most common reason insurers didn’t issue a payment was due to deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded. Real-time claims processing would save time and money.

Denials. Dramatic reductions in denial rates have occurred since last year at Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare, which cut its denial rate by half to 1.05 percent. CIGNA maintained its industry leading low denial rate of .68 percent. Lack of patient eligibility for medical services continues to be the most frequent reason for denials.

Administrative Requirements. For the first time the report card measured how frequently claims included information on insurers requiring physicians to ask permission before performing a treatment or service. CIGNA had the highest rate of claims requiring prior authorization, with more than six percent of claims indicating physician work associated with these requirements. A recent AMA survey of physicians indicated that insurers’ requirements to preauthorize care delayed or interrupted medical services, consumed significant amounts of time and complicated medical decisions.

Accuracy. In addition to measuring overall claims-processing accuracy, the report card examined how accurately insurers reported the correct contract fees to physicians. UnitedHealthcare has shown consistent improvement during the last four years in reporting correct contract fees. Other commercial health insurers showed progressive improvement over four years, but had slight declines this year. The exception was Anthem Blue Cross Blue Shield, which scored 14 percent lower on this measure than it did four years ago.

Timeliness. The report card found that CIGNA and Humana have cut their median claims response time in half during the last fours years. Response time varied for commercial health insurers from six to 15 median days.

The National Health Insurer Report Card is the cornerstone of the AMA’s Heal the Claims Process campaign. Launched in June 2008, the campaign’s goal is to spur improvements in the industry’s billing process so physicians and patients are no longer at the mercy of a chaotic payment system.

“In spite of notable improvements by insurers in the four years since the AMA’s introduced the National Health Insurer Report Card, precious health care resources are wasted because each insurer uses different rules for processing and paying medical claims, said Dr. McAneny. “This variability adds no value to the health care system and only increases unnecessary administrative costs.”

To help physicians better manage each insurer’s requirements for submitting claims, the AMA’s Practice Management Center offers easy-to-use online resources for preparing claims, following their progress and appealing them when necessary. The Practice Management Center’s library of education materials and practical tools are available online at: www.ama-assn.org/go/pmc.

INSURED BUT NOT PROTECTED: HOW MANY ADULTS
ARE UNDERINSURED?

BACKGROUND:Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of
all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and
bankruptcy laws have tightened.
METHODS:We surveyed a random national sample of 2314 bankruptcy filers in 2007, abstracted their court
records, and interviewed 1032 of them. We designated bankruptcies as “medical” based on debtors’ stated
reasons for filing, income loss due to illness, and the magnitude of their medical debts.
RESULTS:Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these
medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for
medical bankruptcy because they had lost significant income due to illness or mortgaged a home to paymedical
bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three
quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attrib-utable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors,
the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.
CONCLUSIONS:Illness and medical bills contribute to a large and increasing share of US bankruptcies.

ABSTRACT:Between 2001 and 2007, an increasing share of adults with private insur-ance—whether employer-based coverage or individual market plans—spent a large
amount of their income on premiums and out-of-pocket medical costs, were underinsured,
and/or avoided needed health care because of costs. Those with coverage obtained in the
individual market were the most affected. Over the last three years, nearly three-quarters
of people who tried to buy coverage in this market never actually purchased a plan, either
because they could not find one that fit their needs or that they could afford, or because
they were turned down due to a preexisting condition. Even people enrolled in employer-based plans are spending larger amounts of their income on health care and curtailing their
use of needed services to save money. The findings underscore the need for an expansion
of affordable health insurance options, particularly during a time of mounting job losses.

Taken as a group, the 7 hypothetical insurance consumers
made 420 applications for coverage. Most of the time
(90%), the consumers were unable to obtain the coverage
for which they applied at a standard rate – only 43 clean
offers of coverage were made (10%). They were rejected 154
times (including 9 cases where Colin was rejected but the
remainder of his family was accepted), or 37% of the time.
Greg accounted for 60 of the rejections. Among the 63% of
applications that were accepted, the vast majority (53%)
imposed benefit restrictions (118, representing 28% of all
applications), premium surcharges (56, or 13%), or both
(49, or 12%).
The average premium quoted for the five applicants
who received any offers of coverage was $333 per month,
or $3,996 per year. Had these applicants been in perfect
health (and therefore not denied coverage or rated-up),
the average standard rate that would have been available
to them would have been $249 per month, or $2,988 per
year. The average premium rate-up, when applied on a
single-only policy, was 38%.

