yzerman19

You're getting into actuarial science now...there are probabilities tied to every scenario. The $100 per month probably has a $10,000 deductible and an 80/20 coinsurance arrangement. It is more than just averages in the actuarial rating tables, but to answer your question, the "average" commercial population annual cost for healthcare is about $4000 per person per year. Remember there is a ton of variation around that number. Some people get cancer and run $1 million, ortho surgery and hit $30k, cardiac surgery hit $100k

Physician comp models were very often based on production as you describe- ever wonder why their are so many MRI machines out there... This is why the hope is around ACO type arrangements based on total cost and shared savings models.

With you that bonuses regardless of performance are gross. I still don't know about the insurance commissioner's interpretation of "premium" it might be a convenient usage of the term. As a monopoly, the senior execs and the board should've managed this better. Talent is mobile, and if you can't provide a commensurate comp package, you will lose talent. Would we rather have BCND be in Fargo or get rolled into Wellmark or Blues of Minn or HCSC (like Montana)? If you want to keep it local, you have to provide the comp to do it. Otherwise you lose the players and the business-

So RVUs (relative value units) are tied to CPT (common procedural terminology) codes. Most healthplans pay providers based on RVUs times a conversion factor. RVUs are basically a representation of the amount of healthcare resources tied to a service- complexity, etc. This methodology is intended to better control costs than the old, old world of discounts off of billed charges (usual and customary). In the old world, providers determined their payment from insurers almost entirely through their chargemasters. If they were in a financial pinch, they just raised their charges, and the allowed amounts went up. RVU based payment helped change that, but resulted in volume driven and high-end specialty care driven practice, which also ended up raising costs. Neither system works very well. Global payment in managed care did help stem the cost growth, but it was unfriendly to consumers and good doctors/NPs/PAs

40k will be subsidy eligible. Remember what I described about loss ratios though- don't blame the insurer, blame the healthcare provider. 85 percent of that premium is going straight through to hospitals and clinics, more like 90 percent plus on self-insured. So, the insurer could work for nothing, and assuming all else equal (in other word providers will still manage care and offer deep payment concessions) and your $1000 premium just dropped to $850-$900. In reality, that $100-$150 saved a ton in negotiated discounts. Having $100 per month after bills are paid is a function of being too highly leveraged. This is a societal problem. It is also a function of asset inflation outpacing wages for twenty years.

Yeah- I think one key thing is that I do not believe anywhere in their mission or charter or the mission or charter of any non-profit healthplans is there a goal about the uninsured. There is an incentive for insurers to want more people covered, as "charity care" that providers perform for those without insurance just gets baked into their cost structure and negotiated back into the rates they collect from insurers. Sales folks are always incented with bonuses (a lot of them make really low salaries and earn a decent living through commissions/bonuses alone), and the financial services industry is built around bonuses. Insurance historically was more part of financial services than it was health, and bonuses are a big part of that industry's compensation. I did read that the article claims premiums, but I am taking it with a grain of salt due to a bias that most reporters don't understand the nuances of the industry. The hotel investment is an interesting move- the issue there is what was the goal and what funds were used? Insurers have to carry huge reserves (Risk Based Capital) in order to pay claims in an emergency. They are generally required by State law and the Blues also have by-laws requiring a certain level of solvency. Clearly you don't just leave the money in a savings account, so perhaps the hotel was part of a broader investment portfolio? Again- Blue Cross of ND had issues- big ones. I think that they paid their CEO way too much for a plan their size. They also operated in a virtual monopoly.

I appreciate your point of view and agree that ND Blues had some serious issues. $15 million in employee bonuses over 5 years is an average of $3 million per year...If they have 1000 employees that is an average bonus of $3,000 per person...that is pretty small. Even if I am misinterpreting and the $15 mil was one year, that is still only $15,000 per person- spread across all levels of staff, again that isn't that substantial. Although, I don't know what their total comp packages look like- lower salary, better bonuses or whatever. Of course it isn't a vacuum. And again, I would guess some big chunks of that are paid through ASO fees (so not premiums) and through Noridian services (again not premiums)

