rivaridger1
08-17-2016, 04:09 PM
I think it well to start a new thread on this topic with a slightly different slant. First of all my wife and I, like many of you, have also been given the " boot ". We are mad, first of all because one of is chronically ill and the insurance choice offered to remain in the Villages Health system does not work unless we want to commit economic suicide. Secondly, we are even madder at ourselves for having bought into the Villages Health model based on representations made at the time implying a long term trusted patient/primary care doctor relationship was to be established. ( What other kind can there be ? ) We should have known any implied representation made by commercial entity that makes its money by building and selling houses was somewhat suspect. My bad !
For those that think us naïve and want to cite the standard rhetoric about how no commercial enterprise
can stay in business without producing profits, we understand your point and actually agree with you. We just happen to think there are some special human relationships wherein moral considerations transcend pure profit motives. We include doctor/patient and laity/pastor among those.
With that out of the way, let's look at the Villages Health organization, it's original promoters and the overall concept from the perspective of a health insurance company owned by stockholders. As a for profit health insurer my primary responsibility as an underwriter is to select and price risks which have a better then average chance of producing an underwriting profit. In the insurance business this is sometimes referred to as " cherry picking ". The underwriting profit consists of whatever money is left over after I have paid all the medical claims submitted as well as the administrative expenses of running my company. Obviously, the better the risk quality obtained through " cherry picking ", the greater the chance of profit.
Now lets say someone comes to my health insurance company promoting the idea they can establish a medical clinic system built around servicing the medical needs of one of the largest and continually growing populations of younger healthy active seniors in the United States. All I have to do to add this group of " cherry picked " insurance risks to my books is design a specialty insurance plan priced attractively enough to have them willingly give up their existing insurance coverage. A little " pro quid quo " incentive might be necessary as well to assure the financial stability of the medical clinics but that is in the interest
of both the promotors and the health insurance underwriter. If as a consequence of some of the restrictions incorporated in the specialty insurance plan, the chronically ill are forced out, so much the better. They are not desirable risks anyway and represent more claim expense. The end result is, as a health insurance company this looks like an awfully good deal for me in the short term, so I sign on to it.
As for the Villages Health system's decision to initially accept those patients who initially applied to become patients without the " correct " insurance, well that is just a calculated business decision to achieve critical mass. Once reaching that, the healthy ones will buy into their specialty insurance plan and those chronically ill in need of broader access to medical care will go elsewhere. No harm done and the young healthy active senior model reinforced.
There is however one potential ' glitch " in this rather idyllic scenario and I wonder if the Village Health system and particularly the promoters have thought about it. All of the young healthy active seniors participating in the system will age and as they do eventually suffer the medical maladies associated with doing so. The Villages itself in a year or two is built out ( so much for the continually growing ), meaning no further huge influxes of young healthy seniors. ( Yes, I know all about the expansion down by the new turnpike ramp but still have problems believing something three miles away can be successfully incorporated into " The Villages " particularly for the purpose of the residents seeking medical services north of 466 ) I really do not think the population of the new owners of re-sales over the next ten years will ever equal in number the population of new home buyers during the past ten years. Does anyone else ?
What this means for the Villages specialty health insurance plan now so attractively priced is more and larger medical claims. I think you can safely assume the largest for profit health insurance company in the United States has thought about this and will do all that is necessary to protect its financial interests. In the scheme of health insurance the size of the Villages Health Advantage Plan(s) is the pimple on the pimple on the elephants posterior and is of little consequence to this organization in the long term. At the moment there are a few bucks to be made by them, later maybe none at all.
Just some food for thought.
Please no troll comments. It is an honest opinion with just a smidgeon of logical thought behind it, I think.
For those that think us naïve and want to cite the standard rhetoric about how no commercial enterprise
can stay in business without producing profits, we understand your point and actually agree with you. We just happen to think there are some special human relationships wherein moral considerations transcend pure profit motives. We include doctor/patient and laity/pastor among those.
With that out of the way, let's look at the Villages Health organization, it's original promoters and the overall concept from the perspective of a health insurance company owned by stockholders. As a for profit health insurer my primary responsibility as an underwriter is to select and price risks which have a better then average chance of producing an underwriting profit. In the insurance business this is sometimes referred to as " cherry picking ". The underwriting profit consists of whatever money is left over after I have paid all the medical claims submitted as well as the administrative expenses of running my company. Obviously, the better the risk quality obtained through " cherry picking ", the greater the chance of profit.
Now lets say someone comes to my health insurance company promoting the idea they can establish a medical clinic system built around servicing the medical needs of one of the largest and continually growing populations of younger healthy active seniors in the United States. All I have to do to add this group of " cherry picked " insurance risks to my books is design a specialty insurance plan priced attractively enough to have them willingly give up their existing insurance coverage. A little " pro quid quo " incentive might be necessary as well to assure the financial stability of the medical clinics but that is in the interest
of both the promotors and the health insurance underwriter. If as a consequence of some of the restrictions incorporated in the specialty insurance plan, the chronically ill are forced out, so much the better. They are not desirable risks anyway and represent more claim expense. The end result is, as a health insurance company this looks like an awfully good deal for me in the short term, so I sign on to it.
As for the Villages Health system's decision to initially accept those patients who initially applied to become patients without the " correct " insurance, well that is just a calculated business decision to achieve critical mass. Once reaching that, the healthy ones will buy into their specialty insurance plan and those chronically ill in need of broader access to medical care will go elsewhere. No harm done and the young healthy active senior model reinforced.
There is however one potential ' glitch " in this rather idyllic scenario and I wonder if the Village Health system and particularly the promoters have thought about it. All of the young healthy active seniors participating in the system will age and as they do eventually suffer the medical maladies associated with doing so. The Villages itself in a year or two is built out ( so much for the continually growing ), meaning no further huge influxes of young healthy seniors. ( Yes, I know all about the expansion down by the new turnpike ramp but still have problems believing something three miles away can be successfully incorporated into " The Villages " particularly for the purpose of the residents seeking medical services north of 466 ) I really do not think the population of the new owners of re-sales over the next ten years will ever equal in number the population of new home buyers during the past ten years. Does anyone else ?
What this means for the Villages specialty health insurance plan now so attractively priced is more and larger medical claims. I think you can safely assume the largest for profit health insurance company in the United States has thought about this and will do all that is necessary to protect its financial interests. In the scheme of health insurance the size of the Villages Health Advantage Plan(s) is the pimple on the pimple on the elephants posterior and is of little consequence to this organization in the long term. At the moment there are a few bucks to be made by them, later maybe none at all.
Just some food for thought.
Please no troll comments. It is an honest opinion with just a smidgeon of logical thought behind it, I think.