from the dancing-elephants-are-hard-on-the-ants dept.
Submitted via IRC for crutchy with a story from Ars Technica.
Following on the heels of UnitedHealth group and Humana, insurance giant Aetna plans to "dramatically slash its participation in the public insurance marketplace" — "claims losses alone spurred decision, but there are clear links to merger."
[...] In 2017, Aetna will only offer insurance policies in 242 counties scattered across four states—that’s a nearly 70-percent decrease from its 2016 offerings in 778 counties across 15 states.
[...] In April, Mark Bertolini, the chairman and chief executive of Aetna, told investors that the insurance giant anticipated losses and could weather them, even calling participation in the marketplaces during the rocky first years “a good investment.” And in a July 5 letter (PDF) to the Department of Justice, obtained by the Huffington Post by a Freedom of Information Act request, Bertolini explicitly threatened that Aetna would back out of the marketplace if the department tried to block its planned $37 billion merger with Humana.
[Continues...]
From the July 5 letter:
[...] We have been operating on the public exchanges since the beginning of 2014 at a substantial loss. And although we have been working to improve our operations over the last 2 ½ years, we are challenged to get to break even this year and it will be some time before we recoup our investment (including a return on invested capital in the exchange business). As we add new territories, given the additional startup costs of each new territory, we will incur additional losses. Our ability to withstand these losses is dependent on our achieving anticipated synergies in the Humana acquisition.
[...] We have consistently indicated to our investors that the public exchanges and the ACA small group business remain risks to our achieving our financial projections since these markets face significant hurdles as outlined above. Should the deal be blocked the challenges will be exacerbated as we are facing significant unrecoverable costs including carrying costs of the debt required to finance the deal [...] and significant unrecoverable transaction and integration costs. We currently plan to cover the above costs, as well as invest in capabilities, improve benefits, pass savings through to members and customers and expand our business using [...] synergies we expect to obtain through the transaction. If we are unable to close the transaction we will need to recover those costs plus a breakup fee and [...] litigation expenses if the DOJ sues to enjoin the transaction.
[...] We currently plan, as part of our strategy following the acquisition, to expand from 15 states in 2016 to 20 states in 2017. However, if we are in the midst of litigation over the Humana transaction, given the risks described above, we will not be able to expand to the five additional states. In addition, we would also withdraw from at least five additional states where generating a market return would take too long for us to justify, given the costs associated with a potential break- up of the transaction. In other words, instead of expanding to 20 states next year, we would reduce our presence to no more than 10 states. We also would not be in a position to provide assistance to failing cooperative exchanges as we did in Iowa recently.
The Ars Technica article continues:
Sixteen days after the letter was penned, the DOJ moved to block the merger. In announcing the department’s decision to file suit, Attorney General Loretta Lynch said it “would leave much of the multitrillion health insurance industry in the hands of just three mammoth companies, restricting competition in key markets.”
In interviews this week, Bertolini has brushed off the tie between marketplace participation and the merger deal, reiterating that the cuts were all based on finances. “As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision,” Bertolini told The New York Times . He noted that the company faced “a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products.”
But Obama allies weren't buying the explanation. In a Facebook post, Senator Elizabeth Warren (D-Mass.), noted that Aetna has the right to fight the DOJ on the merger. But, she said, “the health of the American people should not be used as bargaining chips to force the government to bend to one giant company’s will.”
[To start the discussion: What if, in those exchanges where no insurer chose to provide coverage, people would be permitted to enroll in Medicare? -Ed.]
(Score: 3, Insightful) by Anonymous Coward on Saturday August 20 2016, @08:30PM
So even with $5000 co pay and 12-13k per year still is not enough to make money.
(Score: 0) by Anonymous Coward on Saturday August 20 2016, @10:02PM
Free market is working. You'll think twice before ordering that third Whopper, and over time the average American won't be 60% overweight.
(Score: 0) by Anonymous Coward on Saturday August 20 2016, @11:10PM
I will be sure to pass that onto my sister whose husband had to have an emergency appendectomy and her daughter who broke her arm in the same week. I will be sure to pass on the 'dont eat 3 whoppers',
(Score: 2) by dyingtolive on Saturday August 20 2016, @11:17PM
On one hand, I'm inclined to look at my epileptic sister and say "fuck you". On the other hand, I'm desperately hoping that the above is satire.
Don't blame me, I voted for moose wang!
(Score: 1) by khallow on Sunday August 21 2016, @01:11AM
(Score: 2, Insightful) by Anonymous Coward on Sunday August 21 2016, @02:11AM
Of course it's satire. Referring to the US medical system as "free market" was the easy giveaway. It's not a "free market" when government regulations lock it down to the point where a system of 2000%+ profit is possible by keeping competition (which would drive the price down) away at gunpoint.
(Score: 2) by Azuma Hazuki on Sunday August 21 2016, @02:28AM
It's self-writing satire, in that the poster almost certainly was as deadly serious as an Ebola outbreak when he (it's ALWAYS a he saying this shit...) wrote it.
I am "that girl" your mother warned you about...
(Score: 2) by Capt. Obvious on Sunday August 21 2016, @03:18AM
So your position is despite the numerous costs associated with illness beyond the financial, and beyond the fact that the financial costs are in fact also borne by the sick person, people lack an incentive to not get sick? And that sickness is entirely under their control. Heck, research even indicates that weight loss is not always under someone's control.
I mean, even if medical care were free, does anyone say "yay, now I don't care if I get cancer. Please pass the cigarettes."
(Score: 1, Interesting) by Anonymous Coward on Saturday August 20 2016, @08:46PM
> What if, in those exchanges where no insurer chose to provide coverage, people would be permitted to enroll in Medicare? -Ed.
Long before the current plan, I thought it made sense to slowly migrate toward single payer. Since the Medicare model is not terrible*, why not lower the eligibility age every year by a year -- first year at age 64, then age 63, etc. Or if this seemed like it would stress the system too much, lower the age by 6 months every year. Plenty of time to scale up all aspects of the program.
* Medicare is, afaik, the best (or one of the best?) we currently have at bargaining for reasonable prices from providers -- hospitals, pharma, doctors, etc. Of course Medicare is (potentially?) corrupt, so the usual house cleanings would need to be done on a regular basis.
(Score: 1, Informative) by Anonymous Coward on Saturday August 20 2016, @08:57PM
Old people are politically active, they believe they earned their Medicare, and they won't vote to share it with lazy kids who should get a job and pay for their own healthcare.
