COVID 19, Hospitals, and the insurance companies. A question:

[bbodb1]

As this crisis continues, we are constantly hearing reports of hospitals facing financial difficulties.

If that is true (and I am not suggesting otherwise), why aren't insurance companies fronting the funds needed for hospitals to continue operations?

With as much money as the insurance companies rake in, they depend on hospitals as the primary source of their cash flow. They should be propping up hospitals during this time - not the federal government.

Any thoughts?

 

[TravelTime]

I do not understand why insurance companies would bail out hospitals. Insurance companies are private companies and they pay bills after people have services, not before. It is the government’s job to bail out companies, not private enterprise.

 

[bbodb1]

I guess this stems from seeing insurance companies as a leech in the health care system.

 

[CalGalTraveler]

I wouldn't be surprised if the next shoe that drops are health care insurance bail-outs. 10+ days in an ICU with a ventilator and the numbers of patients must be very expensive. I am sure the insurance companies never planned for this kind of loss. Who will pay these claims?

 

[TravelTime]

If the government starts to bail out hospitals and insurance companies, then maybe the next step is passing universal health care. If we are paying for it anyway through bail outs, then why not? I was never for universal health care since I like our private insurance but Covid-19 is making me look at things a lot differently.

 

[SteelerGal]

Unfortunately , I believe we will see more ppl affected were either uninsured or under-insured.

 

[geekette]

I thought one of the bills passed recently was money to hospitals? Bail out the health care provider (hospital), not the middleman we don't really need (ins cos). They'll deny anything they don't want to pay and should have reinsurance anyway or sufficient reserves.

All those years of putting on annual and lifetime caps, denying lifesaving treatment, denying pre-existing condition coverage, denying maternity coverage, insurance companies will get no sympathy from me. Have their CEOs go without salaries like companies that suddenly had to cease operations. Ins cos are still collecting premiums and payments on services already rendered. Why would we bail them out? This is, after all, how insurance works - you pay them to cover your risk, and they assign premiums by the risk they are willing to take. Nothing has changed for them. And there is no way they would lift a finger to help any hospital, and have no natural affiliation or responsibility to any of them.

 

[Talent312]

IIRC the sum of $100 billion was set aside for hospitals in the CARES Act.
The WH claims caring for the uninsured is a condition of getting the $$.
How much of that is true is anybody's guess.

 

[geekette]

I wouldn't be surprised if the next shoe that drops are health care insurance bail-outs. 10+ days in an ICU with a ventilator and the numbers of patients must be very expensive. I am sure the insurance companies never planned for this kind of loss. Who will pay these claims?

That bill is shared between the patient and insurer. The days of 100% coinsurance are gone (unless there are a few lucky people out there) but allegedly out of pocket max for a patient will hold the line on we the people. So, that leaves hospitals with uncompensated care. Hopefully there are wealthy philanthropists that will give to non-profit hospitals' operating budgets vs having a wing built and named after them.

 

[CalGalTraveler]

But there are so many claims. I doubt the insurance company planned for so many at once. I presume that many of the seniors will be on Medicare so perhaps the government is already paying that bill.

 

[geekette]

But there are so many claims. I doubt the insurance company planned for so many at once. I presume that many of the seniors will be on Medicare so perhaps the government is already paying that bill.

and Medicaid, especially the states that expanded it.

I would say that ins cos had same ability to expect a pandemic as others. We knew one was coming at some point. After SARS, MERS, Zika, Ebola, they should have been planning.

 

[am1]

Id let the insurance companies go bankrupt and start with universal health care for all. Or at least universal and pay for service which could include new insurance companies.

 

[Sapper]

A good insurance company will have a reinsurance policy with some kind of natural disaster rider (which will cover their losses). A bad insurance company will have been paying the reinsurance funds to the CEO’s bank account in a non extradition country, and will declare bankruptcy as the CEO and family board the corporate jet to said non extradition country.

 

[DannyTS]

In Canada we have universal health care but a lot of treatments/visits/tests that are not considered urgent have been postponed and/or because many patients fear more the virus than the condition they were going to treat.

The net result is that many physicians have seen their pay cut considerably even if there is no private insurer to blame

 

[T-Dot-Traveller]

If the government starts to bail out hospitals and insurance companies, then maybe the next step is passing universal health care. If we are paying for it anyway through bail outs, then why not? I was never for universal health care since I like our private insurance but Covid-19 is making me look at things a lot differently.

