When Health Insurance is Free

Did you know that an estimated one of every three uninsured people in this country is eligible for a government program (mainly Medicaid or a state children’s health insurance plan), but has not signed up?

Either they haven’t bothered to sign up or they did bother and found the task too daunting. It’s probably some combination of the two, and if that doesn’t knock your socks off, you must not have been paying attention to the health policy debate over the past year or so.

Put aside everything you’ve heard about ObamaCare and focus on this bottom line point: going all the way back to the Democratic presidential primary, ObamaCare was always first and foremost about insuring the uninsured. Yet at the end of the day, the new health law is only going to insure about 32 million more people out of more than 50 million uninsured. Half that goal will be achieved by new enrollment in Medicaid. But if you believe the Census Bureau surveys, we could enroll just as many people in Medicaid by merely signing up those who are already eligible!

What brought this to mind was a series of editorials by Paul Krugman and Robert Reich and blog posts by their acolytes (at the Health Affairs blog and at my blog) asserting that government is so much more efficient than private insurers. Can you imagine Aetna or UnitedHealth Care leaving one-third of its customers without a sale, just because they couldn’t fill out the paperwork properly? Well that’s what Medicaid does, day in and day out.

Put differently, half of everything ObamaCare is trying to do is necessary only because the Medicaid bureaucracy does such a poor job — not of selling insurance, but of giving it away for free!

When logic and proportion
Have fallen sloppy dead


Writing in Health Affairs the other day, health policy guru Alain Enthoven and health care executive Leonard Schaeffer revealed some of the gory details of what people encounter when they do try to sign up for free health insurance from Medi-Cal (California Medicaid) in the San Diego office:

Of the 50 calls made over a three-month period, only 15 calls were answered and addressed. The remaining 35 calls were met by a recording that stated, “Due to an unexpected volume of callers, all of our representatives are currently helping other people. Please try your call again later,” followed by a busy signal and the inability to leave a voice message. For the 15 answered calls, the average hold time was 22 minutes with the longest hold time being 32 minutes.

This study, by the way, was conducted by the Foundation for Health Coverage Education (FHCE), a nonprofit organization dedicated to helping the uninsured enroll in available health coverage programs. The head of FHCE’s national call center reports that his staff has taken hundreds of calls from people who have tried in the past to enroll in Medicaid, but who found the process so complicated and difficult that they simply quit trying.

I know what you are thinking. What about doctors and hospitals? Can’t they help poor people sign up for public programs and isn’t it in their self-interest to do so? Turns out that medical providers have just as much difficulty with the Medicaid bureaucracy as the patients do:

[I]t routinely takes more than 90 days for the state to enroll uninsured patients into public programs. This is because it is the patient‘s responsibility to apply directly to the state program to receive the needed documentation for hospital reimbursement. Once treatment is provided and the medical incident is over, it is difficult to ensure that the patient continues with the enrollment process.

Can you imagine Aetna taking 90 days to sell someone an insurance policy? What about WellPoint? Or Blue Cross?

Another problem is the Medicaid payment rates. They are so low that California hospitals frequently don’t even bother to try to enroll patients who come to the emergency room, unless they’re admitted to the hospital:

[P]ublic program reimbursement is often so low that hospitals are more likely to only seek reimbursement for patients who are eligible for public coverage that fall into the “treat and admit” category rather than those patients who enter the Emergency Room with minor emergencies or illnesses. Furthermore, hospitals estimate that they receive as low as nine percent of fully-billed charges for Medi-Cal patients. Therefore, the providers have little financial incentive to encourage patient enrollment in public programs.

Most people view ObamaCare as a radical reform. Here’s an idea that is even more radical: why not abolish Medicaid? Texas A&M professor Thomas R. Saving, a former Trustee of Medicare, has proposed the idea of Health Care Stamps. They would work like Food Stamps. People who have them would be able to shop around and buy care in the same medical marketplace that caters to the needs of all other patients — rich and poor alike.

I’ll write more about this idea in the future.

