What Service Does A Health Insurer/HMO Provide Anyway?

In reading the below article – The Numbers and Health Care Reform – I began to ask myself a series of questions – What Services Does A Health Insurer/HMO Provide Anyway? Health Insurers/HMOs do not provide a medical or hospital service. They don’t provide lab or CAT/MRI services or Nursing Home services, in essence they do not provide ANY medical services whatsoever.

So if they don’t provide any medical services whatsoever then why do we have to pay them hundredths of Billions of dollars a year from our health care budget?? With most self-insured groups (any employer with over 500 employees) the insurer/HMO doesn’t even assume the financial risk for services. So why are we paying them Billions of dollars a year??

I am a little miffed at why Health Insurers/HMOs even exist at this point in the life cycle of the health care financing industry if they do not bring any VALUE to the patient or provider. What gives the health insurers/HMOs the right in the first place to be the financial gatekeeper for the health care delivery system? The Answer to this question is that they have NO RIGHT and there is NO REASON why they should be the financial gatekeeper for the health care delivery system

If Health Insurers/HMOs do not bring any Value to the patient or provider then why do we need them in the first place? I think that our elected officials and the Health Insurance/HMO industry should ponder these questions in light of our current health care financing reform debate.

http://www.nytimes.com/2009/09/23/opinion/23wed2.html?th&emc=th

Editorial

The Numbers and Health Care Reform

NY Times, Published: September 22, 2009

Two authoritative surveys in recent days have underscored why all Americans have a stake in successful health care reform. Too many people are being hit with relentlessly rising premiums or are at serious risk of losing their coverage to allow the status quo to continue.

A survey by the Kaiser Family Foundation found that, once again, health insurance premiums rose faster last year than either wages or general inflation. A study by the Treasury Department found that almost half of all Americans below Medicare age have gone without insurance at some point over the last decade.

The Kaiser study , conducted jointly with the Health Research and Education Trust, an affiliate of the American Hospital Association, found that the average premium for a family policy offered at work rose above $13,300 in 2009 — up from $5,800 in 1999. The average employer paid more than $9,800 of that, while the workers contributed more than $3,500. The workers were also hit with larger co-payments and deductibles, while their policies often offered fewer benefits.

The premium increase this year was a relatively modest 5 percent, far below the 13 percent rate in two previous years. But that still far outpaced a 3.1 percent growth in wages and a small decrease in inflation. Absent meaningful reform, worse is sure to come.

Kaiser estimates that, if increases revert to the average of the last 10 years, health insurance premiums in 2019 will average a whopping $30,800, which it calls “a very scary number.” More immediately, a fifth of the employers surveyed said they are very likely to increase the amount that employees pay for premiums next year.

Meanwhile, the Treasury Department’s study highlighted how vulnerable Americans are to losing their coverage.

It found that, between 1997 and 2006, 48 percent of nonelderly Americans went without health insurance for at least one month, 41 percent lacked coverage for at least six months and 36 percent were uncovered for a year or more. That happened during a decade of strong economic growth. The number of uninsured is likely to be higher over the next decade, the study warns.

The argument for reform seems clear. Americans without insurance need guaranteed access to coverage. Those with insurance need a guarantee that they will not be dropped by their insurers and will be able to buy an affordable policy if their employers decide to drop coverage. And ways must be found to slow the rise in health care costs and ease the burden of paying for insurance.