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Health Insurance Hell
The big fault line in the healthcare debate right now is over the "public option" — a proposal that people should have the option of getting healthcare coverage from either a private insurance carrier or from a government program. Conservatives are worried that this would put too much pressure on private insurers, but Michael Hiltzik asks the obvious question: who cares?
The firms take billions of dollars out of the U.S. healthcare wallet as profits, while imposing enormous administrative costs on doctors, hospitals, employers and patients. They've introduced complexity into the system at every level. Your doctor has to fight them to get approval for the treatment he or she thinks is best for you. Your hospital has to fight them for approval for every day you're laid up. Then they have to fight them to get their bills paid, and you do too.
....Why do we tolerate this? The industry loves to promote surveys indicating that most Americans are "satisfied" with their current health insurance — 37% are "very satisfied" and 17% "extremely satisfied," according to one such study.
Yet these figures are misleading. Most people are satisfied with their current insurance because most people never have a complex encounter with the health insurance bureaucracy. Medical care generally follows the so-called 80-20 statistical pattern — 20% of patients consume 80% of care. If your typical encounter is an annual checkup or treatment of the kids' sniffles, or even a serious but routine condition such as a heart attack, your experience is probably satisfactory.
But it's on the margins where the challenges exist. Anyone whose condition is even slightly out of the ordinary knows the sinking feeling of entering health insurance hell — pre-authorizations, denials, appeals, and days, weeks, even months wasted waiting for resolution.
Sounds great to me! Why would anyone want to change this s
ystem?
Health insurance is a weird industry. Healthcare itself is provided by doctors, nurses, hospitals, pharmaceutical companies, hospices, and device makers. Insurance companies do none of this. They don't do research, they don't perform surgeries, they don't change bedpans, and they don't make diagnoses. They're just middlemen. All they do is pay the bills after marking them up 30%. They don't do anything at all to make healthcare better or more efficient.
But for some reason we're supposed to care about whether they continue to exist or not. Why? I care about the quality of my doctors, my nurses, the hospital I go to, and the drugs I take. I don't really care who takes on the administrative task of paying the bills — except that I wish they were handled a lot more efficiently and with a lot less hassle than private insurers typically do. Frankly, a world without private healthcare insurers sounds pretty good to me.
And as long as we're reading the LA Times, they've got a nice piece by Michael Rachlis, a doctor in Toronto, about the Canadian healthcare system. Guess what? It's pretty good! It's not the system I'd choose — in particular, I think public funding should provide a basic level of healthcare but patients should always have the right to pay more for better care if they want to — but it works as well or better than ours for a fraction of the cost. Read the whole thing for more.
Kevin's ignorance of Canadian Health Care
I hate to disappoint you Kevin, but in Canada one can pay more to get "better" coverage. And this is usually done thru a private insurer and quite often it is the employer who provides this extra insurance as a perk.
Example: My 86 year old mother. As a result of the additional insurance that my Dad got thru his employer my Mum has insurance coverage to pay for a private room when she is in the hospital (basline coverage puts you in a ward with 4 people to a room), insurance to pay for dental bills (this is not covered under Canada Healthcare), eyecare,
extra chiropractic care, etc.
I am utterly confused as to why people so routinely bash the Canadian system for delivering health care. Having spent my first 28 years in Canada under that health care system, and the next 23 years in the US confined to whatever health care my employer-chosen insurance company provides, I would chose the Canadian system every day.
Here in these good old United States - I have a limited choice of doctors - I must use those in the insurance company network. Great, I suppose, if you are a male, but I would much rather prefer to have a female primary care provider. Ya think my insurance company cares? No.
Here in these good old United States - Maternity isn't always covered under an insurance plan. Mammograms and PAP tests are limited to once every two years. But heh, treatment for erectile dysfunction is available 24/7/365.
"Here in these good old
"Here in these good old United States - I have a limited choice of doctors - I must use those in the insurance company network."
No, you don't! My favorite doctor is not covered by my health plan. He is considered cutting edge in his field and handles many very high patients whose names you would know. When I visit him, he gives me a discount and free drug samples to treat my illness. He is LESS money than my HMO. When my son and I are both sick (single parent here) he charges for one but treats us both. I'm currently out of work, but spent the $80 to see him anyway and was well within days.
I will lose his services if we go to national healthcare.
Why would you lose him if we go to so-called "national healthcar
e"? If you currently go out of network to visit him and he accepts you and offers you a discount, why would that necessarily change? I'm not totally behind what is being offered but your comment doesn't seem to make sense; would you care to expand on your reasoning so I can better understand?
Of course in Canada you
Of course in Canada you don't get to have a favorite doctor. And why my mother in law had to go to Seattle for an MRI and a mammogram, I wouldn't know. The U.S. health care system is more advanced than Canada. Erectile dysfunction? Not that many weenie Canadian men would care anyway, eh?
More Horsebleep!
Of all the thousands of lies, falsehoods and propaganda about the Canadian system published south of the border, not being able to chose a doctor brings the biggest chuckle but its one I read about often on blogs and websites.
Its about as accurate as the 911 terrorists coming thru Canada story (even McCain believed that one)
Now for sending mother in laws to Seattle, I'm all in favor - just make sure its ONE way :p
great doctor
I work for BLUE Cross Blue Shield, and the health care in this country need to be fixed.
I guess you have medical insurance, good for you and I hope you wont be billed $20,000 for medical care because your insurance will pay a portion. Then, no make complain about US healthcare.
Gimme open enrollment for medicare!
The only way you would lose your doctor is if he refused to see you. Why do you think that would change?
health care
you should stop repeating lies like, you'll lose your doctors services if we go to national healthcare. you either aren't listening to whats being said about the public option or you just lieing for the insurance co.'s. what benefit could you possably recieve from stopping all americans from having health care.