Comments (40)

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  1. Bruce says:

    It’s pretty bad when you lose one-third of your customers over burdensome paper work when you are trying to give away healh insurance for free!

  2. Devon Herrick says:

    Making the process of enrolling in Medicaid difficult is another mechanism for rationing. I like the idea of health stamps.

  3. Simon says:

    Food stamps are fairly limited in what people can actually purchase. Sure, people on food stamps can shop around for the best price (doubt they do, more based on access to transportation), but who will determine what they can buy. It would be tough for consumer driven care within a stamp system for Medicaid.

  4. Joe Barnett says:

    Sounds like enrolling in Medicaid is akin to getting service from the Department of Motor Vehicles. I guess it is supposed to work that way.

  5. John Seater says:

    Isn’t it amusing/pathetic that the volume of calls was too big to be handled for at least three months but nonetheless was “unexpected” the whole time?

  6. Alieta Eck, MD says:

    I liked the first part of the last paragraph. But then you suggested the food stamp approach. Yes, we should abolish the Medicaid system, but we should not replace it with a “health stamp” approach. This still involves a bureaucracy to hand out those new stamps.

    Why not replace Medicaid with real old-fashioned charity? Real free care– freely donated by physicians and nurses in non-government free clinics staffed by volunteering retiring baby-boomers? No bureaucracy, no CPT codes, no billing– just free care where the transaction is done when the patient leaves the NGFC.

    BUT– we are asking for the state to simply protect the volunteering docs–don’t pay them, just protect them in the clinics as well as their private practices. Covering the good docs with malpractice protection would change the paradigm completely, as they would no longer order the 20% extra tests to “cover” themselves.

    It would also put the patient back in control of his own health, having no one else to blame but himself if he becomes ill because of smoking, drinking, not exercising and not getting the recommended early detection screening tests.

    Doctors need to be valued as the highly educated professionals that they are– who have learned about disease– how to diagnose and treat. They should not have to take the role of nagger– and held responsible if the patient chooses to eschew his advice.

  7. Lee Kurisko MD says:

    This article is just another example of the staggering inefficiency of government. It is a fool’s errand to attempt to bolster this with bigger government. Although I would prefer Dr. Saving’s concept of health care stamps without Medicaid, it is still government intruding into a matter that should be addressed through private charity. Private charity was the means by which the poor were cared for prior to World War 2 and it worked fine. It was a part of physician and hospital ethics to care for the poor without the inefficient middle man of government.

  8. Julie Jennings says:

    The success of Massachusetts health care reform (or what is viewed as success) is in large part due to adding more people to the free and subsidized care programs in the state. 3 out of 4 uninsured children in the US have access to either Medicaid or CHIP. We need to look at how we can get more people insured in current programs before we think about expanding program eligibility (PPACA will open up to those earning 400% FPL!!!!).

    Insurance stamps?? Well, I think the idea of vouchers to allow employed persons to access their employer’s health plan with federal money is a good idea. Right now it’s more attractive for some workers to reduce hours or leave their jobs so that they qualify for free care or subsidies. Wouldn’t it make more sense to keep people working and productive and contributing to the cost of health care in partnership with their employers and the government, rather than let them sit back and depend solely on the government (and our taxes) to pay for their health care?

  9. Alieta Eck, MD says:

    You make good points, Julie. All the incentives seem to be toward working less in order to qualify for the government safety nets (hammocks).

    BUT, enrolling the poor into PROGRAMS means paying administrators and not those who actually provide the care. In NJ, Medicaid managed care companies are vying for more patients to enroll. A healthy family of four yields $20,000 to the company–for people who are HEALTHY! The taxpayers are getting fleeced.

    The poor have no assets to protect– thus do not need “insurance.” They need medical care when they become ill. They need routine immunizations. Both could be much more efficiently provided in non-government free clinics.

    And as you state, they need all the incentives to work and not fear losing their “health insurance” in the process.

