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The Case Against Health Insurance Exchanges

By Big Tent Democrat, Section Other Politics
Posted on Fri Apr 22, 2011 at 09:02:16 AM EST
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In a column critiquing Paul Ryan's plan for Medicare, Paul Krugman writes:

“Consumer-based” medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries. [. . . T]here’s something terribly wrong with the whole notion of patients as “consumers” and health care as simply a financial transaction.

Health insurance is inextricably intertwined with the delivery of health care. If markets do not work for health care, they will not work for health insurance either. Controlling health care costs through health insurance exchanges will not work. This is the fatal flaw of the reforms in the Obama health bill.

Speaking for me only

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    • The Case Against Health Insurance Exchanges | 41 comments (41 topical)
    You know how I feel about this subject; (5.00 / 4) (#3)
    by Anne on Fri Apr 22, 2011 at 09:37:15 AM EST
    I don't believe the legislation was ever intended to result in actual reform of the system, not when so much effort was made to protect the essential status quo.

    People don't "shop" for health care the way they do for cars or clothes or groceries; it's bad enough that the existing system has more or less forced people to do that, by restricting their ability to see the doctors they wanted to, or use the facilities they wanted to, or get the drugs their doctors prescribed.  People have been treated like cattle in the stock yards, being forced by the placement of chutes to go in pre-determined directions.

    I think the thing that really ticks me off is that the insurance industry has managed to keep alive the idea that we just can't be trusted to make the right decisions about our health, that if not corralled like a herd of sheep, we'd binge out on health care.

    Better of course for the insurance industry to be able to binge out on the increasingly higher and higher premiums being charged, right?

    More for them, less for us, and still just as offensive as ever.

    Foundational to Dr. Krugman's (none / 0) (#1)
    by KeysDan on Fri Apr 22, 2011 at 09:30:01 AM EST
    argument that patients are not consumers and healthcare doesn't lend itself to ordinary econonics lies in his following statement ..."Medical care, after all, is an area in which crucial decisions --life and death decisions--must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge.  Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussions let alone comparison shopping."

    But, to me, his argument in support of the "Medicare Advisory Board", (which, in fact, is more than advisory), is based on a target of growth in spending, which would, despite his protestations, involve rationing.  And, rationing on the basis of wealth.  Indeed, he admits as much in pointing out that you can always buy more health care with your own money, proceeding with the following Republican talking point:  ..."the last time I looked at it, the Declaration of Independence didn't declare that we had the right to life, liberty, and the all-expense-paid pursuit of happiness."

    Whether it is vouchers or with (none / 0) (#10)
    by MO Blue on Fri Apr 22, 2011 at 10:30:39 AM EST
    a Medicare Advisory Board whose decisions are based on a target of growth in spending it is rationing. Good health care will be only for those who can afford to pay for it. Seems like neither plan will be good for the majority of seniors.  

    Parent
    Agreed, and neither idea (none / 0) (#20)
    by KeysDan on Fri Apr 22, 2011 at 12:20:11 PM EST
    takes into account progress in health care treatments, and their costs.

    Parent
    Jon Walker on Krugman's post (none / 0) (#30)
    by MO Blue on Fri Apr 22, 2011 at 04:31:51 PM EST
    After all, the entire principle underlying Obama's health care law is that he wanted patients to be treated more as consumers. The whole point of Obama's push for expanded coverage with only private insurance marketplaces was to turn patients into "smart insurance shoppers." The exchanges were sold by the Democrats as a consumer-driven way to reduce health care despite, as Krugman points out, the current private health care exchanges in this country having been a total failure at controlling costs.

    Similarly, the entire intellectual and financial justification behind the excise tax was to make employer-provided health insurance more consumer-driven and price conscious. It was designed to increase people's co-pays and deductibles with the intent of making them smarter health care consumers, instead of patients that only worried about getting health. link



    Parent
    As several of us TL commenters (none / 0) (#40)
    by KeysDan on Sat Apr 23, 2011 at 11:33:01 AM EST
    have been saying since the beginning, discussion of health care and insurance has been flawed by health economics that misses the nature of health care.  Its economics and escalating costs have been treated no differently than basic economics--widgets, consumers, customers and market forces.

