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May 22, 2009


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I just called BCBSNC's president's $4 million per year Bob Greczyn's office. After telling his secretary that I didn't appreciate having my premiums go up by 50% in January only to see money spent on this kind of scare tactic propaganda, she informed me that it's "just information" to get "their side" of the story out.

I told her this kind of crap is just one more reason why people want a government option, because our premiums get spent on bullshit other than health care.

Joe Guarino

BCBSNC is essentially correct. A new public insurance program will threaten the viability of private insurance over the long run. And how severe the effect will be likely will depend on how it is done. But remember that the long-term strategy of those advocating universal health care has been incrementalism.

I wonder if there would be objections if BCBSNC was placing ads arguing for a larger role by the federal government in its ads.


Joe, did you not read what I wrote? After a decade in which my use of health care services was confined only to an annual physical and a four-month supply of a prescription medication, my premium was jacked up nearly 50%, from $217 to $303 -- and BCBSNC then spends money to hire a PR firm to fight against insurance reform. It is downright immoral -- I pay for access to health care, not to fund an executive's obscene $4M/year salary and self-interested propaganda.

I do not get the indifference of those who ignore the real-world anger and disgust of actual people they know in favor of adherence to an ideological preference. Next time we see each other, Joe, look me in my face and tell me you think it's preferable that I, a minimal user of the health care system, should pay $300 per month while my "non-profit" insurer pays multimillion dollar salaries to its executives and hires PR agencies to protect their interests. Look me in the face and tell me that for me, this real person you know, that is the best I can expect in this country.


What many people fail to understand is that businesses, in particular small and struggling businesses, are the most hurt by the steady increase in insurance costs. People who have insurance through their employer who also have medical problems are reticent to leave their job because of the possibility that they may be unable to get coverage elsewhere.
I may be missing something, but "freedom" is not a part of this equation. We will continue to pay higher and higher premiums, receive reduced care, and more people will drop off into the no insurance twilight zone. Is this what we really want or do we want the insurance companies to control the dialogue and the result?
The only way it will improve is if the marketplace, which is us, shows some push back and it's high time we do so.

The only way it will improve is if the marketplace, which is us, shows some push back and it's high time we do so.

One form of push back, from a mail list I'm on:

May 21, 2009

Make a Difference With Just 3 Telephone Calls -
A Personal Request from Dannion Brinkley

Health Care Reform is an issue on everybody's mind these days. As you know, I've long been a supporter of integrative health approaches to wellness, including acupuncture. Congressman Maurice Hinchey, of New York, has introduced H.R. 646, The Federal Acupuncture Coverage Act of 2009. This bill would make acupuncture available under Medicare and in the Federal Employee's Health Benefits Package. Right now there are only 18 cosponsors and no Senate companion bill.

For this reason, I am asking you to pick up the telephone this week and call your two Senators as well as your member of the House of Representatives. Please ask them to co-sponsor HR 646 in order to get it passed this year. It is imperative that members of Congress recognize the value of acupuncture along with other effective integrative health techniques. They also need to be made aware of the desire of their constituents to see it included in any health care reform activity. Only Congress can add a therapy to the Medicare benefits package. Moreover, it is likely that if this Administration goes forward with a public insurance program it will be modeled after Medicare.

The telephone number for the switchboard for the Capitol is, 202-224-3121. Please place your calls between 9 am and 5 pm Eastern Standard Time.

Ed Cone

Roch, I think your example is telling, and your passion is laudable.

However, last I checked, Joe is also a real person -- and one who practices medicine -- frontline, preventative medicine of the sort we'd all like to make more available.

Sure, he's got strong political views. Such are not uncommon around here. Maybe the conversation would be more productive if the real person test was applied in all directions.

Joe Guarino

Roch, I insure my entire family of four with BCBSNC with an HSA plan for approximately $450/month. And there are a couple of medical problems in my family that may be more costly than what you seem to be describing that you had.

I am concerned that BCBS is attaining near-monopoly status in NC. But Red Clay Citizen pointed out this is partially because of all the state insurance mandates we have in NC. When you have a lot of state health insurance mandates, it drives out potential competitors. It would be good if we had better insurance competition in our state among private insurers, but state government is the barrier that prevents that from happening.

In the meantime, however, more economical options for coverage likely exist.


Aw, aren't you a sweetie pie, Ed. When you see me promoting an ideology at the expense of Joe's humanity, you let me know. Until then, I'll ignore your patronizing scolding.