(Score: 0) by Anonymous Coward on Saturday August 20 2016, @09:07PM
> Long before the current plan, I thought it made sense to slowly migrate toward single payer. Since the Medicare model is not terrible*,
IIRC there were a bunch of republican-led states that refused to take federal money for medicare expansion because obama. But, again IIRC, the cost calculations for healthcare providers were predicated on that money effectively subsidizing many of the new people coming in via the obamacare health exchanges. Those states still got roughly the same number of people signing up for health insurance, but without as much money to support the costs.
Does anyone have a list of the states that Aetna is abandoning? I found the list of 4 states they are staying with, but I'd like to check the list of abandoned states to see how many also refused the medicare money.
(Score: 0) by Anonymous Coward on Sunday August 21 2016, @04:56PM
You do not remember correctly.
They didn't refuse because of Obama.
They refused because the terms determined that in the future, during a draw-down period, the states would have to pick up some of this expanded budget, and they objected to, among other things, the federal claim on state budgets for what is a federal project, as well as the principle that the federal government could use money to bully the states into doing the federal bidding (on which point, in front of the Supreme Court, they won).
The problem wasn't Obama. The problem was the relationship between the federal and state governments.
(Score: 1, Insightful) by Anonymous Coward on Saturday August 20 2016, @09:42PM
You better be careful what you ask for! In California if you don't qualify for healthcare insurance through "Covered Ca" (which is a fucking clusterfuck), you get dumped into Medi-Cal. Medi-Cal has a recovery clause, which means every dollar they had to pay for your medical bills comes out of your estate when you kick the bucket, leaving your heirs little to nothing. Other states may be similar. So... You pay a shitload for insurance, or you pay total costs out of your estate. No choice Obamacare, filling the fat pockets of the insurance industry.
(Score: 0) by Anonymous Coward on Sunday August 21 2016, @01:25AM
Assets? Oh that's my son's house I'm living in, and that's my daughter's car I'm driving...
If you are old (where kicking the bucket is a possibility) and have assets in your name then you are just asking for government to come around and start taxing your shit before it goes to your family.
(Score: 2, Informative) by khallow on Saturday August 20 2016, @09:48PM
(Score: 1) by Francis on Saturday August 20 2016, @11:48PM
There's nothing wrong with medicaid as long as you're in a state that's not run by the GOP. Around here medicaid is OK, it's not great, but since the Democrats were more concerned with health insurer profits that quality coverage, that's what we have.
But, it's decent enough coverage that you can probably live with it if you have it, but it's definitely not the best.
(Score: 1) by khallow on Sunday August 21 2016, @12:59AM
There's nothing wrong with medicaid as long as you're in a state that's not run by the GOP.
You whistle past the graveyard so well. I especially like how you then admit with some backhanded enthusiasm that there is something wrong with Medicaid even in your state. But then again you "probably could live with it" currently. The question is what happens in a decade or two when Medicaid has had considerable opportunity to degrade in quality and coverage?
(Score: 1) by Francis on Sunday August 21 2016, @01:57AM
I'm not really sure why I bother, you've drank more flavor-aid than the collective residents of Jonestown.
The point you're purposefully ignoring here is that medicaid covers all the things that people need, it just doesn't cover some of the niceties that the more expensive plans cover. Things like chiropractors and massage where appropriate.
I think the more relevant interpretation is that you're spouting off nonsense again and can't admit it.
(Score: 0, Flamebait) by khallow on Sunday August 21 2016, @03:44AM
The point you're purposefully ignoring here is that medicaid covers all the things that people need,
Except apparently in states that are "run by the GOP" or when "probably could live with it" is not good enough. And of course, there still is the matter of the future. Medicaid is already paying well below market rate. I don't buy that will continue without losing most physicians.
I'm not really sure why I bother, you've drank more flavor-aid than the collective residents of Jonestown.
There's that psychological projection again.
My view is that single payer could work, insurance could work. But either would require sane policies which are obviously not evident either in the US or in your writing.
(Score: 1, Insightful) by Anonymous Coward on Sunday August 21 2016, @04:53PM
Direct from a doctor friend of mine (in fact, he's in practice as well as a professor of medicine):
The prices for time provided by Medicare and Medicaid are such that doctors are actually leaving the profession, especially in specialties more affected by them (such as Internal Medicine), to the point that the AMA's restrictions on numbers of medical graduates is leaving this country with reductions in availability of doctors. It's not uniform, it's not massive, but the bleeding has begun.
This is why there are constantly exceptions being written into the statutes around medical billing - precisely to give those doctors a break. Especially the ones who have massive study debt. (There have also been a few articles in the Economist on this topic.)
Another problem is where pharmaceutical companies simply stop making drugs. They have the production lines, the employees, the process, the labels, the everything already sorted out - all they have to do is make, sell, and collect money. But they can't do it at a profit any more, so they don't. The FDA gets huffy and demands prior notice and phase-out periods so that they can try to get someone else to make the stuff - but they can't, the phase-out period passes and the stuff just doesn't get made. Oh well.
So, yeah. Please revisit that bit about negotiating (as opposed to dictating) terms of payment?
(Score: 1, Insightful) by Justin Case on Saturday August 20 2016, @08:48PM
Obamacare was designed to fail, to clear the way for totalitarianism.
(Score: 0) by Anonymous Coward on Saturday August 20 2016, @09:02PM
> Obamacare was designed to fail, to clear the way for totalitarianism.
Lolwut?
(Score: 3, Interesting) by Anonymous Coward on Sunday August 21 2016, @02:14AM
Cloward–Piven strategy [wikipedia.org]. I can see how you hadn't heard about it - it's only been discussed for fifty years.
"a political strategy outlined in 1966 by American sociologists and political activists Richard Cloward and Frances Fox Piven that called for overloading the U.S. public welfare system in order to precipitate a crisis"
(Score: 0) by Anonymous Coward on Sunday August 21 2016, @05:08PM
Yes, there' the famous line from Chomsky:
What's not being mentioned is the opposite side of the coin: Regulate an industry to death, make sure things don't work, people get angry, you nationalise it.
Cloward and Piven were certainly right about one thing (if only by implication), in that nursing along a broken system does not make it better, but that overloading it and breaking it can actually provide an opportunity for improvement.
(Score: 2) by opinionated_science on Saturday August 20 2016, @09:05PM
At any one time the medical insurance industry is represented by 2 groups of people:
a) payers
b) withdrawers
The insurance companies make a "business" by denying coverage to b) while still collecting from a). Of course b) a).
The problem is the pool of folks in a) discounts those 26 yrs old (assuming they had parental coverage), and includes a load of people that were previously denied covered now making up b).