    And, even worse, the Obama administration planners were taken in by  the Dartmouth Atlas, and when that guidepost was found to be, charitably, overstated and misinterpreted, the administration disclaimed relying upon it. Dr. Krugman has been, at limes, difficult to follow on his health care positions. Even in the referenced article, he gets some right but, does it near fatal damage with the  "Declaration" statement that could not have been stated better by Ronald Reagan--which he pretty much did in his early and long slog as a huckster against Medicare.

    Parent

    Health Care From Hell (none / 0) (#2)
    by Upstate Dem on Fri Apr 22, 2011 at 09:32:44 AM EST
    Medicare, Glengarry Glen Ross style.

    http://partisandawn.wordpress.com/2011/04/21/glengarry-glen-medicare-a-play/

    Assuming (none / 0) (#4)
    by lilburro on Fri Apr 22, 2011 at 10:11:00 AM EST
    the ACA was a good faith effort to reform the healthcare system (and I know some people would disagree with that), what was the point of the health exchanges?  I remember Ezra lauding at some point a sort of "insurance company" review system aimed at educating consumers (here's the article).  That's consumer choice exactly.

    Pryor's amendment establishes consumer reviews for the health-care products in the exchange. This is good not just because it gives consumers information, but because it threatens insurance companies. An insurer with low ratings will lose potential customers, not to mention face hard questions from the administrators of the exchanges. It's the sort of thing that could make the exchanges substantially superior to the rest of the insurance market, though it's hard to say how much that'll matter if they remain locked to all but 10 percent of the population.

    This seemed pretty absurd to me at the time but apparently the WH and the Dems in Congress believe that consumer based health systems work.

    Part of me believes the argument "we had to pass something just to get started" on the healthcare reform effort.  I know many Dems that voted for the bill feel the same way.  But to get what we actually want (publicly provided healthcare) we have to hope the bill largely fails.  Although introducing Medicare-buy in to the market before the exchanges crash and burn could help.

    Exchanges was the wrong start (none / 0) (#5)
    by Big Tent Democrat on Fri Apr 22, 2011 at 10:15:58 AM EST
    Medicare Buy In or a Public Option was the right start.

    The health bill is as good as the expanded Medicaid funding.

    That's it.

    Parent

    I leave open the possibility (5.00 / 1) (#7)
    by andgarden on Fri Apr 22, 2011 at 10:28:21 AM EST
    that the exchange <strike>vouchers</strike> subsidies will give more people access to care. But we won't know for a while.  

    Parent
    It won't (none / 0) (#8)
    by Big Tent Democrat on Fri Apr 22, 2011 at 10:29:40 AM EST
    Might as well buy a lottery ticket.

    Parent
    Hmm (none / 0) (#12)
    by andgarden on Fri Apr 22, 2011 at 10:39:14 AM EST
    If I were that pessimistic, I probably would have opposed the whole package to begin with. Is it your view that anything purchased through the Exchange will either be unaffordable or useless?

    Parent
    Actually not true (5.00 / 1) (#16)
    by TeresaInSnow2 on Fri Apr 22, 2011 at 11:31:19 AM EST
    It will be BOTH unaffordable and useless.

    I challenge you to stop thinking conceptually about the wonder subsidies, exchanges!!! (aka miracles) Put yourself in the shoes of someone who is at about 300%-400% of the poverty line and with family.  Go out and find out how much they have to pay for their insurance before subsidies kick in (8-9.5% or more of AGI).  Research what kind of insurance max subsidies apply to (very high deductible policies). The information is all there.  Just google.  

    Then come back and tell us what you found out.  One thing to keep in mind....out of pocket maxes apply AFTER premium AND deductibles are met.

    People will basically be paying into insurance that DOESN'T give them anything but catastrophic benefit.  They will pay into something that almost never pays back out.  When their priority is making do from paycheck to paycheck, buying such insurance will make no sense.  The money they spend on premiums will result in catastrophe in other areas of their lives, like shelter, food, etc.

    Hopefully, you'll then join the "this is not reform" camp....we the realists.

    Parent

    Yes (none / 0) (#15)
    by Big Tent Democrat on Fri Apr 22, 2011 at 11:02:41 AM EST
    I supported the bill for one reason - expanded Medicaid.

