Obamacare was supposed to make insurance easier and more affordable. When the Senate denied President Obama the passage of the public option during the final votes, they removed the incentive to keep the health insurance programs honest in pricing. They would have needed to compete with the public option as well. If our politicians worked for us, this would have been a no-brainer. As a result, insurers markedly raised prices during the 5 years before Obamacare implementation. The government also never implemented the non-discrimination clauses written into the law allowing insurers to reduce competition and incentivize more expensive care over effective competition from less costly providers. This assured them of making even more money by using the 80/20 rule. Years later, we pay ridiculous prices for health insurance. Insurance company tactics have caused mass consolidation in the healthcare industry resulting in higher costs for us. Drug costs have also been allowed to skyrocket compared to any other country. If you get a government supplement for health insurance if you earn under 95K, ultimately we all pay for the balance through our tax dollars, and then at the end of the year, the supplement is taxed so ultimately, it is not free for those receiving a supplement either. Health insurers also have more dirty tricks on self-insured plans affecting state and local townships that are self-insured and continue to offer out-of-network benefits. We, the taxpayers are paying for this as well, and in the USA, 50% of the insurance is self-insured but managed by the major insurance carriers. What happened to out of network insurance benefits? Medicare years ago figured out that they would cover out-of-network care. The fees were slightly higher than the in-network rate. Under Medicare, doctors who saw those patients could not charge more than that limiting fee and this was a good policy for consumers. In the private markets, insurers priced us out of plans that included out-of-network coverage pushing us into their next product we could afford, which was an EPO p,lan, and then raised those premiums as well. EPO plans have no benefits if you go to a provider outside their network. If you worked for a large company or the government, many plans often continued to have a low deductible or higher deductible plan with out-of-network benefits. Doctors gamed the system as insurers often paid 2-3x reasonable and customary fees and many got around the high deductibles with ridiculous fees. Insurers did many things to incentivize patients to stay in-network but ultimately, priced many of us out of the ability to use out-of-network care even if you had out-of-network coverage. Confused? you should be. More recently, insurers sold small towns on the idea that they had a program that would reduce costs and save them money for out-of-network patients. The programs, run by Multiplan and others charged the townships more to administer the plan than they paid doctors using their Data ISight program. Other plans such as American Specialty Health also did something similar but instead of paying claims, they created denials of claims and paperwork, shifting the cost back to the patients supposedly covered out of network. In all, the public paid many of these bills to Multiplan and similar companies and had medical bills to pay that were not covered by their insurer, violating their contracts. In other words, you pay, they don’t either through taxes, or through unpaid medical bills or both. Medicare already had a model that worked and was fair for out-of-network claims. This is the amount they pay period and your deductible is low and fair for everyone. We did not need to make it a game. We already had a model that worked and Medicare patients continue to enjoy this flexibility. Insurers may not have been able to require a limiting fee although a fair and appropriate out of network fee could have been used regardless of what the doctor charged out of network. This would have simplified the system and we would likely still out out of network benefits for most plans. Insurers and Middlemen win, and Consumers lose. Medicare continues to pay out-of-network claims the same way so why can’t insurers just be doing this in a straightforward fashion? They continue to prove over and over why they cannot be trusted and are driving the cost of healthcare upward. Recently, the middlemen and some of the insurers are now the subject of lawsuits for their activities. Great, more resources going to attorneys while doctors either leave practice or consolidate and hide for cover. Again, Consumers lose. Check out the article in the NY Times regarding these programs below How Taxpayers Are Helping Health Insurers Make Even Bigger Profits Then there is Karma. The President of United Healthcare, Brian Thompson was shot to death in New York City today but the assailant has not been found as of yet. Killing the people who engineer and run these schemes is not constructive and suing their companies often takes years. The simplest way to fix this is to seriously consider expanding Medicare or adding a public option on healthcare exchanges. It would be much simpler to add people to Medicare which is a public-private partnership and scale it. Unfortunately, the damage has already been done, and fixing it requires honesty in government, and possibly something as simple as expanding Medicare to those under 65. Of course, they would compete with the inferior Medicare Advantage plans however, you would have a choice. Most of us would love to get middlemen out of healthcare with the precerts, and unnecessary labyrinth that needs more people to work so doctors can get paid. We need to simplify the system. We need healthcare coverage, not cost-shifting and lawsuits years later. Isn’t it time for our government to work for us rather than the huge corporate healthcare interests?