The fact of the matter is that unless the mechanism of medicine is made not-for-profit, this insanity will prevail. There was an excellent NPR series looking at this a few years ago, that explained the lack of incentive for *any* of the parties to lower costs. i.e. the clamiants, the insurers and the clinicians.
Finally, the fact that some members of congress think they are immortal doesn't help - EVERY human ever born will need medical care - it's just a matter of when...
(Score: 0) by Anonymous Coward on Saturday August 20 2016, @09:17PM
First Rule of Acquisition. Once you have their money, you never give it back.
(Score: 4, Insightful) by Justin Case on Saturday August 20 2016, @09:18PM
At any one time the grocery industry is represented by 2 groups of people:
a) sellers
b) buyers
The grocery companies make a "business" and try to make a profit by charging as much as they can to b). However if they get too crazy b) will just go to another a) and everybody knows it, which keeps things more or less in check.
Imagine if you had grocery "insurance". All of b) would want steak for dinner every night.
Imagine if you had "single payer groceries". All of b) would want steak for dinner every night.
Oh and before you bring "need" into it, remember that everybody "needs" food too. Insurance and freebies is the problem, not the profit motive. Profit-making businesses have done a fine job of making food available to almost everyone but the very poorest, and we have charities to help with that.
(Score: 1, Insightful) by Anonymous Coward on Saturday August 20 2016, @09:26PM
Bad analogy, groceries are all priced before you buy.
Healthcare is fundamentally different, you get the bill (often inflated, then later negotiated down to something more reasonable) after the service.
(Score: 2) by Justin Case on Saturday August 20 2016, @09:36PM
And that problem could never possibly be fixed, right?
(Score: 0) by Anonymous Coward on Saturday August 20 2016, @09:56PM
> And that problem could never possibly be fixed, right?
Right. No foolproof way to know before surgery if it will go smoothly or if there will be complications (post infection, internal bleeding, etc, etc.) Just one of many reasons that healthcare can't be priced like groceries.
Another way your analogy is f'ed up is that we all want food. Many of us actually _like_ food so much that we pay extra to go out to eat and enjoy the atmosphere and special food. On the contrary, no one that I know wants to deal with doctors or the healthcare system any more than absolutely necessary. I'm healthy, get a checkup every 10 years or so to have a baseline. I've paid for insurance for many years (a bit grudgingly) as just that, insurance in case I'm in an accident. Or if all of a sudden I contract something that current medicine can actually treat.
(Score: 1) by khallow on Saturday August 20 2016, @10:26PM
No foolproof way to know before surgery if it will go smoothly or if there will be complications (post infection, internal bleeding, etc, etc.) Just one of many reasons that healthcare can't be priced like groceries.
No foolproof way for the grocery store to know if their customers will get injured just due to walking into a store due to a condition of negligence set up by an employee. But of course, markets work in conditions far outside that of the grocery store so we're not even considering stuff that is relevant to a health care market.
(Score: 1, Informative) by Anonymous Coward on Sunday August 21 2016, @02:18AM
http://surgerycenterok.com/pricing/ [surgerycenterok.com]
Care to try again?
The only reason the US medical monopolies can get away with the massive rip-off scam they've been running is with the help of government regulation aka guns.
(Score: 4, Informative) by Capt. Obvious on Saturday August 20 2016, @10:13PM
Except when it hasn't. Or rather, regulated profit-making businesses have done a fine job.
The tragedy of the commons is named after an agricultural issue. The government manages grazeland out west. Subsidized farmers ensure the food supply. the FDA ensures we're not being poisoned. Etc, etc. etc.
(Score: 2) by krishnoid on Saturday August 20 2016, @11:45PM
PETA would like a word with you.
(Score: 0) by Anonymous Coward on Sunday August 21 2016, @12:36AM
Not even close unless you can go years and years without buying food or just buying $200.00 of food a year. And then maybe through no fault of your own, maybe by accident, you have a $250,000.00 food bill. It's about insurance, not about food! Duh.
(Score: 5, Insightful) by sjames on Sunday August 21 2016, @01:15AM
Groceries are pretty much a constant. Medical care is mostly in the form of catastrophically expensive surprises.
There is time to look for the best prices on groceries. You can mix and match, some things here others there. There are many largely interchangeable brands for each item and most people understand food well enough to choose. Finally, you can stock up when prices are good and use that stock when prices are too high.
In medicine, you may not even be conscious when the choice is made for you.Even if you are, you probably can't wait a few days until TPA goes on sale at Kroger. It's doubtful you'll be able to transfer to a cheaper hospital. (Assuming you can figure out what hospital that might be when nobody publishes prices).
It's a perfect storm for a massive failed market. That's why so few countries try to cram it into a market system.
(Score: 0) by Anonymous Coward on Sunday August 21 2016, @02:51AM
So why does the health insurance forcibly sold to USians cover routine care?
(Score: 2) by sjames on Sunday August 21 2016, @05:52AM
Mostly as a hangover from the thinking in the '70s that HMOs would provide routine care to catch problems so they would be merely disastrously expensive over a a lifetime rather than catastrophically expensive. The conspirist in me suggests it's because otherwise the healthcare industry might get a bit of unwanted (by them) market feedback about prices.
I sometimes wonder if they would also like for us to forget that the most common issues (cold, flu, minor sprains, cuts scrapes, etc) can be resolved with simple proven home remedies at least as well as a doctor can handle them.
(Score: 2, Informative) by Anonymous Coward on Sunday August 21 2016, @04:09PM
Feature creep. Prior to the late 70's/early 80's, what we now think of as health insurance was sold as "catastrophic insurance". It was often named "hospitalization insurance". It's purpose was to help protect you against the small, but non-zero, risk that you might have something go wrong that was very expensive. And the insurers acted as the risk spreading pool. The 10% that incurred the huge bills had their expenses spread across the 100% who paid in but never got hit with the huge bills. So most people paid in more than they ever got back.
And, back then, all other routine healthcare was pay-as-you-go. And a Dr.'s visit didn't cost $175. More like $20 (which would be $73.82 in 2016 dollars according to http://data.bls.gov/cgi-bin/cpicalc.pl [bls.gov]).
Then, somewhere along the way, someone (insurers, govt. bureaucrats, who knows) started noticing that folks didn't go to their Dr's routinely for the periodic checkups that might catch a problem while it was a $1,000 fix long before it became a $1,000,000 fix. And so began a gradual push for "insurance" to cover more and more of the periodic routine checks. The reasoning was that if individuals could be better encouraged to go for the routine checks, and the problems caught before they became expensive issues, that the insurance world could save itself money (read as insurers could increase their profit). The initial logic was sound, catching issues early and fixing them before they become expensive items later is a good way to increase profit in a system based around risk.