  10. Brant Mittler says:

    @ Alieta Eck:

    I volunteer at a free clinic in the Texas Hill Country. Most of the people I see are the working poor. The clinic is running out of money. Grants are drying up. Contibutions are markedly down. Last night the director announced that the clinic would meet only every other Tuesday instead of weekly. And that there would be no new patients with over 40 new patients waiting to be seen. Last night I had to send two patients to a local ER, one with a rapid heart rhythm ( which had been incompletely worked up at at ER visit two months ago) and one with severe abdominal pain and a 30 lb weight loss and blood abnormalties that need a hematology evaluation.
    All I can prescribe are generic drugs because the patients can’t afford anything else. A local pharmacy tech who volunteers there told me the price of drugs to the pharmacy has jumped so astronomically in recent weeks that many people to come to the local pharmacy are leaving presciptions behind because they can’t afford them. That’s the reality of free clinics from the front lines health care in Rick Perry’s Texas. That’s free care in the free market.

  11. Alice Zents says:

    @Brant Mittler: thank you for your work.

    But, with respect: free market? What free market???

  12. Bill Hammett says:

    Just a fantastic article.

  13. Beverly Gossage says:

    As much as I like the private charity concept, I think we will need to take a few steps to get there.

    For several years many of us have proposed the “food stamp model”; however, with new technology, this would be even easier today. All carriers and agents have access to online applications and private exchanges (if you will) where the client can apply online. Imagine if the Medicaid eligible could submit a code to the carrier when purchasing a private policy (think discount code when purchasing on Amazon).

    The carrier would be responsible for setting up the technology to receive and verify the code. Of course, the code could be used with a current carrier for a private or employer plan. Paperless transaction.

    Just a few benefits:
    1)Beneficiaries don’t need to find new provider who accepts Medicaid/SCHIP
    2)Overall provider reimbursement rate for private plans should decrease since they are artificially higher to offset Medicaid/Medicare levels.
    3)Lower provider rates often mean lower premium rates
    4)Larger pool of insured in private plans
    5)No jumping from private to Medicaid plan and back due to income fluctuations
    6)THIS IS HUGE: No fear of requalifying for coverage with private plan due to a new health condition that developed while on Medicaid.
    7)Carriers would be willing to assist with getting eligibles signed up for Medicaid.

  14. Alieta Eck, MD says:

    Good job, Brant. Volunteering to care for the poor uplifts the caregiver and the recipient of the care. Does the clinic rely on government grants? If so, it is not surprising that the funds are drying up. Our clinic does not get government funds and brings in enough to pay the $13 per patient visit cost. Our costs are so so because EVERYONE volunteers. No on is paid.

    Hurricane Irene wreaked havoc on our area. We were contacted by a Merck representative who then connected us with Direct Relief USA. http://www.directrelief.org. After I enrolled our clinic (www.zhcenter.org), they sent me a huge list of available medicines, diabetic teaching supplies, syringes, etc that I could choose from. It will be shipped to us free of charge– for us to give out freely.

    When the free market is unleashed, profits enable private companies to be generous. Government programs seem to do the opposite.

  15. Buster says:

    The company, eHealthinsurance.com, has no trouble enrolling untold thousands of people from across the country into a veritable plethora of insurance plans. Yet, Medi-Cal has trouble enrolling eligible people into its plan? This doesn’t bode well for government health care.

  16. Don McCanne says:

    Medicaid is not a model that lends itself to easy and permanent enrollment. As a welfare program, it requires continual reassessment of eligibility status, which is a hassle for all concerned. Since the majority of uninsured individuals do not have major acute or chronic problems, for many of them it is simply not worth the hassle. Should serious problems develop, they can enroll at that time.

    The Affordable Care Act presents some of the same problems. Coverage is dependent on employment status and on income levels, either of which can be quite unstable. Once again, the administrative hassle can be very burdensome. In fact, it is acknowledged that over 20 million people will likely remain uninsured, and certainly many will remain so not only because of the affordability thresholds but also from the unstable eligibility and enrollment issues.

    Contrast that with Medicare. Eligibility is straightforward. Enrollment is simple, and it is for the remainder of your life. Providing everyone with an improved Medicare, with automatic enrollment at birth, would virtually eliminate these burdensome enrollment issues.

