The Guardian asked me to watch and comment on President Obama’s HealthCare Summit. The post, which I wrote yesterday, begins:
The White House Forum on Health Reform ended in a dialogue with President Obama that turned out to be the most revealing part of the afternoon. In that final hour, you began to hear the anger of the opposition – and you caught a glimpse of which principles the president himself considers most important.
You will find the whole story here.
Max, “Single payer is off the table” Baucus took $1 million in campaign donations between 03 and now from health interests.
If you want to see why we are going to have to fight to get meaningful single payer reform I suggest readers check this link out:
http://www.fair.org/index.php?page=3733
big media does not want you to know you are not alone in wanting hr 676
‘fraid this little link says it all!
I second Donna Shalala.
Maggie:
Thanks for summarizing the “summit” for those of us who were unable to view it because the White House website doesn’t support our ancient operating systems.
I haven’t been able to find a description of the “public option”, and many sources say it remains to be defined. So, I wouldn’t want to jump to the conclusion that it’s “Medicare for all”, as you state in your article.
The evidence I’ve seen is that the “public option” that’s being considered will be an extension of the FEBHP, where OPM negotiates for prices and benefits with private insurers, just as any employer-run plan does. This is what Tom Daschle describes in his book “Critical” as the “public option”, and this is how Karen Davis, of the Commonwealth Fund, is describing it in interviews about the Commonwealth Fund “public-private plan” proposal: “a public-SPONSORED plan just like Congress has.” The difference between a “public plan” and a “public-SPONSORED plan” is a world of difference. Supporters of the “public option” in “public-private healthcare reform” are just suggesting that OPM would do this on behalf of more people who might want to opt in. The coverage is better (at least it was when I worked for the feds thirty years ago) and the government still pays more than 50% of the premium cost (100% when I worked for the feds), to make up for the large wage differential between what people are paid for providing public service and what they could make for the same job on the open market. Private insurers are willing to do this because the government is the biggest employer in the country.
The rest of the “private-public plan proposal” is to force people into the individual market (except for those who are covered by their employers and who are becoming fewer every day), which is more lucrative for the insurers than group plans. This is what the private insurers are afraid of: more people in a group plan, fewer forced into the individual market. The “can’t compete with the government” assertion is just a smoke-screen.
The combined public-private plan is still too expensive, for all of the reasons that our current system is too expensive, while our population’s health is still in the pits. The CBO ran the numbers a few years ago, and the public single payer option was still the most cost-effective program.
Thanks for your comments.
geoff t —
As I have stated before, this blog is not a billboard for ads– people selling things–including single-payer ads that do little more than provide links to their sites, or single-payer “rants.”
As have said so many times before, I am not against hte single-payer idea, but I object to the way that single-payers are presenting it, ignoring polical reality.–and dividing progressives
From now on, all such posts will be removed, and the commenter blocked from responding on HealhtBeat in the future.
I am very sorry to have to do this.
But as I have said, this is a blog for people who want to make arguments-supported with unbiased evidence that they can link to –about the numbers etc.
Lisa,
Yes, I too liked what Shalalah said.
ACarroll–
I just use “what some call Meciare for all” as shrothand for “a public sector alternative” that’s more meaningful for most people.
Most Americans don’t know what the federal em;loyees’ plan means.
Medicare is less of an unknown, and thus, less frigthtening,
I would like to know much more about the Federal Employess’ plan–especially the amoun of coverage, and any holes in coverage and costs ( premiums, deductibles and co-pays for )s the least expensive federal emplyees’ plan.
Could you send me info on this? (mahar@tcf.org)
.
“I would like to know much more about the Federal Employees’ plan–especially the amount of coverage, and any holes in coverage and costs ( premiums, deductibles and co-pays for )s the least expensive federal employees’ plan.”
Maggie,
In a recent speech sponsored by the California Healthcare Foundation, Dr. Ezikiel Emanuel characterized the FEHBP available to congressmen and senators as a very rich plan.
I’ve said before that I think the key issue in any public option is how provider payments are set. Will the government negotiate fees with providers like the private sector does or will it try to dictate or administer prices like Medicare does? Will the public plan have to reflect all of its costs in its premiums including services currently provided for CMS by other government departments and agencies? Will it have to cover all of its costs out of premium revenues and reserves (if any) or will it be able to cover any shortfalls with general tax revenues or borrowing without having to pay the money back with interest over a reasonable timeframe? I have no problem with fair competition. I do have a problem with legislators who have no use for private insurers being in a position to set the rules which can quite easily be rigged against the insurers. In other words, the insurers, with considerable justification, don’t trust the Congress to legislate a set of rules that would ensure fair competition on a level playing field. This role might be better left to an independent Federal Health Board that is insulated from politics.