Unfortunately, none of the companies going down this route of increasing their profit by lowering their risk by encouraging routine checks foresaw the unintended consequence of fully insulating the medical system user from the costs of their care. By paying for more and more of the routine stuff, the folks using it lost track of the cost, and generally began to not care (i.e., price competition was reduced) about the costs (because insurance was paying). Plus, this price hiding factor also resulted in far too many idiots believing that insurance is a way to "pay for all my healthcare" at the rate of ten cents on the dollar.
The reason so many idiots think insurance is a magic way to pay ten cents on the dollar for their health care is because that's all they see happening. They visit their doctor, they pay $20 as a co-pay, they think it only cost $20. At least with the old system, they directly saw the costs and were directly incentivized to try to keep those costs down. With the new "pay for everything" method, they saw none of the real costs, and began to not care because "someone else's money" was paying for the costs. Which brings us full circle to now and the obomacare idiots who think obomacare is a way to 'reduce costs' of healthcare. Insurance never reduces costs it always increases costs (because the insurer has to add a profit premium on top). What insurance does, and what it has always done, is reduce risk to everyone by spreading the risk of an unlikely event happening among the few across a large enough pool of members that the net risk is less for everyone. Converting health insurance from a "protect against huge bill" hedge into a "pay for everything you ever have done" is what is quickly killing the system all the way around.
(Score: 4, Informative) by AthanasiusKircher on Sunday August 21 2016, @05:25AM
At any one time the grocery industry is represented by 2 groups of people:
While creative, your grocery analogy is fundamentally flawed in too many ways to mention. Perhaps most importantly, health insurance companies serve two fundamentally different markets: (1) people who need basic everyday care that they could probably pay for reasonably just by budgeting, and (2) people who need coverage for catastrophic events that are difficult or even impossible to save for. The latter is more like term life insurance or fire insurance or whatever, where the risk is spread out across large pools of people, most of whom won't actually ever use the maximum benefit. There is no analogue to (2) in a grocery business. Moreover, those who need (2) often are in dire emergency straits, without the ability to "comparison shop" as they might in looking at different stores.
Anyhow, function (1) is not like any other sort of "insurance" in the normal sense. It's more like an "installment plan" or something, or the "constant payment plan" offered by a gas heat company that lets you pay one standard monthly fee every month to even things out so you won't have to deal with the $400 heating bill suddenly in January. That's really not insurance, nor is it really like anything resembling the market for grocery stores. But that's where people deal with "health insurance" on an everyday basis.
The grocery companies make a "business" and try to make a profit by charging as much as they can to b). However if they get too crazy b) will just go to another a) and everybody knows it, which keeps things more or less in check.
That statement is absolutely unequivocally false for the U.S. insurance market. Why? Because no one knows what they are really paying for health care. Wait -- let me say that again: NO ONE knows what they are really paying for health care.
My vote would be either for a system that limited "health insurance" to catastrophic incidents only, definitively separating that coverage from any "monthly gas-bill" like way of distributing your payments for annual physicals and flu shots... and requiring the charges for the latter services to be available upon request to practice medicine. OR, go with single payer, and kill that nasty cobra (no pun intended) that serves little purpose in standing in the way between doctor and patient, while simultaneously reducing the cost of healthcare by maybe 25% by getting rid of the insurance industry. (Or, well, I don't think private supplemental insurance should be outlawed, but with a reasonable single-payer system it should decrease
That's particularly true in insurance plans with "co-pays," where the actual price billed by the doctor's office and the amount paid by the insurance company for service are dealt with internally. A patient might receive a statement detailing all of those "charges" (the reason for quotation marks will become clear in a moment), but since you already paid your co-pay, all of those numbers are pretty much meaningless to you. It's only on those more rare (and frequently unpredictable) occasions where "coverage is denied" for something that you really need and have to pay out of pocket that you realize the actual cost of anything. And since those things are difficult to sort out except for those who can read the multi-hundred-page annual insurance manual they get with their policy, it's hard to know when coverage will fail. Which means it's difficult to "comparison shop" between plans.
"But wait," you say, "what about those high-deductible plans many people have nowadays? In those cases, you end up shelling the first $5000-13000 per year out of pocket, so surely you see your 'real cost'??"
Except you don't. What you see is this weird set of manipulated numbers which involve the numbers the doctor's office claims to "charge" and then the amount your insurance company says they will pay (which is generally a negotiated fee with a discount, which varies depending on your insurance company, what group of policy holders you're in which affects negotiated costs, etc.). So, again, you see a bunch of money transferring, with one party saying "You owe X" and another saying "We paid Y," but you have no clue how that might relate to the amount you might owe or what your insurance company would pay if you had a different insurance company or no insurance at all.
And it's next-to-impossible to get estimates for healthcare services ahead of time. You might be able to get the standard charge for a doctor's visit with no tests or special conditions in advance. But hospital A might charge four times as much for an out-patient procedure as hospital B, but it's almost impossible to get that information ahead of time, since it doesn't only depend on the actual claimed "charges" the hospital bills, but then what your specific insurance company has negotiated with that particular hospital or hospital network.
Bottom line: you pay a monthly premium, sure. But it's basically impossible to "comparison shop" among insurance companies or healthcare providers, which make your free-market comparison with grocers very problematic. For a patient to be able to make an informed choice to leave an insurance or choose a different provider, they need to be able to get information about actual pricing and costs, which you can't do.
And even if you think you know the way your plan is supposed to work, there's no guarantee it will. When I switched to a high-deductible plan a few years back, I thought it was a good decision for a number of reasons. But it also meant I kept a closer eye on my bills that I was paying out of pocket. Except discounts my insurance company said should apply wouldn't necessarily apply. The "free annual physical" with all sorts of specific tests was denied to be covered -- until I went back and forth between my doctor's office and the insurance company with literally a dozen phone calls spread out over 6 months and FOUR TIMES having the claim refiled until I could actually get it resolved. (Actually, in the end, the doctor's office still made an error in coding, so one of my procedures still wasn't covered when it should have been, but they accidently put a double credit on my account for another reimbursed test that landed me about $3 ahead of what I should have, so I just gave up and quit the "medical billing shuffle" while I was ahead. And all of this was over charges for a standard physical with no unusual tests or anything.)
Imagine if you had grocery "insurance". All of b) would want steak for dinner every night.
Imagine if you had "single payer groceries". All of b) would want steak for dinner every night.
You know what? I don't want "steak dinner." I just want a transparent billing procedure and reasonably accessible and accurate cost estimates for non-emergency procedures. If we had those things, we might have something resembling a free market where a consumer can make a rational choice between insurers. We do not. And people on all sides -- doctors/hospitals, insurance companies, and patients -- make unreasonable demands in these situations, because nothing is transparent.
