2 Questions: How to ensure insurance will pay? Where will providers come from?

[emilynghiem]

Dear Health Care advocates:
I have two questions about mandating ppl buy insurance instead of paying for or invesring in health care directly:
1. how do we insure that insurance companies will pay for costs
i cant even guarantee my insurance will cover costs now
how is this going to be any different
if we need to only support nonprofit insurance companies whose philosophy is
to cover health care and put any profits into helping needy not into high salaries for profit
then do we really need federal mandates to force that
why not support good insurance companies and hospitals that already focus on service

2. as dr. milton wolf brought up in criticisms to obama's health bill as his cousin and as a medical professional and advocate
where are all the providers going to come from
to serve all the ppl being added to insurance or public benefits

my question is why not let opponents against insurance mandates invest
directly in building and expanding medical education training and intern programs
to provide services to help the public and the poor with preventative health care, clinics and outreach. why not count that as a valid choice instead of restricting exemptions and rules to such narrow requirements that it pushes ppl and companies to defer to federal exchanges instead of encouraging and rewarding development of sustainable programs through medical education using paid scholarships or internships to provide low cost or free public health services that would not depend on govt. cant the private sector set that up better than federal govt already overrun with politics and bureaucracy? what is the best way to set up the actual medical providers? look at the mess govt made of VA vet care.
shouldn't medical professional administrators be in charge of development not politicians?

Thanks!

 

[dblack]

No.

 

[C_Clayton_Jones]

Dear Health Care advocates:
I have two questions about mandating ppl buy insurance instead of paying for or invesring in health care directly:
1. how do we insure that insurance companies will pay for costs
i cant even guarantee my insurance will cover costs now
how is this going to be any different
if we need to only support nonprofit insurance companies whose philosophy is
to cover health care and put any profits into helping needy not into high salaries for profit
then do we really need federal mandates to force that
why not support good insurance companies and hospitals that already focus on service

2. as dr. milton wolf brought up in criticisms to obama's health bill as his cousin and as a medical professional and advocate
where are all the providers going to come from
to serve all the ppl being added to insurance or public benefits

my question is why not let opponents against insurance mandates invest
directly in building and expanding medical education training and intern programs
to provide services to help the public and the poor with preventative health care, clinics and outreach. why not count that as a valid choice instead of restricting exemptions and rules to such narrow requirements that it pushes ppl and companies to defer to federal exchanges instead of encouraging and rewarding development of sustainable programs through medical education using paid scholarships or internships to provide low cost or free public health services that would not depend on govt. cant the private sector set that up better than federal govt already overrun with politics and bureaucracy? what is the best way to set up the actual medical providers? look at the mess govt made of VA vet care.
shouldn't medical professional administrators be in charge of development not politicians?

Thanks!

There are healthcare opponents?

Otherwise, advocate for a single payer/Medicare for all program and your concerns will be unfounded.

 

[emilynghiem]

Dear Health Care advocates:
I have two questions about mandating ppl buy insurance instead of paying for or invesring in health care directly:
1. how do we insure that insurance companies will pay for costs
i cant even guarantee my insurance will cover costs now
how is this going to be any different
if we need to only support nonprofit insurance companies whose philosophy is
to cover health care and put any profits into helping needy not into high salaries for profit
then do we really need federal mandates to force that
why not support good insurance companies and hospitals that already focus on service

2. as dr. milton wolf brought up in criticisms to obama's health bill as his cousin and as a medical professional and advocate
where are all the providers going to come from
to serve all the ppl being added to insurance or public benefits

my question is why not let opponents against insurance mandates invest
directly in building and expanding medical education training and intern programs
to provide services to help the public and the poor with preventative health care, clinics and outreach. why not count that as a valid choice instead of restricting exemptions and rules to such narrow requirements that it pushes ppl and companies to defer to federal exchanges instead of encouraging and rewarding development of sustainable programs through medical education using paid scholarships or internships to provide low cost or free public health services that would not depend on govt. cant the private sector set that up better than federal govt already overrun with politics and bureaucracy? what is the best way to set up the actual medical providers? look at the mess govt made of VA vet care.
shouldn't medical professional administrators be in charge of development not politicians?

