Obama Care

I know, I know..... it's not perfect.  Show me a government program that is perfect.  Here's what I don't get about Obama Care.  When this first came into effect those of us employer groups that actually offer *real* health benefits to employees were asked cough up $64 per participant to cover the wave of the uninsured that were about to enter the exchanges so the insurance industry did not take a massive loss treating all those preexisting, nasty conditions (read:  expensive).

Do the math.  It does not take long to rack up $100,000 to fork over to the insurance industry to help fund Obama Care.  How unfair is THAT?  Once again, it's the employers that offer decent benefits are the ones that get **** over by the employers that don't.

For well over a decade we would hold our breath at insurance renewal time to see how badly we were going to get raked with premium increases for the coming year.  Kaiser?  20%.  Health Net 15%  blue Cross and Blue Shield?  12%.  The double digit increases were based on some convoluted formula they did not want you to figure out.  Where there's confusion, there is money.  Don't ever forget that.

I'm getting off track.  Enter Obama Care.  We get our insurance renewals this year.  WTF?????  They have STABILIZED????  We actually got a DECREASE for Blue Shield, albeit a small fraction of a percentage decrease.  It's like when somebody who has been abused for so long is no longer subject to beatings, they take the absence of beatings as a sign of improvement and caring.

Ohhhhhhhh...now insurance companies have to JUSTIFY their rate increases - at least to formal, group plans.  It's hard for them to continue to justify double-digit increases when their profits are in the kabillion of dollars.  That's good news for us, anyway.  It's great news if you're part of a group plan and not some poor, disenfranchised slob on the exchanges.  They don't have any collective bargaining power nor a healthy group paying premiums to dilute their expensive conditions.  That, my dear friends, is why we're seeing 112% increases for those on Obama Care.   Granted, I'm over simplifying the entire scenario but this fact will always hold true:  Insurance companies don't ever do anything that they think will bleed money from them.  They will take the blood from YOU.  They do nothing out of the 'kindness' of their hearts.  I don't care what their emotional, syrupy tv commercials say otherwise.  

Ambulance Rip Off

I'm telling you.... the health care industry is plagued by corruption, confusion, and greed.  I have a front row seat to this circus and it makes me ill. No pun intended.

Today I had to hear an appeal for a health plan.  The appeal was what the participant was charged directly for ambulance service here in Sonoma County and wanted us to cover 100% of the charges incurred by the ambulance company.  


We knew what the UCR (usual and customary rates) are for ground ambulance charges are and paid 85% of that rate -- the plan maximum.  What I heard today was that the ambulance service charged the participant 3x what the UCR rate is -- as the participant got a bill from the ambulance service company looking for payment on the difference that our plan did not cover.

Question:  Why is the ambulance service billing customers for exorbitant fees waaaaaaaaay above the 'usual and customary rates'?  Because people don't realize what the FAIR rate is for an ambulance ride and they are ripping people off by sending out inflated invoices.  People don't think to question what the UCR even is or that it actually exists. 

Scrutinize EVERY BILL you ever get from a hospital -- they are the worst.  Add to the confusion the implementation of Obama Care (ACA) and nobody knows what's really going on.  Nothing is working like it's supposed to.  It's an administrative nightmare.  The greedy are still trying to capitalize on human illness, suffering, and needs.  That's part of the reason why it's such a mess.  A for-monetary-gain-health system is evil.  Even Kaiser, who pats themselves on the back proclaiming "not for profit," is really for profit.  Don't be fooled for one second.  There is no limit in reserves for a non-profit organization.  Kaiser has more money in "reserves" than they can count while jacking up your premiums in double digit increments.  

And.... medical providers, pharma, dental providers, etc., are ALWAYS the first ones to sponsor and appear at our glitzy industry golf tournaments bearing raffle prizes for the drawing at dinner.  They seem to have plenty of money for that.