wnyc.org / 93.9fm / am 820

This is all absolute bollocks. I had Empire Blue Cross Blue Shield for several years, and they played the same game all the insurance companies do--they refused to cover "out of network" doctors who I'd been seeing for years, and they told me that I needed to "find an alternative" to several medications because they didn't want to cover them. Great, Empire--except that for one of those medications, there was no alternative, so I was stuck shelling $50 out of my pocket every month. Puh-lease.

This blog post is linked on both Kaiser Health News & the Office of the House Democrat Majority Leader, Steny Hoyer's website http://democraticleader.house.gov/blog/blog.cfm?pressReleaseID=3193

The post, talks about the heavy concentration of health insurers in many markets

http://www.healthreformwatch.com/2009/06/17/healthy-competition-how-a-competitive-health-insurance-market-influences-cost/

I guess you had to be Fair and Balanced by putting an Industry Shill on, although others have noted this Industry does have other platforms to press its case. The Insurance Industry has (a) methodically excluded people from health coverage for years (that may be the "super efficient Private Market"), but it's bad Public Policy.; (b) Medicaire has lower Administrative costs than the 'efficient' HMO's; (c) my care has been Rationed for years by my insurer. What do I lose by a Public Option? Zero. What can I gain? Cost reduction and competition. Keep the Public Option.

How is it that insurance companies don't have the IRS to take monies from your bank accounts to pay for health care or fine you for not having health care, or have specialized death services for those over 60 with serious illnesses or pain that government doesn't want to pay, or will ration medical services? These are the provisions in the Obama Death Care bill. They will use the IRS to seize your assets to pay for health care; not for you, but others. In fact, Obama Death Care will support minorities and illegal immigrants over tax-paying senior citizens. I don't call this health care; I call it Nazi eugenics and euthanasia.

FOR PRIVATE "insurance : Americans pay for things that MAY happen.

public / not-for profit: Americans pay for events that actually happen. 100's of times less expensive.

The "MATH" is NOT the same....

money / resource is ALWAYS rationed in any society. Regardless of the systems.

dr dave

Ask your guest what happened when Blue Cross took over the Medicare reimbursement contract for Queens as NGS. It happened last August and there are still major problems. I don't know what they promised Medicare but GHI was doing just fine. We were getting paid and could talk to a person if there were problems. I work for my husband, a physician in private practice, and I don't think health insurers should be for profit. Our daughter lives in Quebec and feels the health system is far superior to what was available to her when she worked in Washington DC. We should have single-payer as an option and let the private companies compete.

I am 29, In good health, I pay $450 a month in COBRA for what is supposed to be one of NY's best coverages, Oxford.
I injured my knee and I needed 6 months of physical therapy. After 3 months my plan stopped the therapy because I told my therapist my knee was improving and they decided to stop the sessions. After my doctor gave me a bogus second prescription for an inexistent problem in my knee so I could continue the treatment, took 2 months for them to ask how it was going. I said it wasn't improving. They again stopped the treatment. Years have passed by my knee still hurts. I stopped Oxford and took my dollars elsewhere with international emergency insurance.

I hope these crooks all go broke and a new generation of healthier health insurance coverages emerge to compete with the governament plan, just as FedEx and UPS both do a great job to stay ahead of USPS for a premium price. I wish I had an option like that to treat my knee, which still hurt.

okay, I just checked Marc Ambinder's Atlantic site - the afl-cio is organizing people to counterdemonstrate at town halls...

C'MON DOWN, WNYC'ers!!!

http://politics.theatlantic.com/2009/08/labor_gets_involved_in_town-halls.php#comments

I'm dead serious when I write that it warms my heart to read all these pissed-off, energetic New Yorkers - so passionate on the issue of health care.

How can we corral all this energy into ACTION?

Norman 107

as in Liberty or DEATH. funny?

markBrown
i'll be dead in 20 years. why should i wait!

your guest last comment was that the insurance industry wanted a fact based discussion not a PR debate,
He then went on to address the last callers comment about how little cost for complete overage by in France [single payer] by a PR ploy. He he said that full coverage was available in ny BUT VERY EXPENSIVE.
He also said that we need a larger pool of people being insured.
The only legitmate comparison to do that is the current Public Option.It is called Medicare.
It and it alone has the ablity to do what he said has to be done.
Further more what he did not addressed in his remarks about profits that insurance companies make the corresponding conditions that find profit making providers getting paid for the same proceduers that medicare pays them less for.
There is know way to escape the fact that profit either from the provider or the insurance company adds to the cost,
It providers ann
insurmoutable barrier to tens of millions of americans.
thanxs
giovanni

Hi Brian,
I work for a company that overturns commercial payor insurance denials on behalf of hospitals. I have very mixed feelings about Healthcare reform particularly because we are all too familiar with hospital struggles with Medicare and Medicaid. However, someone has to cover those that the commercial industry reject through predictive modeling and at this point, given insurance company tactics, which my company fights every day, I have little faith that they will genuinely effort to that end.

