Tag Archives: health insurance

INSURANCE BUSINESS CAN BE MESSY

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#insurance #healthinsurance #riskmanagement
The insurance business can be messy and complicated.

Some insurance is mandated. For example, a minimum amount of auto insurance, usually liability insurance, in case someone else gets hurt, is required in most states.

Health insurance, under the Affordable Care Act, is now mandated. We can certainly debate the necessity of that – perhaps later.

Life insurance may be the only one that is completely optional, meaning it’s not mandated and many people can live without it.

But even if insurance isn’t mandated, it may be – or should be – something we can’t really live without. When a person doesn’t buy flood insurance because it’s too expensive, but lives in a flood-prone area and gets flooded, many thoughts crowd her mind, and the minds of others watching. Those others watching may want to help, but may cringe at a Go Fund Me request to help HER. They might prefer to help the responsible folks take care of necessities that their flood insurance may not cover.

As for health insurance, the business model may seem complicated.

All insurance business models are about “risk management,” which may seem like a vague term to most, but we’ll use health insurance as an example as we break it down.

The health insurer collects premiums from folks who are healthy, and not making any, or are making very few, claims. When a person gets to a point in his life that he needs to make perhaps significant claims, those premiums he paid all those years may not matter.

The insurer will use all kinds of gimmicks, technicalities and even trickery to find ways to either not pay a claim, or pay as little as possible. They may often put consumers, already dealing with what ails them, through an incredible process to get their money. The more daunting the process, the more likely people will give up.

Remember this: just as consumers don’t like to be put through a wringer to get what they are owed, the insurers don’t like to be pestered day in and day out, either. The rule of thumb: if your policy says you are covered, fight for what you are owed. If the company doesn’t pay, sue.

Then, we have the standoffs between providers, usually big providers who may be the only game in town, and insurers over fees, reimbursements etc. You see insurers use their leverage to give the least to the provider, and you see the provider using its leverage by not taking the insurer’s policyholders as patients.

Remember, an insurer’s promise of coverage with your provider is made to be broken. In standoffs like these, the patients (policyholders) suffer and no one cares.

New York Times columnist Paul Krugman wrote that despite the exit of some big insurers from the Affordable Care Act marketplace, the law is working well, reducing the number of uninsured Americans considerably. His column was published Aug. 22, 2016, in The Atlanta Journal-Constitution. Though some insurers’ exit from the marketplace is a concern, Krugman says the problem can be fixed if people can learn to work together to do so.

The U.S. is the only major nation in the world in which health insurance is left up to the free market. Some advocate that we move to the single-payer system, in which we’d all have health insurance through the government. There are pitfalls here, too.

The insurance industry provides many, good-paying jobs. Many of those would be gone in a single-payer system. Drug and device companies rely on their U.S. profits for much of the money that goes to researching new and better treatments.

What to do? Determine what insurance you need and buy it. You may have to give up some pleasure and deal with some messy situations along the way, but going without can create far worse consequences. Remember the Fram Oil Man ads: pay me now, or pay me later.

If you are having trouble paying your premiums, look for other ways to make money. There are many part-time options out there that could even give you enough to surpass your main income. To check out one of the best, message me.
Insurance is messy. You may have to shop around frequently for the best deal, but paying penalties, or just taking the risk that you won’t need it, is a recipe for disaster.

Peter

CHANGE ISN’T ALWAYS WHAT YOU WANT

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“You must be the change you wish to see in the world.” Mahatma Gandhi

Today, more than ever, change is constant.
Sometimes we see it coming. Often, we don’t. Regardless, we wonder what we could have done about it, presuming the change isn’t good.
Some things are beyond one’s control. Some things are totally within one’s control.
If change is beyond one’s control, how one responds to it is totally within one’s control.
One certainly can’t control the weather, and, as this is written, weather is severe in some parts of the United States. We can control how we prepare for and respond to severe weather.
Have you been through some change lately? If so, how are you dealing with it? Are you trying to reconstruct the past, or are you figuring out your place in the future?
Are you expecting change? What are you expecting? How do you feel about it? Is it going to help or hurt you? Most importantly, what are you doing now to prepare a response?
Are you expecting no change at all for the foreseeable future? Don’t be blindsided. Change IS coming. You may not know what the change will be. Therefore, you have to think of the worst change that could befall you, and prepare your response. What if you lose that job you think you are so secure in? What if your spouse walks out on you? What if there is an unexpected death close to you? What if YOU die?
All of these things will require a response. The good news: you can prepare a response in all these scenarios. At the time of the change, emotions will run high. That’s no time to think about how to respond. We don’t want things like these to happen, but they could – and they might. There are many prudent actions to take BEFORE they happen. Have a plan. Write it down. Have appropriate financial safeguards in place. Have appropriate insurance – yes, that goes for health insurance, even if you are young. Insurance is an investment, even if you don’t use it right away. Penalties are throwing money away.
Remember, in regard to your job, company ownership can change. You can get a really bad manager. Companies also reorganize a lot more frequently than in the past, because of changes in the marketplace, technology etc. Even if you have a great job, and are good at it, any one or more of the above changes could kill your career. How do you prepare to unexpectedly leave your job?
You can be a good saver. That certainly will help. You can be a very careful spender. Remember that money you don’t spend stays with you. However, remember the difference between being “cheap” and being frugal. (See health insurance vs. penalty above).
There are ways outside of a job to generate income. For one of the best, visit www.bign.com/pbilodeau. It may be something you’d never thought of, but getting into it while you have an income – and before you really need it – could pay handsome dividends if the worst happens. Heck, it could pay big dividends even if the worst doesn’t happen.
Harkening back to Gandhi, you may not like the world as it is. You may love the world as it is, but don’t expect it to stay that way. If it does, that’s your good fortune, since you can’t control “the world.” In either situation, there are things you can do to make the world a better place, and secure your place in the future.
Don’t let circumstances beat you. Prepare for the worst and expect the best. You will be so much better for it.
Peter