  17. Brant Mittler says:

    @ Dr. Eck:
    No, our free clinic does not rely on government grants, but rather grants from private foundations.
    And from visiting your website, it is clear that you are going a great job.


    But as to John’s point about Medicaid, we all know that states have made it hard for folks to enroll in Medicaid to save money. They don’t have to raise taxes as much.

    Don McCanne is right. All this bureacratic hocus pocus would end if all would be enrolled in Medicare at birth. I don’t look forward to government rationing any more than I do private insurance rationing. But at least I can labor under the delusion that I can vote some people out of office. Can you vote the CEO of Humana out of office? Do you think the “free market” will allow for that?

  18. Lois H says:

    Who allowed all of the free immigrants in to the country. I work at a federally founded clinic and until 1996 The clientele we served was pregnant women and infants, and the elderly. The came all the free immigrants who took a toll on the healthcare market because they did not put anything into the system.

  19. Brant Mittler says:

    @ Lois:

    The free immigrants you refer to are the ones who build our houses, pick our crops, clean our buildings, make up beds in J.W. Marriott’s hotels, and do all the other work that red blooded free market Americans don’t want to do. As I recall, it was conservative Republican Georgia onion farmers who screamed bloody murder when their field workers faced deportation several years ago. When I was a consultant in San Diego in the late 1990s, the community there blamed their health care cost woes on the free immigrants you complain of. Then the State of California did a study that showed that the Border Patrol was dumping the sick immigrants they apprehended into the community rather than incur their costs of illness in their budget.

  20. Al says:

    Brant writes: ” But at least I can labor under the delusion that I can vote some people out of office. Can you vote the CEO of Humana out of office? Do you think the “free market” will allow for that?

    Brant, if the patients had control over the money, which is the free market we do not have today, they could vote their insurer out the following month when the premium was due. I think that is a lot more effective then voting out a President every 4 years only to get another one that isn’t much better.

    Medicare for all would be an absolute disaster. The government at present can’t handle Medicare for all over 65 so why would one conclude that they could do so for the entire nation?

  21. Frank Timmins says:

    If Aetna, Blue Cross or any other health insurance carrier were to enroll only 33% of the eligible participants, they would cancel the policy for everyone immediately because of “selection” against the plan. In other words the carriers know that only the sickest will sign up while the healthy will not (until they become sick). Of course, this is not a particularly good analogy for the Medicaid mess because no premium is being paid to Medicaid. But it does give a clue as to how clueless the bureaucrats would be in trying to administer some kind of nationalized health program.

    Insofar as abolishing Medicaid and issuing “healthcare stamps”, what an excellent idea. We can make the comparison (and I am sure you will) of how food stamps have not endangered the financial health of the food distribution system. The same could certainly not be said of Medicaid (and Medicare for that matter).

  22. Brant Mittler says:

    Sorry for my confusion. John seemed to be talking about government vs. private insuror efficiency in signing up insureds. The point I was trying to make is that Medicaid doesn’t want to sign up insureds. It would cost too much. They are deliberately inefficient and ineffective. I just signed up for Medicare. It was a breeze. How to pay for the societal debt incurred is a different issue. Don very well explained why Medicaid sign up does not work like Medicare sign up.

  23. Frank Timmins says:


    “Can you vote the CEO of Humana out of office? Do you think the “free market” will allow for that?’

    I’m not sure you quite understand how this government bureaucracy business works. We don’t “vote them (government bureaucrats) out of office”. They are career public servants, and they make it their business to make sure they maintain job security. Tattoo removal would be a better point of reference for the difficulty in getting rid of intrenched bureaucrats.

  24. Brant Mittler says:

    I completely understand how government works. There is no difference between the two main political parties in being influenced by and passing policies that benefit the large insurance companies, big corporations, and Big Pharma.
    Both Bob Dole and Tom Daschle are employed at Alston+ Bird.

