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SVTPerformance's Chain of Restaurants
Road Side Pub
Healthcare Industry Post CoVid Prediction
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<blockquote data-quote="IA Shelby" data-source="post: 16551503" data-attributes="member: 122099"><p>I don’t have the time to debate all of the opinions that have been presented as fact but I will comment on a few.....</p><p></p><p>1) premiums would remain the same if Obamacare went away..... First you need to understand what type of policy you are describing as Obamacare had very different levels of impact on different market segments. Large group fully insured policy - very little impact. Individual market - huge impact.</p><p></p><p>so let’s take the individual market. The reason why premiums skyrocketed was primarily due to the fact that the individual market went from being underwritten to a community rated, guaranteed issue product. Prior to Obamacare the bad risk could be denied and on;y good and average risk could get insurance. This kept rates lower. The ability to differentiate age band was a 5 to 1 ratio allowing you to rate older people at 5 times the lowest age rating. Obamacare changed that to 3 to 1.</p><p></p><p>if these changes went away you would be absolutely premium rates drop like a rock in the individual market.</p><p></p><p>also know that insurance companies rates need to be actuarial justified and approved by state insurance regulators.</p><p></p><p></p><p>2) in regards to UHC and their stock price...understand what is the primary driver of the profits for United Health Group. It is not health insurance. It is their Optum division which is not health insurance. Understand what they are telling wall st now. They are deemphasizing commercial health insurance and placing their bet on Medicaid and Medicare Adv<em>anatge programs and Optum.</em></p><p><em></em></p><p><em>3) providers and fee schedules....understand that unit cost (negotiated rates) is 1 leg of a 3 legged stool. The other two are utilization and intensity. And yes there have been significant increases in intensity which results in higher payments to providers. </em></p><p><em></em></p><p><em>One also needs to understand the amount of malpractice insurance that is required which requires higher payments to providers. What it also encourages is over use of tests and other medical services because providers do not want to be held liable for not running those extra three tests t<u>hat could have potentially prevented a complication or death.</u> </em></p><p><em></em></p><p><em>I don’t deny this is a massively complex industry. It has several challenges. If you recall Amazon, Berkshire and JP Morgan and their celebrity CEO’s three years ago formed a company called Haven that was going to fix this issue. Today they announced that the company is folding and will not exist in a month.</em></p><p><em></em></p><p><em></em></p><p><em></em></p></blockquote><p></p>
[QUOTE="IA Shelby, post: 16551503, member: 122099"] I don’t have the time to debate all of the opinions that have been presented as fact but I will comment on a few..... 1) premiums would remain the same if Obamacare went away..... First you need to understand what type of policy you are describing as Obamacare had very different levels of impact on different market segments. Large group fully insured policy - very little impact. Individual market - huge impact. so let’s take the individual market. The reason why premiums skyrocketed was primarily due to the fact that the individual market went from being underwritten to a community rated, guaranteed issue product. Prior to Obamacare the bad risk could be denied and on;y good and average risk could get insurance. This kept rates lower. The ability to differentiate age band was a 5 to 1 ratio allowing you to rate older people at 5 times the lowest age rating. Obamacare changed that to 3 to 1. if these changes went away you would be absolutely premium rates drop like a rock in the individual market. also know that insurance companies rates need to be actuarial justified and approved by state insurance regulators. 2) in regards to UHC and their stock price...understand what is the primary driver of the profits for United Health Group. It is not health insurance. It is their Optum division which is not health insurance. Understand what they are telling wall st now. They are deemphasizing commercial health insurance and placing their bet on Medicaid and Medicare Adv[i]anatge programs and Optum. 3) providers and fee schedules....understand that unit cost (negotiated rates) is 1 leg of a 3 legged stool. The other two are utilization and intensity. And yes there have been significant increases in intensity which results in higher payments to providers. One also needs to understand the amount of malpractice insurance that is required which requires higher payments to providers. What it also encourages is over use of tests and other medical services because providers do not want to be held liable for not running those extra three tests t[U]hat could have potentially prevented a complication or death.[/U] I don’t deny this is a massively complex industry. It has several challenges. If you recall Amazon, Berkshire and JP Morgan and their celebrity CEO’s three years ago formed a company called Haven that was going to fix this issue. Today they announced that the company is folding and will not exist in a month. [/i] [/QUOTE]
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