    The rest of the bill was a joke.

    Parent

    Yes (none / 0) (#21)
    by Ga6thDem on Fri Apr 22, 2011 at 01:04:53 PM EST
    and anyone who has been in the individual market knows the bill is crap. Most people to get something they can afford will buy "junk" insurance. My premium from Kaiser was 10K a year with a 5K deductible for a family of four AND that was the best plan out there because none of the others offered any mental health coverage.

    We were paying at one time 6K a year for a policy with a 10K deductible that had no mental health and a 1K prescription deductible.  

    Parent

    Your use of the word "vouchers" (none / 0) (#11)
    by lilburro on Fri Apr 22, 2011 at 10:38:39 AM EST
    just depressed the hell out of me (as you're right - there's no difference between subsidies and vouchers).  Can someone explain how this system is going to work (well) again...

    Parent
    It is going to work well to prop up (5.00 / 1) (#13)
    by MO Blue on Fri Apr 22, 2011 at 10:47:29 AM EST
    the health insurance industry which was in the process of pricing itself out of the market. With the mandate and government subsidies it will be able to thrive while ever increasing its rates for its overpriced products and decreasing the actual health care costs that they cover.

    Parent
    But there are going to be (none / 0) (#9)
    by lilburro on Fri Apr 22, 2011 at 10:30:02 AM EST
    many administrative costs in setting up the health insurance exchange system and getting people accustomed to it.  The insurance companies will be delighted to know they are such a valued part of the system and won't give that up easily.

    Lots of people supported the ACA because it could "be fixed."  I hope that glib assurance proves correct.

    Parent

    It can't (none / 0) (#22)
    by Ga6thDem on Fri Apr 22, 2011 at 01:06:35 PM EST
    be fixed and that's one of the reasons I thought that passing nothing would be better than this. However, that being said it has come in advantageous when debating with wingers and telling them that Ryancare is the same thing as Obamacare.

    Parent
    Wouldn't it be better (5.00 / 1) (#28)
    by jimakaPPJ on Fri Apr 22, 2011 at 04:13:17 PM EST
    to push a single payer system based on Medicare rather than arguing that Obamacare is the same as Ryancare?

    Parent
    I do that (5.00 / 1) (#31)
    by Ga6thDem on Fri Apr 22, 2011 at 04:39:13 PM EST
    too but first it's so much fun to make their heads explode.

    The wingers around here are so much fun to play with because they all listen to talk radio and all say the same things over and over again.

    Besides, wingers hate the government so much that you'll never get anywhere with them. I've found a lot more support for single payer for people who are actually willing to debate the issue and not scream sound bytes.

    Parent

    I don't want to pop your bubble (none / 0) (#32)
    by jimakaPPJ on Fri Apr 22, 2011 at 06:37:41 PM EST
    but the Left wing is just as bad as the Right wing when it comes to mouthing platitudes and talking points.

    The major difference I see is that the Right wants to control who you sleep with and the Left wants to control what you eat, drink and smoke.

    Parent

    Depends (5.00 / 1) (#34)
    by Ga6thDem on Fri Apr 22, 2011 at 07:21:34 PM EST
    on where you go with the left wing. Yes, people like ABG who start every sentence with Barack Obama has done more for _  in three years than any other president yeah, but I live in winger territory.

    No, wingers don't just want to control who you sleep with. They want to mandate your religion too. One of the wingers here in GA wants to make having a miscarriage punishable with the death penalty so wingers really like a lot of people in jail.

    Parent

    I'll see you a miscarriage and raise you (1.50 / 2) (#37)
    by jimakaPPJ on Fri Apr 22, 2011 at 07:31:11 PM EST
    sky high gasoline prices mostly caused by Left wing environmentalists who have blocked drilling, new refineries and nuclear power in the US for the past 40 years.

    See we all have our pet causes.

    Mine is cheap enough gas to be able to drive to Walmart for our weekly shopping without having to decide what days we don't have meat.

    Not there yet but the outlook is grim.

    Parent

    We had (5.00 / 1) (#38)
    by Ga6thDem on Sat Apr 23, 2011 at 07:33:23 AM EST
    the same thing going on before there were environmentalists (high gas prices) so in reality we didn't learn our lesson. Can you imagine where we would be if we had started getting off gas in the 70's?