What's more, my health insurance with Blue X is so complicated and confusing that it is almost a hassle to use. I am covered through my husbands plan but they refuse to provide a card with my name on it, in some cases it looks as though he is getting OBGYN work! In addition, they refuse to provide me with a letter in writing saying that they have received proof that I have had continuous coverage- something that would protect me if I were to get sick because technically they could claim it as pre-existing. My point is, even those of us who are fortunate enough to be covered are within a system that actually discourages using it- simply through a web of complicated and odd rules. We have actually been getting checks from Blue X! So now, I have to call my Doctor and go out of my way to pay them.... but actually, I have to call my husbands too because- we don't know for who the check applies? weird.

Finally Brian, please consider having Linda Fotheringill, Principle and Co-Founder of Washington & West, LLC on your show as a guest for another perspective for your Healthcare reporting and updates. Our work on behalf of Hospitals with regards to their increasing difficulty in getting paid by the Commercial Insurance Industry is a unique perspective. Also, you might want to consider reporting on Medicare's Recovery Audit Contractor Program - kicking into gear as we speak.
www.washingtonwest.com (an updated website is under construction and near completion!)

I like the way they call their worst policy the "Liberty" policy.

Dear Brian, It really is about money and competition. the insurance industry is scared that there would be a govt system which really works well. I've had medicare for 14 years. I choose great doctors hospitals and psy about $1300 a year for wonderful service and skill. I have never been turned down for any medical procedure and feel every American is entitled to this kind of medical care. We should support Congress in this endeavor. Those who want something else, that option should be available.

I still never found out what his answer was to the question of what useful service do insurance companies provide.

Did I miss it?

One of the excuses they give is the managed care argument: they deny payment to unnecessary or overpriced procedures, in order to keep prices down.

Of course the question is, are they saving more than the 15% they charge for administrative costs?

Paul Krugman said that when you compare Medicare Advantage with standard Medicare, Medicare Advantage costs 15% more, so they don't seem to be saving any money.

Mr. Wagar misrepresented the "must issue" rule in NY State:
1. He said that, due to the high rates, many people don't take out insurance until they become severely ill, effectively "gaming" the system. HOWEVER, if a person has been uninsured for more than 63 days, the insurance company can exclude pre-existing conditions for ONE YEAR. The cancer patient in his example might be dead by then.
2. Companies that write group/employer health insurance policies in NYS are required to offer personal policies. HOWEVER, they are not required to offer the same choice of policies. For example, United Healthcare / Oxford offers its Freedom network in group/employer policies, but offers only its inferior Liberty network to individuals/families.
3. Other states typically do not have "must issue" rules. If we have a mixture of public and private insurance, it would make sense for private insurers to deny coverage to ill or high-risk customers, effectively dumping them into the public plan. I would also expect the NYS insurers to lobby (buy?) our state government to remove the "must issue" provision, with the argument that you no longer need "must issue" to guarantee coverage availability for everyone.

#99 (Jawbone:)

Switch from IE to Mozilla Firefox. it has a built in spelling/typo warning: It turns possible typos red, just like ms-word does

On the question of "lack of competition", here is the answer from the Washington post. More of an issue of concentration:

A public option such as that proposed by House Democrats, with prices initially set at 5 percent above Medicare rates but well below private insurer rates, would inject competition into markets that are now oligopolies: An American Medical Association study found that a single insurer controls more than half the market in 16 states and a third of it in 38 states.

MY Idea is SIMPLE.

(and I told BRIAN over two years ago),

and NO ONE anywhere has picked up on it yet.
(see my blog and search for top-ten)

SINGLE payer health care, phased in over (5-20 years) , Starting with the EXISTING insurance system.

See my post HERE for more details:

In essence, Every single existing company will start to accept new clients (uninsured) to be paid by government at fixed fee.
They will manage the new clients in a new pool.

At some point (every X months/years)
A reduction from Y (for profit carriers) to Y-1 carriers takes place, and winner gets more management fees for winning/making costs lower, better service...

Look here:
http://sos-newdeal.blogspot.com/2009/06/health-care-its-competition-stupid.html

or here for my MAIN top-ten list..
http://sos-newdeal.blogspot.com/2009/02/top-ten-list-what-i-believe-and-want.html

And 2 years later, I am no longer a crackpot, but just a visionary!

Mark in NJ

Wendy [63], in New York, state law requires HMOs to cover preexisting conditions! So you can switch to another plan, as long as it's an HMO. You can get more info from the state dept. of insurance, or maybe even via 311.

I cannot tell you how much I appreciate sites with an edit feature! As you can read, my typos are abundant...

Why don't I see typos when I do a quick proofread, but they jump out and bite me on the nose when they're in final, irrevocable submitted form?

