What Are You Hearing?

In place of a Health Alert today, I am going to relate some things I have been hearing and ask you to respond in the comments section on whether your intelligence is similar to mine.

  • Aetna and UnitedHealth Care pulling out of California is only the tip of the iceberg. Tens of thousands of individual policyholders all over the country are getting cancellation notices this summer, effective December 31st.
  • Insurers pulling out of entire states and cancelling their individual business has actually been going on for several years, but is not getting reported.
  • In general, the health care media is reluctant to publish anything negative about ObamaCare, unless the White House admits it; and even then the news is accompanied by the official spin. (The reality is worse than people are being led to believe.)
  • There has been a significant drop off (on the order of 10% or more) in new business purchases of health insurance.

Just when everything looks so dark

  • California is not an aberration. Plans in the exchange will pay providers somewhere between Medicare rates and private fees and the networks will be very narrow. (Think of these plans as Medicare Plus, with a lot of doctors not participating; if Massachusetts becomes the model, they will be Medicaid Plus.)
  • In states that have been aggressively setting up their own exchanges, there has been a great deal of back-and-forth communication between the exchange managers and the insurance companies to make sure everything works right. But in the 33 states where the federal government will be running things, there has been no communication at all.
  • As far as the technical specs are concerned, the insurance companies need a lead time of about 15 months — 12 months to get their systems designed and about three months to beta test them. So the industry needed these specs from the federal government one year ago. They still don’t have them.
  • Crony capitalism is becoming rampant — with some health plans, for example, getting special exemptions not given to others at the state level.

Comments (63)

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  1. Ralph Weber says:


    What I was seeing in the marketplace, was paralysis until after the 2012 elections, then starting a month after that … panic. Businesses were finally open to doing something, and doing something immediately. Many of the big carriers, and big consulting houses were doling out mainstream expensive solutions, and employers were firing staff and cutting hours, and resigning themselves to the fines instead. With the help of a benefits attorney and an actuary, we developed some real innovative solutions that cost between $75 and $175 per month with would get you out of one or both fines respectively. The Wall Street Journal wrote about what we were doing, and a marketing organization heard about it and wanted to market our products. One of the big 5 carriers heard what we were doing and told all of their agents not to sell our products, so just yesterday, my contact at the marketing organization was fired.

    Now I’m seeing new reluctance to move by employers…a new reason to procrastinate.

    Regarding crony capitalism, my opinion is that if the political spectrum is a circle, then crony capitalism is at the 5:00 position, communism is at the 7:00 position, and Fascism is at the 6:00 position where the left and right meet.

  2. mdb says:

    The insurance companies need specs, but every system the exchanges interface with will need specs (employer, states, fed government agencies, etc.) and many of those specs will be interdependent (longer to implement). The design and testing of all the interdependent interfaces would take a decade.

    The exchanges as envisioned, will not happen. By the time they are designed, they will be obsolete.

    • JD says:

      There is no doubt that we are all watching a train wreck as it is happening, but how extensive will the damage be? Will we ever be able to pick up the pieces? I think that your analysis is correct. Hopefully we can get this thing reversed instead of being tethered to an obsolete system.

    • Chuck Bortell says:

      Totally agree with “mdb” and echo completely; therefore, will not regurgitate, except to emphasize. However, rather than the “train wreck”, my metaphor is the TITANIC. Just like PPACA, “Titanic” was behemoth and fatally flawed in fundamental design, and suffered faulty construction. Thus, it foundered while barely underway on its maiden voyage. PPACA will do the same; except the type of collapse is uncertain. Maybe, an oozing sinking like the “House of Usher” into its toxic swamp; or, maybe, centrifugal disintegration? Slow or rapid?

      The problem for the insurance industry is concocting a replacement. Maybe, “private Health supplementary insurance, similar to the U.K. or MedSupps? Whether we like it or not, we are already at the “Socialized” point, per the clock example above.

      “In my humble opinion”, OBAMA will try to delay and defuse with confusion and digressions spawned by the MSM; until there may be a window for a “Single Payer” scheme. For the latter, whom and how would funding occur, for the “Single Payer” to disburse funds? Even Medicare with its flaws, has a “45-year Waiting Period”.

      Fair winds and following seas,
      Chuck Bortell

  3. Ralph Weber says:

    We all know the carriers lobbied hard for obamacare. But why? Because they make so much “hidden” money in the PPO “discount”. Just look at what’s happening with Blue Cross of Michigan. Another $5 million just awarded to an employer.
    The carriers (All of BUCAH) will fight to preserve the opacity with all kinds of spin.
    They hate that a private TPA can create solutions that cost way less than their “solutions”

    • JD says:

      That’s how things get done in fascism, the “leaders” get compensated to do something irrational and counter-productive.