Ed Cone

Thanks, Roch, for taking to heart my oft-repeated pleas for a modicum of civility in the comments! Have a super weekend!!


I wrote about this here.

Joe is right, the so-called public option would dramatically shift the landscape of private insurance. They'd (continue to) cherry pick profitable customers, focusing on those who have the resources to pay for premium service. In the meantime, risks in the public plan would become more broadly shared across the general population, as already happens with Medicare.

If you put public health care out front as the goal and mission, a public option becomes part of the solution. If you put the survival of today's insurance companies as the prime directive, well, the whole discussion is moot. They're surviving just fine and nothing needs to change.


Krugman's main point is that the insurance industry initially pushed that they were for a move towards more universal health insurance, but since then have quickly retreated. Is anyone disputing that? It would be as if Joe G. talked about being pro universal care, and then talked about how it would lead to chaos in medicine - give Joe credit for consistency and openness about his opinions.

When quoting percentage increases in premiums, they should be compared to increases in health care costs in general, or how much an insurance company pays out per-person, or per-family. If health care costs increase 10%/yr, premiums need to increase at the same rate.

Joe, have medicare and medicaid made private insurance nonviable? Part of this is moot. Hospitals already provide treatments that they will not be fully reimbursed for. To a large degree those costs are borne by people with private insurance, and the gov't through medicare/medicaid. Standardizing that system and shifting away from emergency and towards preventative care is a good start.

I heard BCBSNC is really concerned with their relationship with state govt employees and are worried that those large pools might move to the govt option.


“The fact sheet on the meeting, one has to say, was classic Obama in its message of post-partisanship and, um, hope. “For too long, politics and point-scoring have prevented our country from tackling this growing crisis,” it said, adding, “The American people are eager to put the old Washington ways behind them.”

“But just three days later the hospital association insisted that it had not, in fact, promised what the president said it had promised — that it had made no commitment to the administration’s goal of reducing the rate at which health care costs are rising by 1.5 percentage points a year.”

“Indeed, it’s now clear that even as they met with the president, pretending to be cooperative, insurers were gearing up to play the same destructive role they did the last time health reform was on the agenda.”

How does paragraph 1 and paragraph 2 lead logically to Krugman’s conclusion in paragraph 3? Does the “fact sheet” in paragraph 1 expose paragraph 2 as a lie? I don’t know. I wasn’t at the meeting and I doubt he was either, but he is leaving unconnected some pretty important factual dots in backfilling his article to support his ideologically predefined conclusions.
But then why should that surprise anyone?

Destructive role? What got destroyed in 1993 other than Hillary’s role as unelected co-president?

His default assumption is that Obama speaks only truth and that everybody else in the “Medical Industrial Complex” (how clever and original )is lying. If anyone has a link to this fact sheet (if not a figure of speech)or other accounting of what was agreed upon at this meeting, I would appreciate it. My attempts to locate it were unsuccessful.

Main blog post:

It appears that Obama thinks that he can work with insurers & hospital groups, but insurance groups are lobbying against some of Obama's goals. Krugman is mostly critical of Obama for hoping that aligning goals would actually make goals align.

CP, if providing insurance for those who don't have it is not an idea that can be destroyed, then, yeah, nothing happened in '93.


de·stroy [di stróy]
(past de·stroyed, past participle de·stroyed, present participle de·stroy·ing, 3rd person present singular de·stroys)
1. vti demolish: to demolish or reduce something to fragments
2. vti ruin: to ruin or make something useless
3. vti abolish: to abolish, rescind, or end something

Encarta ® World English Dictionary © & (P) 1998-2004 Microsoft Corporation. All rights reserved.


WS, that last post was somewhat childish and unappreciative. Thank you for taking the time to find the links.

Joe Guarino

James, the survival of "today's insurance companies" is not the primary objective for those opposing a new public insurance option. Instead, it is the preservation of the private system of health care. Some of us-- providers and consumers and taxpayers-- don't want to be forced to a more socialized system and all that will entail.

Winston, Medicare and Medicaid have not made private insurance non-viable. But they each serve very discrete, defined populations. Even then, however, government pays about 50% of the health care dollars in the US right now, if my recollection serves me correctly. A new public insurance option offering coverage to the uninsured will siphon even more away from the private system; and its existence will prove irresistible for many individuals and families. In addition, employers would become less likely to offer coverage, if there is a public option, unless they are absolutely required to do so-- which raises another set of issues. It will be very difficult for private insurers to compete with a public program that will likely be cheaper (and subsidized by tax dollars).