NEW JERSEYITES CAN’T AFFORD THE STATUS QUO

Roughly 5.5 million people in New Jersey get health insurance on the job1, where family premiums average $14,154, about the annual earning of a full-time minimum wage job.2
Since 2000 alone, average family premiums have increased by 86 percent in New Jersey.3
Household budgets are strained by high costs: 23 percent of middle-income New Jersey families spend more than 10 percent of their income on health care.4
High costs block access to care: 12 percent of people in New Jersey report not visiting a doctor due to high costs.5
New Jersey businesses and families shoulder a hidden health tax of roughly $1,000 per year on premiums as a direct result of subsidizing the costs of the uninsured.6
AFFORDABLE HEALTH COVERAGE IS INCREASINGLY OUT OF REACH IN NEW JERSEY

16 percent of people in New Jersey are uninsured, and 71 percent of them are in families with at least one full-time worker.7
The percent of New Jerseyites with employer coverage is declining: from 72 to 64 percent between 2000 and 2007.8
Much of the decline is among workers in small businesses. While small businesses make up 77 percent of New Jersey businesses,9 only 53 percent of them offered health coverage benefits in 2006 -- down 4 percent since 2000.10
Choice of health insurance is limited in New Jersey. Horizon Blue Cross Blue Shield alone constitutes 34 percent of the health insurance market share in New Jersey, with the top two insurance providers accounting for 59 percent.11
Choice is even more limited for people with pre-existing conditions. In New Jersey, premiums can vary, within limits, based on demographic factors and coverage can include exclusionary periods for pre-existing conditions.

http://www.healthreform.gov/reports/statehealthreform/newjersey.html

Another Blue Cross/BS (pun intended) story: two years ago, I had an emergency procedure, performed in my doctor's office, to treat an internal abcess that was extremely painful and my doctor was concerned was about to go systemic -- as in "threat of sepsis."

It took six months and an appeal for Blue Cross/BS to pay. First, they repeatedly demanded "surgical notes" that they were repeatedly told did not exist -- it wasn't that kind of procedure. Then their examiner called my doctor for "more information" -- but only at times when, as his recording clearly indicated, he was not in the office. None of my doctor's phone calls in response were returned.

The claim was denied; we appealed. My company beat up on Blue Cross/BS and someone finally spoke to my doctor and ascertained that I had been at risk for sepsis (as clearly stated in every document that BC/BS has previously received). THEN BC/BS claimed that the procedure was not an "emergency" procedure, because it has not been performed in an emergency room. (In other words, if you get hit by a car, and are treated at the scene by a passing physician, it's not really an "emergency" -- presumably because he doesn't hang a sign on the wreckage that says "Emergency")

I got paid -- after six months of fighting -- for a no-brainer claim that should have been paid in two weeks. My employer pays $23,000 per annum for my family policy. Wellpoint made $3 billion plus in 2008. Mr. Wager is full of BC/BS.

NEW YORKERS CAN’T AFFORD THE STATUS QUO

Roughly 11.2 million people in New York get health insurance on the job1, where family premiums average $13,971, about the annual earning of a full-time minimum wage job.2
Since 2000 alone, average family premiums have increased by 97 percent in New York.3
Household budgets are strained by high costs: 16 percent of middle-income New York families spend more than 10 percent of their income on health care.4
High costs block access to care: 12 percent of people in New York report not visiting a doctor due to high costs.5
New York businesses and families shoulder a hidden health tax of roughly $800 per year on premiums as a direct result of subsidizing the costs of the uninsured.6
AFFORDABLE HEALTH COVERAGE IS INCREASINGLY OUT OF REACH IN NEW YORKERS

14 percent of people in New York are uninsured, and 67 percent of them are in families with at least one full-time worker.7
The percent of New Yorkers with employer coverage is declining: from 61 to 59 percent between 2000 and 2007.8
Much of the decline is among workers in small businesses. While small businesses make up 81 percent of New York businesses,9 only 51 percent of them offered health coverage benefits in 2006 -- down 3 percent since 2000.10
Choice of health insurance is limited in New York. GHI alone constitutes 26 percent of the health insurance market share in New York, with the top two insurance providers accounting for 47 percent.11
NEW YORKERS NEED HIGHER QUALITY, GREATER VALUE, AND MORE PREVENTATIVE CARE

http://www.healthreform.gov/reports/statehealthreform/newyork.html

MEDICARE FOR ALL -- with a ROBUT PRIVATE **OPTION**

The last part is to satisfy the policiticans' need for Big Donors. And there's probably some role, boutique coverage, additional coverage, Niche markets. But not control of the people's HEALTH CARE.

It's amazing to think that through the entire discussion no mention was made, given Empire's profit incentive (and mandate), that it has an incentive to increase its spending base. While the country could improve its health by preventive measures, including education about eating habits and exercise, the insurance industry is pre-programmed to spend as much as possible in order to create profits at a certain margin.