    And you're saying that Reagan and Bush folded to environmentalists?

    I know the price of gas is hurting a lot of people but yet nothing is being done to change alter the dependency on gas.

    I really thought Obama blew it when he didn't start building green energy plants.

    Nuclear power would be ideal if it didn't have nuclear waste. Japan shows us what can happen with that.

    Parent

    Yes, Reagan folded (none / 0) (#39)
    by Harry Saxon on Sat Apr 23, 2011 at 08:16:45 AM EST
    when he had the solar hot water system from the Cater Administration taken down because of the environmentalists.

    Nothing like revisionist history, told by a 'social liberal', is there, Ga6thDem?

    Parent

    I heard recently... (none / 0) (#41)
    by sj on Sun Apr 24, 2011 at 04:07:32 AM EST
    ... (in the wake of the crisis in Japan) that there is another type of nuclear power that is much less hazardous.  Wherever I heard/read it, it said that our current type of nuclear plants were chosen because of the plutonium byproduct and its use in atomic weapons.

    I thought "that can't be right" so I went looking.  And sure enough:

    Locked in a struggle with a nuclear- armed Soviet Union, the US government in the '60s chose to build uranium-fueled reactors -- in part because they produce plutonium that can be refined into weapons-grade material. The course of the nuclear industry was set for the next four decades, and thorium power became one of the great what-if technologies of the 20th century.

    The alternative is thorium based rather than uranium based.  This is the best article I found about it.

    After it has been used as fuel for power plants, the element leaves behind minuscule amounts of waste. And that waste needs to be stored for only a few hundred years, not a few hundred thousand like other nuclear byproducts. Because it's so plentiful in nature, it's virtually inexhaustible. It's also one of only a few substances that acts as a thermal breeder, in theory creating enough new fuel as it breaks down to sustain a high-temperature chain reaction indefinitely. And it would be virtually impossible for the byproducts of a thorium reactor to be used by terrorists or anyone else to make nuclear weapons.

    Read it and weep for what might have been.  Other nations are actively pursuing this, at long last.  As usual, the US is slow to follow...

    Parent

    Oh please (none / 0) (#6)
    by jimakaPPJ on Fri Apr 22, 2011 at 10:21:03 AM EST
    it also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.

    I just love it when someone like Krugman makes a dumb statement that the opponents of single payer plans will just turn around and insert up his nose.

    He should concentrate on developing the costs of a single payer plan and its overall economic advantages rather thank hucking Obamacare.

    He's correct (none / 0) (#18)
    by Harry Saxon on Fri Apr 22, 2011 at 11:57:02 AM EST
    Ezra Klein in the LAT:

    When it comes to healthcare, the U.S., Britain and Canada are hurting
    Healthcare in all three countries has the same problem. They just feel it in different places.

    April 07, 2009|Ezra Klein

    When asked by the New England Journal of Medicine to detail his healthcare vision during the campaign, John McCain concluded with a rousing denunciation of "new government bureaucracies that will translate into higher taxes, reduced provider payments and long waiting lines."

    ........................................

    For The Record
    Los Angeles Times Thursday, April 09, 2009 Home Edition Main News Part A Page 31 Editorial pages Desk 1 inches; 51 words Type of Material:

    Correction
    Health costs: An Op-Ed article on Tuesday said that more than twice as much is spent on healthcare per person in the United States as in any other country. The U.S. spends more than twice as much as the average of other developed nations, but not twice as much per person.

    ....................................

    Well, sort of. American healthcare controls costs in another way. Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves. So although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of those who can't afford care simply won't get it.

    When that very same survey also looked at cost problems among residents of different countries, 24% of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22% said they didn't get a test or treatment. Those latter numbers are probably artificially small: If you can't afford to see a doctor, you never know that you can't afford the treatment she would recommend. In Britain and Canada, only about 6% of respondents reported that costs had limited their access to care.

    Click or Klein Me

    Krugman has written favorably about single-payer health care, BTW:

    Why Americans hate single-payer insurance

    Because they don't know they have it. A commenter points me to this:

        At a recent town-hall meeting in suburban Simpsonville, a man stood up and told Rep. Robert Inglis (R-S.C.) to "keep your government hands off my Medicare."

