Wednesday, June 10, 2009

Reforming health care (Part V): Adjust insurance involvement


During the recent presidential campaign, one voice had a particularly ironic ring to it: John McCain, the GOP’s Chosen One, claimed "market forces" would solve the problem, ignoring the fact that "market forces" caused the mess in the first place. This man who’s received government-administered care all his life warned of the terrible consequences of allowing bureaucrats to control health care. With no worries about his own access to health care, McCain wants insurance company execs to continue denying care to people who need it while receiving fat bonuses for performing that odious task.

Market forces, indeed!

In the long run, the goal must be universal single-payer coverage. But as much as we want to kick those evil insurance companies out of the health-care picture, it won’t happen overnight. In the first place, it’s just not wise to tell an entire industry to simply fold up its tents and go away quietly. Such a move would create so much chaos that even the recent banking/auto scare would seem like an economic boom in comparison.

Instead, Congress should pass reforms that squeeze so much profit out of insurance involvement that companies voluntarily drop out of that part of the business. That would give them time to adjust their business models and move personnel to other departments, minimizing any resulting layoffs. Insurance businesses have a lot of irons in many different fires (pun definitely intended). They’ll find other ways to use the resources they now focus on the medical industry.

At the same time, Congress must establish a comprehensive government plan that is cheaper than private insurance. Such a policy would be so seductive that people will abandon insurance companies, hastening their decision to bail. You see, millions of people still believe private insurance is superior to government-administered care. That misconception is based on the fact that Medicare has so many holes that force beneficiaries to buy supplemental insurance to cover the gaps that were manufactured by meddling insurance lobbyists in the first place. Talk about a vicious circle!

It’ll take time to lure all those people away from tradition. But when that finally happens, for-profit medical insurance will be history--at last!

Besides the army of lobbyists and lawyers whose sole purpose is to prevent solutions to the health-care crisis, a series of anti-reform commercials is scaring people by citing rare problems from the U.K. But for every single occurrence elsewhere, there are thousands of cases of neglect resulting from bad policies on the part of U.S. insurance companies:

Insurance companies deny coverage of diagnostic tests, often leading to avoidable patient deaths.
Insurance companies deny coverage of medication and treatments, forcing patients to "just live with the pain."
Insurance companies deny effective treatments, calling them "experimental," often leading to avoidable deaths from treatable conditions.
Insurance companies require preapproval in emergency situations, hindering timely care and sometimes leading to avoidable deaths.
Then there are new-employee waiting periods and that infamous pre-existing condition clause. You know: when insurance companies deny medical care to people because they need medical care.
These and other policies are the reason Congress must set strong guidelines for insurance reform, including:

Abolish all waiting periods for coverage and restrictions on pre-existing conditions.
Patients can choose their own doctors and receive care at any accredited medical institution.
Insurance must pay for all preventive care, including regular physicals, vaccines, and diagnostic tests.
Insurance must pay for all necessary medical care, including pain medication and treatments.
All prescription medications must be covered, with no formularies allowed. Only equivalent generic brands can be substituted for a brand-name drug.
Insurance must fully cover so-called "mental" or "psychological" care, with no temporal or monetary limitations attached.
When a person becomes temporarily unemployed, their health insurance premiums would be paid by a government subsidy until they return to work.
If Congress can establish a truly effective government insurance program, in spite of all those lobbyists, then it won’t be too long before every American will be standing in line to get that superior single-payer coverage from Uncle Sam. It not only can happen, it must happen!

Rising life expectancy to help lower insurance premium


Life insurance premium rates are likely to drop over the next few months owing to longer life expectancy, with a new mortality and morbidity table expected to be in place by the fourth quarter of 2009 to replace the current one, which is of 1994-96 vintage.

The new rates will include the claim experience of individual companies and will be based on 2006-08 data.


The Mortality and Morbidity Investigating Centre, an affiliate of the Institute of Actuaries of India, plans to publish the mortality table by October. The institute has been working on the table for the last six months.


Data and statistics are currently being collected from various insurance companies though a handful of large players, including government-owned Life Insurance Corporation of India, are yet to submit data, said IAI President G N Agarwal.


With the risk perception falling, premium rates, which are based on mortality rates, are expected to fall as well. "Over the years, life expectancy has increased, mortality has come down drastically and this gives a room for the rates to drop," said Agarwal, who is the chief actuary of Future Generali India Life Insurance Company, a joint venture between the Future Group and Italy's [ Images ] Generali.


Agarwal said over the last 12 or 15 years, according to data available so far, mortality rates have come down by 25 to 30 per cent in the higher age brackets, which may translate into a reduction of 15 to 20 per cent in certain segments.


While the impact will be felt most on term covers, unit-linked insurance plans are also expected to see an impact, but only on the insurance component. In the case of endowment policies, the impact is likely to be on bonus payments on certain policies, since 8 to 9 per cent of the premium is linked to mortality rates.


"Term and savings-cum-life endowment (policies) are likely to see a reduction in premiums, while on the other side, rates on annuity products may go up. Insurers have already factored in the anticipated improvement in their mortality table," said SBI [ Get Quote ] Life Appointed Actuary Sanjeev Pujari.


The new tables are likely to provide data for various product categories and on the experience of individual insurers, since it would be based on the sex, age and geography, among other factors. At present, the tables only provide the mortality rate per thousand.


For instance, according to the Indian Assured Lives Mortality (1994-96), which has been in effect since January 2005, for people who are 40 years old, the probability of their death is 2.053 per 1,000. For 60 year olds, the probability is 13.073 per 1,000, which results in a higher premium.


The new table is expected to provide additional data by classifying customers into various segments on the basis of economic groups as well, making pricing according to their profile possible.


Pujari added that since the industry was opened in 2000-2001, private insurers have enough experience to contribute to the table.


"Some actuaries have been reducing premium rates for life covers over the last few years as life expectancy has increased. I don't expect the new table to reduce the premium rates drastically," said ICICI [ Get Quote ] Prudential Life Insurance Appointed Actuary Abhijit Chatterji.


However, actuaries said the new table would be predominantly based on LIC [ Get Quote ] data, since private insurers would not have rates for ages beyond a particular limit. Private sector insurance companies have a relatively younger client base and therefore have data for fewer age groups.


Once the tables are finalised, apart from the industry-wide data, Insurance Regulatory and Development Authority has also agreed to allow companies to decide the premium based on their experience, which would be based on their own tables.