There is, effectively, no incentive to improve health. We are profiting from our own tendency to offer expensive, invasive procedures to solve any number of advanced problems, many of which are preventable. And the result -- astronomic premiums -- is guaranteed under the current regime.

We need change now.

Sick of the for-profit insurance INDUSTRY being in control of our health care.

We all need to become activists over this issue! Contact your Congress-folks and demand real reform; urge friends and family to call/write/email Congress; volunteer with Organizing for America, Health Care for America Now or MoveOn, for phonebanking, canvassing or otherwise. Now's the time!

The issue is whether we consider a healthy populace a national security issue. If we do, do we really want to outsource healthcare to the private sector?

We need universal Medicare, with an option for supplemental private medical insurance for those who desire it and can afford it.

PS Bills for our newborn were initially denied because of pre-existing condition. What? The insurers, of course, found another reason.

More frustrated.

one more thing. Why do insurance companies catagorise payments to patients as a loss?

My elderly parents are on Medicare and I've seen it in action--it's great! My mom just had a hip replacement for very little cost, and she's retired.

SINGLE PAYER FOR ALL. Healthcare should not be for-profit.

Karen from NYC, your posts rock. If you and HJS want to start a progressive version of the teabaggers, I'm down--let's storm the BCBS office!

He just conceded the worst problem.

Yes, with guaranteed issue, you can get insurance, but the premium is unaffordable.

He wants the government to force healthy people to buy insurance, to spread the costs.

The problem with that is that low-income healthy people still can't afford insurance.

Under the Obama plan, they would give a subsidy to the insurance industry, to get your premium down to 12% of your income.

The only way to force them to be honest and not play with our lives and well-being is to have a public option that will force them to make real changes to the way they deal with Americans' lives or get out.

This segment hasn't added any value at all to the discussion about health care reform. If WNYC is going to invite someone with so profound a vested financial interest in the debate as Mark Wagar, then Brain Lehrer needs do do more homework and be prepared to discuss the hard details. Wagar's answer to the final caller's comment/question was laughable. and Lehrer merely asked him whether there was "anything else he wanted to say." Very weak segment. Where's WNYC's social conscience?

to anser the last caller, yeah, you could get coverage, by law, but you have to pay an arm and leg to get it. they're not going to hand it to you out of benevolence. the health covereage of the states, no matter where you are does not in any way, shape or form compare to France or to anywhere else in europe

Wouldn't have a choice with single-payer? Bureaucracy? We've had to change our pedetrician 3xs because our insurance changed. I won't go into the confusing and redundant paperwork and bills we get.

Simply, why does the insurance company have a right to refuse someone healthcare? Profits? This is morally wrong!

Very frustrated!

A shameful and revolting pack of lies from Mark Wagar.

(What is in his interest is one thing: status quo.

That's the bet his co., Blue Cross, made when it switched over from non profit to profit a few years ago.

brian -- please ask your insurance co executive liar about this big part of the "costs" of health care: private insur co's make 20-25% profits each year, they pay hundreds of execs multi-million dollar salaries each, they spend millions on advertising. in a govt run public option plan none of that massive cost would exist, so overall costs would go way down. of course, prov insur co's cannot "compete" with that!

These parasites are dinosaurs. Let them rest in peace. Find niche markets for their high profit requirements.

this segment is disappointing.

He is competently defensive and correctly identifies some legit problems.

He has been in business many decades -- what is his solution, via his company or his industry?????

Mark Wagar is lying through his teeth. I pay almost $900 per MONTH for my insurance -- one person, $10,000 per year.

Empire has denied EVERY claim I have ever made -- only three or four -- every one denied. I fought the denial in each case, and won in each case.

My 8-month old son was rushed to the emergency room where he stayed overnight. Empire DENIED the claim.

Empire is a subsidiary of WellPoint which has made its profit priority perfectly clear.

Dr. David Himmelstein says that currently having single payer would save $400 Billion each year; the earlier figure was $350 Billion per year. That's $400 TRILLION over 10 years --not the 50-70% INCREASE in current costs Obama is HOPING to achieve!

--that's from eliminating the profit private insurers must make, eliminating the maze of often conflicting insurance company rules and regulations, eliminating the cost of marketing and advertising, eliminating the need for a denial of care bureaucracy, etc.

Example: I called my Big Insurance Parasite to get clarification on whether a simple procedure required a referral or a prescription; I got differing answers from each rep I called (I always call at least two, thinking that if two say the same thing it's probably accurate -- not always, however!). I escalated to supervisors; still different answers. I escalated to management.

Finally, I was told that if I lived in southern NJ, I would have needed a referral, but since I lived in northern NJ a prescription sufficed. Same parasite, same individual plan; different rules! Which can cost the patient MONEY. And drive the doctors' office people crazy!