Thanks!

There are healthcare opponents?

Otherwise, advocate for a single payer/Medicare for all program and your concerns will be unfounded.

Why not have the advocates who passed and support the ACA pay for all the requirements set up through the Democrat Party using that system of representation to structure and pay for it through their membership which agrees to the mandates; and allow the opponents of insurance mandates to pay instead for programs setting up actual providers of the services through either businesses, schools, churches or charities in networks? why not have ppl pay for the policies and programs they believe in supporting and set up the funding per Party?

Isnt there enough development and reform work to do to create jobs through both major Parties to serve the constituency and sectors of the public through means of their choice?
Why waste resources fighting politically? Why not invest directly in options equally needed

 

[Greenbeard]

1. how do we insure that insurance companies will pay for costs
i cant even guarantee my insurance will cover costs now
how is this going to be any different

It's not entirely clear what you're asking.

If it's a reference to the most egregious contractual loopholes that could leave you high-and-dry--annual or lifetime payout caps, pre-existing condition exclusions, rescissions for anything less than outright fraud--the answer is that those don't exist anymore.

If it's a question of whether your insurance policy will actually cover a service when you need it, the answer is that a certain minimum benefit richness will now be required.

And if it's a question of disagreeing with your insurer's decision-making process, you have new rights to internal and external appeal and access to consumer assistance programs modeled on Connecticut's successful program.

where are all the providers going to come from
to serve all the ppl being added to insurance or public benefits

my question is why not let opponents against insurance mandates invest
directly in building and expanding medical education training and intern programs
to provide services to help the public and the poor with preventative health care, clinics and outreach.

I don't know who you're suggesting is against these investments. Supporting and expanding community health center capacity is an important part of the ACA: The Affordable Care Act and Health Centers.

So are investments in expanding the primary care workforce and supporting preventive medicine. It's not hard to find examples of the ACA's investments in this area: from the Teaching Health Center Graduate Medical Education program to this handy list of programs to expand primary care residencies and training opportunities, building up academic capacity for primary care instruction, and expanding the physician assistant workforce.

That said, even the industry will admit (if pressed) that a significant component of the looming primary care "shortage" is a care delivery design issue in which the existing workforce is being used inefficiently (as opposed to simply needing more raw numbers).

Or as the chief lobbyist for the Association of American Medical Colleges, Atul Grover, said to Sarah Kliff in her article "Doctor shortage? What doctor shortage?":

Grover concedes that forecasting workforce shortages is tricky business; it’s hard to know what the health care workforce will look like in a few years from now, let alone a full decade.

AAMC’s model does factor in expected growth in the non-physician workforce – some of the demand diversion that Green mentions in her paper. But it does not expect that type of workforce to grow fast enough to wipe out the doctor shortage completely.

“You can see this idealized world where there are all these Patient-Centered Medical Homes, and everyone is working in teams,” Grover says. “But that’s just 1 percent of the health care system. There are so many scope of practice issues and so many reimbursement issues that can slow this.”

But reforming and improving the way care is delivered to better approximate that "idealized world" is exactly what the ACA is for (via things like new opportunities for the kinds of models Grover referenced in Medicaid and in initiatives that span Medicare, Medicaid, and private insurers and more).

The things you're talking about are not mutually exclusive. We can fix broken insurance markets at the same time that we fix design flaws in the health care delivery system.

 

[lynn63]

Due to the mandate insurance companies are required to pay for 80% of your healthcare. However the government did not incorporate any fines or penalties if they don't. They also did not make that requirement on a individual's healthcare expenses.

There is no way to tract this from an individual standpoint since our medical history is suppose to be confidential information.

 

[emilynghiem]

I don't know who you're suggesting is against these investments. Supporting and expanding community health center capacity is an important part of the ACA: The Affordable Care Act and Health Centers.

