Health Insurance

I have nightmares that I'm going to wake up, and everyone's driving a Prius and living in a condo, and we're all getting health insurance - Kid Rock

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How hospitals could kill the health insurance industry

Some of the world's most powerful retailers have been brought to their knees in recent years thanks to the "Amazon effect." The internet juggernaut has simply been able to provide almost all the goods consumers can buy more conveniently and has effectively taken over the retail industry. It appears people like Amazon (AMZN) founder and CEO Jeff Bezos saw this opportunity all along, and precious few retail investors saw it coming.

But is there is a similar disruptive event on the horizon here in the U.S. when it comes to something just about all of us have to buy? When it comes to the controversial and increasingly all-consuming market for health insurance, the answer appears to be…

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Featured

Insurance Policy

How an industry shifted from protecting patients to seeking profit.

Luigi Mangione, UnitedHealthcare, and the American Health Care Scam

Nowhere is the scam woven more tightly into our cool national fabric than in health insurance. The arrangement of our health finance system is lethal and inordinately expensive. Here, alone among peer countries, sickness makes you poor, poverty makes you sick, and any fever, fall, or freak accident, nor matter how slight, can quickly become a ritual of humiliation, degradation, bankruptcy, or death. Few are spared and none are distant. Over 20 million Americans have started a GoFundMe crowdfunding campaign to address medical costs; one in five American adults have donated to one. Only 12 percent of these campaigns reach their goals. We all know what happens to the losers: debt, if they’re lucky; death, if they’re not.

The Failures of the Health Insurance System

The problems with private health coverage are not things that marginal changes can fix. They are inherent in the system. Health insurance corporations don’t make money by providing care; they make money by denying payment. They benefit if a high-cost patient gets fed up and takes their business to another company.

Articles of Interest

The Tonic Guide to Healthcare

A comprehensive, easy-to-follow FAQ about getting medical care, whether you have good insurance, bad insurance, or no insurance at all.

Amazon will expand its Amazon Care on-demand healthcare offering US-wide this summer

Amazon is apparently pleased with how its Amazon Care pilot in Seattle has gone, since it announced this morning that it will be expanding the offering across the U.S. this summer, and opening it up to companies of all sizes, in addition to its own employees. The Amazon Care model combines on-demand and in-person care, and is meant as a solution from the search giant to address shortfalls in current offerings for employer-sponsored healthcare.

Choosing a Health Insurance Plan Is Not ‘Shopping’

This is not shopping. Shopping is a fun activity, like choosing a pie from the bakery or picking out cereal at the supermarket. The farthest thing from “shopping” is the arduous annual ritual of reviewing the complex and all but impossible to decipher health insurance options.

Does Anyone Really ‘Love’ Private Health Insurance?

I am alive today not because of insurance companies but despite them.

Health Care Is Broken. Oscar Health Thinks Tech Can Fix It

The goal of Oscar is to do to health care what Uber did to the taxi industry: use smart digital technology to make everything faster and easier for customers, and then use the data gathered to build radically new services, which can collect more data that leads to new services. (Ideally, Oscar would like to accomplish this without cracking as many eggs on its own head as Uber did.)

How American Health Insurance Got So Infuriating

The U.S. spends almost twice as much as comparable wealthy countries, including those with private insurers, on healthcare. Cracking down on insurance companies can only go so far in rectifying the disparity. That is because the bulk of America’s health bill stems from the high cost of hospital services, drugs and care in general. Even if we were to eliminate insurer profits, we wouldn’t make much of a dent in the high cost of U.S. healthcare. But that doesn’t mean the insurance system can’t work better.

How Health Insurers Can Be Heroes. Really.

The industry is profiting from the pandemic. It needs to pay back by cutting premiums and co-payments, help private practices and finance more protection and care.

Insured, but Not Covered

It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills. But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.

Prepare for buyers' remorse when Biden/Harris nationalize health care

Assuming we have a Biden/Harris administration in 2021, U.S. health care policy will take a hard turn to the left, all the way to nationalization. Americans should prepare themselves for buyers’ remorse. To those who might stop reading here, note the following: Every change in health care described herein was publicly asserted verbally or in writing by prominent Democrats.