It costs the health care providers incredibly due to having to hire so many people to try to figure out what's going on with private insurers, each with many plans, differing regulations, and, I found out, differing geographical regulations!!!

So, Dr. Himmelstein, of Harvard, where he's lead cost studies of health care spending in this country which are used by many different sides of the debate, and of PNHP.org, where he advocates for a plan which serves people not shareholders and executives' compensation.

Those savings, per PNHP, would mean coverage for everyone, from day one, dollar one.

We can't afford to not have Medicare for All -- oh, yea -- with a robust private insurance **option.**

And Norman, you can't embed the link to the New England Journal article (really an editorial), but you can put the full URL here so readers can copy & paste it into their browsers: http://content.nejm.org/cgi/content/full/361/5/440

Missing a retort here Brian ---

He keeps saying "our profits are low and prices are rising because costs are"

Covering PREVENTATIVE rather than simply SUPPORTING THE EXISTING SYSTEM BY CUTTING CHECKS FOR meds and surgery once the results of behavior or formerly correctable conditions would save 90% of such costs.

WHAT IS HIS POSITION ON PREVENTATIVE AS AN ALTERNATIVE?

The argument is similar to the recent one relating to the environment, ie conservation vs. "drill baby drill"

Ok folks, this is a no-win situation if we accept this dribble. Let's get a mass mailing out to the President. He needs to know that we "have skin in the game" and will support in on a public option. We don't want him to back down or give in to this guys harking about loss of support, increased costs, possible bankruptcy--by those blue dogs and republicans.

It is up to us. If we it back on our haunches and do nothing we will have hell to live with in the future. It is up to us to demand real reform.

He's advocating for less regulation! Yes, less regulation worked for the banks and it will work for health care. It worked to get them more money and more citizens unemployed! YEAY!

This person makes no absolute sense!

What percentage of your gross goes to political contributions? It is a fact that the health care industry is the nation's no. 1 contibutor, bar none.

The arguement that people don't want the public option is because of government rationing is ridiculous. The real truth is that we already have it, but the insurance companies do it, not the government. They are the ones who have claims departments deciding who has coverage or not. I've never had insurance where I could get a routine physical. Only if I went to a doctor when something was wrong would I have coverage. That's rationing. Plus its more expensive for me. It is a fact that preventative medicine saves money. 97% of medicare costs go to care. Only 70% of costs to private insurers pay for actual care. The rest is for their administrators (not doctors). The real cost of medicine are claims. The US is the only nation that makes a profit from denying claims. That is why we pay twice that Europeans pay. The fact that these insurers spend all this money to deny people care is what we really pay for. medicare is a single payer system, more efficient and guarrantees care. private insurance doesn't.

Health care should not be a profit-making enterprise.

QUESTION FOR YOUR GUEST:

Why should health care be for-profit at all?

What is the net benefit to society that for-profit insurance companies and hospitals provide in return for the economic rent they extract?

Not-for profit institutions like NYC's MSKCC spearhead cancer research and provide some of the best cancer care in the world.

We have Medicare and supplemental insurance with Aetna. The primium increase with Aetna has increased for us by about 35% per year. We started out with $500 deductable for each of us and had to go to $1000 deductable for each of us in order to afford it. Now, we don't know if we will be able to afford this.

My husband and I are 71 and 74 respectively and we are in relatively good health.

Why such staggering premium increases?

Why should we support a system that has a middleman? Good question.

The real answer is that the insurance industry costs 15-30% of the health care dollar which is spent on administrative costs and profits, according to Marcia Angell, former editor of the New England Journal of Medicine.

What has Mr Wagar's salary been over 2007 & 2008?
My insurannce, HIP, CEO's salary went up 200% to over $4 mill/year.
My premium went up over 20%.

He keeps saying that the COST of the actual care is going up and that's why your premiums go up. The part he's not clarifying is that the Cost is based on the cost of care for everyone in YOUR STATE and on YOUR PLAN. Insurance companies constantly change their plans, so the pool of who is on your plan in your state gets smaller and smaller! If you're self-employed, it's even worse because then you have pre-existing conditions and can't even SWITCH to a different plan that might have a bigger pool. I am self-employed and our insurance has gone up 20-25% EVERY SIX MONTHS!!!

Obviously "competition" among private health insurers isn't keeping costs to consumers down or improving (or even maintaining) access to health care. I have no problem w/a government option's providing some actual competition.

Dear sir,

Can you please ask your guest about the influence of "CYA" procedures, that is, redundant or unnecessary tests, on ballooning costs? It seems he's either not thinking of it, or deliberately avoiding the topic.

why not ask this guy why there is 4 people who work in the health insurance industry for every doctor and patient. There are more insurance people than docotrs and patinets combined. That is the problem right there. This is a parastic industry plain and smple. Ask him Brian, I dare you.