        "I had to politely explain that, `Actually, sir, your health care is being provided by the government,' " Inglis recalled. "But he wasn't having any of it."

    One of the truly amazing and depressing things about the health reform debate is the persistence of fear-mongering over "socialized medicine" even though we already have a system in which the government pays substantially more medical bills (47% of the total) than the private insurance industry (35%).

    In a way, this is the flip side of the persistent belief that the free market can cure healthcare, even though there are no places where it actually has; people also believe that government-provided insurance can't work, even though there are many places where it does -- and one of those places is the United States of America.

    Click or Krugman Me

    515 words.

    Parent

    Last year we paid about $8000. (none / 0) (#26)
    by jimakaPPJ on Fri Apr 22, 2011 at 03:04:12 PM EST
    So if Medicare is government provided healthcare.....where do I go go get my money back??

    Parent
    Um, that's not what Krugman wrote (none / 0) (#27)
    by Harry Saxon on Fri Apr 22, 2011 at 03:28:29 PM EST
    But thanks for leaving off that Krugman was 'defending' Obamacare.

    Parent
    Standardize reimbursement codes (none / 0) (#14)
    by samsguy18 on Fri Apr 22, 2011 at 10:47:33 AM EST
    Until someone actually has the courage to make this decision the insurance companies...the AMA....the Pharma industry.. the device companies and the politicians will continue to do what serves their best interest. I firmly believe standardizing fees will dramatically increase the quality of care and the delivery of care. If everyone is being paid the same fee the patient will focus on finding the best care not on how much they will have to pay. Believe it or not I've had patients who felt if the doctor or the hospital charged the highest fee he must be the best !  As an example I recently had a patient with a neurological problem...she consulted three different surgeons ...their fees ranged from 5000.00 to 20000.00 for the same procedure. Krugman's statement "Politicians and supposed reformers talk about the act of receiving care as if it were no different than  a commercial transaction and their own complaint is that it isn't commercial enough " Obama's Independent Advisory Board is not the answer.Most Americans will be affected when the board Implements age limits...curbs or reduces procedures to meet budget constraints and they WILL ration  care    We need courageous reform.      

    I call that "Death Panels." (none / 0) (#17)
    by jimakaPPJ on Fri Apr 22, 2011 at 11:43:15 AM EST
    .Most Americans will be affected when the board Implements age limits...curbs or reduces procedures to meet budget constraints and they WILL ration  care    We need courageous reform.
         

    Parent
    Gee, and it's only been two years (5.00 / 1) (#19)
    by Harry Saxon on Fri Apr 22, 2011 at 11:58:05 AM EST
    that we've been hearing warnings about them, and Obama decided to make it come true.

    Parent
    The problem with healthcare is cost is (none / 0) (#23)
    by Slado on Fri Apr 22, 2011 at 01:10:09 PM EST
    not a concern for the consumer.

    I am a major consumer of health care costs.  I have had (4) major surgeries to remove tumors from my body and countless follow-ups, blood tests, CT's, MRI's on and on no need to go further into it.

    I've always been blessed to have good work provided health insurance.  

    I know at the start of one of these episodes that I will exceed my deductible.   So I know eventually I'll burn through the few thousand dollars I will be out of pocket but in the long run I'll come out ahead.

    What I've never had to worry about is what it really costs.  I show up for checkups, tests, surgeries, buy drugs and I really don't care what it costs.   Why should I?  Why should I question my doctor when he wants me to get and MRI, PET Scan and a CT (happened 3 months ago when he misread my blood results).  Why risk it?   I have no real skin in the game.   I might have to pay my share which is a few hundred dollars but I'd ask a few  more questions if it cost thousands.

    Also I never shop around to find out where the cheapest scans could be gotten, discount drugs, even a different doctor.   Why should I?

    My point is simple.  No plan deals with the problem that all consumers of healthcare (unless they don't have insurance) don't really care what it costs and that is why it is all too expensive.   The market for healthcare is inflated, wildly inflated in my opinion because of the removal of competition and the every day price influence of a savy consumer.   If you've taken Econ 101 this has been covered.   Too much demand driven by no concern of cost leads to high prices.   Demand would be lessened if people had to be somewhat responsible for what it costs.  We can argue over how responsible and what role society should play but I think we can all agree that one of the main causes of our crisis is the lack of need for the consumer to worry about price.