Insurancecompaniesrescindcoverageevenwhendiscrepan ciesareunintentionalor
causedbyothers. Inonecasereviewedbythe Committee,aWellPointsubsidiary
rescindedcoverageforapatientinVirginiawhoseinsuran ceagententeredhisweight
incorrectlyonhisapplicationandfailedto returnitto himforreview. Thecompany's
AssociateGeneralCounselwarnedthatthe agent'sactionswere"notacceptable"and
recommendedagainstrescission,butshewasoverruled.
• Insurancecompaniesrescindcoverageforconditionsthat areunknownto
policyholders. In2004,FortisHealth,nowknownasAssurant,rescindedco veragefora
policyholderwithlymphoma,denyinghimchemotherapyand alife-saving stemcell
transplant. ThecompanylocatedaCTscantakenfiveyearsearlierthati dentifiedsilent
gallstonesandanasymptomaticabdominalaorticaneurysm ,butthepolicyholder's
doctorneverinformedhimofthese conditions. Afterdirectinterventionfromthe Illinois
AttorneyGeneral'sOffice,the individual'spolicywasreinstated.
• Insurancecompaniesrescindcoveragefordiscrepanciesu nrelatedto themedical
conditionsforwhichpatientsseekmedicalcare. InNovember2006,aTexasresident
withapolicyfromWellPointwasdiagnosedwithalumpinher breast. Thecompany
initiatedaninvestigationinto thepatient'smedicalhistoryandconcludedthatshefaile d
todisclosethatshehadbeendiagnosedpreviouslywithost eoporosisandbonedensity
loss. Thecompanyrescindedherpolicyandrefusedto payformedicalcareforthe lump
inherbreast.
• Insurancecompaniesrescindcoverageforfamilymembersw howerenotinvolved
inmisrepresentations.WhenaUnitedHealthsubsidiaryde terminedin2007thata
policyholderinMichiganfailedto disclosehisabnormalbloodcountandother
2
conditions,thecompanyalsorescindedcoverageforhissp ouseandtwo children. When
hisspousecalledto findout"[w]hywedroppedwholefamilyinsteadofhusband,"the
companyofficial"[c]alledherbacktoldhercoveragewasvoidedto medicalhistorynot
onapp."
• Insurancecompaniesautomaticallyinvestigatemedicalh istoriesforall
policyholderswithcertainconditions. WellPointandAssurantinformedthe
Committeethattheyautomaticallyinvestigatethemedica lrecordsofeverypolicyholder
withcertainconditions,includingleukemia,ovariancan cer,braincancer,and even
becomingpregnantwithtwins. UnitedHealthwasunableto explainspecificallyhowits
investigationsaretriggered, claimingthatitutilizedacomputerprogramsocomplextha t
nosingleindividualinthecompanycouldexplainit.
• Insurancecompanieshaveevaluatedemployeeperformance basedontheamountof
moneytheiremployeessavedthecompanythroughrescissio ns. TheCommittee
obtainedanannualp~rformanceevaluationoftheDirector ofGroupUnderwriting~t
WellPoint.Under"resultsachieved"formeetingfinancia l"targets"andimproving
financial"stability,"thereviewstatedthatthis officialobtained"Retrosavingsof
$9,835,564"throughrescissions. Theofficialwasawardedaperfect"5"for"exceptional
performance."

I can understand how you may be confused, but let me explain what happened: you did a Loki. Here's what I said:

As for your characterisation of the US vs the UK wrt access to care, do you imagine that high costs of treatment don't block access to care in the US? Are you truly that naive? US patients forego important checkups and medication because of high treatment costs. US patients suffer due to limited access when they're sick and need swift care, even though they in their desperation may turn to ED:s. How can you not know that?

If you scrutinise those five sentences you'll find no mention of uninsured people in particular, even though by rights they should be an important consideration to anyone who doesn't hate human beings (there are some people who pretend to care about individuals but then disregard the plight of tens of millions of individuals).

What you did was a classic "Loki", where you suddenly spewed out a statistic on how many people are insured and made a claim about the cost of healthcare to people. Because I have great patience even with your Loki-ing I provided links to demonstrate that "being insured" does not in itself make a person immune to the problems I referred to in my post. Ie. not only is 16% of your population uninsured--at great financial, physical, psychological, social, dare I say moral cost both to themselves and to the rest of the population--but the remaining 84% also face obstacles that lead them to eg. not filling prescriptions or getting necessary follow-ups or for that matter seeing a doctor when they're sick. On top of that they can still be on the hook for paying large out-of-pocket costs, they can still become bankrupt or severely inconvenienced due to medical bills, etc. Some of that may be attributed to the high rate of incorrect claims processing (approaching 20%!) but that is also a real obstacle. Or do you imagine people have unlimited time, energy and money?

You've already said you don't need statistics, do you now want to say that you don't need to read the posts in a discussion where you're an active participant?

