Components of Optimal Health Insurance: #4 – Contract Free Healthcare Zones | Robert Nelson, MD | LinkedIn


Robert Nelson, MD

Does anyone else see a problem with this arrangement? And yes, it is all very legal. But that doesn’t mean it is prudent or even ethical to continue this convoluted, monopolistic, expensive, and restrictive method of accessing and paying for healthcare!

Look carefully at the characteristics of how health plan networks operate and follow the money flow from start to finish. What holds it all together? Despite its byzantine complexity and 40+ years of being entrenched into our national psyche, there is one linchpin that holds the whole perverse system together: It is the physician contract!

The provider (or provider’s employer) buy-in is what propagates and guarantees the survival of this behemoth. Without provider network agreements, the whole thing collapses like a house of cards!

via Components of Optimal Health Insurance: #4 – Contract Free Healthcare Zones | Robert Nelson, MD | LinkedIn.

Health Plans’ Mastery of Obamacare Poses Challenge To Repeal | Health Policy Blog |

Basically, when it comes to access to care, Obamacare has returned us to the status quo from before the Great Recession – at great cost to taxpayers. And that is only the picture in broad strokes. Very few people account for most medical spending, and those very sick people are doing poorly in Obamacare plans. A politician who offers a compelling plan to restore prosperity, as well as repealing and replacing Obamacare, should not face overwhelming odds convincing Obamacare beneficiaries.

The real obstacle to advancing an alternative to Obamacare will be interests in the health sector, which has mastered Obamacare remarkably. The latest evidence is the first quarter earnings reported by UnitedHealth Group and Hospital Corporation of America, both of which Forbes colleague Bruce Japsen describes as having had the “best Obamacare quarter yet.”

via Health Plans’ Mastery of Obamacare Poses Challenge To Repeal | Health Policy Blog |

Government Bailouts Business Strategy for Obamacare Health Insurance Co-ops | Health Policy Blog |

Taken together, these facts suggest CoOportunity executives purposely set rates low to gain market share — assuming taxpayers would bail-out their losses. The strategic plan was simple: 1) underprice premiums to gain market share; 2) Let taxpayers bailout the losses with emergency solvency loans and the risk-adjustment distributions; 3) increase premiums later once the dust settles.  This seems to be a common theme among health insurance co-ops. This type of activity should not have been allowed.  Most stakeholders — apparently including CoOportunity Health — expected taxpayers to bailout struggling co-ops indefinitely.  It’s now clear that is no longer going to happen.

The spectacular failure of CoOportunity Health was a wakeup call to other health insurance cooperatives, state insurance regulators, HHS and taxpayers. But it won’t be the last co-op that goes broke owing taxpayers large sums of money.  Going forward, state insurance regulators and other government regulatory bodies need to be on the lookout for co-ops that have strategic plans premised on losing taxpayers money while gaining market share — expecting taxpayers to bail out the insurer.  I suspect it will happen again and again until most of the co-op health insurers lose all their taxpayer financing and go bankrupt.

via Government Bailouts Business Strategy for Obamacare Health Insurance Co-ops | Health Policy Blog |

Paying With Other People’s Money | Robert Nelson, MD | LinkedIn

download (23)An established principle of money management goes something like this: “No one cares about your money more than you do”. Evidently, the government doesn’t agree. The feds have adopted the Lawrence Garfield approach, because it is obvious that the government LOVES your money… A LOT! As is evident by how much of it that they spread around. Sharing the love, I guess.

But this is only because the government knows better than you how to spend your money. It is for your own good that they confiscate… collect taxes for the greater good. You might actually do something stupid with your own money if you keep too much of it; like save it or pay off debt or donate to a charity or give to your place of worship or invest for the future – or worse yet, spend it on something you want (greedy capitalists).

To prevent your reckless, dare I say selfish, use of your over-abundance the federal government has designed much better programs where your ill-gotten dollars can be put to better use. And it is easy to lose, I mean risk…. uh, to invest in these programs. You really don’t have to do anything… other than pay more taxes of course. But as Joe Biden has reminded the citizenry, it’s our patriotic duty to give up the green to our overseers   uh…pay our taxes.

