This is an extremely good article written here by Wendell Potter who worked many years on the other side before he retired and saw the real picture of what is happening in healthcare.  He states there are 28 people representing consumers and at least a thousand lobbyists there for insurance firms.  He says everyone is waiting in the hallways as the meetings are locked up and no press and lobbyists inside.

Wendell Potter Tell All Book–Deadly Spin–One to Put On My List as “He Knows Algorithms and How they Create Profits”

“It is at these closed-door meetings that some of the most important discussions are taking place, and decisions are being made.”  These are the results that bring out the champagne on Wall Street, when you reduce the amount you spend on medical care and make your customers pay more. “

The NAIC has to figure out which company functions qualify for the medical loss ratios so every administrative function does not get added in.  I can see a whole lot of topics on that one and one I wrote about before was their venture capital arms and we should be sure that those gambles are not under the area of patient care, even if it is medical technology, it’s still an investment and not a direct action.  Blue Cross for example invested in those add supported tablets in doctor’s offices but again this is an investment and not actual care like getting a shot.

BlueCross BlueShield Venture Capital Firm invests in Phreesia

Wendell Potter says they are trying to get just close to everything under the sun covered and perhaps this kind of pressure is why the CEO of Aetna is retiring as Wall Street and the way the algorithms of profit work is that they want the least amount of money spent on care and as he states here, they consider money spent on care to be a loss!

And Now A Word From Wendell Potter About Healthcare Reform and Medical Loss Ratios..

Mr. Potter continues on to describe the flurry of lobbyists that were sent out all over the country prior to this meeting too.  Coming full circle here he further states that the big profits from United may actually help the consumers and give the insurers less of a leg to stand on. 

You know this is really ugly and again one reason health insurers should not be traded on the open market and should go back to being non profits as this really sucks.  Even being represented here being outnumbered as consumers with only 28 and over 1000 lobbyists is nowhere near being fair.  I glad I read this one today and use the link at the end to see the entire article, good stuff.  BD

Health Insurers Sending Big Dollars to the GOP–The Folks Who Largely Lack General Consumer Digital Literacy And Health IT Literacy As Relates to the Power of Algorithmic Formulas

Here’s a related video that goes over some of what is happening. 

Insurance Lawyers Finding More Loopholes

ORLANDO -- If you are hopeful that the consumer protections in the health care reform law actually wind up benefiting consumers more than the insurance industry, please send a thank-you note to executives at UnitedHealth Group, the largest U.S. health insurer.

United announced Tuesday morning that its third-quarter profit jumped 23% -- much more than investors and analysts had expected -- largely because it spent far less of its customers' premiums on medical care than it did this time last year. When an insurance company spends less of every premium dollar it takes in on medical care, it has more left over to reward shareholders and a handful of senior managers who already are among the highest-paid executives on the planet.

United's announcement is cause for joy because maybe, just maybe, the nation's state insurance commissioners -- whom Congress gave the responsibility of determining how major parts of the new law will be implemented -- will finally realize that they don't need to give the big insurers the truck-sized loopholes they have been lobbying so hard for over the past several weeks.

It could turn out that UnitedHealth will help consumers the same way the nation's second largest insurer, WellPoint, did several months ago when it announced that it was hiking premiums as much as 37% for many of its customers in California. The news coverage of that proposed increase so outraged members of Congress that they mustered the gumption to finally pass a reform bill that, until then, seemed to be on life support.

The more they can get the commissioners to write the often obscure but critically important rules in their favor -- even if those rules violate the health care reform statute -- the happier it will make Wall Street. That is what is really going on here. It is as simple as that.

Wendell Potter: Thank You, UnitedHealth Group. Your Jaw-Dropping Profit Announcement May Be Just What the Doctor Ordered.


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