  25. Don McCanne says:

    Health care stamps? For those of us who still have a vivid memory of ration stamps during World War II, this idea is repulsive. During the war, we had to ration, but we were all in this together, and we each did our part. Certainly we didn’t ever want to be in that situation again.

    But health care stamps? Imagine, being admitted to a trauma center with major injuries, but conscious and able to provide information to the admitting clerk.

    “I have a $50 stamp, a $10 stamp, and a $5 stamp. Will that do?”

    How can conservatives oppose comprehensive government health programs because they ration, and then turn around and support such explicitly extreme and heartless rationing as health care stamps?

    With health care now being unaffordable for far too many of us, shouldn’t we all be in this together? Or should we, as individual consumers, simply go out an shop the trauma centers to see what health care we can get with $65 in stamps?

  26. Beverly Gossage says:

    The Medicaid elibibles would receive a “voucher” to pay toward a health insurance policy. They don’t use these funds to pay for health care.

    An exception would be to purchase an HDHP/HSA with the “voucher” and put the difference (if any) into the account.

  27. Frank Timmins says:

    Don, where in the world did you get the idea that healthcare stamps would involve the exact physical process that are used with food stamps? I am sure that it would be quite a bit more sophisticated than that.

    And WWII stamps were about rationing products in short supply for emergency use. There is really no correlation with that and the idea of healthcare stamps.

    There is a correlation for all these with regard to the stamp user having an option to use these stamps at what ever distributor they choose, instead of waiting in ration lines at a reduced number of distribution points.

  28. Brooke C says:

    Fellow healthblog devotees;
    I am concerned that one of the major issues at hand is ignored in both today’s blog as well as the comments: Medicaid does not make money. Commercial insurance does. Therefore, Medicaid does not have incentive to insure all the uninsured (beyond the “obvious” trickle down incentive of reducing healthcare costs to hospitals and thus, overall costs). Alternatively, the more people BCBS insures, the more profit they generate. The whole way these insurers operate is collecting premiums from enough healthy people to cover the risk/cost of the unhealthy. The profit lies in the ability to cover (collect from) more healthy people than the overall cost of the sick.

    Medicaid only covers the sick (in general). Medicaid may be funded by taxpayers, but it usually commits to paying for more than it even collects (Read up on Medi-Cal : it runs out of money midway through every year). There is no profit margin. There is no profit. It hurts the Medicaid system to insure the remaining individuals (even though it hurts the greater good more not to insure them).

    Why would the current Medicaid bureaucracy (currently held accountable to Medicaid budgets, not overall health spending budgets/costs) spend more valuable resources trying to cover people? They do not even have enough money to pay for the people they already cover. They are incentivized by our giant government to keep costs down. They are incentivized not to help cover the uninsured.

    Talk about cutting off your nose to spite your face.

  29. Al says:

    Don M wrote: “How can conservatives oppose.. ” preceded by the earlier statement “Providing everyone with an improved Medicare, with automatic enrollment at birth, would virtually eliminate these burdensome enrollment issues.”

    Why haven’t we already improved Medicare over the past almost 50 years? If a company had been trying to improve itself for 50 years with continuous monthly changes and scores of changes in basic philosophy or executives wouldn’t you think the basic model was faulty and not invest in that company?

  30. Pierre LeMonde says:

    There are MANY Medicaid applicants who do not follow through with their application. The Medicaid caseworker contacts them and tells them they need to verify x,y,z but the client frequently fails to do this. Or they don’t do it within the time deadline given (the federal government requires the application be processed within a certain amount of time).

    California is a pathetic state. Please do not lump in ALL Medicaid bureaucracies with one state that is severely dysfunctional.

    Most of the time if a person doesn’t sign up for Medicaid it is THEIR fault, not the Medicaid workers.

  31. wanda j. jones says:

    John, and all–what an excellent series of ideas.

    Dr Eck is right about volunteering, and the model of a community health center. These work great when it is a sliding scale site and underwritten by a combination of fees, subsidy from local providers and the county, plus, maybe, a federal grant. These were cut out of the recent budget, which contained funds for 1000 more. Talk about poor policy-making.

