SCREW THE BLUES: Reform the Reform by Elyssa D. Dur

SCREW THE BLUES: Reform the Reform by Elyssa D. Durant, Ed.M. All Rights Reserved
by Elyssa D'Educrat
July 14

To learn that the CEO of Blue Cross Tennessee received a $2 million bonus is really not news at all. It is merely more of the same, and exactly what we can expect if the Healthcare Industry is expected to "curb" their spending. It just ain't gonna happen.

This is just goes to demonstrate that we MUST have immediate intervention, regulation, oversight and accountability over the Healthcare Marketplace.

I did not need another reason to demonstrate the need for immediate intervention, however for those who do, please read the excerpt below from KnoxViews:

"Blue Cross CEOs gorge on profits from premiums."

"The chief executive officer of Blue Cross of Tennessee got a big salary boost to over $2 million this year. Searches for "salary president ceo blue cross [statename]" will get you the figures for the rest of the states. To keep it simple, though, let's just assume that the 50 CEOs of each Blue Cross operation in each of the 50 states makes roughly what the top guy in Tennessee gets, Tennessee not being exactly one of the wealthiest states. That means we're looking at well over $100 million of our health insurance premiums poured into the homes, yachts, and kids' private schools of a tiny elite instead of going into the provision of health care for Americans." -Vigil Proudfoot, KnoxViews available: http://knoxviews.mobi/node/11418


Obama's plan to come to the table with the Healthcare Industry is being passed off as Healthcare "reform" is a farce. The concept of self-regulation as the newest chapter in healthcare reform effort is a joke, and my concerns continue to grow with each passing day. Since that compromise was made, have any of us seen any movement towards reform or seen our healthcare dollars get more bang for the buck?

Asking or expecting the health industry to reduce costs through self-regulation without accountability is simply ridiculous. Especially when we see reports such as these that show a CEO salary of several million dollars.

Health care is already completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.

By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.

We rely upon one the ratings of physicians who have self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.

Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.

Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like "Reasonable and Customary Rates" and then choose to pay 80% of that amount. Therefore, by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.

Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.

The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly "priceless."

Good luck to those people who actually purchased supplemental plans they saw advertised on TV, you have been duped. Giving people (especially the infirm and the elderly) a false sense of security is unfair and unjust.

Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate for "just in case" scenario that results in major, catastrophic medical loss.

The administrative cost alone on the part of the "Responsible Party" is probably more costly than the initial service they received at whatever hospital for whatever condition.

You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and should be considered a public good.


We cannot believe or expect health insurance conglomerates will control their own spending and free from government intervention. We need to do something NOW!


Elyssa D. Durant, Ed.M. © 2007-2016

"You may not care how much I know, but you don't know how much I care!"

Available online: http://knoxviews.mobi/node/11418



Elyssa D. Durant
Research & Policy Analyst
Columbia University, New York