Reader Comments of the Week

Mary Carroll wrote:

“I’ve been a licensed producer for 30+ years and an insurance professional for nearly 40 years, and I have a string of letters (including CEBS and CPCU) after my name. There’s a pretty simply solution to the MLR problem: charge a fee for your services.

“Though I felt ‘improved Medicare for all’ would have been a cleaner approach to health care reform, I opposed that because it would have put several hundred thousand insurance agency/brokerage employees out of work, and I care about the folks who do the kind of consulting work that I did for many years. But demanding that the MLR be lower so you can go on collecting (unchanged) commissions is simply dumb.

“Is your expertise worth two or four or eight percent of premium? Sell your clients! And if you can’t sell that fee, perhaps your expertise isn’t as valuable as you think. I understand the problem: under a commission system, some clients are paying more than the services they receive really justifies, while others demand so much that no commission would adequately support that level of service. But you’re simply going to need to be straight with your clients and tell them what the services they want cost…”

In response to Tragic Tale

David Paul wrote (via e-mail):

“I could find no fault with the thoroughness of the article, and your writing was, as always, superb. I was left, however, with a nagging sense of, “Well, that was an engaging human interest story, but what’s Bill’s conclusion?” I imagine it is that our healthcare delivery/financing system remains broken, and largely because it is, in your words, “a Wall Street-run system.” A secondary conclusion seems to be that PPACA has done little to redress its serious faults. But don’t most of us who grapple with this subject on a regular basis already know this?

“I’d be interested to know, if you could wave a magic wand, the three or four changes you’d make to rectify/perfect our healthcare system. Here is my attempt:

1. Instill in human beings a greater sense of personal risk management. 

2. As a corollary to #1, instill in people the vital importance of obtaining life insurance, disability insurance, LTC insurance, and/or dread disease coverage (more risk management).

3. That said (#2), I would instill in corporations/business people/shareholders/(I guess all of us) a more measured sense of equitable distribution of wealth.

4. Grow the number of non-public health carriers in the country, preferably on a smaller scale, local basis.  I especially like the model where integrated healthcare systems control the financing as well. 

5. If you will indulge me in a #5: do more with catastrophic reinsurance.  When/if insurers purchase excess of loss coverage on a per occurrence basis, they share the costs of these high severity/low frequency cases much more broadly and worry less about the money lost and more on the patient. “