Hi TravelTime ,
(I am using your post to add information / not to question you personally.)

Have you every used the US interstate highway system / and considered that it
is basically run as a universal “highway healthcare” system .

The federal Interstate Highway Trust Fund Act goes back to the 1950’s and
President Eisenhower .It was done in part to have the infrastucture in place in case of national emergencies -including war .

The interstate highway system is administered by individual states / but without the federal money - a free to use interstate system might not exist .
The pay for use - New York State Thruway & certain other state toll roads were
planned / built before the IHTFA too over the role of primary payer .

Canadian healthcare has a similar structure . (It was more like the US medical system into the 1950’s & early 60’s ) Historic division of powers ( federal,- provincial,) mean that each province runs its own system . The federal government transfers a portion of the total dollars needed to each province . The stipulation is that if a province allows extra billing ( ie - a doctor bills you ) then it forgoes the federal money.- voila - a single payer system .

As a country Canada spends about 10% of GDP on healthcare . The USA spends over 15 % .

Canadian Hospitals are non profit - with a single payer , the province in which they are located . Canadian doctors operate their own practices - with a single revenue source - a province .
There are definitely cost controls that are designed to save the taxpayer ( you):money on your tax bill .
Doctor Specialists - can only be reached trough your family doctor on referral,.

FYI - US states can choose the age of majority / drinking age . In the mid 1980’s they all moved to 21 yr old - because Congress passed a law stipulating that Highway Trust Fund money could only go to a state if it’s
drinking age was 21 . Wyoming was the last hold out (1986).

If you live in the USA ,you have SOCIALIZED HIGHWAYS - that are free and everyone pays for through federal gasoline taxes. .

Canada has a similarly,structured system for healthcare of (resident) citizens and legal residents .

 

[TravelTime]

Hi TravelTime ,
(I am using your post to add information / not to question you personally.)

Have you every used the US interstate highway system / and considered that it
is basically run as a universal “highway healthcare” system .

The federal Interstate Highway Trust Fund Act goes back to the 1950’s and
President Eisenhower .It was done in part to have the infrastucture in place in case of national emergencies -including war .

The interstate highway system is administered by individual states / but without the federal money - a free to use interstate system might not exist .
The pay for use - New York State Thruway & certain other state toll roads were
planned / built before the IHTFA too over the role of primary payer .

Canadian healthcare has a similar structure . (It was more like the US medical system into the 1950’s & early 60’s ) Historic division of powers ( federal,- provincial,) mean that each province runs its own system . The federal government transfers a portion of the total dollars needed to each province . The stipulation is that if a province allows extra billing ( ie - a doctor bills you ) then it forgoes the federal money.- voila - a single payer system .

As a country Canada spends about 10% of GDP on healthcare . The USA spends over 15 % .

Canadian Hospitals are non profit - with a single payer , the province in which they are located . Canadian doctors operate their own practices - with a single revenue source - a province .
There are definitely cost controls that are designed to save the taxpayer ( you):money on your tax bill .
Doctor Specialists - can only be reached trough your family doctor on referral,.

FYI - US states can choose the age of majority / drinking age . In the mid 1980’s they all moved to 21 yr old - because Congress passed a law stipulating that Highway Trust Fund money could only go to a state if it’s
drinking age was 21 . Wyoming was the last hold out (1986).

If you live in the USA ,you have SOCIALIZED HIGHWAYS - that are free and everyone pays for through federal gasoline taxes. .

Canada has a similarly,structured system for healthcare of (resident) citizens and legal residents .

I appreciate the information you shared. Just out of curiosity, does Canada also have private doctors that do not participate in the single payer system? What I mean is do you have private doctors that cater toward the wealthy and are privately paid by individuals? Just wondering because in the USA, concierge medicine is growing as doctors opt out of insurance payments. I could see the USA having a two tier health care system if it moves to universal health care with the government as the single payer. I have an employee whose husband is a doctor at Stanford. Even Stanford is doing concierge medicine because it is a money maker. She said the rest of Stanford does not make any money. I thought I heard that Canada does have doctors who focus on the equivalent of concierge medicine too.