With that fatherly guidance in mind, let’s examine one scheme… an investment opportunity brought to you by one of the many pork sandwiches … special interest pay-days.... social infrastructure programs packed into the 2,700 pages of ObamaCare. Of course, being a non-profit kind of thing, your dividend is the satisfaction of knowing that you’re throwing good money after bad… you are lining the pockets of aging insurance executives …reinforcing the social fabric of the country and helping to make us all more dependent on government bailouts and make the economy weaker… stronger as a nation!

Without further adieu, let me give you a prospectus on this sure bet investment in the future of America.

But first a word from our financial risk department:

If anyone is still not convinced of the flawed assumptions and faulty financing mechanisms that permeate the ACA (ObamaCare), then please read the article below. But to summarize, a good crony deal is a deal that socializes the losses while paying large salaries to retired insurance executives to mismanage the company. Nowhere is this more evident than the Non-profit ObamaCare co-ops.

via Paying With Other People’s Money | Robert Nelson, MD | LinkedIn.

Aetna CEO sees piles of taxpayer financed profits thanks to Obamacare |

aetna-chart-cc-565x502That’s nice. It sure is good to know that the crony deal of the century (so far) Obamacare, is working out for the giant insurance companies. I was worried for them.

I’m joking of course since the giant health insurance companies along with Big Pharma wrote a good piece of the law. A law which was not even supported by a majority of Americans but was forced through Congress on questionable procedural grounds. A law which has now financially addicted a good portion of the American people like it was designed to. Yep, good times for the health insurance companies.

Not the small businesses of course. That’s a different matter. But they don’t have lobbyists and friends in the White House so that’s the way it goes in Obama’s America.

And all the profits the Aetna CEO is so happy about? They are a direct transfer of wealth from the middle class via taxes to his corporation’s bottom line. Congratulations big government people. Way to embrace corporatism.

via Aetna CEO sees piles of taxpayer financed profits thanks to Obamacare |

Fair-Healthcare Zones: No Third-Party Contracts Permitted! | Robert Nelson, MD | LinkedIn

third-party-insurance-quote-m5uykrfyBut these government-given advantages enjoyed by the health plan networks are just the icing on the cake compared to the fact that these network health plans utilize strictly defined benefits that rely on a totally separate provider contract that must be in force in order to use those “benefits” (really mostly pre-paid health maintenance plan that is heavily restricted)!

And, to make matters even more economically perverse, a non-negotiable cumbersome and expensive “claims” process is required by the payer and must be filed by the provider for each encounter used by a subscriber, no matter how minor or inexpensive. It is only after the properly documented and coded “claim” has been filed with the payer that the doctor gets paid.

Read the entire article at Fair-Healthcare Zones: No Third-Party Contracts Permitted! | Robert Nelson, MD | LinkedIn.

Bye, Bye “Bailout”: CROmnibus Takes a Small but Important Bite out of Obamacare | Health Policy Blog |

JRGrahamThe CROmnibus, with which the lame-duck Congress keeps the government open in 2015, takes small but important steps to repeal Obamacare. For the short term, the most important anti-Obamacare achievement is eliminating taxpayers’ liability for Obamacare’s risk corridors, often described as a “bailout,” to health insurers participating in Obamacare’s exchanges.

In June, I testified before the House Oversight and Investigations Committee about this insurance “bailout.” In that testimony, I advised Congress to define a limited liability to the program. So, budget neutrality is a better result for taxpayers than I had expected. Also, the CROmnibus prevents any other funds controlled by the Centers for Medicare and Medicaid Services from being used to fund risk-corridor payouts. This is a significant win for taxpayers.

via Bye, Bye “Bailout”: CROmnibus Takes a Small but Important Bite out of Obamacare | Health Policy Blog |

Taking the Crony Out of Capitalism – Paul Jacob – Page full

TeaPartyOccupyLee implores the “new Republican majority” to “make clear that our support for free enterprise cuts both ways. To prove that point, we must target the crony capitalist policies that rig our economy for large corporations and special interests at the expense of everyone else — especially small and new businesses.”

For starters, Lee suggests dissolving the Export-Import Bank and the Overseas Private Investment Corporation, and eliminating the “taxpayer bailouts for big insurance companies in Obamacare’s ‘risk corridors’ program.” He also notes the need to “break up taxpayer subsidies for the energy industry or large agribusinesses.

”Echoes of Ralph Nader, but with deep free-market rumblings. Not discord, but harmony.

via Taking the Crony Out of Capitalism – Paul Jacob – Page full.