Summary
Pennsylvania is a bell weather for hospital reporting in the US. The "hospital costing containment council" (I forget the name) is famous for highlighting percentage of patients acquiring hospital infections after arrival. Accountability for these very high costs lay with people managing hospitals and doctors supervising care of ancillary medical personnel, not insurance companies. Arbitrarily assigning 15% of all premium to create plan, sell plans, pay premium tax on plans, administer claims, reinsure plans, contract with providers, do customer service, and assume first dollar risk is ill advised and threatens the both profits and commercial availability of medical insurance in PA.
Analysis
"The bill also would allow the Insurance Department to disapprove a rate increase request, in part, because the insurer has not operated efficiently or has not controlled costs for avoidable hospital-acquired infections or management of chronic disease." With the notable exception of Kaiser owned hospitals, insurance companies do not control or supervise nursing. Herein lies the fundamental problem with our system - and that is a physician leadership vacuum where standards of care are not created by consensus, and policed by locally elected or appointed physician counsels. This same lack of standard making and leadership is the primary fuel for a need of defensive medicine by physicians who know no other way to "insure" themselves against poor medical outcome - regardless of malpractice.
