Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Greedy Insurers

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To restrain greedy private insurers....

A predictable result of the absence of a Public Option is the veritable shell game we are about to see perpetrated by private insurers.  Do you blame them?  After all, their 'medical business' (as opposed to the 'business of medicine'--health care) is threatened by reform

In 2014, you must have insurance and the government will help with subsidies and to help people shop for coverage, a centralized, competitive marketplace (a health insurance exchange).  Until then, however "the people most likely to buy individual insurance are those who need it most: the sick and the infirm."  Thus, the insurers will see this risky group as a liability and will find ways to reduce their exposure.

When the new law requires them to spend at least 80% of the premium dollars collected on service and to improve quality, some insurers "May curtail sales to individuals or small businesses if they find requirements too difficult to meet."

To cover children, regardless of their having a preexisting condition or two, these business persons would stop writing new coverage for children in the individual insurance market

Robert Peer.  "Covering New Ground in Health System Shift," NY Times, Aug. 2, 2010

Be aware. Call them at their word to support doing the right thing at the right time and place. Make that a predictable result.


If you haven't had your fill of how insurers can give you a 'bad hair day,' read what may appear as a conspiracy of forces against you--" style="text-decoration: none; color: rgb(170, 0, 51);" target="_blank">Patient Rights Resources In California and UCLA Hospital/Physicians" where the author states: Now I had the opportunity, like everyone else, to see just what a nightmare our health care system is...."