So are investments in expanding the primary care workforce and supporting preventive medicine. It's not hard to find examples of the ACA's investments in this area: from the Teaching Health Center Graduate Medical Education program to this handy list of programs to expand primary care residencies and training opportunities, building up academic capacity for primary care instruction, and expanding the physician assistant workforce.

That said, even the industry will admit (if pressed) that a significant component of the looming primary care "shortage" is a care delivery design issue in which the existing workforce is being used inefficiently (as opposed to simply needing more raw numbers).

Or as the chief lobbyist for the Association of American Medical Colleges, Atul Grover, said to Sarah Kliff in her article "Doctor shortage? What doctor shortage?":

Grover concedes that forecasting workforce shortages is tricky business; it’s hard to know what the health care workforce will look like in a few years from now, let alone a full decade.

AAMC’s model does factor in expected growth in the non-physician workforce – some of the demand diversion that Green mentions in her paper. But it does not expect that type of workforce to grow fast enough to wipe out the doctor shortage completely.

“You can see this idealized world where there are all these Patient-Centered Medical Homes, and everyone is working in teams,” Grover says. “But that’s just 1 percent of the health care system. There are so many scope of practice issues and so many reimbursement issues that can slow this.”

But reforming and improving the way care is delivered to better approximate that "idealized world" is exactly what the ACA is for (via things like new opportunities for the kinds of models Grover referenced in Medicaid and in initiatives that span Medicare, Medicaid, and private insurers and more).

The things you're talking about are not mutually exclusive. We can fix broken insurance markets at the same time that we fix design flaws in the health care delivery system.

This is helpful GB thank you.
So you are saying that the 1500 required payment to federal exchanges if people don't choose private insurance
would be invested in expanding and improving health care providing clinics and services?

a. do people have a choice to apply their 1500 to parts of the plan they agree with and not pay for problems they religiously oppose supporting, for example, for health care if people won't get off their pot or other drugs and cause themselves cancer and other expenses charged to taxpayers, or if people shoot each other and cause the public to pay for their ER. what if people don't believe in paying for problems but only sustainable effective health care for people who accept financial responsibilty for paying their own costs they incur for their actions.

this is similar to people only wanting to pay for prochoice or prolife facilities/programs
do taxpayers have a choice or is it thrown together and left to chance what is paid for

b. is spiritual healing and the cost of medical care that would be reduced
included in medical reforms?
do people have a choice to fund that?
or does regulating spiritual-based helath care exceed the
jurisdiction of federal govt where this should be handled locally privately or by states

is the costsaving and lifesaving factor of spiritual healing
included in the plans, and do people who believe in funding programs
based on that have a chocie to direct funds there if we are forced to pay 1500 by law?

 

[Greenbeard]

Due to the mandate insurance companies are required to pay for 80% of your healthcare. However the government did not incorporate any fines or penalties if they don't.

There are federal civil penalties for noncompliance.

So you are saying that the 1500 required payment to federal exchanges if people don't choose private insurance
would be invested in expanding and improving health care providing clinics and services?

I'm saying that building and bolstering community health centers and the primary care workforce is not an alternative to the new insurance marketplaces, those investments are being made in parallel with the development of the marketplaces. It's not an either/or proposition.

a. do people have a choice to apply their 1500 to parts of the plan they agree with and not pay for problems they religiously oppose supporting, for example, for health care if people won't get off their pot or other drugs and cause themselves cancer and other expenses charged to taxpayers, or if people shoot each other and cause the public to pay for their ER.

There are religious exemptions from the individual mandate but if you're buying insurance, no, you can't earmark your premium dollar for "good" people whose conditions you approve of treating.

b. is spiritual healing and the cost of medical care that would be reduced
included in medical reforms?

I'm not sure I know how to answer that. If you're asking if insurers can pay for whatever might fall under that umbrella, I'd say that insurers can pay for anything they like.