I recently called my healthcare insurer to ask why I wasn't reimbursed for a particular service. The clerk told me that the service was covered but that the provider put in the wrong code so the claim was denied. I asked for the right code but the clerk told me they can't/won't provide this to a customer or provider. This is typical of what customers have to deal with. My plan is a top notch plan but still the company is trying to give out the least money possible. That is capitalism and the imperative is to make as much money as possible and is fundamentally at odds with providing good health care, which may not be so cost efficient. This is a point which the industry cannot dispute.

To Norman from Manhattan
Does the proposed plan include dental / vision?
I am in favor of universal health care, take it out of my taxes.
If people want additional private coverage, let them pay for it separately.
Doctors should be salaried, not paid per operation, procedure, visit, etc. Maybe more small towns would have a doctor.

someone please tell him he needs a new business model or his industry will be in the same boat as newspapers and carriage makers

So the regulations that he just said are responsible and great (in NY) is increasing cost 20% every year.

This is actual "change we cannot believe in"!

My Employee provide Health Plan from Cigna (mind you I don't have a choice)is "situated" in Deleware as their "contract state," which means they are not subject to the same laws as NY situated insurance companies. That's how they get around for paying for things. In my case, I was receiving treatment for a biologically based mental illness. According to Timothy's Law, adopted by NY State, that treatment should be on "parity" with my medical benefits, which means there should be no cap on treatment. So, I've spent thousands out of pocket to treat my illness. By being situated in Deleware, they are able to get around NY State Laws. How is this fair?

Why should health care be for-profit at all?

What is the net benefit to society that for-profit insurance companies and hospitals provide in return for the economic rent they extract?

Not-for profit institutions like NYC's MSKCC spearhead cancer research and provide some of the best cancer care in the world.

Norman: Check out their 10Ks, which are public documents.

does america have the intelligence and courage ot catch up with where the rest of the industiralized nations were 50 years ago?

we are number 37 in the world we pay the most and get the least

ask him about that. why do we pay the most and get the least?

Gee, it's easy to "say" that we're not just for profits and we do things a public option program doesn't do but could you be a more specific:
What was the profits for the shareholders last year?
What exactly would Blue Cross do that Medicare isn't doingt?

I have Blue Cross/BS (BS is right) through Wellpoint/Unicare. They pay their doctors so little that those few of my doctors who were in their network, have dropped out. They dispute virtually every claim and charge my employer $23,000 per annum for a basic, not very good family policy --that doesn't count a $2,000 deductible and co-pays.

Wellpoint's profits in 2008 were over $3 billion. Mr. Wagar is a very well paid shill.

Who does he consider his customers the Employers of the people or the people and possible patients?
Interesting background on his company, read the Curious Conversion of Empire Blue Cross in Healthaffairs.org

single payer single payer single payer

Have the government mandate everyone to have insurance, not allow the government to compete with private insurance, and not allow the government to regulate.

Hummmm...this worked out prefectly for the Banking industry, so let's continue this path!!!

this guy just said we have to get more people covered. why not getting EVERYONE covered? this men put profit over health. it is as plain and as simple as that. this man is greedy and i think he may have brain damamge becasue he cannot see the total lack of morality that the system of inforced death he supports

Listen, I have coverage that I pay for every week through my company, BUT I still have a $1500 medical deductible, stop this madness!! Don't cry for these private insurance companies!!

Wager's reluctance to approve of the "cost controls" or "price dictation" is about the means not the ends. Both processes arrive at the same outcome: lower costs and lower prices. I think having him explain why he disapproves of the government's means of reaching this end. I suspect he wants the government to use private insurance as the means instead of going around them.

He said profits are 4% of premiums? That means a loss ratio of 96%.

That doesn't sound right. HIP has a loss ratio of 85%.

I couldn't find the financial statements on BCBS web site, so I couldn't check it.

we might have to pay for what the government isn't paying but we are ALSO paying for the uninsured.

MY HEALTH IS NOT A BUSINESS!

MY LIFE IS NOT A BUSINESS!

The insurance industry has brought this on themselves -- by treating us, the consumers, with contempt.

EVERYONE I know has an insurance horror story.

Reform is coming. You can only abuse your customers for so long.

Simple quick question,

I have been paying 100% of my own insurance for the last 10 years (self employed). Why the hell is my insurance so dam high and only going up?

Oh and the Massachusetts model is failing miserably so that’s a bad example…..

Of course he wants more people covered, AT HIS PRICE!

Why not blame the pharmaceutical & biotech companies instead? Have you looked at their profit margins? Costs are pretty high for doctors' equipment too.

Here's the quote Brian needed:

NEJM, 4 Jun 2009, 360(23):2483, Insurance-industry investments in tobacco, J. Wesley Boyd, David Himmelstein, Steffie Woolhandler. Milton Friendman wrote, "Few trends could so thoroughly undermine the very foundations of our free society as the acceptance by corporte officials of a social responsibility other than to make as much money for their stockholders as possible."