      • Ralph Weber says:

        Precisely. I got a lot of criticism for writing about fascism in MediCrats, but it is what differentiates obamacare from hillarycare

    • Howard says:

      Guess we will just have to watch this train wreck happen in all the states that went along with Obamacare.

      • JD says:

        Isn’t a lot of the funding coming from the nation as a whole? Unfortunately, I don’t think that we will be safe from all of the destruction.

    • John Fembup says:

      Ralph, you have still not answered my question about documentation about “what’s happening” for insurers other than Blue Cross.

      Thanks –

      • Ralph Weber says:

        I dont see a question

        • John Fembup says:

          “I dont see a question”

          You don’t? Then I’ll add a question mark.

          What about documentation for “what’s happening” for insurers other than Blue Cross?

          You might also look here:


          Thanks –

          • Ralph Weber says:

            I’d suggest you either google it and research it yourself, or hire someone to. I gave you a link to Lexus Nexus, but I dont have time to do your research

            • John Fembup says:

              “I dont have time to do your research”

              Ralph, with due respect, this is not a matter of “time.” You clearly have the time to post here frequently. You also have the time to defend what you assert.

              After all you made your assertions, not me. I’m only asking for a link to your source.

              You were quick to provide a source for BCBS Michigan. You have ignored my repeated requests to provide your source for the other assertion you made, that “BUCAH” engages in the same practice.

              You either have sources or you don’t. Your link to “lexus nexus” refers only to BCBS MI. That suggests you have no source relating to other companies and that you have been blowing smoke.

              You can correct this suggestion whenever you like by providing a link to your source relating to other companies.

              Thanks –

              • Greg Scandlen says:


                When I was with the national BCBS Association, the Virginia plan got into trouble because it was basing its coinsurance on full charges, even when it got a huge discount. In some cases it ended up not having to pay anything, such as if the coinsurance was 70/30 and the discount was 70%. Virginia enacted legislation to prevent this in the future.

                I have no idea if non-Blues have ever done this, but the lack of transparency on PPO payments certainly allow for shenanigans.

                • John Fembup says:

                  Thanks Greg. At one time I was VP & chief underwriter at one of the largest Blues – not Michigan. 15 years ago, our general counsel insisted we rewrite all our contracts to disclose how discounts were applied. I also worked for a commercial company that initiated a lawsuit against the Michigan Blues on the issue of hiding a portion of their discounts. I’m willing to believe this issue affects the Michigan Blues. But I haven’t seen evidence of other company misconduct.

                  Ralph has implied that he knows for a fact that the so-called “BUCAH” companies all do the same thing.

                  I have asked for confirmation which, except for Michigan Blues, he has been unwilling or unable to share.

                  I think if he had hard evidence it would be easy to share. Instead he claims he doesn’t have time to post a link to it.

                  Sounds lame-o to me – doesn’t it to you?

  4. Mark Pauly says:

    Point #2 about individual insurance shrinking in terms of financial attractiveness for years is surely true; Mutual of Omaha and some others pulled out. My monograph for Hoover Health Reform without Side Effects showed that profit margins were modest and have since been hit by the Medical Loss Ratio “refunds.” So I agree the individual market has been seriously disrupted and many insurers except those subject to political pressure would like to wait on the sidelines. I doubt that 10% of the market for business insurance has been lost given that most of it is self insured. Perhaps 10% of the 49% that is market insurance, or less than 5%, at most.

  5. Ian Duncan says:

    There does seem to be an influx of new health plans and Co-op plans coming in to fill the space that the traditional health plans vacate. This may work or it may not: the ones I am familiar with don’t have their own networks and rent networks from existing plans. Their capitalization may also be an issue going forward. And I have had some (admittedly limited) experience with the principals of a couple of plans with limited managed care experience. As those of us with managed care insurance experience know, its easy to manage a health plan in the upswing of the cycle, but the downswing will prove another issue.

    • Greg Scandlen says:


      Is there any advantage whatsoever to a Co-op? If so, I can’t see it. Seems to me it will have to do everything a commercial company does but with a WHOLE lot less management expertise.

      • Frank Timmins says:

        I think they call it “re-inventing the wheel” which of course is all the ACA is about anyway. Actually it’s worse. The ACA “re-invents” processes that were not only previously invented, but proven to not work.