 

[Miss Marty]

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[T-Dot-Traveller]

I appreciate the information you shared. Just out of curiosity, does Canada also have private doctors that do not participate in the single payer system? What I mean is do you have private doctors that cater toward the wealthy and are privately paid by individuals? Just wondering because in the USA, concierge medicine is growing as doctors opt out of insurance payments...

not really,
If someone has that much money - you go,to the USA,& pay $ 50 K to get you knee replaced now instead of later .

Lasic Eye Surgery , Dentists ,Chiropractors etc are not universal healthcare.
- so you or your work insurance pay .

A lot of blood test lab work is done by private labs - but if you have a doctor referral than you don’t pay .

Prescriptions are also personal or insurance co pay .The drug stores are required to sell at cost - but charge a specified dispensing fee that is per prescription . There are some differences once you are past 65 .

Professional Sports teams have team doctors on staff or retainer.

 

[TravelTime]

not really,
If someone has that much money - you go,to the USA,& pay $ 50 K to get you knee replaced now instead of later .

Lasic Eye Surgery , Dentists ,Chiropractors etc are not universal healthcare.
- so you or your work insurance pay .

A lot of blood test lab work is done by private labs - but if you have a doctor referral than you don’t pay .

Prescriptions are also personal or insurance co pay .The drug stores are required to sell at cost - but charge a specified dispensing fee that is per prescription . There are some differences once you are past 65 .

Professional Sports teams have team doctors on staff or retainer.

Thanks for sharing. This is interesting.

 

[Sapper]

Hi TravelTime ,
(I am using your post to add information / not to question you personally.)

Have you every used the US interstate highway system / and considered that it
is basically run as a universal “highway healthcare” system .

The federal Interstate Highway Trust Fund Act goes back to the 1950’s and
President Eisenhower .It was done in part to have the infrastucture in place in case of national emergencies -including war .

The interstate highway system is administered by individual states / but without the federal money - a free to use interstate system might not exist .
The pay for use - New York State Thruway & certain other state toll roads were
planned / built before the IHTFA too over the role of primary payer .

Canadian healthcare has a similar structure . (It was more like the US medical system into the 1950’s & early 60’s ) Historic division of powers ( federal,- provincial,) mean that each province runs its own system . The federal government transfers a portion of the total dollars needed to each province . The stipulation is that if a province allows extra billing ( ie - a doctor bills you ) then it forgoes the federal money.- voila - a single payer system .

As a country Canada spends about 10% of GDP on healthcare . The USA spends over 15 % .

Canadian Hospitals are non profit - with a single payer , the province in which they are located . Canadian doctors operate their own practices - with a single revenue source - a province .
There are definitely cost controls that are designed to save the taxpayer ( you):money on your tax bill .
Doctor Specialists - can only be reached trough your family doctor on referral,.

FYI - US states can choose the age of majority / drinking age . In the mid 1980’s they all moved to 21 yr old - because Congress passed a law stipulating that Highway Trust Fund money could only go to a state if it’s
drinking age was 21 . Wyoming was the last hold out (1986).

If you live in the USA ,you have SOCIALIZED HIGHWAYS - that are free and everyone pays for through federal gasoline taxes. .

Canada has a similarly,structured system for healthcare of (resident) citizens and legal residents .

One of the reasons socialized medicine works in Canada is there are laws regarding how much a pharmaceutical company can increase prices. The other big one is that 34% of US health care costs are tied to administrative garbage with insurance companies, then the insurance companies profit margin... on top of the hospital, doctor, labs, pharmacy, etc profits... none of which are made clear to the sick individual who is experiencing an inelastic good or service.

What I am getting at is if the US wants to go socialized medicine like Canada or Europe, there will need to be a complete overhaul of not just the hospitals or doctors offices, but the companies who build the equipment, the pharmaceutical companies, the pharmacies, and basically kill the medical insurance companies. There are some strong lobbying groups right there. The other side is most consumers of the medical products are either unaware they are being shafted or are too indifferent to cause a big stink to the politicians. So you have a lawmaker who really only cares about being re-elected (they already have great medical care they voted in for themselves at tax payer expense) with very strong lobbying groups offering lots of cash to help get them re-elected (or to their competition if they oppose the medical lobby groups) and an electorate who do not care enough to show up to the voting booths for this topic, if at all.