I hate this Backrupt, poverty claim for hospitals and doctors with no proof. Show me! They make billions in profits. So now they will only make thousands of profits? Boo-Hoo!

sorry i see that "guaranteed issue " and coving pre existing conditions are the same thing

BRIAN:

ASK him WHAT I SUGGESTED TO YOU OVER TWO YEARS AGO:

a S I N G L E P A Y E R plan

Phased in over 20 years

Starting with the existing for profit plans like HIS today

ie, He would start enrolling the uninsured, and be paid by the government

AND then every two years would bid for more and more people.

Why are they minimizing that insurance is a for-profit business? There's nothing wrong with that, per se, but there's an inherent conflict of interest if you are both for-profit and tasked with healthcare.

I had Blue Cross and had my premiums triple -- TRIPLE -- within 7 years. When I left, for HIP, I was paying almost $1,000 for an HMO. With each increase, there was no warning, just a letter announcing a 25-50% increase coming next billing cycle. In the meantime, I never heard a peep from their industry about reform. I really hope this industry goes the way of buggy makers and the useless middlemen like this dude find another line of work. Loansharking, maybe?

Whereas under the insurance company's proposed plan the government will subsidize insurance companies.

and what of pre existing conditions?

MEDICARE FOR ALL!

I do know some people who do not want to give up their current insurance:
People on Medicare and
A vet I know on VA coverage.

How does having multiple insurers, all with different formularies, changing approval requirements, and routine denial of claims help us? Why is this better than having just one system that we could change as needed to best serve the needs of Americans rather than multiple systems that necessitate a high administrative overhead?

You guys--Congress and Insurers--have destroyed lives for 20 years.

You're incompetent, obviously. You can't do the job, period.

Now it's time to let someone else have a go at it.

GET OUT OF THE WAY!

What are these health care important things a private for-profit insurance company do that VA, DOD health care plan, and Medicare and Medicaid DON"T do?

Deny care? Rescind coverage after expensive care?

Yes, guaranteed issue -- but at unaffordable premiums.

MEDICARE FOR ALL -- with a ROBUST PRIVATE OPTION.

Says it all.

I haven't heard a single member of Congress complain about their government-run health plan.

Why are they denying us a gov "choice?"

bri
2 WEEKS?!!? how will i live!!
please don't do best of!

Ask him what is the IPO merger of HIP and GHI creating this new entity Emblem Health accomplishing for the members?

comments/questions:

how is it my insurer (cigna) offers "choice" when there is only one facility in manhattan that is approved to perform mammographies, and is impossible to get into?

how does bcbs claim "partnership" in lowering costs at the behest of congress? why couldn't they lower them without this intervention? what will they cut, other than service, which they already limit/deny us in the first place? this from someone who has to argue payment for simple blood work with her insurer every other month, which takes hours of my time.

NYC from NYC,

According to Henry Waxman (D-CA) on Democracy Now this Tuesday, the premiums for the public option under the Obama plan would be 12% of your income. Multiply your gross income by 12% and you'll get your premium. So it will still be around $358.

Was that the change you wanted?

Listeners beware: You can bet your dialing fingers Wager's people have callers ready to jam Brian's phone boards with "support" for Wager's anti-public option position. Make sure you call first.

I hope that you hand Wager a print-out of these posts. Also, Rachel Maddow did a fine expose last night regarding who is backing and paying for the "tea parties" that are reminiscient, not of the American pre-revolution, but rather of the fascist bust-ups of anti-Nazi political rallies in pre WW-II Britain.

Guess who is putting up the money? Shameless, greedy, I won't use the expletives, corporate interests such as Wager's crib, BC/BS -- with the old Bush/Cheney operatatives administering the operation -- that's who.

Can I make a citizen's arrest via the blog board?

And the letter that the Blue Cross web site is encouraging people to write is a pack of lies. No studies other than hack "studies" financed by the insurance companies and conducted by PR agencies suggest that people would lose their private coverage if there were a public option. Employers have multiple incentives for providing such coverage and Medicare has not prevented people from purchasing supplemental coverage if they wanted such coverage.

Also, a public plan permits people to choose their own doctors and would be superior to the crap offered by the insurance companies for mega bucks and are rife with exclusions -- and are canceled on pretexts when people really get sick.

This man works for a criminal syndicate, not a business. His company and others like it treat us and our health as though they were hog futures on a commodities market. Right now, the health care industry is part of a campaign that includes, inter alia, subverting the first amendment by encouraging mobs to disrupt public meetings under the pretext of "protext." Other weapons include lies and fear-mongering.

All for money. That's all you're about, Wager -- money.

I work for a small business. The insurance offered for single people is $358/month and DOES NOT include dental or vision coverage.