Again, incrementalism. You also have the military system, the VA system, SCHIP's and the public health system biting off discrete populations under governmental models. So it is not just Medicare and Medicaid.

Dave Ribar


Insurance is almost always socialized or it isn't insurance. Insurance "works" by pooling risks across people who face uncertain health shocks; that pooling is the socialized part of it. Other things held constant, bigger pools (more socialization) mean better insurance.

Small fragmented pools lead to a problem called adverse selection. People who have higher needs for insurance (because of worse health, age, lifestyle, etc.) demand it, but by demanding it they signal potential insurers that they have higher needs. The insurance market breaks down, and you have lots of uninsured folks. The problem is especially severe for anyone that can't join a pool that is set up for non-health reasons, like a set of employees or a union. NC already partly recognizes this problem by subsidizing a high-risk health insurance pool.

Unfortunately, bigger pools bring problems of their own. The biggest is that this usually means fewer insurers (concentration), which in turn means that the available insurers have more market power. More market power means that insurers can pressure providers and customers.

In the end, we face an unpalatable set of choices. A broken market, where many people are left uninsured, or a more socialized market, which can provide more insurance but leaves the insurers--public or private--with undesireable amounts of market power.

As we've seen with Medicare, Medicaid, and the VA system, "more socialized" medicine can work and provide higher levels of care than would otherwise be provided. It's far from perfect (look especially at the VA system), but it's better than the alternatives.


But Joe .... what if populations are better-served by the alternatives? A dear and deeply conservative friend of mine recently -- and reluctantly -- caved in to the high cost of his health insurance and turned to the VA. He's diabetic, and his premiums in combination with his meds were breaking him.

To his great chagrin, he likes the docs better, says he gets more attentive treatment, and will save thousands annually. It's killing his conservative soul.

His profession? He sells group health insurance.

Joe Guarino

Dave, I don't think of private insurance as "socialized". It collectivizes risk, yes, but is not socialized.

While you indicate that Medicare and Medicaid seem to have worked well, in fact, governmental involvement has had a tremendously inflationary effect. For those that decry the cost of care, that should be a big deal.

TL, I am not sure we can assume that populations will be better served than the alternatives. Rationing and delays in treatment are not always a great deal. But a conservative would argue that, as a matter of principle, that should not be the deciding factor, because governmental involvement should be minimized. But I think there are probably free market alternatives that are superior to the current system, and superior to higher degrees of socialized medicine.

While it is understandable that certain individuals will turn to the public system in desperation, or to save money, that does not make a more public system a better choice for the wider population.

Ed Cone

" a matter of principle...governmental involvement should be minimized."

But if another system works better than minimal government involvement, aren't higher principles served?

A healthier population is a freer population.


A little late to the conversation but nonetheless on point about BCBS - there is a law in NC that prohibits groups like the Chamber of Commerce from advocating for group health insurance that would combine a bunch of small businesses into one larger business to get larger business rates and benefits. Of course, that would lower the costs for health insurance for small business (the cost is the major reason many small businesses don't offer health coverage). Instead, I pay 3+ TIMES what Roch states above even AFTER his rate increase. My family's insurance costs went up 25% this past January. Do the math.

It's the insurance lobby that is spearheaded by BCBS and UHC that keeps that horrid and anti-business (except their own) law in place.

They're paying lobbyists with my (and Roch's) premiums. And their PR agency.


[[ It's far from perfect (look especially at the VA system]]

Phillip Longman already has.


the current system is absolutely broken and, i never thought i would say this, but if everyone had medicare my life would be a lot easier. right now it seems as if every test i order needs "approval", every surgery i do for private insurance needs authorization. 28 cents on every dollar goes to either profits or administration of private insurane. the cost for medicare is 2 cents on every dollar...for a 60,000 dollar a year salary an employee in new york would have an average family plan is a cost to the company of 20,000 a year. this would represent a 33 percent tax on a 60,000 salary, a 20 percent on a 100,000 salary and a 100 percent tax on a 20,000 salary. presently, a 3.8 percent tax is able to insure 44 million members on medicare. an additonal 16.2 percent payroll tax should be able to provide coverage for everyone, including the 40 mil uninsured. present this to a ceo who would pocket an average of 8000 dollars on each employee
it will be the greed of bizness that will ultimately push for the government option, this would provide them with greater earnings a better stock price etc etc

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