    The expectation that everything should be covered by insurance is ridiculous.   Insurance should be for major events (like one of my surgeries).   The office visits, blood tests and small every day health care costs that help me sleep at night should be my responsibility.  

    Until we get over the idea that everyone (in this country anyway) deserves to live for ever and have all their healthcare needs satisfied free of charge we'll never get our system under control.

    Being (none / 0) (#25)
    by Ga6thDem on Fri Apr 22, 2011 at 02:29:16 PM EST
    able to shop around only works in certain cases. I shopped around with my first child and the prices were virtually the same for all doctors in the area.

    And another problem is that who should decide on these tests? Most patients don't have the knowledge to know whether they really need them or not.

    Parent

    You bring up another pet peve of mine (none / 0) (#33)
    by Slado on Fri Apr 22, 2011 at 07:04:29 PM EST
    Again I am a unique health case but I only have my experience to draw from.

    The first time I was diagnosed I was told by two different oncologists I was terminal.

    I was lucky at the time to have a physician for a father and he refused to accept the diagnosis.   I kept looking for a doctor to treat me and eventually found one.

    Point being is we are all responsible for our own health.  Doctors provide a service.   They are not preists who offer absolution.  

    1/2 of all doctors where in the the bottom half of their medical school.   We don't treat lawyers this way.   Why do we offer doctors such reverence?

    Medical science isn't that complicated.  It is a science based on knowledge and research.  Every patient can learn about their disease or case in simple language and understand the odds, risks and possible solutions.   Don't like the answer?  Get a second or in my case third opinion.

    Somewhere in this country there is a doctor who is an expert on your case or disease.  If there wasn't there wouldn't be a name for it.

    Shop around, google and take control of your outcome.

    I'm off my soapbox.  Happy Easter.

    Parent

    Well (none / 0) (#36)
    by Ga6thDem on Fri Apr 22, 2011 at 07:27:09 PM EST
    I actually agree with the keep going until you find one that works but so many people just take what is told to them. I had a doctor almost kill me one time and the ONLY reason he didn't is because I kept screaming that I knew his diagnosis was wrong.

    Googling for medical info can be both helpful and scary. I one time thought I had skin cancer from googling and ended up having a benign skin issue. So i caused myself a lot of stress for nothing.

    Most people in this society don't seem to think that 1/2 of doctors are in the bottom of the class. We reward the bad doctors the same as the good doctors.

    Parent

    "Insurance should be for major events" (none / 0) (#29)
    by sj on Fri Apr 22, 2011 at 04:15:23 PM EST
    Hmmm.  Maybe.

    But health care, now.  That's a different matter.

    Parent

    But you can, and I'm sure you do (none / 0) (#35)
    by jimakaPPJ on Fri Apr 22, 2011 at 07:24:09 PM EST
    check the bills.

    Years ago I caught a double billing for a MRI for my spouse. Exactly same price, one day apart. About $1400 if my memory serves me right. Caught a double billing on my Mom for physical therapy to get her up and walking. About $7,000.

    No one from the insurance company or Medicare said "thanks." Of course you shouldn't need a "thanks" for doing the right thing, but I had the distinct feeling that no one really cared one way or the other.

    Maybe we need to start caring.

    Parent

    I appreciate Krugman's opinions, but he does need (none / 0) (#24)
    by BBQinDenver on Fri Apr 22, 2011 at 02:13:15 PM EST
    greater care with his facts. Yes, overall Medicare Advantage is perhaps 7% above traditional fee-for-service Medicare.  BUT there are two types of providers:  the proprietary for-profit, and the not-for-profit (which includes providers of services, such as Kaiser Permanente). The not-for-profit Advantage averaged about 97% of Fee-for-service; it was the for-profit sector that achieved charges more than 7% above Fee-for-service Medicare.  This spread should not surprise you.  It is unfortunate (and typical) that the difference in providers is [?almost] never mentioned. (and yes, I have received my care through traditional KP since 1974, and KP Senior Advantage since 2010.)

    The Case Against Health Insurance Exchanges | 41 comments (41 topical)