    Medicaid is blocking users in another way; a medical colleague in a rural community told me he had been waiting a year to get a provider number so he could bill Medicaid. The local hospital said so few of its medical staff could or would take Medicaid, even through the area was largely agricultural, that the hospital was in danger of closing, and was down to less than 50% occupancy. Patients were driving an hour to the nearest town with an ER.

    “Medicare from birth” is a terrible idea; it would mean that the gross errors present in Medicare today would apply to every citizen at every age. The Federal bureaucracy would intrude on patient care decisions at every stage of life and illness. I’m on Medicare and have experienced 10-day delays in approval for a cardioversion which was ordered for my atrial fibrillation, and a week’s delay in approving a replacement medication that no longer requires monthly lab tests to determine my coagulation time, thus saving the program money. As I have had these diagnoses for 4 years, there should be no need for a review, and no delays in changing treatments.

    Moreover, Medicare also underpays providers and plans to cut half a trillion out of the existing program over the next decade, as Boomers enter the program, and existing beneficiaries age into their final chronic diseases. Medicare has skewed economics of hospitals so that doing more is incented, up to the last breath. You cannot possibly earn enough money to pay the taxes that will be required if everyone is on Medicare. As it is, only 1.73 earners are paying into the program for today’s Medicare patients, the rest coming from the general fund.

    As for stamps for Medicaid patients, I am looking forward to the efficiencies of a form of debit card, that could be programmed differently for each person to have “electronic vouchers” good for a routine physical, a series of pre-natal visits, 5 visits to a doctor per year, (the average) and a “scrip” for 3 medications or so. As I said, programmed for each person. Could include 1 – 21 counseling sessions with a case manager.
    We will have these, and they will be fraud proof by also containing a bioidentifier, such as retina or palm prints. Additional funds could be recorded on request of the treating physician or hospitals. These cards could be issued by the same people who interview people for welfare, or even low income housing. Moreover, they can be electronically turned off at a distance if the person is found to be ineligible.

    There is, apparently, little concern that doing more of the same under Obamacare is just terminally stupid. The government has a lousy track record as a de facto Board of Trustees for the Medicaid program, and Medicare. It has zero credibility in my book for the following: original program design, timely moderni-zation, funding integrity, performance oversight, protection against negative unintended consequences,or common sense about incentives creating unwanted behaviors on the part of all stakeholders, from bureaucrats, to enrollees, to providers and vendors.

    If there were equivalent incompetence on the part of major private health plans, you would not have to just focus your anger on the salaries of executives. Private corporations have real boards and real shareholders, and real trained employees who can lose their jobs for incompetence and malfeasance.

    John–keep up the mirror on this topic; people who influence policy should understand the reality of existing government programs before they make any more of the population subject to more of the same.

    Sorry to be so long…

    Wanda J. Jones, President
    New Century Healthcare Institute

  32. Brant Mittler says:

    @ wanda jones:

    If you had delays in getting approval for cardioversion for a fib, you must be in a Medicare Advantage ( HMO) plan. Otherwise why would there be a delay?

  33. Richard Bensinger says:

    John, this is in response to your negative comment about Medicaid as if they were the only offenders in this game.

    Actually Aetna and United Health care penalize both doctors and patients for filling out forms not to their liking. This is a continuous headache for both groups and a way for the insurers (more than those two) to hold on to their money and deny care. Medicaid is no worse or better.

  34. Alieta Eck, MD says:

    Two questions need to be answered. 1) Is provision of health care the proper role of government? and 2) If so, what is the least expensive way for the taxpayers to underwrite this?

    I happen to think that government cannot provide health care. It can only meddle, restrict, coerce, overpromise and underpay for the services it offers. Doctors provide the health care. In Medicaid, the administrators do well. They get salaries and benefits. Medicaid HMOs do VERY well. They sign up healthy families and get $20,000 from the taxpayers– for people who are unlikely to need services. The doctors actually lose money on Medicaid, getting paid 10 cents on the dollar 6 months later. Their costs exceed the income, so they lose money on every Medicaid patient. Employed doctors might do OK, and hospitals are now hiring physicians who take care of hospitalized Medicaid patients, but the taxpayers are taking on way too big a burden– 1/3 of the average state budget.