You would be pooled with everyone- healthy, unhealthy etc. The premium (if you don't qualify for a subsidy) will likely be somewhere between $500 and $1500 a month depending on the benefits you choose. In the current world, a healthy person who is willing to take a very high deductible can buy a policy for $100 or less a month, a person with cancer would be denied. This was done to keep insurance affordable for the masses, not for profits. Community rating will drive those prices way up for healthy folks, but it will also create options for the otherwise uninsurable (although in some states like Minny a high-risk pool subsidized by the state already existed)

So here is the insurance company dilemma- hospitals and clinics demand hefty payments or they go out of network (non-par), so insurers continue raising reimbursement rates to maintain the network (would you buy an insurance policy in Fargo with neither Sanford nor Essentia?). Then large employers say its too expensive, so they build benefits (usually with the assistance of highly paid consulting houses) that "cost-shift" to the subscriber- i.e. raise the deductible, so that the subscriber has more out of pocket liability. This move manages the employer's health care cost trend, but jacks up the employee's share. For many, many years insurers have taken these arrows, when really this was all about the employer and the consultant, the insurer was really a silent partner in that regard. On the fully-insured side, once one plan moves to a high-deductible, and creates the product with the lower premium, all the competition will move there too, because people are price sensitive, and that is the single biggest lever you can pull in insurance design, you now have a race to the bottom on benefits. Adding to it is the risk-selection bias, where you really like healthy folks who tend to be fine with high deductibles. As for insurer "profits" be sure not to confuse revenue and profit. Insurance is not a high margin game, especially in ND/Minny with the dominance of non-profit plans...no Wall Street to please means lower prices and lower margins. We in the upper midwest are fairly insulated to the healthcare crisis in other parts of the country. A trip to Hawaii isn't that great a bonus...$5000? Not a ton for an incentive for hard work. It isn't charity. You are correct that the sole community provider impact to medicare reimbursement from the Feds would've substantially impacted Altru. Their response would've been to negotiate higher rates with the private insurers, raising costs. Furthermore, a limited amount of healthcare services would've been split between two entities. Neither hospital would've been viable as a result...too much overhead, not enough revenue- unless, again, they negotiated astronomical payment amounts. The economics of healthcare are perverse. Competition tends to raise healthcare costs. At the end of the day in the US, we already have a two-tiered healthcare system and it is only going to get more divided under Obamacare...

Its the opposite in healthcare- you pay list price (or if you're lucky a slight discount) without insurance. WIth insurance the total payment is significantly less. That is the biggest benefit to having insurance- you are paying significantly less for healthcare services than you would if you were to just stroll into the hospital or doctor's office. Billed charges are pretty much irrelevant in healthcare- "allowed" amounts are what drives the payments. Other important things to note. Most insurance (60%-70%)is ASO (administrative services only) or what your employer would call being self-insured. In this regard, your employer sets the benefits and takes the risk on claims costs- the insurance company simply processes claims, prints membership cards, and gives you access to their discounted payment rates within their network. In this space, the insurers make very little to no margin. This is a great benefit to the employer, and was created by federal law. It takes the profit out of insurance in that space. Benefit changes under Obamacare which will require coverage for certain things will not benefit the insurer- it will simply cost your employer more. On the fully-insured side, insurers take risk and still make profits (think of this like the casino). However, Obamacare is requiring "community rating" meaning that the insurance company has to bet the same whether or not you are a good bet or a bad bet. In healthcare, like everything, the 80/20 rule exists. 80 percent of people drive 20 percent of healthcare costs and vice versa. Now if you have to bet the same, you split the middle, meaning costs go up for 80 percent of people and down for 20 percent of people. This money will not go into the pocket of the insurance companies, but rather through the insurers and out to providers (hospitals, clinics, etc). The required medical loss ratios (MLR) require this. MLR is the percent of premium paid out in claims, and is also governed under the affordable care act. As for your penalty for no insurance, that is NOTHING- when's the last time you heard someone was in the hospital and it cost less than $10,000? At that rate it would take 20 years (time value) to break even on that $600. One of the problem with the affordable care act is that the penalties are way less than the cost of an insurance policy...incenting people to not buy insurance until they are sick, and just paying the penalty. WIth "guaranteed issue" you can do this, and in the process completely disrupt the function of insurance. Health insurance is expensive, because healthcare is expensive. The brains on the knowledge workers in the industry, the devices, the imaging equipment, the drugs...it costs a lot of money. That money has to come from some where. 40 years ago it was common for people to die in their 60's, and 50's were old. We've easily added 10 quality of life years over the last 40, and that costs a lot of money.

of course there are exceptions at times during games...Dave doesn't approach the game like Jaques Lemaire, Scotty Bowman, or Mike Eaves is what I am getting at. It is not our strategy to trap in order to win.