My parents are both retired government employees and they’ve always had and still have health insurance, I think it’s called “Champus”? Is this what you’re referring to, when talking about federal employee coverage?
Sort of a tangent, but related to the idea of people going to jail.
Since when did we allow prosecutors to settle with firms which pay a criminal fine, but then admit to no wrongdoing?
Firms don’t commit crimes, people do. There should be no such thing as a perpetrator-free crime. At a minimum if there is no clear person at fault then the CEO should be held liable. This is what Sarbanes-Oxley does. The CEO has to sign off on the financial statement, even though, in practice, he wouldn’t know all the details of everything being asserted.
Sort of like the captain going down with the ship. In Japan people resign over the perception of wrongdoing. Here we can’t get them even to admit their role when the firm pays a fine.
It’s all about incentives (or disincentives). There is lots of talk about this these days with regard to the mortgage meltdown. Those writing the loans, supplying the house valuations and the like did not take any of the risk.
As it stands now when a fine is paid the only people who suffer are the stockholders who see their profits diminished. Realistically they had no way to control the behavior of the management of the firm.
I think this should be part of health care reform. A great deal of the excess spending is due to fraud on the part of drug makers and device makers, who misrepresent the efficacy and safety of their products.
If a few CEO’s went to jail over some of this activity, we would see a lot less of it.
See this report about the drug Seroquel for an example of such misrepresentation. As far as I can tell no one has been punished.
http://clinpsyc.blogspot.com/2009/03/internal-documents-suggest-that.html
There’s a more criminal behavior happening in health care than financial fraud. But yes, the blame lies at the top and FBI raids are in order. I’d like to see some JCAHO suits charged as well, they are an absolute fraud. Donna Shalalah for Surgeon General.
“Single payer is off the table.”
It is time for single payer advocates, and I am a fan of single payer, to begin to deal with the realities of health care reform as they exist in 2009.
I was extremely happy with Obama’s straightforward defense of a federal insurance option following Grassley’s comments.
If you really believe in single payer, if you really believe it is the best and cheapest solution to America’s health care problems, the time has come to stop pounding your shoe on the table and to get behind the proposed federal health insurance alternative.
If federal insurance really offers significant advantages in cost and benefits over private insurance (and single payer is really just a great big federal insurance program,) then we would expect that the federal insurance alternative will eventually, through market forces, come to dominate the market for health insurance and become, by default, a single payer system.
The ironic thing is that conservatives actually believe this. The people who don’t seem to get it are the single payer militants, many of whom persist in ignoring the fact that there is not enough support of single payer by the politicians who will make the decisions about health reform to make it a viable alternative. Instead they are continuing to engage in what appears to be an effort to attack the reform effort from the left. This, in effect, amounts to coming to the aid of conservatives in hurting the prospects for reform if their own ideas are being ignored.
… and another thing.
The “federal option” has been specifically described as “Medicare or a program exactly like Medicare” by Obama and other members of his administration. It is distinctly seperate from the FEBHP, which is not an insurance program but in fact is a buying consortium that negotiates for private insurance programs for federal employees, getting low prices and good benefits because of huge buying power but still operating with private insurance. This is definitely different from the “federal insurance program” that is being discussed as a program in which the federal government acts as the actual insurer.
Pat S wrote:
“The ironic thing is that conservatives actually believe this. The people who don’t seem to get it are the single payer militants, many of whom persist in ignoring the fact that there is not enough support of single payer by the politicians who will make the decisions about health reform to make it a viable alternative.”
————–
I am a progressive, and I believe in general in group beneficial social actions through government efforts. The epiphany I see now concerns what is government and what is it capable of doing over the longer run? Another way of looking at this is how the heck did this country elect the likes of the Bush administration (twice)?? No matter what social programs get enacted through one administration, what happens to these very important programs when the likes of the Bush administration gets back into power?? Can we be assured such administrations won’t happen anymore?
Barry, Robert, Pat S, Lisa, NG
Thanks for your comments.
Barry–
I have said this before, but let me say it again:
The goal of health care reform is to provide higher quality care at a lower cost than we do now for all Americans.
The rules of the game will be set with that in mind.
