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Health insurance and the quality of healthcare

One of the more influential of the non-profit organizations that studies the healthcare market is the Commonwealth Fund. It has just published a survey of healthcare, looking at issues of access to preventive and the usual medical treatments, the availability of insurance, and cost, quality and treatment outcomes including mortality rates in communities across America. Alarmingly, there were major differences even within large cities that could literally be the difference between life and death, with the general conclusion that healthcare was in serious trouble. The Fund sends a warning message that, unless there are real and serious commitments to improve, the general standard of care will fall and the number of preventable deaths will rise. However, there's a further issue flagged that needs some consideration. If you look at the availability of healthcare insurance, there were fewer companies offering cover in the areas where the level of poverty were highest. In some areas, only 5% of the population is uninsured. In some parts of Texas, more than 50% of the population has no insurance.

This failure of insurance companies to even have a presence in some areas is disconcerting. It reflects a profit-oriented judgement that there will not be enough business to justify the cost of employing local representatives. Instead of companies viewing their role as providing a social service, they only look for the size of the market. This means entire communities either have no access to insurance or, effectively no real choice as to the insurance provider. Worse, there's also evidence the insurance industry has no incentive to use its significant financial muscle to keep control over the cost of healthcare. Given that it's the paymaster to hospitals, physicians and the pharmaceutical industry, it could represent all the policyholders and lay down formal guidelines as to the price it will pay for access to treatment. Instead, it accepts all price rises and passes those increased costs on to the policyholders through the rising premium rates. The insurers do not care so long as they continue to make a profit.

Given the importance of poverty in the findings of the Fund, there will come a time when the middle class cannot afford to buy individual health plans and employers decide not to offer group plans as a part of the remuneration package. At this point, presumably, the insurance industry will see it as in their interests to protect their policyholders and force the healthcare industry to reduce its prices. Until then, it seems there will be no effective limit on the premium rate rises that affect policyholders every year. This points up the serious failure in the Affordable Care Act. While it does take steps towards making health cover more accessible to more people, it failed to control costs. Even though more people will be brought into the healthcare net, the longer term picture is rising costs payable by all policyholders. Health insurance should be a right to all citizens. Or, if you prefer, it should be affordable to all except those below the poverty line. But the reality is that the preventable death rate is rising and the health insurance quotes rise every year you look for renewal savings. There should be a major political debate on how to protect us in this situation.

Welcome to Regulation 194 which has just been approved by the New York Court of Appeal. Agents and brokers have just lost the case and will now be obliged to tell residents of that state how much they will earn a commission from any sale they recommend, and whether there are any terms and conditions that will make their commission higher or lower. That now puts all agents and brokers advising and selling financial products on the same footing. This is transparency in action. Now you might reasonably ask whether similar laws are in operation in other states. After all, government is supposed to protect consumers from any criminal practices. Well, remarkably, these rules are not so common. There are no federal rules requiring disclosure. It's expected you will protect yourselves. How are you supposed to do that? Well with the internet, you can get free health insurance quotes before you go see an agent. Armed with this information, it's obvious who's offering the best value. If you fail to do this before seeing an agent, you are asking to pay a high price for your health insurance plan .


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