Posted on 11/03/2013 1:06:12 PM PST by Cincinatus' Wife
In an exclusive interview with The Daily Caller, Dr. Robert Nirschl — a practicing orthopedic surgeon, former faculty member of Georgetown and a former member of the legislative committee of the American Academy of Orthopedic surgery — dismissed the recent issues suffered by HealthCare.gov and the media feeding frenzy surrounding it, arguing that the systemic flaws within the law had not yet surfaced, and that when they do, it will be catastrophic.
Nirschl took apart the concept of “health insurance” arguing that it’s an inaccurate buzzword. What is being legislated is not insurance at all, Nirschl said. By its very nature, “insurance” is a way of protecting against an unforeseen, catastrophic incident. It works by having large groups of people paying premiums into a central fund with the understanding that if they were to suffer an unlikely incident, they will be compensated. The likelyhood of people claiming out of the central fund is a calculated through a risk assessment, and the riskier the “bet,” the higher the premium. Nirschl points out that since the 1950s’s true health “insurance” has not existed.
“The facts of the matter are that the product we have had has, since the UAW (United Auto Workers) negotiated with General Motors in 1959 to do first dollar coverage, we destroyed the concept of insurance,” Nirschl said. “The product we have had since 1959 has been a hybrid of a service maintenance contract plus insurance. If you’re going to buy true insurance, you want to buy it for a catastrophic event, example, auto insurance. If I go to my auto insurer, I don’t want to be covered for oil changes and lube jobs. I want to be covered for a car crash and so when we went to first dollar coverage thats when it [health insurance] became a service maintenance contract.”
Nirschl explained the consequences of including supplementary services on premiums using his auto insurance analogy: “One hundred percent of folks are going to use the service. One hundred percent of people who want cars are going to get oil changes and lube jobs, so it doesn’t lower the premium. It increases the premium, and at the same time it adds an enormous administrative cost… We squander 35 percent in administrative costs by this form of insurance… For maintenance services, oil changes and lube job, you want to pay out of your own pocket, and you want to basically have insurance for a car crash, for catastrophic things. So we have destroyed true insurance.”
Nirschl says that that destruction of ‘true insurance’ and the wide scale implementation of ‘service maintenance’ has come at a cost. By his calculations, it likely runs as high as $1 trillion dollars annually on “useless costs, administrative costs which deliver absolutely no service.”
When asked about the future of the law, and if it is now sacrosanct in American minds and unable to be repealed, Nirschl said no.
“As the law unfolds and as people are seeing the derogatory effects of it — I mean, the granddaddy of that situation was Prohibition. That was not sacrosanct and for that matter, all of the Jim Crow laws from way back when were the law of the land, so when ever I hear some of our politicians say: ‘Well, this is the law of the land, and so we can’t do anything about it.’ Well, as an example, Martin Luther King did a lot about it. I think that when the people really see what it’s all about it should go the way of Jim Crow laws. It should go the way of Prohibition.”
You might think such companies are being stupid or "socialist" for doing it, but they are already doing it.
I guess you'll have to shop somewhere else.
If you want to insure your car and you park it on the street you may pay more than someone that parks their car in a locked garage. This is your business, and it is also the business of the car insurance company that provides you with the insurance.
Unless you want to completely get rid of the individual health insurance market, then insurance companies should be able to know a heck of a lot about you in order to come up with a fair premium.
A lot of us are fortunate. We are part of large pools of insured. Our insurance companies don't have to know a lot about us in order to set the premiums correctly because everything averages out. We get the advantage of relatively lower premiums without a significant invasion of privacy.
Those who try and get individual insurance are either young and healthy and get to pay less, or old and sick and either get to pay a lot more or get denied.
When you get auto insurance you only need to "rat out" your car. When you get health insurance you need to "rat out" yourself.
Indeed, which is 2014 will be the year of the pitchforks.
This guy tells it correctly.
When we transitioned from “insurance” to “prepaid healthcare” it broke the connection between cost and user.
Heck, if I want to best this, go with an HSA high deductible for Catastrophic Coverage and a Concierge Service on the other end of the spectrum or pay the check ups, soar throat visits etc with Cash out of a Tax Free type pool within the HSA.
