thehealthinsurancelist.com

A Preferred Provider Organization is a form of managed care closest to an indemnity plan. A PPO negotiates arrangements with doctors, hospitals and other providers who accept lower fees from the insurer for their services. As a result, your cost-sharing will be lower than if you go outside the network of providers. (more...)

Ultimately all health care is paid for by business activity. Business provides the wages, the return on investment, the insurance, the taxes that pay directly for health care, and the insurance and taxes that fund government programs. When the government manages to provide services at all, it can give you nothing that it does not take from you or others, or from your employer and other employers. The total added value the government creates for your benefit is nothing.

The government now uses your money to pay for 50 percent of health care. That is up from less than 10 percent, forty years ago. The increase in health care costs that has accompanied this process is largely caused by government...the actual origin of the "health care crisis," discovered and proclaimed by Richard Nixon and Edward Kennedy in 1971. Their proposed solution was more government. They got it.

The "crisis" was created by government, not just through its own reckless spending, but through the consequent destruction of much of the free market.

In a free market, if you did not have much to spend on insurance premiums, you could buy a policy that simply covers you for a major illness or a severe injury. Many people worry about the financial ruin that might result from such misfortune and want coverage only for that. They are willing to take their own risk for routine medical expenses if they have reasonable coverage for emergencies.

Such policies are often forbidden by state governments. In California, for example, such policies are not available. Legislators and regulators have imposed 49 specific coverage requirements on all insurance companies. Many states have such requirements. It does not matter if you do not want coverage for chiropractic, or in vitro fertilization, or electronic shock or hypnotherapy for mental illness...you may still have to pay for it. That is, providers in the insurance business are not allowed to offer a policy that you might want and that they would like to offer...they are forbidden. If those restrictions drive the cost of insurance up to more than you can pay, you can thank the government. Insurance policies will get even more expensive in California if the recent proposal of the Governor to require coverage of such "wellness" care as gym and Weight Watcher memberships becomes law.

There are those in the insurance business in other states who could help you with a policy that meets your needs at a cost you can afford. But they cannot, because policies from out-of-state providers are outlawed by your state government. When bills were proposed in Congress to allow for a national market for health insurance, insurance commissioners and other state officials around the country rallied in opposition, because consumers in each state would lose the protection of their state's regulations. It appears that state officials are horrified at that thought of leaving the citizens of their own states to the tender mercy of the regulators in other states.

But relief is on the way. Massachusetts passed a law that you must buy insurance with these expensive regulatory burdens or pay a fine. Isn't that helpful? California now wants to do the same thing and also wants all physicians and hospitals to pay a new tax...not on net income but on gross revenues. That will increase their billings and your insurance premiums further. But who cares?...you would have to buy the insurance, and imposing coverage on everyone is all that matters.

As Cover the Uninsured Week approaches, a new Commonwealth Fund report by researchers at the National Women’s Law Center finds that even women with health insurance coverage are more likely than insured men to go without needed health care because of costs. Also, a higher percentage of women than men struggle with medical bills.

The report, Women and Health Coverage: The Affordability Gap, by Elizabeth M. Patchias and Judith G. Waxman of the National Women’s Law Center finds that women are at a disadvantage because they have greater health care needs and lower incomes than men. More specifically, the report finds that 38% of women are struggling with medical bills compared with 29% of men. And, the high cost of health care services and premiums is forcing many women, even women with health insurance, to go without needed care. In fact, 33% of insured women and 68% of uninsured women don’t get the health care they need because they can’t afford it. In contrast, 23% of insured and 49% of uninsured men are avoiding care because of cost. Further, 16% of women are underinsured, meaning they have high out-of-pocket costs compared to their income, while only 9% of men are underinsured.

"Women are more likely than men to go without needed health care services because of costs, yet they still have higher out-of-pocket expenses. This disparity exists for both insured and uninsured women," said Waxman, vice president for Health and Reproductive Rights at the National Women’s Law Center. "As policymakers and advocates explore how to expand and improve health coverage, they should ensure that any proposal provides comprehensive benefits and low cost-sharing."

Other factors contribute to this gender gap in health care coverage and access: women are slightly more likely than men to purchase coverage in the individual insurance market which is often more expensive and less comprehensive than employer coverage. Women are also more likely than men to take prescription drugs.

"These findings show that comprehensive health care coverage that doesn’t require high out-of-pocket costs is vital to ensuring that women get the care they need to be healthy," said Sara Collins, assistant vice president for the Program on the Future of Health Insurance at The Commonwealth Fund. "As policymakers consider health care reform initiatives, they should consider plan designs that will result in meaningful, affordable, and equitable access to health care for everyone."

HMO — Health Maintenance Organization. This is a broad term that, in general, refers to any organized plan other than a traditional health insurance company that provides for your health care. Some plans are very tightly structured so that all care is provided by the HMO's employees in the HMO's hospitals or clinics, while other plans are cooperative agreements among independent doctors, hospitals and other health care providers.