        Greg, I think the big problems in a coop as Ian describes is the provider contracting issue. If all “exclusive” provider (carrier and PPO) contracts were outlawed, we could make some progress.

        • Don Levit says:

          We don’t need to outlaw them.
          We simply need the “active” exchanges to do their work, as opposed to the “passive” exchanges.
          In the ACA, it allows for exchanges to negotiate rates with providers.
          In this way, the playing field, as according to the law, will be level for small businesses and individuals.
          With prenegotiated rates, one does not even need a network!
          Don Levit

          • Frank Timmins says:

            Don, this is a bit off point, but I don’t see how provider contracting (no matter the group involved) can do anything but lead to an impaired competitive environment.

            In my view, an insuring entity that can attract premium or membership fees based upon special pricing arrangements continues to degrade the direct relationship between the physician and the patient. While it may appear to be cost effective to the bean counters, it does not take into account the problem of third party intervention (and that is at the heart of the healthcare problem).

            • Don Levit says:

              I agree with you that third parties need to be left on the preiphery. As long as they are not involved, the transaction is simply betwen patient and provider.
              But when a third party is needed, for larger claims, shouldn’t they be included in the negotiations, for the third party is the one paying the provider.
              If the active Exchanges negotiated prices for every procedure for every provider, and if providers end up with about the same revenues from the insurers, wouldn’t it be more efficient (and level the playing field) to have all insurers reimbursing providers equally – no competitive advantage for the larger players in negotiating rates.
              Don Levit

              • Frank Timmins says:

                Don, I absolutely agree. At some point on the expense scale the patient (or patient advocate) becomes a passenger instead of the driver. As you know that almost always involves a facility expense.

                Put another way when healthcare expense reaches the “proper” insurance level, third party forces must become involved. But even then, I question the notion of “exclusive” contracts between insurance companies and hospitals simply because it reduces insurance competition on the retail level. There has to be a better way to build this mouse trap.

                • Don Levit says:

                  I agree. Exclusive contracts does not level the playing field for small businesses and individuals. It excludes most of the playing field from the “elite” providers.
                  If providers can get, in total, “normal” compensation for normal work, why should they complain if everyone is in the game, at the same price, adjusted for region of the country.
                  Don Levit

        • Vince says:

          As a provider I could not agree more with the outlaw of provider contracts. I have always subscribed to the philosophy that the insurance companies should put out their fee schedule and let the providers have the option of taking them or not. The insurance companies that have too low rates and oppressive regulations will be shut out by the top providers, demand will either run these out and they will need to adjust or go out of business. Those that will work with providers to provide adequate funding, reasonable regulations will flourish and the market will dictate not government.

      • Devon Herrick says:


        A reporter called me the other day asking how I expected Co-ops to fare under health reform. I told him to expect problems for precisely the same reason you indicate. Progressives somehow thought co-ops could do a better job insuring people than the legacy firms that have been insuring people for decades — despite the fact that the regulatory landscape has changed and it’s become harder now.

      • Sean Parnell says:

        Greg: One potential benefit from co-ops is that, as new entrants, they may be more willing to think outside the box and innovate – that lack of management expertise you cite might also be considered as a possible lack of investment in the legacy status-quo. I wrote a bit about it here: http://constantinegroup.us/2013/06/04/health-care-co-ops-innovators-in-insurance/

        That’s not to say that they will be innovators, only that the possibility is there.

    • John Fembup says:

      Ian, could I have known you at Aetna in the 1990’s?

  6. Mike Braun says:

    From an agents perspective, there has been no communication about getting trained on the federal exchange. We are supposed to have a producer ID. We already have state and NPN but the excahnges require another. I have been registered on the enrollamerica website. This is a community organization that is responsible for rolling some of these programs out. I wanted to see what information was coming from them. Just rallying the troops. Typical community organizing.

    With UHC and Aetna pulling out of the Ca market shows that it is uncompetitive and carriers in the exchange under pricing the product. With premiums set below market and provider payment set below market, this is a recipe for disaster.
    This seems to be a disaster coming full steam.

