Tag Archives: Medicare

Healthcare in the Senate: Another Example of the DESPERATE Need for Campaign Finance Reform

Time and again we have seen good ideas to benefit the people by regulating companies emerge from Congress in the form of legislation that does exactly the opposite of what it was intended to do, and amounts to nothing short of massive theft by the very industries that were supposed to be regulated.  That certainly appears to be where healthcare reform is headed.

While all the details have not been released yet, by all accounts the Senate has finally killed off the public option and replaced it with weakened non-profits run by for-profit insurance companies and an opportunity for uninsured people age 55-64 to buy into Medicare.  Many progressives have reacted with jubilation to the Medicare proposal because ultimately they would like to see this concept extended to all citizens.  They should be cautious with their enthusiasm.

It is really important to remember the core dynamic of health insurance, which is that statistically speaking, young and healthy people pay for more insurance than they consume in healthcare.  As they get older and sicker, they start consuming more healthcare than they pay for.  When insurance is structured this way, young people are essentially forced to save in advance for their future healthcare costs and the net effect is “low” premiums for everyone.  If young people are not included in the insurance pool and the only people with insurance are those who have very high healthcare costs, then the premiums will be very high because the insurance company essentially ceases to spread risk among the population and begins to be just an unnecessary payment processor, but one that has enormous administrative costs and a requirement to generate a profit.

So now look at what is shaping up in the Senate.

The insurance companies have won a mandate for all people to buy insurance from them.  This guarantees that young, healthy people will be in the insurance pool, which will allow companies to do some combination of A) increase the profits they distribute to their shareholders and B) manage the cost of their insurance premiums.  By giving people age 55-64 the ability to buy into Medicare, the insurance companies have also, probably, increased the ease with which they can force people in this age group out of their insurance pool.  So they have brought in millions of young, healthy, highly profitable customers, and they are getting ready to kick out millions of older, sicker, less profitable customers.  You wonder why they have been saying all day that they won?  This is why.  It is good to be them.  They are now essentially getting ready to sell expensive insurance exclusively to people who have no healthcare costs.

Medicare, on the other hand, is being set up to fail because just the opposite is happening to it.  It is being forced to take on millions of new older, sicker, customers with high healthcare costs but it will not get any younger, healthier customers to which they can spread the costs.  So Medicare is becoming more of a “payer” and less of an “insurer”.  This is going to cause Medicare’s average cost per customer to be much, much higher than the average cost of the private insurers.  Because Medicare coverage for this age group is going to be forced to be self-financing, the premiums are going to be very, very high. The effect will be that as people turn 55 they will be forced out of their lower cost private insurance, where young people subsidize them, and into Medicare which will end up having much higher premiums than they’ve been paying.

And when Americans look at the two systems side by side they will see private insurance with low premiums (they’ll forget that private insurance only has healthy customers) and Medicare with high premiums (they’ll forget that Medicare only has older, sicker customers) and they’ll conclude that “government can’t compete”.  Republicans will have a field day.

The single-payer proponents should be in favor of giving a buy-in to people age 55 -64 only if they know that next year it will be extended to people 45-54, the year after that to people 35-44, the year after that to people 25-34, and the year after that to everyone.  To be excited about what is currently on the table now is to be cheering the tsunami that is about to wash them away.

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UnitedHealth $7 billion more than Medicare to pay less than 10% of Medicare’s bills.

In 2007 UnitedHealth Group made a net profit of $4.65 billion on revenues of $75.43 billion.  6.2%, which sounds reasonable and fair.  That’s NET profit of course.  UnitedHealth Group also paid $2.6 billion in income tax.  Now, they don’t have a choice in this last bit, but the fact remains that a government run alternative would save the profit and the income tax UHG takes out of the healthcare system and which amounts to 9.8% of the insurance premiums they collect.

But that’s just the beginning. I’m not here to make a case that the government should run businesses solely because it doesn’t have a profit motive.  We have good reason to believe that in lots of cases that’s a bad idea.

United Health’s 2007 Cost of Goods Sold (their actual insurance payouts) were $56.2 billion or, 74.5% of their $75.43 billion of revenues.  We know that of the remaining $25.5% is $7.3 billion in tax and profit.  Now, as it turns out, UH wrote off $796 million in depreciation and amortization which the government also does in its own way, which left it with $10.583 billion in operating expenses, or 14% of gross revenue.  This 14% is where the REAL pain is.

A large portion of this goes to doing their damndest to not insure people who might need insurance and to cut them off from insurance in the instance that they ever do.  So, this really is the heart of our healthcare issue, which is that insurance companies make money by NOT paying for healthcare costs people pay them to pay for.  But the heart of the problem isn’t the only problem.

The other problem with the 14% (and actually, lets go ahead and make it the whole 25.5% again) is that the comparable cost for the combined Medicare and Medicaid program is… are you ready?  2.6%.  That’s right.  Medicare and Medicaid expect to pay out $709 billion of medical payments covering healthcare for 95 million Americans (about 1 in 3) with administrative overhead of $18.6 billion.  Actually, a lot of this 2.6% covers fraud and abuse prevention and loss accounts, quality improvement programs, research, and grants to states for various things.  The actual program administration costs are one half of one percent.  That’s right.  0.5%

Another way to look at it is that if Medicare had a similar cost structure to United Healthcare, it would spend $180 billion on administration and profit to provide services to all those people instead of the $18 billion it actually spends.  Or, if UnitedHealth were as efficient as Medicare, its overhead would be less than $2 billion.

Sources:

United Health Group 2007 Financial Statements.

Centers for Medicare and Medicaid Performance Budget for FY 2009.

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