Both Medicare and public-sector plan will set fees for services (as Medicare does now), and if they follow the Medicare Payment Advisoroy Commissions’s recommendations (and budget director Peter Orszag’s recommendations) they will raise fees for many services that provide significant benefit to patients (primary care, pediatric, palliative, othe prevenetive care and chronic disease mangement) and lower fees for servcices that are now done in large volumen in part because they are so lucrative, and provide relatively little benefit to patients: much diagnostic imaging, some surgeries, angioplasties for stable heart patients,
chemo for dying patients who might (or might not) live another 5 day if they have it.
In other words the fees will be all about rewarding care that helps patints–not about making life easier or harder for private insurers.
“The markets” cannot set these prices because as economists have pointed out over and over again, (going back to Kenneth Arrow, the father of healthcare eocnomics) “the market” doesn’t work to reward quality or lower prices in healthcare.
Private insurers will, no doubt, do what they are doing now—follow Medicare’s fee schedule almost exactly, but adding 5% to 15% to fees.
If they can make money while doing that– even though no longer able to cherry-pick, or sell Swiss cheese policides with holes, more power to them. If they can’t—too bad.
The fact Medicare gets some help from other Federal agencies is irrelavent—just as it is irrellavent that some private insurers might have help from the bond market (in years when the bond market is doing particularly well, by investing premiums there.)
Medicare doesn’t play the bond market–doesn’t take the risk, or enjoy the potential profits.
. And private insurers don’t enjoy some of the efficiencies that a public-sector plan might enjoy (i.e. it might collect premiums when you pay your income taxes, using the income tax form)
Bottom line Barry: only the most innovative and intelligent private insurers –who put patients’ interests first–will survive when competing with Medicare-for-all
My advice: tell your clinents to sell their insurance stocks, if they haven’t already.
We are not going to design health reform with an eye to doing what is best for insurance companies. IF they can figure out how to add value, fine. But if a public sector plan can offer more to patients for less money– so be it.
A final note on private health insurance: Warren Buffet has always liked to invest in insurers, but if memory serves, he has never put a penny into a health insurance company.
This is no doubt because he believes that a) it’s very hard to make a profit in that business and b) it’s a pretty seamy business which cuts a lot of corners when trying to avoid the sick.
Robert-
-You are absolutely right.
When a corporation does something that is clearly illegal–and hurts customers, the environment, whoever or whatever– at most it pays a fine and usually NO One Goes to Jail.
IF the fine is very large, the stockholders suffer the consequences–their stock is less valuable, at least for a while.
These stocks often bounce back because Wall Street really doesn’t care
that the company is corrupt, as long as it makes money.
The CEO may resign–but he gets a big bonus when he leaves and then he goes on to become the CEO of another company.
We need laws with teeth, and, as you say, if we cannot proove which individual(s) had he bright idea to cotinue making a product that they knew killed people so as to avoid losing market share, then the folks at the very top should take the fall.
This would give them an incentive to avoid hiring overly aggressive executives.
In this administration, Wall Street may have less power than it did in the past. Obama’s anger about bank executives taking bonuses was real.
Pat S– You write: “I was extremely happy with Obama’s straightforward defense of a federal insurance option following Grassley’s comments.”
Me too. I couldn’t write his words down fast enough.
And yes, it is ironic that the conservatives fully understand that most for-profit insurers won’t be able to compete with a public-sector plan.
The only way that most of them know how to make money is by shunning the sick and selling low-cost policies to healthy people who won’t use them (while making sure that their are enough holes in those policies that if those seemingly healhy people do get sick, they’ll find they’re not covered.)
This is why conservatives are so dead set against a public-sector option.
Meanwhile, liberal single-payer sdvocates cannot see that Obama’s plan is a clear back-door to single-payer. It lets Americans CHOOSE single-payer themselves. This is the only way we get single-payer in a Democracy.
Pat S & Barry: On insurance for Federal employees– Yes this is a menu of private- sector plans. Emanuel and others have said that the public sector plan would offer benefits “as rich as” those offered by the Federal Employees’ plan, but as Pat S points out, the public sector option would be like Medicare in that it would be administrered and overeen by the government.
I very much doubt we would farm it out to private insurers. We just did that with Medicare Advantage and we’re not very happy with how that turned out. . .
NG–
Let me say that we have to blame the American people (not “government” for electing Bush twice.
The American people, with a little help from voter fraud and the Supreme Court putting its politically biased thumb on the scales of justice. . .
And this is not the first time in history that we have elected bad government.
I do think that this administration could oversee a good public sector alternative.