Insurance and freebies is the problem, not the profit motive.
Well, this mess we call "insurance" is the problem -- I agree -- due to an extra layer of unnecessary bureaucratic profiteering mucking up stuff in the middle. I have no problem with a doctor earning some money for services. The "profit motive" of the middleman is the problem here, and there's really no good reason for it to be there.
(Score: 0) by Anonymous Coward on Sunday August 21 2016, @01:07AM
payers and withdrawers?
YOU forgot two other important participants
1) the insurance companies taking their cut
2) the providers, especially pharma taking their profits.
and of course govt, taking more control to do it 'their way', which is what got us to the state we are in.
that is, where there is little feedback between cost and actual benefit.
A private system with the feedback works, but is pretty harsh for folks without cash.
A public system with the govt being the provider via civil service seems to work in other parts of the world.
(Some say these systems are only working because good ole US capitalist is providing the drug research.)
The US seems to be trying to demonstrate that a mix of public and private is possible. (I don't think connecting these profits to the public hog trougth is sustainable.)
Remember Churchill: the Americans can trusted to do the right thing after they have tried everything else.
Just hope I survive until they switch to the right thing.
(Score: 0) by Anonymous Coward on Monday August 22 2016, @02:50AM
The US isn't the only one with a mix.
Germany and the UK both do, to my certain knowledge. There are probably others. I think South Africa may be one. Canada kind of does (its private sector has been largely bullied out of existence, but may be recovering after some court victories).
The government being the sole provider tends to work OK for things like falling off a roof, having a car crash, and regular vaccinations. By modern standards, basic stuff. It's dealing with more complex, chornic conditions, or where the formulary has to be quite flexible, that they come unglued.
There's a lot of research in this, you could probably learn a lot in a few hours with Google.
(Score: 0) by Anonymous Coward on Sunday August 21 2016, @05:15PM
Good news! NPR didn't get it quite right!
Turns out, there is incentive to lower costs, and the insurance market is supposed to be that, as long as there is competition among insurers, and insurers have the muscle to push providers in price terms.
What has not been solved yet is the problem that while we are getting more nurses, nurse practitioners and so on, our supply of actual MDs has not been growing reliably, and is actually falling.
Lots of people want to pooh-pooh this, pointing out that lots of people want to become doctors, and so on (hand-waving here the AMA's gatekeeper function keeping the supply down) but we don't have to wonder in the abstract how it will turn out; we already have a case study in a closely-related field: large animal veterinarians.
It's a poorly paid job, compared to suburban vets, it's a hard and draining job, and every bit as tough to study for. Result: we're running out of large animal vets. But what does it matter? Who cares about them? Only our entire agricultural system, pretty much.
Oh, dear. Maybe this might be a problem.
(Score: 0) by Anonymous Coward on Saturday August 20 2016, @09:19PM
It was a crony socialist conspiracy pushed by the big pharma, the liberal establishment and MSM. And Wall Street and George Soros were in on it too.
(Score: 2) by jmorris on Sunday August 21 2016, @03:36AM
Obamacare was designed to fail,
Exactly. look up the video of Jakob Hacker (described as the Architect of Obamacare) explaining how Obamacare isn't a Trojan Horse for Single Payer because 'it is right there.' Meaning it was so obvious it couldn't be accused of being hidden. It was so obviously designed to fail that he wasn't going to dispute it. The idea is to hook so many people on it before all of the insurers pull out that the cry for the government to 'do something' will carry them to exactly where they wanted to go in the first place but the political will was lacking. Look at this article summary where the call to just make Medicare universal is already being bleated by morons who can't do math. Medicare is already broke, adding millions more unhealthy people to it will only bring on the kaboom faster and harder.
(Score: 2, Disagree) by snufu on Saturday August 20 2016, @10:14PM
Another half hearted legislative fart written by insurance companies that is predictably regressing back to the status quo of for-profit insurers cherry picking their markets. The only difference is that now citizens are picking up the tab for high cost pre-existing cases.
(Score: 5, Insightful) by bzipitidoo on Saturday August 20 2016, @10:45PM
But they don't. What I find ridiculous is for the insurance adjusted price to be higher than the discount hospitals offer to those who have no insurance. I know, I've been there. I argued with insurance and hospital. They would not budge. I asked that they review their prices, and each time they claimed their prices were correct.
I asked that they explain why they were charging $300 each for three $2 bags of saline solution, and further, why insurance reduced the price of those 3 bags to the wildly different amounts of $151, $64, and $28 respectively, and got a lot of creative bull. No one at the insurer's or hospital's call center could explain it. Some thought it reflected additional drugs added to the saline solution. Nope, each drug is a separate line item. Some thought it was a mistake and set the price to $27 each for all three. No, no mistake, and soon those agents' changes were rejected. One said the prices were meaningless fluff, and the real price was set in a secret agreement between hospital and insurer which neither he nor I would be allowed to see. Wrong again. What I finally learned is that the price of the line item depends on the so called "emergency level". Apparently, emergency level ranges from 1 to 5, and the higher the level, the more expensive every item is. Those 3 prices are for level 4, 3, and 1 respectively. That's the worst cluster fucked, deliberately obscure billing mess I've ever seen, and I'm sure mine was relatively simple compared to many other patients.
I found a helpful medical billing advocate who found a few problems, but not near enough to reduce the charges to anything reasonable. One thing they found was the $151 bag of saline solution should not have been charged at all. Level 4 includes that in the facility fee.
I concluded there were only 2 reasonable choices. Tell the hospital to go to hell, or accept being robbed and pay up. The third choice, which I attempted over a period of a year, was to work within the system to get that bill reduced. It was taking way too much of my valuable time. Seemed calculated to wear the patient down. Peculiarly, if one opts for the first option, refusing to pay, there's little the hospital can do about it. Their debt collector dogs will threaten to ruin your credit rating, but the credit rating agencies recently reclassified medical debt as less serious. So that threat is now mostly empty. The worst they can do is sue, but that's so costly they won't do it, isn't worth the expense and trouble, unless the unpaid amount they claim is very large, say, over $5000. Plus, there's always the chance the victim will fight back and cause facts embarrassing to the hospital to surface.
(Score: 2) by krishnoid on Saturday August 20 2016, @11:43PM
You have another option -- while they may not reduce the line-item charges, you could write them a letter offering to settle the bill for 50% of the total, paid immediately. This worked in a few situations I was involved in -- in some cases they were willing to settle for 50%, in some cases, 60%, in some 70%, in some cases, they insisted on the whole amount, in some cases they wrote off the whole amount.