[GGT]

I'm still wrapping my head around the fact that, according to GGT, we don't fund education or welfare or health. (Or would it be not to GGT's desired amounts?)

It's not about the amounts, since we spend more on education and health than other "top" nations. It's about the lower quality and outcomes, compared to those same nations. Loki arguing that stats don't matter, and suggesting that since 84% of Americans are "insured" means we have a great health system was....not only absurd, but patently false.

[Veldan Rath]

So your post that we don't fund these was false? You are not happy about the implementation then?

[GGT]

So your post that we don't fund these was false? You are not happy about the implementation then?

If that's how you want to deconstruct my post, yes.

The broader implication is that American legislators are fighting over certain pieces of the pie, during a globally constrained pie moment. Cutting public spending on education, R & D, healthcare, or infrastructure doesn't mean the private sector will pick up the slack. Private entities operate on quarterly or annual profits, a very short lens. Our government is tasked with decades long or century wide "investments" that can't be pigeon holed or compartmentalized.

[Dreadnaught]

Yes, as we all know, private companies have never invested or made long-term strategic decisions.

[Veldan Rath]

If that's how you want to deconstruct my post, yes.

The broader implication is that American legislators are fighting over certain pieces of the pie, during a globally constrained pie moment. Cutting public spending on education, R & D, healthcare, or infrastructure doesn't mean the private sector will pick up the slack. Private entities operate on quarterly or annual profits, a very short lens. Our government is tasked with decades long or century wide "investments" that can't be pigeon holed or compartmentalized.

Tasked and fails.

[GGT]

Do you think our spending and budgets reflects national priorities and values?

[Veldan Rath]

Jesus of course not...it reflects personal pet projects and vote buying schemes...and you want to give them MORE!

This is the whole point you keep (willfully) missing. The jerkwads in DC do not give a flying fig about you, me, the kid with cancer, the old lady with diabetes, or the fag with AIDS, UNLESS it can get them another round of goodies garnered from being a Senator or Congressman. These ninnynonnies then pass laws (about subjects they know nothing about) and then leave the meat and potatoes on HOW to enact the laws to regulators that no one can hold accountable.

This is what GE and I (and to a lesser extent Loki) have been railing about all this time.

You CANT hold a Federal Bureaucracy's feet to the flames. Is damn institutionalized and you want to cede more of your (and mine thank you very much) FREEEEDOMMMMM to them any chance you get, then get horrified when the dick form the other party gets in charge and then starts (ab)using the damn power you gave to the dick from YOUR party.

I DON'T want to vote for Mittens...gods help me...but I don't want to vote for the 'Most Transparent Administration' (HAHAHAHAHAHAHAHA) either, who's screeners throw out the god damn race card everytime disagrees with his policies. (The Great Uniter my damn foot)

[GGT]

Nice rant Veldan Agree we've got "institutional" breakdown, and I'll join you on the mistrust, cynicism, frustration, even anger. But we'll still need federal government to fund and/or coordinate domestic things private groups can't deliver to the whole country: public education and public health, expensive R & D in science and medicine, big infrastructure projects, disaster response, social safety nets, etc.

Those become important parts OF our "freedom and liberty" in action, not just theory or ideology. How "free" are people if they (or multiple millions of fellow citizens) are ignorant/uneducated, sick and can't get medical care, crumbling roads-highways-bridges-rails-airports are mobility obstacles, earthquakes, floods or wildfires are left to states? Not very conducive to "freedom and liberty" in a civilized society or a first world nation -- that wants to consider itself Exceptional.

(All the other expenses on defense/military are necessary, too. But we overspend and overreach (debatable if it's even made us safer), can't sustain all the international interventions....and can't even provide vets with the healthcare they deserve!)

I don't happen to think the solution is as simple as shrinking 'teh gummint', starving the beast, defunding federal agencies, deregulating industry, privatizing public services, etc. I think that's based on a false premise that gov't can't do anything, or do it right/well. IMO that's a reflection of dysfunctional politics, which can be changed, and changes all the time. (see Tea Party, filibusters, supermajority, Citizens United, super PACs... )

I don't want to cede power-by-proxy to lobbyists, Big Oil, Insurance Industry, Big Pharma, "Wall Street", Big Banks, billionaire cronyism -- buying legislators, buying favorable laws. That's what messes with accountability, and holding anyone's feet to the fire. IMO that can be changed but it'll take time.

ps I don't belong to a "party".

[Veldan Rath]

I'm sorry but we managed to struggle along without the Fed Department of education till what the 70's?

And when did we start slipping?

Federalizing does NOT mean better. (cough TSA cough)

[GGT]

You're blaming DoE for our educational 'slippage'? And using that to condemn federal government in general?

Privatizing doesn't mean better, either.