The Health Insurance Shell Game

Focusing primarily on cost, costliness, and administrative priorities takes the health of the “health care system” as the primary goal. It is a focus that provides no measurable advantage in caring for people. Persisting in this approach, and even expanding it, provides a temporary diversion, but not a solution. Neither the practice of medicine nor its infrastructure is the reason for medicine to exist.

We are all complicit in the big lie of health insurance

We demand limits on spending even as we hold that life and health are priceless.

Can Amazon, Berkshire Hathaway, and JPMorgan Revolutionize Health Care?

Jeff Bezos, Warren Buffett, and Jamie Dimon have decided to start a health care company. At this point, nobody has any idea what it will actually do.

Covid-19 Will Transform Health Insurance as We Know It

With mass unemployment looming, the U.S. must find new ways to guarantee health care for all—or risk bankrupting states and hospitals.

Even Doctors Are Frustrated With Health Insurance

The killing of a top health insurance executive outside a Midtown Manhattan hotel this month triggered an outpouring of public anger at private health insurance companies. WSJ’s Julie Wernau reports that many doctors are among the aggrieved. And two doctors explain how dealing with health insurers is getting worse.

Focus On Health Coverage Misses The Point

Whenever the newest proposal to overhaul health care is introduced and scrutinized, the focus always turns to how many people will “lose” their health-care coverage. That’s because hospital and insurance lobbies have done a brilliant -- if self-serving -- job convincing lawmakers and media that coverage is the issue. Only it’s not. Lack of coverage is a byproduct of the real problem -- cost.

History Of Employer-Based Health Insurance In The U.S.

So how did the U.S. end up with an employer-based system instead? Well, our colleagues over at NPR's history podcast Throughline wanted to find out. Their latest episode tells the story of the battle for health insurance in the U.S. It's long and complicated, and it could have ended up another way.

How the Molina Brothers Got Bounced From the Family Health-Care Firm

Molina Healthcare’s former CEO called his removal from the company his father founded a ‘palace coup,’ but investors had been dissatisfied with the insurer’s uneven results in an industry unsettled by the Affordable Care Act.

I'm sick. It's not my fault. And I shouldn't have to pay more for my health insurance

Sick people should not be blamed for their illness.

Insurance start-up Oscar seeks to shake up healthcare through its app

Welcome to Oscar Insurance Corp., a Silicon Valley-backed start-up promising big changes to the cumbersome healthcare industry through its sleek mobile app.

Maternity Insurance for Pregnant Women

The American Pregnancy Association is a national health organization committed to promoting reproductive and pregnancy wellness through education, research, advocacy, and community awareness.

National Health Insurance - 50 Million Reasons

Despite the advent of Obamacare, most estimates indicate that about 50 million Americans remain uninsured. So, why can't the United States insure all its citizens like the rest of the industralized world?

ObamaCare, Is There a Fix?

It’s not defunding ObamaCare or granting everyone the current ‘federal worker option’ or even socialized medicine. Just ask our neighbors, the Canadians.

Obamacare: Good Medicine, Bad Politics or the Other Way Around?

Many people believe that the U.S. health care system is “sick” and needs resuscitation. But, doesn’t the United States deliver some of the best medical care in the world? And for heaven’s sake why would even Canadians cross the border for medical care when they already have a system envied by many? So, why Obamacare?

Should Health Insurers Cover Infertility Treatment?

Laws in 15 states mandate that health-insurance providers cover infertility treatments, and there's a push to make it more. But should health insurers be required pay to for a service unrelated to ensuring health?

States Look at Establishing Their Own Health Insurance Mandates

At least nine states are considering their own versions of a requirement that residents must have health insurance, a move that could accelerate a divide between Democratic states trying to shore up the Affordable Care Act and Republican states intent on tearing it down.

The inside scoop on your health insurance and the American Dream

Washington political machinations focus far too much on rearranging the deck chairs on the health care Titanic. History shows us that all great societal challenges -- whether they are civil rights, energy independence or better food -- are solved bottom up. It's on us to solve the problem. There is a growing DIY health reform that is restoring the American Dream one community at a time.

They Hated Health Insurance. So They Started Paying For Each Other’s Care.

