Silicon Investor (SI) -- The First Internet Community

STOCKTALK

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor. We ask that you disable ad blocking while on Silicon Investor in the best interests of our community. If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.

Strategies & Market Trends : Mish's Global Economic Trend Analysis -- Ignore unavailable to you. Want to Upgrade?

To: Crimson Ghost who wrote (68402)	9/1/2007 4:32:01 PM
From: 10K a day	Respond to of 116555

Posted on: Friday, 9 March 2007, 09:01 CST Blecher &Amp; Collins Files Class Action Law Suit Against State Compensation Insurance Fund and Wellpoint Health Networks Today a class action lawsuit was filed in Superior Court, Los Angeles against State Compensation Insurance Fund and Wellpoint Health Networks and its wholly-owned subsidiary Blue Cross of California. The lawsuit alleges: "the deliberate and collaborate efforts of the named defendants to suppress payments made to physicians for services provided to workers' compensation ('WC') patients to artificial levels substantially below fair market value. The State of California and studies by private entities have confirmed that physicians incur significantly increased costs when treating WC patients. As a result, the State of California adopted an Official Medical Fee Schedule ('OMFS') which accounts for these higher costs. However, the surgical rates in the OMFS have not been increased since 1985. In fact, the rates in the OMFS were reduced across the board by five percent (5%) effective January 1, 2004. The present OMFS continues to under-compensate physicians significantly even after the slight increase in the rates for certain non-surgical procedures effective mid-February 2007. At the beginning of 2005, defendant State Compensation Insurance Fund ('SCIF') directly operated its own network of physicians to provide medical care to WC patients of its insureds. SCIF paid physicians in its network in accordance with the OMFS. In mid-2005, SCIF dissolved its network and required its member physicians to contract with defendant Wellpoint Health Networks, Inc. ('Wellpoint'), through its wholly owned subsidiary and operating entity Blue Cross of California ('BCC'), in order to continue to furnish medical services to WC patients of SCIF's insureds. Simultaneously, BCC, which had earlier tried, unsuccessfully, to create a WC provider network, actively tied its insurance products by demanding that physicians in its commercial (i.e., non-WC) provider network also participate in its WC provider network and, correspondingly, that physicians seeking to participate solely in its WC provider network also participate in its commercial provider network. BCC, as the operator of the largest preferred provider network in California, has substantial market power. BCC exercises that power by, among other matters, reimbursing participating physicians at deeply discounted rates ('Prudent Buyer Rates') for medical services furnished to commercial patients. The Prudent Buyer Rates overall are substantially lower than the rates in the OMFS. However, BCC reimburses physicians treating WC patients, who also maintain commercial health insurance coverage through BCC or one of its more than 300 'affiliates,' according to the Prudent Buyer Rates, and not the OMFS or any other higher schedule. The arrangements between BCC and its 'affiliates' constitute price fixing. By locking tens of thousands of California physicians into a provider network and using their overwhelming market power to extract below cost prices, defendants have created a tremendous barrier for competing provider networks to furnish medical services to WC patients. Accordingly, defendants have improperly amassed substantial additional profits because their collective action, coupled with BCC's exercise of its market power, have forced the physicians who provide a significant volume of WC patient care in California to accept clearly non-compensatory, below market reimbursement. From a healthcare delivery standpoint, defendants will, by artificially depressing reimbursement levels to some of the lowest in the country, make it impracticable for a sufficient number of physicians to treat injured workers and make it difficult, if not impossible, to recruit a sufficient number of new physicians to California." The complaint seeks treble damages under the California Antitrust Laws and injunctive relief to rectify the unlawful conduct.

To: Crimson Ghost who wrote (68402)	9/2/2007 1:15:08 PM
From: ballsschweaty	Read Replies (6) \| Respond to of 116555

<most of them have longer lived healthier populations we we do while spending less per capita.> The U.S. has the most technologically advanced medical system in the world. The reason for the lower lifespans and unhealthy population has little to do with the healthcare system and everything to do with the unhealthy lifestyle habits of most Americans. We're the fattest people in the world. By the time the healthcare system gets involved, there is no amount of pills and surgery that can reverse the damage caused by years of eating too much, drinking too much booze and not exercising enough. An ounce of prevention is definitely worth a pound of cure. The answer to the U.S. healthcare problem is not socialization. Americans need to stop eating hormone and pesticide laden bacon and get up off the couch and start exercising. Healthy lifestyle habits would eliminate about 80% of the costs while extending lifespans considerably.

To: Crimson Ghost who wrote (68402)	9/2/2007 11:45:16 PM
From: NOW	Respond to of 116555

is 24 recos a record? Great post.

To: Crimson Ghost who wrote (68402)	9/4/2007 5:39:12 PM
From: Joe Btfsplk	Read Replies (4) \| Respond to of 116555

Wow! Gone for just days and you have assembled armies of Goths, Visigoths, Vandals, and some Mongolians, angry and armed, in support of your view. While we await the crumbling of your ideology and the abject surrender of your barbarian hordes, can I offer a guess and a few observations? Obviously, there’s a bundle of intelligent and educated folks who favor government health insurance and control. Could they have been mislead? Our views on economics generally trickle down from theoreticians at the top of the information pyramid. Until recently that peak was occupied by academics who believed in the efficacy of designed economies. Experience didn’t treat their ideas kindly and the remnants are reduced to defending the idea that certain sectors can be managed. The influence of that thinking lingers. Twenty-odd years ago the Economist devoted most of an issue to a survey of health care around the globe. Different countries lead in different measures; it sticks that Singapore then lead in natal, the U.S. was middling, and Japan, with one of the heaviest incidence of tobacco use, was tops. They noted that there doctors and hospitals and insurers competed with the butcher and the baker and the candlestick maker for the consumer yen. In reviewing Britain’s NHS they featured an early 20’s young lady who waited in queue through early adulthood for correction of a serious facial disfigurement. She thought the NHS was just peachy, because it was “free”. Warring factions can pull lots of links in support of their beliefs. This is typical of those I find credible. prairiepundit.blogspot.com This piece recognizes the drag social programs have created elsewhere. Nationalized health care is often a big chunk of the problem. bizzyblog.com The market required judicious application of tort law and contract enforcement – and great humility. Its successes create expectations that interference can rush delivery of desired outcomes, aka the fatal conceit. There are vexing questions involved. We will not stand by and watch some poor child do without something as vital as needed health care. The question is how best to achieve that. Do we drive costs up, a la John Edwards, or ignorant legislators with their mandates. Or do we strive to provide for those at the margins while letting the general level of wealth go up while the market drives medical costs down? Incidentally, I also hold blind faith in groceries as a nutritional source.