    So to answer the second question– We would do very well if physicians simply volunteered to take care of the poor for free in a non-government free clinic– for say four hours a week for primary care, and two operations or deliveries a month for surgical specialties. This would cost the taxpayer NOTHING and remove a huge bureaucracy from the taxpayers. EVERYONE volunteers.

    If the states would provide the medical malpractice protection for their entire practices as their only “reward,” the doctors would do this. As it is now, doctors are too stressed, economically and emotionally, to volunteer very much.

    Volunteering in this way would put the doctors, not the administrators, back in control of the care of the poor patients. As the patients transition out of their indigent state, they would see these same doctors in their private practices.

    Taxpayers would be the huge winners. HMOs, Medicaid administrators and trial lawyers night balk. But they had their turn, and spending $1.40 for every $1 we take in taxes, is unsustainable.

    We need to stop thinking of the poor as people “entitled” to a big government program. Instead, treat them like our neighbors who need help–until they get back on their feet. The don’t need medical care stamps– they need medical care. And who can argue with “free.” We have done this for 8 years in the Zarephath Health Center. It is a model that works.

  35. Jennie Fiedler says:

    Private insurers are really good at signing you up and taking your money in the form of premiums. What they don’t seem to be really efficient at is paying your health claims! The Single Payer option is still the best deal going but it would destroy the private health insurance industry and there would be only one government funded health service in the form of Medicare, which already exists. I’ve heard all the arguments about free market competition and value of services rendered and they’re all valid. However, there is already a system in place that everyone who works above the table pays for in the form of the Medicare tax. Since our leaders in this country have seen fit to deregulate business and industry to the point that their shenanigans have cost the working people of this country their jobs, their homes and their retirements on a scale never seen before anywhere in the world, its painfully obvious the insurance industry is going to take advantage of the free-for-all as well and health insurance will remain the luxery item it is, going up in price and down in coverage with each year of record breaking profits. Corporations whine ever more loudly about how expensive it is to employ Americans and protect our environment all the while making more and more money and paying fewer and fewer taxes. We’re not just “on the road to serfdom” anymore. We’ve arrived.

  36. Frank Timmins says:


    If there are any industries in this country that are heavily regulated it is the health insurance industry. With regard to high health insurance premiums, when the smoke clears these insurance premiums basically reflect the actual cost of the healthcare. I have a lot of problems with the insurance companies but their profit margins on the premiums is not one of them.

    An example of over-regulation in the insurance industry that has dramatically increased costs is state mandating of health insurance benefits. If they were eliminated immediately there would be an instant decrease in the overall premium costs.

    Deregulation is not the cause of people losing jobs. Over-regulation often is – along with crony capitalism (Fannie Mae and Mac). Obama’s favorite company GE gets special dispensation as it sends thousands of jobs to China. Solyndra gets preferential treatment that takes jobs away from traditional energy companies only to bankrupt at the taxpayers expense.

  37. Larry Foster says:

    Those two guys are dumber than a nail, thank you for sharing.

  38. Beverly Gossage says:

    Perhaps you are not aware that, according to the AMA report, Medicare has the highest percentage of denied claims compared to private insurance companies.


  39. Don McCanne says:


    About that AMA insurer report card, let’s look at the claims accuracy in the 2011 report:

    Metric 6: First ERA accuracy:

    This metric measured the percentage of claim lines where the payer’s allowed amount was equal to the physician practice’s expected allowed amount. For this metric, it was necessary to obtain the actual contracted allowed amounts (i.e., fee schedule) for each claim line.

    81.08% – Aetna
    61.05% – Anthem Blue Cross/Blue Shield
    83.02% – CIGNA
    87.04% – Health Care Services Corporation
    81.99% – Humana
    88.41% – Regence
    90.23% – UnitedHealthcare
    96.19% – Medicare


    Admittedly, Medicare falls short, but the private plans!?

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