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Sunday, July 26, 2015

Cigna plus Aetna equals profits

Although Americans spend uncounted millions, probably billions, for health care coverage, we as a nation know very little about what we're paying for;  and it may get worse.  

In other words, we're paying for insurance to help us stay well while the companies who take our premiums want to be gatekeepers for the coverage we need when we're sick.

Health insurance profits are targeted towards to keeping people well, while collecting their (our) premiums. Contracts are signed with physicians and managed care groups who are given incentives for keeping "well" people among their beneficiaries. When people get sick, on the other hand, the plans kick in to case manage the care provided. As a result, many people who pay for wellness care find they're at a disadvantage when sickness care is needed and they're prevented from having access to high cost curative therapies. Did you ever see a health insurance advertisement featuring sick people speaking about how much they love their plans? Of course not.

On the other hand, Medicare, Medicaid, and Obamacare subsidies will pay for people who are sick and enter the plans without regard for pre-existing conditions, like diabetes.  

Now, we see where Cigna and Aetna, two big for profit health insurers, want to merge to create even more profit from providing wellness care. In other words, the plans collect your premiums for keeping you well and parcel out the coverage when you get sick.

Here's my crystal ball prediction. People who have complained about Obamacare, because they wrongly see it as government run healthcare, haven't experienced the consequences of profit driven "Aetna plus Cigna equals profits" coverage.

When health insurance companies like Aetna and Cigna are controlling the market place of coverage provided, they will destroy their competition including those plans subsidized by the Obamacare plans.  Health insurance rates will increasingly be driven by profits, rather than by patient care needs, even more so than now.

What America needs is Medicare for All. At least, in Medicare plans, the beneficiaries are given access to government websites that given them a quality analysis of their medical providers. Medicare also has public data to show the trends in health care utilization. 

In other words, a Medicare beneficiary can find out what their premiums are paying for and about the comparative quality of their providers. On the other hand, Aetna and Cigna will report some data in retrospective time of their choosing and only using their sanitized data.

Americans have little knowledge about what their health insurance premiums are providing for their benefits.  Although it's nearly impossible to educate everybody about the fine print in our health insurance laws and the coverage provided, we can at least demand that mega mergers, like what's proposed by Aetna and Cigna, be stopped. What we want are the assurances of knowing there will be competition in the health insurance industry. Most important, we need to know that those who pay the providers for the coverage we receive are looking out for out best interests rather than profits.

Medicare for All - we pay for it, we deserve it.  Stop mega mergers by "Aetna plus Cigna equals profits".



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