    • Chuck Bortell says:

      Regarding Agents: In short, HHS through the Exchanges, has “nationalized” and confiscated Agent commissions; and, then promised favors to allied entities such as H&R Block for its purportedly “free” and “self-serving” counsel. However, in Florida (my location) there is a relatively new law requiring “Navigators” (e.g., H & R Block, et al)to be licensed, with a reasonably hefty financial penalty for non-compliance. (How about the Walgreen’s clerks?) Consequently, the “Agents” need an ad hoc organization that will help enforce the “Navigator” licensing mandate. In Florida, it takes the Division of Insurance Fraud (i.e., sworn law enforcement authority) to inspect non-insurance entities. How do we mount such a posse? Present any ideas and register at
      Fair winds and following seas, Chuck Bortell – Florida Agent

  7. Devon Herrick says:

    I believe policy makers and proponents of the Affordable Care Act tend to underestimate the impact of uncertainty on insurance markets.

    Supporters of the ACA believe that the market for health insurance will be fine — everyone (including insurers who are supposed to cover everyone) just need to be patient. Yet, if anyone wants the ACA to work, it’s insurers. Even the ones opposed to the ACA; they still want it to work since it’s the law of the land. However, it’s a little too much to expect insurers to be patient in the face of uncertainty.

    Insurance by its nature is about transferring a risk in return for a premium. If uncertainty makes it impossible to accurately price risk, there will be a risk premium for that uncertainty. There will also be higher premiums for the higher risks that the ACA’s new regulations will require (i.e. guaranteed issue/community rating).

    One fear is that the people most likely to learn about the exchange policies are those who are sick. The healthy have less reason to seek coverage. Insurers want to ensure that the market doesn’t suffer adverse selection before taking on the risks. That is why insurers want to wait on the sidelines before diving into the market.

    • Ralph Weber says:

      Devon, You’re right that “insurance” is about transferring risk, however most health plans today are 2 opposing forces which are bundled. 1) Insurance, and 2) Benefits. By trying to make them one product, both suffer. We’ve taken them apart and finance each part differently. Something politicians would never figure out, and something BUCAH does not WANT you to figure out

      • Don Levit says:

        Great to know you have done so, separating insurance and benefits.
        Maybe we need to reconnect.
        We are in the process of purchasing an insurer licensed in 49 states. We plan to make our patented product available in 2014.
        My E-mail is donaldlevit@aol.com.
        Also, I would like to learn of more details of your anti-competiitive experience.
        Don Levit

    • Mike Farrell says:

      Take your observation a step further and convince all of the insurers who offered proposals to participate on the exchanges – to pull the plug on the feds. I recognize that, at first glance, insurers likely would be reluctant to bail on the feds because they see new customers coming their way, however, are these the type of new customers insurers really want? I believe anyone buying insurance coverage on the exchange will likely be someone who is either too poor to afford coverage (looking for a subsidy) or a high risk medical individual who was previously declined insurance. These are not good (or profitable) customers! Why would insurers want them?

      State and federal regulators are evaluating the exchange proposals now and negotiating final premium rates and benefits with insurers. It is my understanding that contracts to participate in the exchanges will be sent to insurers sometime toward the end of August or early September. I’ve been told the insurers have until September 6th to sign these contracts. What if every insurer suddenly bailed out and rescinded their offers? If every insurance carrier did this on Sept 6th, it would blow up the whole exchange idea.

  8. Patrick Skinner says:

    HHS published proposed rules for regulation of insurance plans and market conduct for Exchanges and SHOP. There is significant difference in compliance rules for agents/brokers doing biz in the exchanges between Fed and State oversight, as well as lack of communication between them. If an honest action results in a mistake, the Feds may discipline the agent/broker, but not notify the State insurance department, therefore not protecting the public outside the exchange. The Fed oversight also does not follow due process and appeals of market conduct violations.

  9. John Fembup says:

    “Insurers pulling out of entire states and cancelling their individual business has actually been going on for several years, but is not getting reported”

    I can confirm this based on direct experience. Before I retired, I was the head underwriting officer at two major companies and so was in a position to know – for those major companies at least.

    as you have heard, withdrawals have not been limited to individual policies – it also included product realignments by county within states and even complete product withdrawals from counties or states.

  10. Ken says:

    great post today. And with the comments, very informative.

  11. Greg Scandlen says:

    It is assumed that the Blues will participate everywhere — and likely be the dominant player in Exchanges. However, apparently the Blue plan in Iowa/South Dakota is staying out in 2014. It will be interesting to see if others do the same.

    I believe there is one state where no carriers want to participate in several counties.

    • Chuck Bortell says:

      Agree! But, to add, the Blues will become the public relations “poster child” for the “Single payer”; once the “Exchanges” have “proven” the competitive model will not work. (Note: the PPACA mandating a “non-profit” be available in each Exchange, has always been a curious factor. Obviously, regular insurance carriers would not expose their shareholders to gushing cash hemorraghe.