When Geoff Perlman’s 20-year-old son broke his arm in December 2022, the bill was paid by strangers who chipped in to cover the costs. And rather than paying a monthly premium to a health care company, Perlman writes a check each month, never exceeding $420 for his family of four, to foot strangers’ health care bills, covering part of a pregnancy for one family or chemotherapy for another. Perlman, a 61-year-old tech CEO from Austin, Texas, is a member of CrowdHealth, a health care startup that seeks to replace health insurance with a crowd-funding model that the company says lowers costs and diverts money from insurance conglomerates to real people

To Understand Your Health Insurance Policy, You Must First Learn These 4 Terms

With all of this chaos, is it any wonder that most Americans don't understand their own health insurance policy?

Trump’s New Health Plans Are Only Cheaper Because They Offer Less Coverage

Most short-term coverage excludes benefits for maternity care, preventive care, mental health services, or substance abuse treatment.

UnitedHealth's Optum To Escalate Growth As Provider Of Medical Care

We expect Optum to be an increasingly disruptive technology, moving more care to outpatient and the home and owning more physician practices and practice patterns.

Where is Managed Care Now?

The challenge of managed care today is not whether we should be for it or against it. The alternative - totally unmanaged care - comes with the price tag that neither the public sector, nor the private sector can afford. Global economic competition and the impending retirement of the baby boom generation means that neither corporations nor taxpayers can go back to the old fee-for-service, use-whatever-you-want system.

Why Do We Have Health Insurance Companies Anyway?

Some doctors argue that their patients would fare better paying out of pocket.

Why Public Health Insurance Could Help, Even if You Don’t Want It

It is anyone’s guess whether Democrats will unite around the goal of creating a single-payer health care system or even take a less ambitious approach — introducing a public health insurance option. Adding public insurance as an option in the complex American health care system has been treated as a consolation prize for those who really favor single-payer health care, but the lighter approach might pack much more punch than you might think. What’s more, the best way to see that is by looking at the Indian labor market and the Mexican grocery market.

Why So Many People Choose the Wrong Health Plans

If you get health insurance from your employer, you have to make decision every year about which coverage to choose. So here is a warning: If you are simply sticking with an old plan with a low deductible, that may well be a wrong and costly choice.

Resources

24 Health Insurance Terms Explained in Plain English

Learn what premiums, deductibles, copays are and how they work together.

FAIR Health

Get essential information on costs for thousands of procedures and learn insurance basics.

MediBid

MediBid is an online marketplace which is about quality, choice, and value. Many insurance companies show you no more than whether your doctor is “in-network” or not. MediBid allows you to see the training, education and experience of the doctor before you make your selection.

AHIP

AHIP advocates for public policies that expand access to affordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality, and innovation.

California Department of Managed Health Care

There are several things you can do if you have a problem with your health plan. First, contact your health plan to file a complaint. (A complaint is also called a grievance or an appeal.) You can file a complaint with your health plan over the phone or in writing. You may also be able to file a complaint on your health plan's website. If your health problem is urgent, or if you already filed a complaint and are not satisfied with your health plan's decision, contact the Help Center at the Department of Managed Health Care (DMHC). An urgent problem is a serious threat to your health. You can also file a complaint with the Help Center if your HMO does not make a decision within 30 days.

Council for Affordable Health Insurance

The Council for Affordable Health Insurance (CAHI) is a research and advocacy association of insurance carriers active in the individual, small group, HSA and senior markets.

InsureBlog

Updated Blogs on Insurance Issues, Principles, and Solutions.

InsureKidsNow.gov

Insure Kids Now! is a national campaign to link the nation's uninsured children -- from birth to age 18 -- to free and low-cost health insurance.

Lumity

We relieve the pain of company health plan and benefits decisions. Save money and deliver better outcomes for everyone.

National Committee for Quality Assurance

NCQA's Health Plan Report Card is an interactive tool designed to help you find the health plan that's right for you

National Patient Advocate Foundation

National Patient Advocate Foundation is a national non-profit organization providing the patient voice in improving access to, and reimbursement for, high-quality healthcare through regulatory and legislative reform at the state and federal levels.

ObamaCare Facts

The ObamaCare Health Insurance Exchange Marketplace opened Oct 1st, 2013. The ObamaCare health insurance exchanges, or ObamaCare exchanges, are online marketplaces for health insurance. Americans can use their State's "Affordable" Insurance Exchange (also known as a marketplace) to obtain coverage from competing private health care providers.

Office of the Patient Advocate

Our site will give you tools to get the most out of your medical care, including a Report Card on the top HMOs and medical groups in California. Our goal is to help you make informed decisions about your health care and to become your own best advocate.