This was about 2 decades ago, though.
(Score: 2) by bzipitidoo on Sunday August 21 2016, @04:12AM
Yes, you're right. Not an attractive option to me because, as I understand it, that's called a "settlement". Meaning, they'll take that 50%, and still harm your credit rating, just not as much as if you paid nothing. I find that unacceptable. Now, if they agreed to take 50% and not damage your credit at all, then I'd be more interested. One thing the hospital was quick to offer was 20% off if I paid in full right away. They seemed very eager to sell me on that one, as if they knew very well I could refuse to pay at all and they would be unable to do much about it. It's a better deal for them than selling your debt to a debt collector. But no, 20% off was still more, quite a bit more, than the discounted amount they would charge if I had no health insurance at all. They should have offered me the option to not use my health insurance, bill me as if I had none, but they did not. My health plan has such a high deductible that I was on the hook for the entire amount of the not very discounted price the insurer got out of the hospital.
I forgot to mention that one other thing they might wish to try is to deny you service, if you visit again and they feel you owe them for previous services. Be real hard to say no if you should have some life threatening condition in need of immediate treatment. Maybe, they could even band together and maintain a blacklist so you couldn't go to a different provider for treatment. But they can't do that to people. I find it most interesting that denying service is against the law. So they can't get you that way either.
The law seems set up to encourage and drive patients towards becoming deadbeats. All these provisions to make the medics powerless to take your money or really hurt you, if only you will accept being labeled as a rotten, lousy, cheat who won't pay your medical bills. Surely it would make much more sense to reform the system and scrap this "fee for service" model that so warps our medical care. But no, greed rules. And, it's like authorities want dirt on everyone so they can have their way with any peasants so foolish as to stand up for rights or otherwise bother them. As further evidence, one little way the law works against the patient who refuses to pay is that debts can be "re-aged". Debt has a 7 year time limit, but every time you make the tiniest payment, or possibly even just discuss the debt, they can set the 7 year clock back to 0.
(Score: 2) by krishnoid on Monday August 22 2016, @06:25PM
Meaning, they'll take that 50%, and still harm your credit rating, just not as much as if you paid nothing.
I think you can negotiate a 'paid in full' status rather than a settlement. Considering they're in an industry that centers around making people whole again, it seems counterintuitive that they'd actively try to fix your body and then make an additional effort to screw up your life (credit rating) right afterwards -- especially for people who are offering in good faith to pay what they can. I have to suspect that if they wanted to use your credit rating as a weapon, they'd be working in the financial sector instead.
There may be some accounting/financial reporting funniness that requires/encourages they report things this way to the credit agencies. However, I think an independent attorney/advocate could negotiate something that gets them their money and gets you a clean credit rating. Maybe it's worth a shot.
(Score: 3, Interesting) by Valkor on Saturday August 20 2016, @10:52PM
(Score: 3, Informative) by Anonymous Coward on Saturday August 20 2016, @11:24PM
My father about a year ago found out he had cancer. So he whips out ye ol insurance policy that he had since about 1980 for it.
Denied. 'only your spouse is covered'.
So he calls them back up and reads them the policy. Still denied. 'only spouse is covered you will need to talk to your agent about it'. 'Thats funny that is not how *I* wrote this policy for *myself*'. 'oh... uh I need to find a supervisor' 'you do that'.
My dad was the originating agent and wrote the policy for his whole family. He finally was able to afford to get the chemo he needed. Oh he is also a veteran. Last I heard the VA was still thinking about if they could get the chemo chemicals. That was 8 months ago.
The moral of the story. Always resubmit if they decline coverage. *ALWAYS*.
(Score: 3, Interesting) by stretch611 on Sunday August 21 2016, @01:44AM
The truth is that all big companies are exactly the same.
I worked for one large company... an ex-monopoly... still a monopoly in some markets... so big that every person and the US knows who they are... (fortune 50 company.) We had a internal company system that I was a developer on. We had a PCI audit that we were deficient for no encryption on the credit card numbers (among other issues found.) We were going to be fined for the deficiencies so the company decided to fund fixing them. (another point of not caring about anything other than profit.) The database also contained unencrypted social security numbers. Our development team asked to encrypt them as well. We were denied because that was not an issue raised in the PCI audit.
Another company I worked for was a b2b credit card issuer. A big company in the field but unknown to many because it does not have consumer products. (Their customers included many fortune 500 names, and national, state, and local governments.) The system I worked on let their customers log in to our system, issue new cards to their employees, set spending limits on the cards, and declare what purchases were valid. (Each customer had an overall credit limit with the company, but the corporate customers were allowed to issue and change limits of any individual card.) The credit card numbers were never encrypted in our system and there were no plans to do so. The password security was so bad I could look at the table and "unencrypt" passwords in my head. It was a simple text reversal and character replacement. (e.g. ABC was replaced to be EFG then reversed to GFE... ) We had a password system overhaul while I was still there... They wanted to add email based password resets to avoid extra calls to customer service. We asked to be allowed to change to a real password hash and were denied.
I have worked for other companies as well... I've seen multiple examples of bad security... even one case where the login credentials for admin access to an online shop was validated in hard coded javascript. Many people don't care and are willing to sacrifice security to save a few bucks. There are a few willing to spend some money on security... though more likely the small companies are willing to pay for security... big companies rarely do.
Now with 5 covid vaccine shots/boosters altering my DNA :P
(Score: 5, Insightful) by archfeld on Saturday August 20 2016, @11:28PM
Seems simple enough, if you won't participate in the US medical plan you can't sell insurance to anyone in the US. Let them go play ball in someone else's field. It is about time the US insists on a level playing field for individuals and corporations. If corporation are entities and have rights don't they incur corresponding responsibilities ?
For the NSA : Explosives, guns, assassination, conspiracy, primers, detonators, initiators, main charge, nuclear charge
(Score: 2) by NCommander on Sunday August 21 2016, @03:38AM
I like this solution, but worry on the impact of those who get coverage from an Aetna plan themselves. The only way to "rip them out" so to speak would to make any contracts they have with businesses and individuals void. Furthermore, I'm not sure there are legal grounds for this; insurance coverage is incredibly spotty as is, and no hospital/clinic/etc. supports every coverage. At one point, my insurance was through Blue Cross/Blue Shield of Massachusetts. I ran into some very fun problems with coverage because I lived in Oregon and later Alaska at the time.
Honestly, at this point, I'm somewhat hoping the entire system will collapse and we'll be forced to go single payer as a solution. Not holding my breath for it though.