      (I presume the “Blues” will be granted hefty sums from HHS to compensate for adverse selection.)

      What are the inside deals? Would the same be available to others?

      Fair winds and following seas,
      Chuck Bortell

    • S. W. Bondurant, MD says:

      Mississippi has 82 counties. Humana and Magnolia Health Plan will offer policies on the Federal Exchange in 4 counties. In 42 counties one of the two will offer policies but not both. In 36 counties there are no companies that will offer policies. So,,,if the individual mandate stands, does a citizen get fined by the IRS if he does not have health insurance in 2014 and lives in one of those 36 counties where the Federal Exchange does not have any policies for him to buy?

      • Chuck Bortell says:

        Agree that scenario is a MAJOR factor. However, such issues will eventually provide the rationalization for “Single Payer”; which may not be too bad. Perhaps, a MedSupp to “Single Payer” market will evolve?

        Fair winds and following seas,
        Chuck Bortell

  12. Beverly Gossage says:

    As an agent, President of a chapter of NAHU, and Insurance Commissioner candidate, I have seen carriers consolidate. In KS Preferred Health Systems sold to Coventry which sold to Aetna, for example. The purchase of private policies has escalated as small businesses are threatening to drop coverage and private rates are still affordable (for a short while) as carriers are giving a rate guarantee through 12-31-2014 to avoid the Obamacare gargantuan increases due to guaranteed issue/community rating bands and benefit requirements.

  13. Sal says:

    It’ll be interesting to see where this goes.

  14. Ron says:

    1. I see small business moving to self-insured arrangements to avoid much of the ACA pricing restriction and to benefit from their own health support prograns and populations.

    2, I see fully insured plans taking 17-18 month rate renewals that take them to 12/1/2014 to avoid immediate impact of ACA.

    3. I see tremendous movement in new services and vendors focusing on wellness, transparency, and health literacy developing products and services to assist employers. Chaos creates opportunities and entrepreneurs are active in developing new telemedicine approaches and other services for improved acces to care givers.

    4. I see HSA/HDHP gaining momentum as full in very large groups.

    • Don Levit says:

      what do you see as the potential for “excepted benefits,” particularly those which fill deductibles?
      Don Levit

      • Ron says:

        Don, there may be a growing market for voluntary and supplemental products.However, with individulas sharing more of the cost through defined contribution approaches and putting tax advantaged funds into the growing HSA/HDHP market, it may be a tough sale for those marginal dollars.

        I do think there is a great opportunity for a specific disease prescription drug policy that would cover Rx for many chronic conditions that does not violate the HSA elibility. Noone has developed this product, but I believe with 66% of large employers now offerring HSA/HDHP’s and many going to full replacements, the time is right for an AFLAC or Colonial to offer such a product. It would open the door to nearly every large employer for many other supplemental product sales.

  15. DoctorSH says:

    I see major issues with implementation of Obamacare, a law no one fully understands the implications of.

    As Obamacare falters and does not fix anything, expect the next crisis in healthcare officially recognized by the Obama administration, blaming of the hospitals, insurers, Pharma, the Ama , and any of the back door players that agreed to go along with it.

    The govts will bite those players in their behinds and by calling it a crisis will go for some type of Medicare for all single payer scheme, which was their wish all along.

  16. Joshua Jeffries says:

    In response to: “In general, the health care media is reluctant to publish anything negative about ObamaCare” – I could not agree more! Let me preface this with the fact that there are some good outcomes of Health Reform for the consumer and their protection. However there is also one very large gaping hole. How is the media not publishing news on the fact that if an employer offers “affordable” coverage for the employee only that it disqualifies the entire family from receiving Federal subsidies inside the State and Federally run exchanges? This is going to be a major financial setback to working poor and the middle class in America. Employers nationwide (not all) are shifting employer premium contributions to employee only coverage (and therefore reducing or eliminating dependent premium subsidies) to avoid PPACA employer penalties and manage corporate expenses thus leaving the employee exposed to cover the higher cost of covering their dependents. Because the employees coverage as an individual is affordable it leaves the employee to fund the cost of their dependents which can be anywhere from $500-$1,500 a month depending on your location and plan design elected. With reduced employer premium assistance for their dependents and being disqualified for Exchange based subsidies due to having “affordable” individual coverage how will these families pay to cover their souses and children? Something will have to give especially by 2016 when the individual penalty for not having coverage reaches $695 or 2.5% of household income. I suppose the administration envisions every family in America to be a dual working household paying strangers to raise their children (daycare) so families can afford to pay for health insurance.