Having said all of that, (and I am sorry I am saying this) if this COVID situation becomes so bad that the insurance companies fail, the hospitals fail, in some ways the medical supply companies have already failed (looking at you 3M), and there is a public outcry on how everyone completely messed up... maybe.

 

[Sapper]

I appreciate the information you shared. Just out of curiosity, does Canada also have private doctors that do not participate in the single payer system? What I mean is do you have private doctors that cater toward the wealthy and are privately paid by individuals? Just wondering because in the USA, concierge medicine is growing as doctors opt out of insurance payments. I could see the USA having a two tier health care system if it moves to universal health care with the government as the single payer. I have an employee whose husband is a doctor at Stanford. Even Stanford is doing concierge medicine because it is a money maker. She said the rest of Stanford does not make any money. I thought I heard that Canada does have doctors who focus on the equivalent of concierge medicine too.

One of my doctors constantly complains about the insurance companies, he has two people on his staff specifically to deal with the insurance companies. He recently decided to wind down his office with an eye toward retirement. He is thinking of going all cash no insurance because it would reduce his costs and reduce his patient load so he can do a Tuesday-Thursday operation and have Friday-Monday off. I was a little nervous about having to pay him cash instead of through the insurance, however, it ends up being not much different than my copay with the insurance (and I have good medical insurance).

I thought Stanford was a not for profit entity.... it’s been 24 years since I was on campus, but something along the lines of Stanford being set up to help educate the children of California.

 

[bogey21]

I wouldn't be surprised if the next shoe that drops are health care insurance bail-outs. 10+ days in an ICU with a ventilator and the numbers of patients must be very expensive. I am sure the insurance companies never planned for this kind of loss. Who will pay these claims?

Apparently the Federal Government will cover the uninsured at Medicare rates...

George

 

[Brett]

One of the reasons socialized medicine works in Canada is there are laws regarding how much a pharmaceutical company can increase prices. The other big one is that 34% of US health care costs are tied to administrative garbage with insurance companies, then the insurance companies profit margin... on top of the hospital, doctor, labs, pharmacy, etc profits... none of which are made clear to the sick individual who is experiencing an inelastic good or service.

What I am getting at is if the US wants to go socialized medicine like Canada or Europe, there will need to be a complete overhaul of not just the hospitals or doctors offices, but the companies who build the equipment, the pharmaceutical companies, the pharmacies, and basically kill the medical insurance companies. There are some strong lobbying groups right there. The other side is most consumers of the medical products are either unaware they are being shafted or are too indifferent to cause a big stink to the politicians. So you have a lawmaker who really only cares about being re-elected (they already have great medical care they voted in for themselves at tax payer expense) with very strong lobbying groups offering lots of cash to help get them re-elected (or to their competition if they oppose the medical lobby groups) and an electorate who do not care enough to show up to the voting booths for this topic, if at all.

Having said all of that, (and I am sorry I am saying this) if this COVID situation becomes so bad that the insurance companies fail, the hospitals fail, in some ways the medical supply companies have already failed (looking at you 3M), and there is a public outcry on how everyone completely messed up... maybe.

sure, if the pandemic bankrupts insurance companies and hospitals and the medical supply chain fails then there will be a "public outcry" .... against socialized medicine !

 

[geekette]

One of my doctors constantly complains about the insurance companies, he has two people on his staff specifically to deal with the insurance companies. He recently decided to wind down his office with an eye toward retirement. He is thinking of going all cash no insurance because it would reduce his costs and reduce his patient load so he can do a Tuesday-Thursday operation and have Friday-Monday off. I was a little nervous about having to pay him cash instead of through the insurance, however, it ends up being not much different than my copay with the insurance (and I have good medical insurance).

I thought Stanford was a not for profit entity.... it’s been 24 years since I was on campus, but something along the lines of Stanford being set up to help educate the children of California.

I am an uninsured cash customer and I agree, the cost is about the same as I paid after insurance. So far none of my doctors have refused me.

 

[Sapper]

sure, if the pandemic bankrupts insurance companies and hospitals and the medical supply chain fails then there will be a "public outcry" .... against socialized medicine !

That will be a failure of capitalistic medicine. There are pluses and minuses to both systems, we are currently seeing the failure of the capitalist medicine system. There can also be a failure in a socialized medical system, see Italy.