HEALTH INSURANCE AND JOBS

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If you are fortunate enough to work for someone who provides you with health insurance, count your blessings.
But also know that it probably won’t last.
Not only have state and the federal governments set up insurance exchanges, companies are also setting up private insurance exchanges.
Leading the trend is a company called Towers Watson, whose CEO, John Haley, was profiled in the Oct. 31, 2013, edition of USA Today.
Having health insurance with your job used to be a beautiful thing. Not only did a company pay you a salary and contribute toward your pension, it also paid a portion of your health care costs in the form of insurance.
If you hung around the company long enough, you could stay insured until Medicare kicked in.
But the recession that started in 2008 changed that mind-set. People lost jobs, and, therefore, lost their health insurance. People started to seriously question whether it was a good thing to have health insurance tied to a job. It was bad enough for a person to lose a salary. But losing health insurance compounded the problem many times over, especially if that person had a sick family member, or were sick themselves. Never mind what the stress of unemployment might do to their health.
Working people really began to wonder whether it was really good to have an employer have that much power over one’s life.
But modern companies want to provide good employees, and prospective employees, with the best packages possible. They understand that without good people, they will not thrive, and they will not survive over the long term.
Yet, health insurance as we know it is a serious cost to employers. Private insurance exchanges may be a vehicle to reduce those costs, and still provide affordable insurance to employees. If they can be devised so that the employee doesn’t necessarily lose benefits if he is laid off (he may lose the company subsidy), these exchanges might be the perfect solution.
We all want affordable health care. We all want to be able get the care we need under any conditions, without impoverishing ourselves or our families.
Between the government exchanges and the private ones, we might be on to a good, long-term solution.
Sure, the federal exchange Web site has had glitches. These, hopefully, are fixable. We might have to tweak the Affordable Care Act as time passes, to make sure it’s as effective, and inexpensive, as it can be to those insured, while not creating too big a government expenditure.
What if you had enough money on your own to buy whatever insurance you wanted? That would be ideal. If you are looking for a way to do that, visit www.bign.com/pbilodeau.
Meanwhile, shop carefully on whatever exchanges which you are allowed to shop. Choose the plan that is right for you. Also remember that paying penalties is throwing money away. Even though it might cost you more, when you buy actual insurance, you are at least getting something for your money. So buy insurance. You, your family and your community will be healthier for it.
Peter

MEDICARE’S EFFICIENCY

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Medicare gets bad press as a big federal expense, but it is the hero of a recent expose on health care costs.
In fact, journalist and author Steven Brill, who investigated hospital costs nationwide, found huge markups on things you purchase as part of your hospital care.
Brill wrote the piece for Time magazine, and Time Managing Editor Richard Stengel cites the 10,000 percent markup hospitals put on acetaminophen as just one example.
In fact, Brill said on ABC’s This Week Sunday morning show Feb. 24, 2013, that if the introductory age for Medicare were lowered, not raised, health care costs would drop.
Unlike most businesses, hospitals charge you for everything you use, including the little paper cup you get with your acetaminophen in it. It probably costs the hospital pennies per cup to buy, but they might charge a few bucks for it.
And prices vary from place to place, as consumer adviser Clark Howard cited in an Atlanta Journal-Constitution column Feb. 28,2013.
What’s happening is that if you don’t have any insurance, you’ll get billed the marked-up price for your hospital care. Insurers, because they represent lots of people, can negotiate those prices down. And Medicare, the federal health insurance program for senior citizens, is only allowed to pay, by law, somewhere around the hospital’s cost for the item.
We can certainly debate whether hospitals would lose money if more people were on Medicare. Health care workers sing the blues over how little Medicare pays for things, and some providers won’t treat Medicare patients for that reason.
We also know that hospitals and other health care providers have to make up for those people whom they treat, but who can’t, or won’t, pay them. Hence, they mark up bills for paying patients to help recoup.
Brill also pointed out on This Week that Medicare processes claims for less than a dollar per claim, while private insurers pay about $20 to process each claim.
The point the Brill story makes is that insurance lowers medical costs. Medicare lowers them the best, but would a system in which everyone were on Medicare be sustainable? Would hospitals and other health care providers be able to survive on Medicare pricing?
Unlike other businesses, in which technological advantages and competition LOWER costs, technological innovation and competition can RAISE costs in the health care arena. Suppose Institution X get a CT scanner. Institution Y across town will want one, too, even though one scanner would probably service the whole area.
Institution Y doesn’t want to send its patients to Institution X for CT scans, out of fear that patients will elect to get all of their care at Institution X out of convenience. What if Institution Y LOWERED its prices because it doesn’t have the overhead to maintain the expensive CT scanner? If you cut your hand, would you want to pay the overhead for a CT scanner just to get a bandage?
The point is that people need to see, and care about, what things cost and how they are billed. Insurance makes people less concerned about that, but even though the patient may not be paying much of the cost, he still should negotiate bills. Don’t pay $5 for a paper medicine cup that you know costs the hospital a few cents. Or, better yet, have insurance for everyone and have the insurers negotiate prices down, Brill points out.
Health care is tricky, and there is plenty the average person doesn’t know, or care about. The Brill piece helped expose some of it, but it will be tough to get health care costs down considerably. Also, if we could reduce the costs considerably, how many health care providers can survive with the lower margins? Health care costs are high, in part, because we, as patients, don’t know where the money goes. If everyone were losing money, the system would have changed a long time ago. Someone, or some entities, benefit largely from this lack of knowledge. The money trail needs to be exposed, and the Brill piece goes a long way to do that.
If you don’t want to worry so much about costs, visit www.bign.com/pbilodeau. Not only will it help you save money on some medical care, it can help you earn enough money, perhaps, that you can easily pay for anything you need.