But, Obama will be in office for, at most, eight years. . . .
Who knows who will be in office next. Sarah Pallin????
This is one reason why I think ‘private sector alternatives’ are a good idea.
I suspect that, as in Europe, most of them will turn out to be non-profit private sector plans competing with the Government plan.
It’s very hard for a for-profit company to ccmpete with non-profits–if they’re on a level playing field.
And there is no reason to set up a profit-making business as the middleman between sick people and healthcare providers–unless the for-profit business is so innovative that it can offer better value to its cusotmers, AND make profits for its shareholders.
Thanks for the excellent recent review of the Guaranteed Healthcare Access Plan of Ezekiel Emanuel. Do you know if he attended the conference?
From my experience I conclude that his plan is far superior to any other proposal or any existing plan in the world. Furthermore, it should appeal to those groups who have scuttled previous proposals. Those who are happy with their present plans will likely be able to keep them since the good plans will opt to keep their business by enrolling in the program. Fiscal conservatives should like it because it frees states to lower taxes due to the shedding of healthcare expense for state employees and the poor, while controling costs and providing fair funding through a dedicated VAT. Supporters of American business will like it because it frees businesses from the expense and headache of providing healthcare to their employees.
Clearly, progressives will like it for the reasons pointed out in your recent post.
Richard–
Thanks very much.
I still like Zeke Emanuel’s bill.
But now (at the beginning of a depression) is not the time to try to introduce a new tax.
At the beginning of a deep rescession/depression simply wouldn’t fly in Congress.
Still, health care reform is going to be a long-term process. And I can imagine, at some point down the road that the whole idea of vouchers, funded by a dedicated VAT tax that (as I explain in the review) is NOT REGRESSIVE might catch on.
Robert–
I have asked everyone not to use HealthBeat as a billboard for links to single-payer sites.
There are plenty of places to hear the single-payer arguments and rants that have gotten wide exposure for many years.
I have explained on this post and elsewhere why single-payer won’t work.
I’m not having that discussion again–no point, it falls on deaf ears. The majority of single-payer advocates believe only what they want to believe, do not care waht other Americans want, and simply ignore the facts about costs and savings.
Obama has explalinedwhy single-payer won’t work many times.
You can google it.
As usual, the single payer post you link to is studded with misinfromation and outright lies.
I will not allow healthbeat to be used to spread misinformationn. There is already too much of that in the blogosphere.
I check my facts very crefully.
I do not have the time to read every single-payer post that someone might link to.
RE: “…Ezekiel Emanuel. Do you know if he attended the conference?”
Yes, he was a participant at the summit and co-moderated a breakout session with Valerie Jarrett, if my memory is correct. I tried to find an online video of each of the 5 breakout sessions but haven’t succeeded thus far (links would be appreciated if anyone has them). The only breakout streamed live by C-SPAN which I watched online was the one moderated by Melodie Barnes and Dr Robert Kocher.
I was curious about Kocher and found this out from the recent NEJM article 3/4/09 titled
Budgeting for Change — Obama’s Down Payment on Health Care Reform
“…A recent study by the McKinsey Global Institute4 estimated that the United States spends $643 billion more every year on health care than its peer industrialized countries, after adjustment for wealth (see graph and table). These findings have had a profound influence on the thinking of Orszag and his colleagues. Two McKinsey principals who worked on or oversaw this study, Robert Kocher and Diana Farrell, recently joined the staff of the National Economic Council in the White House….”
Re Donna Shalala, to my knowledge she’s cashed in in a big way since leaving HHS under Clinton, serving on the board of the for-profit health insurance co UnitedHealthCare. A quick google of Shalala and UnitedHC turns up SEC filings of large stock sales of UnitedHealthCare by Donna Shalala. Someone tell me if my concerns are misplaced.
Ann Malone–
Thanks for your comment.
Yes,I saw Zeke running one of the breakout sessions.
One website provided access to all 5 sessions–which was great– I was able to move from room to room to room without being impossibly rude.
I could just decide “Boring!” and click on a different room.
But from what I’ve been able to tell, the streaming video is no longer up–at least Ezra Klein removed it from his post on American Prospect.
(That’s where I originally found it. Unfortunately, I can’t remember the name.)
And at the time, after the break-out sessions ended, you just got a picture of an empty room . . .
On Shalala–As a prvate citizen, she has every right to sit on a corproate board.
If people asked me to sit on boards (which they don’t) United would not be my first choice–but she might well have felt she could do some good.