Still always moving
(Score: 2) by archfeld on Sunday August 21 2016, @06:17AM
I've run into issues myself, since I began splitting my time between CA and AZ. I really like my Kaiser coverage in CA, but they don't offer or cover anything out of state unless you are just traveling, but splitting my time equally puts me in a bind, and I have no real choice in coming to AZ, my parents need watching over and they are here. In the long run I am going to have to switch coverages entirely and I find that the insurance companies are venal in the extreme and not having a single entity cover everything really, needing referrals and different Dr.'s for all kinds of things really sucks.
https://en.wikipedia.org/wiki/Kaiser_Permanente [wikipedia.org]
For the NSA : Explosives, guns, assassination, conspiracy, primers, detonators, initiators, main charge, nuclear charge
(Score: 5, Interesting) by meustrus on Sunday August 21 2016, @03:41AM
There is one major point in all of this that probably isn't what the regulators considered: Aetna made a threat to the operation of the government based on its market share. And its threat was aimed at gaining an even larger market share. Under no circumstances should a privately held corporation be in the position to make threats against the law and its agents (the government). By proxy, that is making a threat to every American citizen. This is the clearest "smoking gun" I've seen of the trend towards corporations claiming big government power over the actual big government, free from politics threatening to clear house when the governed are unhappy. It's past time to stop these mergers from happening. It's time to break up ALL the big corporations so that the only reasonable response to this kind of threat is "go fuck yourself".
If there isn't at least one reference or primary source, it's not +1 Informative. Maybe the underused +1 Interesting?
(Score: 2, Interesting) by khallow on Sunday August 21 2016, @08:59AM
Under no circumstances should a privately held corporation be in the position to make threats against the law and its agents (the government). By proxy, that is making a threat to every American citizen.
No, that's a terrible idea. First, businesses should be able to threaten every American citizen as long as they don't break any laws in the process. Here, it's a vague "we won't play ball, if you don't give us more ball" threat. That's freedom of speech. Closely related to that, if government can shut down a business for such vaguely threatening talk, then they can do that to anyone and they'll rapidly cease to be a proxy for every American citizen as they pursue their own agenda instead. And come to think of it, it's healthy for the citizenry to be told "Fuck you" every so often when the public tries directly or via government to stifle lawful activities. But maybe we should go back to punishing gays because the public thinks they're bad, icky people. What's good enough for dealing with Aetna, is good enough for dealing with the many undesirable groups in the world.
Second, we should wonder why that is even considered a threat, much less a threat that might work. In a healthy market, competitors would already be using those words to steal away customers. And if Aetna carried through, it'd be blood in the water as competitors scoop up Aetna's customers like sharks plowing through a dense school of fish.
It's only when the market is fucked up that such threats have even a shred of credibility. So then, we should be asking who fucked up the market. It's the same government that you care about so much because they supposedly are a proxy for the citizens of the US.
Finally, business is an important counterweight to government. It's worth noting that every democracy has a variety of divisions of power. Most of these are formal, such as explicit division of executive, legislative, and judicial power which is near universal in democratic societies. The division between business and government is an important one. When we let government win every conflict with the business world, we open the door to traditional fascism with nominally private businesses still operating at the beck and call of government.
(Score: 2) by meustrus on Sunday August 21 2016, @08:15PM
First of all, nobody's talking about shutting down any businesses. Splitting them up, sure, but only at the point where a non-government organization has the clout to do government-like functions. That's the real problem here. See, the great thing about capitalism is that a bunch of different corporations can tackle the same problem in different ways, and we as consumers get to pick what we think is best. But after these corporations have solved the actual problem, they go into competition mode. Healthy competition is producing a better product than your competitors, for a better price, with a better public image. Unhealthy competition is edging competitors out of supply chains, leveraging greater assets to loss-lead so that no competitor can turn a profit, and rigging the game by changing the government regulations such that only you can meet them effectively. And whether the competition is healthy or unhealthy, at the end of it all you have fewer companies with less possibility for startups to disrupt the market. Then, with no more ways to make their operations better, the few companies left start merging with each other to further increase efficiency. Then capitalism breaks down as there is no longer any competition and the few top dogs can keep little guys out of the market completely with those unhealthy competitive practices I mentioned earlier.
Health insurance is one industry with this problem. The biggest problem, really, is how massively expensive medical care is. And it doesn't have to be. There was another commenter on this story talking about the three different prices ranging from ~$20 to ~140 for three $2 bags of saline, among other things. We're overspending on healthcare, and for what? Why is it so expensive to provide healthcare in America? It's the Matryoshka doll of bureaucracy around insurance and regulatory requirements.
So who do you think wanted all that bureaucracy? Some evil collective of government workers? No! The health insurance companies themselves wrote most of the laws that they operate by. And even if they didn't, it would be Congress, not the power-hungry office drones we are so fond of despising. Congress who, in a world without corporate lobbyists, would have literally nothing to gain from writing bad laws. The best thing that come to a politician from writing burdensome regulations benefiting the big dogs in an industry is to then become a highly-paid lobbyist for that industry.
Which comes back around to my primary point: the big dogs in certain industries are too big. They are not being "an important counterweight to government". They are threatening the government. They are writing laws for the government. They are bribing the government. They might as well BE the government, except that you can't elect them out of office. The only thing you can do is split them up until they are too small to have that kind of clout. And if you want government to be smaller, it can't and won't be until the corporations it works with are smaller too.
If there isn't at least one reference or primary source, it's not +1 Informative. Maybe the underused +1 Interesting?
(Score: 0) by Anonymous Coward on Monday August 22 2016, @06:12AM
Wrong about some stuff here.
For starters, one of the major problems with Obamacare (if you were paying attention you should remember this) was that a lot was actually left undefined, and for the executive branch (i.e. the civil servants) to work out, and until those were published, the insurers, hospitals and everyone else didn't really have any clear idea what the rules would be. So, yes, they most emphatically were written by the suits in D.C., and no, the insurers didn't get to simply write that stuff. They could suggest things - well, so could (and did) lots of other people, many of whom were not being painted at the time as the ultimate evil behind the economic slowdown.
All the handwaving about competition is irrelevant in the teeth of the degree of regulation they have to deal with. It's a highly regulated market, very tough to enter, with the government at federal and state level tracking it very carefully. The only free market question here to either the insurers or the public is the flavour of condoms to be used when they get screwed. And, as this whole story makes painfully clear, Aetna got screwed.
Now, as for your fantasy of a high-minded congress if only there weren't no lobbyists? Hah. Tammany Hall was a political machine, make no mistake, but the modern political system is very much a spoils system from the ground up. Why do you think the democrats spend so much time gargling the flavour of union out of their mouths? And the republicans ditto with evangelicals? Or the military? Or inner-city minorities? Or Iowa corn farmers? Or any one of a number of other electorally important groups?