Peter

INSECURITY BEGETS A SAVINGS MENTALITY

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Imagine living with such fear that a recession, an illness or bad weather could bankrupt you.
Some Americans live that way now, as do many around the world. But a few decades ago, nearly every American felt that insecurity.
New York Times columnist David Brooks, in a June 2012 column, says although the nation needs to reduce its deficit, Americans don’t really want to. Despite the political bluster, Brooks says, solving the real problem of reducing debt is fraught with political peril.
The current generation of Americans has been led to believe that debt is not a problem. They live on borrowed money, via credit cards, all the time, and think nothing of it. There is always insurance to take care of the big expenditures. Buy now, pay later. Or, pay a small premium and live without fear.
Before the plethora of insurance products, before credit cards became actual currency, Americans always lived in fear of that big event that would either kill them, or leave them penniless. The only way to postpone the inevitable was to save their money. That meant giving up a lot of things one might want, and even some things they need. People would die because they could not afford the treatment that would save them. Secure families were wiped out by drought, tornado or hurricane. There was no insurance, only self-insurance.
Even the staunchest deficit hawks don’t want to see EVERYONE, except for the very rich, living on the edge through no fault of their own. They even want room to save the irresponsible from themselves. But to do that costs money. Hence, we have a debate about government spending vs. over-taxation.
GOVERNMENT SPENDING IS DROPPING
Let’s frame the debate in reality. First, as economist and New York Times columnist Paul Krugman preaches, government spending IS decreasing, mostly at the local and state levels. Those budgets are getting balanced off the backs of teachers, firefighters, police officers and other government workers who are losing jobs at a rapid rate nationwide.
As we try to get more people back to work, every teacher, firefighter, police officer and other public worker who gets laid off ADDS to the unemployment problem. Think of what bigger cuts in government spending will do to unemployment. Would such cuts enhance the private sector to the degree that it could absorb all those government workers – plus a good number of those public and private employees already out of work? Common sense would say, probably not. That’s not even considering the PRIVATE businesses that might close as GOVERNMENT cuts more spending.
We do need to get government spending under control. We do need to get our national debt down. We need NOT to be indebted to foreign creditors, even though many of those creditors NEED a vibrant and free-spending U.S. to prosper themselves.
We see what Brooks was talking about when he referred to debt solutions as politically unpalatable. Many Americans love the idea of debt reduction, until it hits their own lives. Generations past were willing to risk everything – or at least they were FORCED to risk everything.
Today, there are things in place to cushion such risks. No one wants those cushions to be taken away, but we still have to reduce our national debt.
As individuals, we need to get our own houses in order FIRST. Eliminate, or reduce, unnecessary debt. The first rule: if you are buying something that will last years, it’s OK to borrow and pay back over time. If you are buying something to consume quickly, or in a short time, pay cash or don’t buy it at all.
The second rule: if you are a government worker, or have a private-sector job you feel will not last you as long as you want it, make sure you save as much of what you earn as possible. Then, establish a Plan B for income, so when your job disappears, you can walk out with a smile. For a great Plan B, visit www.bign.com/pbilodeau.
As for national debt, it didn’t happen overnight, and it will take time to eliminate. We have to do it in a way that hurts the fewest people. Everyone won’t escape unscathed. We will all pay for it in some way. But some ways are less painful, overall, than others. Let’s find those ways. Let’s not go back to the days when we were one uncontrollable disaster away from bankruptcy.
Peter