As for selling the stock– I don’t understand why anyone in their right mind would have held onto health insurance stock after McCain was nominated. (He, like most Democrats, was against the windfall bonus for Medicare ADvantage insurers. And this is the only thing that has kept the industry afloat.
So Shalala was not trading on “insider information.” Anyone who reads the Wall Street Journal knew the industry was in deep trouble, and that, most likely things will only get worse.
That said, while everything she has done as a private citizen is no doubt perfectly Kosher, I would think that being on the board would make her less than ideal candidate for a healthcare position in the administration– unless she could show that as a board member, she had advocated for the public good–and ideally, accomplished something . . .
“A final note on private health insurance: Warren Buffet has always liked to invest in insurers, but if memory serves, he has never put a penny into a health insurance company”
Maggie,
Actually, in the middle of 2007, Berkshire Hathaway owned 4.8 million shares of UnitedHealth Group and 4.2 million shares of Wellpoint worth approximately $580 million combined at the time. The decision to buy those two stocks may have been made by GEICO’s Chief Investment Officer, Lou Simpson, who has a stellar investment track record spanning decades and manages a portion of Berkshire’s investment portfolio, but I don’t know for sure. At any rate, the SEC filing at that time indicated a material recent increase in Berkshire’s investment in both stocks.
Maggie:
I was surprised to see your comment: “it’s very hard to make a profit in that business.” I wonder how you came up with that conclusion? From what I’ve been seeing, the positive results for the health insurance industry have been stunning. For example, the figures that Jacob Hacker used to support the public plan option (from what I’ve heard, he’s advising the healthcare team in the WH) are in his report (link is at http://institute.ourfuture.org/public_plan). The summary of this plan includes these figures: “Insurance company and hospital profits have skyrocketed during this consolidation. The combined profits of 14 of the country’s largest private health
insurance companies rose from $3.5 billion in 2000 to $15 billion in 2007 – an increase of 330 percent, according to company SEC filings. CEOs at the health
insurance companies were compensated a combined $147.6 million in 2007 – an
average of $10.5 million each, or 259 times more than the $40,690 an average
worker made that year. Despite complaints about Medicare payment rates, U.S. for-profit hospitals reported $43 billion in profits in 2007, their best single-year
jump in profits in at least 15 years, according to the American Hospital
Association.” This is what I’ve been seeing elsewhere.
Are you referring to specific, perhaps smaller, health insurance companies while Hacker is reporting on the top 14 in the industry?
ACarol, last year United Healthcare (NYSE:UNH) posted net income of approximately $3 billion on revenues of $80 billion and paid income tax of $1.65 billion. As a percentage, profit was about 3.7 percent. And, as a percentage, taxes were over 55% of net income.
Compared to other industries, this type of return is not exorbitant. The net profit ratio for health insurers is 4%. The net profit for the overall health care industry is 12.78%. The net profit for the financial industry is 13.38 and for the tech industry is 10.99.
ACaroll, Last year United Healthcare (NYSE:UNH) earned a profit of almost $3 billion on $80 billion in revenue. They also paid $1.6 billion in income taxes.
As a percentage of profit, UNH earned 3.7%. This is hardly “stunning”. The health insurance average is 4.0%. Which is also hardly stunning compared to other industries.
The average profit for the entire health care industry is almost 13%. Also for comparison, the tech industry averages nearly 11% profit while the finance sector average over 13%.
I think you are mesmerized by the numbers in the billions. When the overall number in the health insurance market is $2.5 Trillion and growing, numbers in the billions are actually not that big in a relative sense.
Barry, Acarrol and Scott-
Barry– Interesting Buffet bought UNH– probably because it appeared to be such a bargin. (By the summer of 2007, it was down sharply from its 2006 high.)
Now, of course. . .
(I just looked at a 5-year chart. Sure hope he no longer owns UNH!
Acarrol & Scott—
Scott is right; health insurance is not a terribly profitable industry–compared to the drug industry, the device industry or other “growth industries”
Jacob Hacker is a great person–I like him very much. But he’s a political scientist, not an economist, and when it comes to the cost of health care–what is driving health care inflation, how much it will cost to cover everyone, I’m afraid he’s usually very wrong.
Your assumption that insuerrs are making a fortune is a common assumption, based in part on misinformation spread by single payer advocates who like to pretend that if we just got rid of the insurers, healthcare would be affordable.