1. We've never played the trap- not a left wing lock nor a 1-2-2 not even a third man high 2. As I stated on another thread, dump and chase is not a strategy, it is a reaction play on entry 3. The cycle...I'm as sick of it as a human being can be Rocco is very dynamic, but let's be realistic. You don't change up your team for one player. We didn't do it for Parise or Toews (as special as any players can be) we aren't going to change up to accommodate Rocco.

Why not? With his season over he's probably having some fun...probably has some buddies in GF...

At Rangers games they still chant "Potvin sucks"...even when they aren't playing the Islanders...

I meant in the PWR at the time...I thought I remember seeing them pretty high up in the PWR before they laid the egg in the ECAC tourney

Weren't they a two seed going into the conference tournament though too? Or at least towards the end of the regular season?

1. Undrafted 2. 5-10 178 in the 1990's NHL Pretty dominant scorer in the minors- Probably a victim of being a role "tweener," timing, and not being a draft pick

interesting to look at drafts in retrospect...in the 2009 entry-draft, Seth Helgeson was selected before? A. Corban Knight B. Jordan Samuels-Thomas C. Erik Haula D. NIck Jensen E. Anders Lee F. Nic Dowd G. All of the Above Answer...G

I never saw this year's UND team demonstrate that they could compete like that...in fact, Agostino and Miller looked ever bit as capable as Kristo and Knight. In terms of straight up ability, I thought that big horse Jordan Samuels-Thomas and Matthew Pecca- both of Quinnipiac looked like two of the best players that i have seen play all year- I thought the Miller-Agostino line was phenomenal- PERFECT hockey in the tourney I thought Johnny Geadreau was the most individually offensively skilled kid I saw play all year- followed by Pecca and Kristo Nick Bjugstad, Anders Lee, and Jordan Samuels-Thomas were NHL men playing in the NCAA- physically dominant with some paws, I can't imagine a line made up of those guys Stephen Johns and Danny Dekeyser make my all NCAA shut-down pairing- again, men playing NCAA NIck Jensen and Jacob Trouba were the best all-around d-men in my opinion

The way Yale played in this tournament, they beat this year's UND team 7 outta 10. Yale beat the #2 overall seed and WCHA champ Gophers, our team, the #3 overall seed and Hockey East champ Lowell, and the #1 overall seed and ECAC champ Quinnipiac- they were the best team in the country when it counted. Quite frankly, I don't think this year's UND team could've beaten the Yale, Lowell, or Quinnipiac teams I saw in the this tourney on a regular basis.

Telling ya, being the totally disrespected underdog lit their fire...a very good team with something to prove becomes an unbeatable team

Pellerin?

no doubt- Toews is probably the best 2-way center in the WORLD Osh never spent a minute in the AHL- he went to the NHL as a top-6 forward, and scores 18 goals and makes some big checks I have compared Danny's skill set to Drew Stafford- but Drew was a first rounder and is big... Danny put up solid numbers at the WJC which generally translates very well to the pro game. If you don't even go back to the two super stars you brought up, Danny and Corban were second line on the Pony Express team...

NEVER have I posted that Danny Kristo is my "hero"- and I'd actually agree with you that Kristo will never be Parise or Toews at the next level- Where I disagree with you is around him toiling around in the ECHL- If you are talking pro-prospect, Danny's a 2nd round pick, which, with his skill set, probably gives him about a 33% chance of making it as a career NHLer...

Its probably all he could get...he is not a big-time NHL prospect. Not meant to rip him, but much like Duncs, he had a great year in college, but isn't destined for a Parise or Toews NHL career.