miami_thomas
VIP Member
- Jan 20, 2011
- 1,019
- 86
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I'm new to the board so let me introduce myself quickly. I'm a Chief Systems Analyst for a small non-profit health insurance company. I have been working in health insurance for over ten years.
When I first noticed the MLR(Medical Loss Ratio) in the beginning I really did not pay it much mind. It's purpose to me seemed pointless and felt it was just in the health care bill to make it look like it was going to keep "The Big Bad Insurance" in check. You see the MLR is the portion of the health care bill that states premiums have to be broken down by 80% medical costs and the remainder is for administration and profit. I thought to myself so that is the current break down now. I always remembered meetings where we looked at the current percentages of each and it was always around 75% to 85% for medical costs.
I was of course mistaken in that assumption. Truth is the MLR can be used for something much more. You see I was thinking in terms of just the MLR as numbers and that is not all it is. You see you can say that 80% must go to medical costs. But what is a medical cost? That is where this can become very dangerous you see the US Department of Health and Human Services gets to define what a valid medical expense really is. For now it has been made a broad definition, which the left seems to be upset about, that allows things to stay the same. However, this can change at anytime.
You see what is a medical cost? You could say a hip replacement is a valid medical cost but it is not really saving someones life it is just improving the quality of life. The same could be said for plastic surgery as well. You see the only true way to drive down health care costs is to drive down demand. I assure you this will be used eventually with this purpose in mind. It wont happen right away it will be phased in piece by piece and try to "Nudge" people into not seeing the doctor for things considered not valuable in saving a life. It could even go so far as to say that treatments that will not extend life more than 10 years is not a valid medical cost.
These definitions will not make the treatments unavailable to the patients but it will make the treatments not be covered under your health care plans. I know some will say that they would never use it in this way but I ask you should the government have the power to do it? I say no the government should not be in the business of making decisions regarding patients health. That should be between the patient and his/her doctor.
When I first noticed the MLR(Medical Loss Ratio) in the beginning I really did not pay it much mind. It's purpose to me seemed pointless and felt it was just in the health care bill to make it look like it was going to keep "The Big Bad Insurance" in check. You see the MLR is the portion of the health care bill that states premiums have to be broken down by 80% medical costs and the remainder is for administration and profit. I thought to myself so that is the current break down now. I always remembered meetings where we looked at the current percentages of each and it was always around 75% to 85% for medical costs.
I was of course mistaken in that assumption. Truth is the MLR can be used for something much more. You see I was thinking in terms of just the MLR as numbers and that is not all it is. You see you can say that 80% must go to medical costs. But what is a medical cost? That is where this can become very dangerous you see the US Department of Health and Human Services gets to define what a valid medical expense really is. For now it has been made a broad definition, which the left seems to be upset about, that allows things to stay the same. However, this can change at anytime.
You see what is a medical cost? You could say a hip replacement is a valid medical cost but it is not really saving someones life it is just improving the quality of life. The same could be said for plastic surgery as well. You see the only true way to drive down health care costs is to drive down demand. I assure you this will be used eventually with this purpose in mind. It wont happen right away it will be phased in piece by piece and try to "Nudge" people into not seeing the doctor for things considered not valuable in saving a life. It could even go so far as to say that treatments that will not extend life more than 10 years is not a valid medical cost.
These definitions will not make the treatments unavailable to the patients but it will make the treatments not be covered under your health care plans. I know some will say that they would never use it in this way but I ask you should the government have the power to do it? I say no the government should not be in the business of making decisions regarding patients health. That should be between the patient and his/her doctor.