If it is the paperwork and lack of competitive price comparison ( GM found this out, they paid anywhere from $2,000 to $400 for a colonoscopy ), then pay cash and put the prices on line so we can shop!
We all know we don't need Fedzilla, we here could figure out how to fix all this craziness in almost no time flat if we could get Disney on the Potomac out of the way...
Excellent observations and statement of the truth by Dr. Nirschl:
“The facts of the matter are that the product we have had has, since the UAW (United Auto Workers) negotiated with General Motors in 1959 to do first dollar coverage, we destroyed the concept of insurance,” Nirschl said. “The product we have had since 1959 has been a hybrid of a service maintenance contract plus insurance. If you’re going to buy true insurance, you want to buy it for a catastrophic event, example, auto insurance. If I go to my auto insurer, I don’t want to be covered for oil changes and lube jobs. I want to be covered for a car crash and so when we went to first dollar coverage thats when it [health insurance] became a service maintenance contract.”
bttt
Bookmark
Martiny and her colleagues can pick and choose, buffet-style, from a dozen or more plans offering insurance at different prices, with low to high deductibles and big or small co-payments, for medical, dental and vision coverage.
“I like it so far,” Martiny said. “It will take a little time to make sure we're choosing the best option for us financially, but I prefer having the ability to make my own decisions regarding my family's coverage.”
Private vs. public
he outsourcing of employer-provided insurance to what are known as “private exchanges” stands to radically transform the way health insurance is provided in the American workplace, experts say. They have been described as similar to a 401(k) plan, and they could someday become as common as the retirement program.
For employers and employees alike, health insurance problem forces tough decisions. But while they offer both employer and employee something desirable in the bargain, the private exchanges also shift responsibility and possibly additional cost to workers, some of whom may not be prepared to handle it all.
“This is part of a fast-evolving strategy in which employers transition from the “defined benefit” strategy they have employed for decades, in which the employer was responsible for providing for a set percentage of the coverage expense, to a “defined contribution” strategy, in which the employer provides a set-dollar amount, said David Bottoms, vice president of The Bottoms Group, an Atlanta employee benefits consulting firm.
“This closely mirrors the evolution in the retirement plan space from defined benefit plans — pensions — to defined contribution plans — 401(k)s,” he said.
The very idea makes some people nervous.
“You've got to do all the legwork,” said Steve Rossey, 42, of Moreland, Ga., who gets employer-provided coverage through his job working for a home restoration company. “I wouldn't be a big fan of it. The common employee doesn't know anything about picking the right insurance, and what they don't know can cost them thousands of dollars.”.......................................
Every week, our county agency would have a big Chiropractor's RV pull into the parking lot and therapeutic massage was given to county employees "free".
:-/
Aside from the fact that humans are not vehicles or other purchased items-
I live in the country and park my truck on the other side of my gate-vehicles are rarely stolen or vandalized here-it is remote and folks are armed. I choose to live in a remote place with few conveniences-people who choose to live in cities pay more because there are more people, more exposure and fewer deterrents to the theft and vandalism of vehicles.
It is entirely your choice whether to “rat out” your info, and that is how it should stay-some of us choose not to have our personal information, etc in the hands of any outsider, or out there in cyberspace to be misused or stolen.
The size and kind of monster risk pool that Obamacare insists on creating is unsustainable-even if people had to sign up and start paying at age 12, most would either pay a penalty and save their cash, or wait till they were in a near-fatal accident to sign up for just long enough to get fixed.
I like the old cafeteria plan insurance that Obamacare junkies hate-pick and pay for the coverage you want/need. When people pay for their own stuff, they are not as eager to run to the doctor and take five or six prescription meds every day for life-or to keep gobbling processed, chemically enhanced food and sitting around till they are fat and their knees-and a bunch of other stuff-needs replacing. The whole scam is going to operate in the red from the gitgo, and there will never be enough money to fund it-that is what government does.
If I were young and wanted to have another kid, or if I had some chronic condition that was not surgically correctible, then I would pay a higher premium, period. When it comes to paying for services relative to individual health-one size cannot fit all.
Now, that IS a perq-county employees here are lucky to get a working lunch paid for-there are only about 18,000 people in the whole county, and only one town with more than a few hundred people, so something like that would be noticed pretty fast...
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