" when administrative costs, including profits, exceed 15 percent of premiums."
So basically, if administrative costs are 14% then they are not allowed to make more than 1% 'profit'.
Well, they ought to be out of business in a very short time then.
Angelides "Talking Point" was first recorded back in 1952. It sailed to the top of the charts, where it stayed from June through November, when it was finally defeated. It's been recorded by several Democrats since then, including a 1979 remake by Linda Ronstadt and The Moonbeam. The name of that song from 1953 that defeated "Talking Point"? It was "Ha Ha I Won" by Goodwin Knight and the Republicans. |
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(Go Israel, Go! Slap 'Em Down Hezbullies.)
The difference in cost margins in the way HMO's skim off profits through things like "computer licensing and data processing charges" to the home office, "supervision and management fees" to the home office, administrative overhead, etc.
For profit HMO's did such a good job of bringing money to the bottom line during the 90's that their stock outperformed every other segment on Wall Street including High Tech and Dot Com startups. The chairman of United (whose empire also includes a huge medical insurance company) just cashed in on a $1.8 billion payday -- and I'm sure he "earned" every penny.
It needs to be remembered that HMO's are not insurance companies and do not offer an insurance product. They have no financial reserves -- and cannot have any by law. Instead, HMO's are nothing more than shell companies which collect "contributions" from "members" and then use this cash to pay medical bills and other "operating expenses."
It also needs to be remembered that all "risk management" companies, including insurers and HMO's, are in the business of taking in premiums and not paying claims. As such, they are infamous for hiring legions of lawyers to battle claimants, regulators and the like -- and consider this "just part of the cost of doing business." And all too often, the b*stards win.
The net result is that this is one area where government regulation actually does a little good by holding insurance company theft down to somewhat manageable levels. And in areas where there is almost no regulation -- through ERISA preemption for example -- the wolves very often run wild.
If HMOs are getting non-profit benefits while jacking rates when it isn't necessary, they need to be held accountable.