My take home pay is about $2,100/month
My rent is $1,866/month

There is no way that I can afford the insurance offered by my company. I am not alone.

We, the USA, needs universal health coverage.

There has to be a reason that people are traveling to other countries for health care. This is crazy!

how much does this guy take home? my death and illness is HIS profit (ie 2nd or 3rd home in aspen?)
which lobby groups does his company give money to?

who is the progressive version of the tea baggers?

if someone brings up choice FYI in the UK u can still by private health insurance if u want it!

You can ask this creep the following:

1. Why all the doctors on my BC/BS PPO (via Unicare) are dropping out due to the low rates of compensation being offered -- these MDS include the radiologist who has been performing my mammo/sonograms for the past 10 years;

2. Why Unicare/BC/BS has classifed the surgery for my husband's hereditary ENT condition as "dental" leaving us to figure out whether to pay a $50,000 protjected bill on our credit cards or wait to see if the next throat infection he develops as a result of the condition kills him;

3. How much he earned last year.

Whether he would be willing to come to my home so that I could take out my wooden spoon and give him a piece of my mind. Because, trust me, if I could get this s.o.b. alone, in my house, I'd beat the living daylights out of him without a second thought.

Medicare for all, and put this fool in jail, where he ought to be, rather than on the air in a civilized community (wooden spoon aside, that is; sorry, I'm mad).

You might ask Mark Wagar whether the policyholders of the Canadian affiliate of BCBS face long waits.

BTW, the one good thing BCBS is doing is their Technology Evaluation Program.

It decides questions like whether there's enough evidence to use CAT scans to diagnose chest pain (No).

It's like the free-market version of the UK's NICE or the Cochrane Collaboration.

please ask this: knowing the long history of health and disability insurance where claims experience of both ended up destroying most insurers businesses (so they left the health insurance business) and adding to that the failure of insurers with the efforts to control health costs (both HMOs and utilization review failed) how can we expect private insurers to do better in the future?

Just got back from walking the dog.

If you go to the Blue Cross Blue Shield web site, and click on the link, "Tell Congress to get health reform right," it leads you to send the following message:

1 Compose Message
Message Recipients:
Your U.S. Senators
Your U.S. House Representative
Delivery Method:
Email
Printed Letter
Subject:
We don't need a new government healthcare bureacracy
Required text:
(This text will be included in your message)
There is no question that healthcare reform is badly needed. However, I am concerned that proposed draft legislation by the House of Representatives to create a new government-run health plan will cause me to lose my current employer coverage. I want to be sure that I can keep my current coverage, and I urge you to oppose any new government-run health insurance plan.

I don't understand why a new government-run plan is needed to help people get health insurance. I've read that studies indicate that many people will lose their current employer coverage if a new government plan is created. I'm worried that the U.S. is headed toward a Canadian system where people face long waits for medical care and services.

I'm glad Congress is moving forward with healthcare reform, but I ask that you oppose any proposal to create a new government-run plan. We all have a big stake in healthcare reform, so let's get it right.
Your Closing:
Your Name:

No, Robert. From your perspective --

it's good to have an insurance executive over, and ask him tough questions, and show how ridiculous his answers are.

It also gives us a better idea of what the enemy is like.

I have to go out and walk the dog.

Will somebody look up the campaign contributions from the insurance industry from 2009 and 2008? I think the NYT had a story about that.

Also, could somebody go to the BCBS web site, and look up their "loss ratio"? It will be a number around 85%, which means that they pay 85% of their revenue for health care, and keep 15% for administrative costs and profits.

Also, go to democracynow.com and look up the interview with Wendell Potter, the former head of PR at CIGNA, who exposed everything.

Do you really have to give yet another platform here to the health care insurers? They've held the reigns for all these years and we know their side and really don't care to hear it. Sometimes this "fairness in journalism" if it is even that is baloney.

Another question, which many listeners were asking yesterday:

The industry says that if we had single payer, we wouldn't have choice.

In Canada, people can go to any doctor or hospital they want.

In the U.S., we can't go to a doctor or hospital that isn't covered by our insurance company.

How do we have more choice than single payer?

At best, I can choose which insurance company will restrict my choice.

But in Canada, the health care system wouldn't restrict my choice at all.

***

BTW, there's a great related article in the New England Journal of Medicine:

"American Values" — A Smoke Screen in the Debate on Health Care Reform

Allan S. Brett, M.D.

Volume 361:440-441

July 30, 2009

This message board doesn't let you embed links, so you'll have to go to nejm.com and find it yourself.

How could your guest yesterday call it competition when employers will be taxed 5-10% of payroll if they don't join the public plan?

My question for Mark Wagar:

Doctors and hospitals in New York State and Canada perform the same procedures and have the same outcomes. Yet in
Canada they have no insurance companies.

Insurance companies get at least 15 cents of every health care dollar. Why do we need insurance companies?

What are we getting for that 15 cents?