Yeah, if you want congesscritters to be more task-oriented, change the system so that people vote for issues, not people, and that congresscritters are legally liable for disobeying the outcome of an issue vote, with the default vote being NO.
... never happen ....
(Score: 1) by khallow on Monday August 22 2016, @06:56PM
First of all, nobody's talking about shutting down any businesses.
I was responding to:
Aetna made a threat to the operation of the government based on its market share. And its threat was aimed at gaining an even larger market share. Under no circumstances should a privately held corporation be in the position to make threats against the law and its agents (the government).
Then what should be Aetna's consequences for its alleged threat?
Which comes back around to my primary point: the big dogs in certain industries are too big. They are not being "an important counterweight to government". They are threatening the government. are too big. They are not being "an important counterweight to government". They are threatening the government. They are writing laws for the government. They are bribing the government. They might as well BE the government, except that you can't elect them out of office. The only thing you can do is split them up until they are too small to have that kind of clout. And if you want government to be smaller, it can't and won't be until the corporations it works with are smaller too.
You just describe a successful government effort to make a bunch of big market players. Splitting up big businesses, no doubt selectively, (or for that matter small businesses which get political bothersome or don't contribute enough bribes) is a form of shutting down that business (especially, if the pieces just end up in the hands of other large competitors for a cheap price). Perhaps, we shouldn't expect the party making the problems to fix them?
And I strongly disagree that small businesses are a precondition for small government. The US government was able to pass such onerous, big business-creating regulation in the first place because it was big. Currently, they're writing regulation faster than anyone can read it and the rate of creation is going up. In a few decades, regulation creation will be faster than you can flip the pages. No way that small businesses can thrive in such an environment.
(Score: 1) by khallow on Monday August 22 2016, @07:01PM
(Score: 2) by CirclesInSand on Sunday August 21 2016, @10:48AM
Under no circumstances should a privately held corporation be in the position to make threats against the law and its agents (the government).
Private organizations should absolutely be able to defend themselves against government members and their unjust laws. Just because something is legal and carried out by a government member doesn't mean that it isn't theft.
(Score: 2) by meustrus on Sunday August 21 2016, @07:43PM
meustrus:
CirclesInSand:
Somehow I don't think we're talking about the same thing.
If there isn't at least one reference or primary source, it's not +1 Informative. Maybe the underused +1 Interesting?
(Score: 2) by CirclesInSand on Monday August 22 2016, @10:51AM
That's because you misquoted yourself. You said "be in a position to make threats", not "make threats". One is an ability; the other is an act of communication.
(Score: 1, Informative) by Anonymous Coward on Sunday August 21 2016, @05:27PM
Read their communication again. Carefully, this time.
Government: you have to offer the following kinds of policies if you are in these markets, because of Obamacare
... time passes ...
Aetna: We tried. We're losing money hand over fist. We want to have a merger, maybe improve our situation.
Government: Maybe. Probably not.
Aetna: Look, if we can't merge, we can't make money, we have responsibilities here, we'll just have to drop out of this market to stop bleeding cash.
Government: No. No merger. Also: fuck you.
Aetna: Welp, looks like option B, leaving the market, is on the cards.
Witless masses: Oh noes! Teh ebil corpomoration hatez peepulz!
Reality: The terms of Obamacare aren't working there. Aetna is under no obligation to participate, so they're not. Nothing to see here.
(Score: 2) by meustrus on Sunday August 21 2016, @07:41PM
That much has nothing to do with anything but capitalism. Obamacare got nothing to do with it. In fact, if it's so unprofitable, I find it hard to believe that a merger would make a difference to them staying in the market. And fun fact: health insurance is incredibly profitable, and it only exists as an industry because of government regulation.
If there isn't at least one reference or primary source, it's not +1 Informative. Maybe the underused +1 Interesting?
(Score: 0) by Anonymous Coward on Monday August 22 2016, @01:44AM
Oooh, is that a fun fact? I love me some fun facts! I can play this game too!
Just because "health insurance is profitable" does not in any way imply that any individual health insurance plan, or set of plans, or market, is inherently profitable.
Did you get that? It's a subtle point, but it's quite possible for the health insurance industry to be a profitable one on average, while certain products in that market are not profitable.
That's what happened here: Aetna provided policies according to the dictates of Obamacare, and within the limits dictated, within certain markets, they could not find a way to make them profitable. Given that this continued over the course of years, not just a morning's smoke session, it's a pretty fair bet they tried. And failed. The numbers behind the failure are now public.
OK, so much for the basic fun facts. Now let's have another fun fact! Mergers result in changes in the market position. This may sound like Walmart-style squeezing of everyone else, but there's something special about the insurance industry: the creation of a larger, and more diverse risk pool. So, here's another fun fact: there's every reasonable reason to believe that, if they had had their merger, they might have been able to cut a profit on those policies and continue offering them! Oooh, that was fun!
Oh, and let's have another fun fact (since I'm having more fun than a barrel of inebriated monkeys) and observe that health insurance has existed as a product since before a government willed it into existence. Obamacare policies exist because of government fiat, but health insurance as an industry does not.
This is so much fun it might not even be legal, but who's gonna stop me? You? Didn't think so.
Because another fun fact (isn't this crazy?) is that this is precisely the sort of thing that was predicted: companies would have a hard time cutting a profit, and just stop offering policies, while the ones who did remain in would end up with monopoly power, and massive, chunky premiums (assuming that the government let them). And whaddyaknow? (fun fact alert!) the premiums have been rising. Nationwide, they have risen substantially, and in fact since inflation is dancing a tango with 0% that means health care costs have continued to beat inflation, year-on-year, despite all the earnest promises that Obamacare would totally control costs. Oh boy, another fun fact: the number of provisions in it that had a credible attack on cost rises? Nil. Again, as seen on TV, whenever they talk about that. Oh, wait, TV rarely talks about that because it's boring and makes the government pout. Oh well!
It gets yet funner (is that a word? It sounds like a fun word, so it totally should be!) when you remember that the health care market has both supply and demand ends, and that the supply end is continually growing as new products come to market (new drugs, prosthetics, procedures, you name it!) and yet also under pressure (lack of new MDs, rapid retirement of old MDs who are tired of the new BS, hospitals and clinics being closed, merged and redeployed under the new rules, you name it) in terms of ability to provide for that supply.
Wait, let me put on my moustache tattoo and fedora. "I believe that your pocket analysis, despite being heartfelt, is simplistic and elides certain critical factors."
What fun!