    No doubt consumers will need representation and protection in a post Health Reform world after they enroll into a health plan and from what I have seen to date Navigators will not provide that. Find an intelligent insurance agent you can trust or hire your own professional support team with a solution like ours, http://www.employeeprotector.com. I worry about consumer protection issues inside these State Exchange health markets without the support of an agent, employer HR team or personal advocate looking out for them.

    • Don Levit says:

      Excellent points, particularly on the affordability of coverage aspect.
      Do note, however, that if dependent premiums and employee-only premiums exceed 8% of household income, penalties are not assessed against the dependents (assuming employee-only coverage is less than 9.5% of household income).
      I expect to see a huge market developing for spouses and children, particUlarly children, outside of the exchanges.
      The ACA defines dependents as children, not spouses, and employers must offer coverage to “dependents. IF PREMIUMS EXCEED 8% OF HOUSEHOLD INCOME, CATASTROPHOIC POLICIES CAN BE OFFERED TO ALL, NOT JUST THOSE UNDER 30.
      Don Levit

  17. Ron says:


    Don, there may be a growing market for voluntary and supplemental products.However, with individulas sharing more of the cost through defined contribution approaches and putting tax advantaged funds into the growing HSA/HDHP market, it may be a tough sale for those marginal dollars. I do think there is a great opportunity for a specific disease prescription drug policy that would cover Rx for many chronic conditions that does not violate the HSA elibility. Noone has developed this product, but I believe with 66% of large employers now offerring HSA/HDHP’s and many going to full replacements, the time is right for an AFLAC or Colonial to offer such a product. It would open the door to nearly every large employer for many other supplemental product sales. – See more at: http://healthblog.ncpa.org/what-are-you-hearing/comment-page-1/#comment-190623

  18. Wanda J. Jones says:

    John and Colleagues:

    This is so important. Among the deliberate mistakes built into the law are the provision not to verify income for applicants in the exchanges. We already have tremendous fraud in Medicaid, so here we get even more. Along that line, the fact that people and firms chartered to sign up enrollees are like ACORN, and will be paid by the number they sign.

    Everyone seems to look to all these problems as leading inevitably to single payer. Of course, that would be ghastlier than this stupid law, and even more problematic to implement. Before this law goes much further, those of us still concerned should aim for repeal before it destroys the insurance industry.

    On the subject of co-ops, I agree that they are high risk. In fact, many of the new organizations that are permitted by the ACA are ripe for capture by people with no known experience and with a careless attitude toward money. I’ve been asked by a Baptist Minister to help set up an HMO for his members. When I said that it was bound to lead to worse access and worse costs since it was, essentially, based on apartheid, he became enraged. A union in the LA area boasted that they would take a contract from MediCal to negatively enroll [yes!] many people in the LA region, and that there would be enough money in this to pay all his doctors a huge annual salary. I told him his calculations did not include paying for the actual healthcare received by the enrollees. He was stunned that that was supposed to be the centerpiece of his project. I say these things, not to damn all innovations, but to limit the face powder spread over all the problems by the administration. Someone with a good staff should be tracking all the money being spent by all parties to “prepare” and to estimate the decapitalization of the insurance field.

    John, the public needs a constant report card of what is and isn’t happening. starting with the tally of employers who are ending their coverage.

    San Francisco has a mandatory plan designed for the restaurant industry and any other where the individual location may be small, but there are many of them. Early on, the restaurants would add the cost to the bill so visitors would be able to see what created the price of their meal. I’d like to see that done by providers: basic cost of care; cost of mandates; cost of regulations; the full cost-shift from Medicare and Medicaid; and the cost of defending against the additional regulatory strains caused by such things as the RAC process.

    Wanda J. Jones, MPH
    New Century Healthcare Institute

  19. Doctorsh says:


    May I suggest that third parties should not be involved in the transaction between doctors and patients.
    However no problem if the third party wants to help with the hospital costs.


  20. Ralph Weber says:

    The best way to keep the PPOs out is ot pay on a set schedule, then the PT can shop the procedure knowing how much the plan will pay. He can either go direct, or use MediBid, knowing how much the plan will pay. This maintains the doctor/patient relaitonship

  21. Ernest Taylor says:

    Well the pull back of cuts for the Advantage healthcare plans announced in April, which was preceded by Humana’s lobbyist Mark Hayes has created quite a stir in healthcare and political circles for sure. The WSJ article in April is quite extensive on it.