Below a USA story reports that when you poll people, they assume insurance company profits are a major force dirving health care costs–and then the story explains why that just isn’t true:
“Half of the people polled blamed profits of drug and insurance companies as one of the single biggest factors [behind the spiralling cost of healthcare], while 37% blamed too many medical malpractice lawsuits, and 36% blamed doctors and hospitals making too much money.
“‘Profits might explain part of why costs are high, but it doesn’t explain why costs are rising,'” says Paul Ginsburg, an economist at the Center for Studying Health System Change. New treatments and increased demand are fueling the rise, he says.
THIS PARAGRAPH BELOW IS VERY IMPORTANT:
“‘The thing I find dismaying is the public doesn’t recognize that it’s the additional medical care they’re getting that’s driving costs up,” Ginsburg says. “They have to come to grips with the fact that we won’t be able to slow the rise in costs without making trade-offs.”
“Princeon healthcare economist Uwe Reinhardt also says the focus on profits is misplaced.
“Hospitals typically have margins of 5% or less, insurers range from 5% to 8%, while drug industry profits are higher, in the 15% to 20% range, he says. But, he says, even those profits can’t be blamed for rapidly rising health care spending.
“‘I once calculated that if you rebated all the drug company profits to patients, health spending would only go down by 1.2%,'” he says.
As I’ve written in the past, over-treatment and over-use of advanced medical technologies is driving the climbing cost of healthcare.
Until we cut that waste, health care inflation will continue to climb.
Scott– I like you are right: people are mesmerized by numbers in the billions. And those who like to pretend that the insurers are the major problem love to quote “last year the biggest insurers make $XXX
billion–without mentioning what a small percentage of revenues the number is. You have to put the number in context.
This is the sort of misinformation that makes me want to tear my hair out!
Maggie and Scott:
I believe you both changed the meaning of the sentence in the report and then claimed that it wasn’t right for the meaning you gave it.
The sentence talked about the “profits” of the industry, not “revenue” and not “profit margin.” It claimed that the “profits” grew between 2000 and 2007. It also didn’t evaluate whether it did better, worse, or the same as, other industries. The question was whether it is a profitable industry. It is–as profitable as the financial services industry (not surprising, since insurers are part of that industry).
I am a single-payer supporter, and Jacob Hacker isn’t; he supports the “healthcare exchange” idea, and I don’t. Profits DO increase the costs of healthcare compared to public systems; insurers DON’T spend as much of their healthcare dollar on healthcare as government programs do. Private insurers had to be given a “sweetener” in order to entice them to participate in Medicare Advantage. They add unnecessary costs to the healthcare system. I believe that most single-payer supporters know about the Dartmouth Atlas research and know that the rapidly increasing costs over time are due to ever-more expensive drugs and devices that are not cost-effective. However, as Paul Ginsburg states, profits partly explain why costs are high.
ACarroll–
I really do understand terms like “profits” “revenue” and “porfit margin.”
(Before I began writing about healthcare, I was a financial jouranlist for 18 years; senior editor at Barron’s for 12 years.
Here’s the company’s recent “sales”(money they took in from sales) and profits (money they had left over after paying reimbursements, taxes, salaries, advertising, etc.)
Sales $81.186 bil
Profits $2.977 bil
Scot is right– profit as a percentage of sales (or revenues) is how you measure the success of a company. And,after taxes, the company’s profit was only about 3.7% of sales.
That is anemic.
Just “making a profit” isn’t enough if you want to stay in buiness as a publicly traded company.
You have to be more than marginally profitable, or people begin selling the stock and you don’t have enough capital to stay in business.
For the last 20 years or so, very succesful companies (not just tech companies, but companies like Disney) aimed for double-digit profits (as a percentage of revenues)
Private insurers didn’t make those profits. And recently, they have been creamed.
The notion that private health insurers make money hand over fist is, I’m afraid, a myth.
Understandaly, may people ressent insurers(premiums have been going up) but they have not been enormously popular.
The amount insurers must pay out to reimburse for health care has been spiralling as the price of healthcare and the amount of healthcare that Americans consume has climbed.
These are simply the facts.
I don’t particularly like for-profit insurers; I don’t think that they add value to the system.
But I’m not willing to lie about the numbers in order to try to support my point of view.
(To be fair: many people who “lie” about the numbers simply don’t understand the numbers.. They don’t know how to read a balance sheet.
They’re just repeating the misinformation they have heard and want to believe.
But they also are stubbornly unwilling to learn when someone tries to explain the numbers.
Nice blog.I read & enjoyed this blog. I just use “what some call Meciare for all” as shrothand for “a public sector alternative” that’s more meaningful for most people.