?
Where did you find the information that you would lose access to your doctor under "national healthcare"? I can't see anything in the current proposals that would cause that. The Democrats pledged to let patients keep their current physician at no extra cost. It would allow your doctor to spend more time with patients and less filling out insurance forms required by the existing system. Doesn't that make better sense?
How do you know you will
How do you know you will lose his services under a national healthcare system? By the way, I find $80 to be expensive for a doctor's visit compared to the $25 I used to pay in France (that's without supplemental insurance). And I never had to rely on a doctor's "handouts" (until I came to the US) for medication, because it was always affordable in the first place due to pharmaceutical regulation. And there is no such thing as an in- our out-of-network provider - You get to see whomever you choose, whenever you choose and wherever you choose. You can switch doctors from one day to the next if you want to; there is no waiting period at all.
So obvious it's sad
Well said. It just shows you how far the cult of the marketplace has taken control of the American psyche when obvious points that Kevin just made are invisible to the majority of citizens. Instead, we are told that high administrative overhead for an essential service is a wonderful thing that should be protected at all costs. And most people seem to agree.
That's what the reformers are up against.
"are invisible to the
"are invisible to the majority of citizens."
Yeah, we just so fucking dumb. I'm so happy we have all you smart people to know what's best for us.
Yes, most people are really
Yes, most people are really fucking dumb. Ask any salesman. Do you believe otherwise?
It's a burden to us.
By the way, "Yeah, we just so fucking dumb." needs a verb. Or, were you just being colorful as well as dumb?
Your post speaks for itself and yourself
Enough said, whoever you are. I'd be ashamed to identify myself with that crappy post, too.
______________________________________________________________
If I would have known I was going to live this long, I would have taken better care of myself.
~~~ Eubie Blake, as attributed by Mickey Mantle, and many, many others.
Principled conservatives
If there were any actual principled conservatives out there, people who actually believe in totally unfettered capitalism instead of corporate welfarism, then they would be arguing for a system where consumers pay producers directly; they'd be all for everyone paying for their own healthcare directly to doctors and hospitals. It would be a horrible system (I can't decide whether it would be worse or not to our current system) but for conservatives at least it would be consistent with what they supposedly believe.
____________________________________________
Principled conservatives
Why would paying producers directly be such a horrible system? Its how we worked for 200 years, before 1958 when the Unions started this third party payer system for health benefits.
It would be a horrible
It would be a horrible system because if you had to pay the provider directly (without either public or private insurance), a catastrophic health issue would wipe you out financially. That happens under the current private health insurance system when a private insurers try to weasel out of coverage by refusing the pay, but at least in theory, health insurance should prevent against killer costs by spreading risk across many insureds.
Catastrophic mistake
First of all, we don't have our choices now. There is no free market. The so-called market is boogered up with government requirements. Insurance is expensive because single males are required to buy pregnancy coverage, for example, in some states.
But as far as direct payment, it would be possible - if it were to remain legal - to buy catastrophic insurance while paying for day-to-day services directly. Not horrible. Just another choice.
I even do this now for my 24 year old son. I pay for his doctor visits. I also pay $50 per month for an insurance policy (with Aetna) that pays for medical bills over $5000 in one year. Catastrophe averted for only $50 per month.
$50 savior insurance
I truly hope your son never has to rely on that Atena policy. I personally found that the insurers lawyers make sure the company is healthy, not you. It is called greed not Health Care.
Sorry, unions had little to
Sorry, unions had little to do with the advent of health insurance. It came out of the wage and price controls of WWII. Labor was scarce (we were killing them) and wages were frozen so fringe benefits were some of the only inducements available to employers. It wasn't taxable income so the guys on top wanted it as well only more so. Hospitals and MD's had a deep pocket source of income so chains of hospitals with corporate motives and IPA's sprang up to keep prices high. The insurance companies responded by putting together PPO's and HMO's to control costs. There is plenty of blame to go around but to lay it all at the doorstep of the "Unions" is ignorant, simple minded and agenda driven.
Union Role Important.
Most of your facts are correct, but they don't support your conclusion. Unions had voluntarily agreed to a wage freeze while the war was raging. Union leaders advocated for employee health care, and they had been. Perhaps most prominent was UAW President Walter Reuther. The circumstances of WWII were favorable to negotiate for this benefit. But unions had a lot more than "very little to do with it".
principled conservatives????
I've got news for you Aris....consumers ARE paying providers....just not directly. If you choose to pay a number of bureacrats (public option) or administrators (private insurance) that then turn around and pay the provider...go ahead. You're just going to pay more in either event than if the recipient payed the provider and didn't have ANY middlemen. One only really NEEDS insurance to cover catastrophic events; that's what insurance should be for. You forget that HMO's and other private insurers arose from our last great government healthcare venture...MEDICARE! That worked out well.
health care
that is just one lie piled on top of another. your just another shill for the insurance co.'s
And your statement is a Red Herring...
But then, there really is no intelligent argument in favor of universal healthcare coverage - shy of indirect support for communitarianism.
Medicare works well
I have been on Medicare for more than six years. During that time I have had my share of serious health issues. There is no doubt in my mind that Medicare has been the best health insurance that I have ever had and supposedly I had among the best private plans.
Medicare, unlike the private plans that I had are unobtrusive. No worry about precondiitions, no concern about preapprovals and no concern about ever being turned down for needed care.
Under my private health insurance it was always a concern and often a struggle to get them to pay.. even when I was preapproved.
My advice to America: MEDICARE FOR ALL!!!
Medicare for all!
Medicare for all is where we should be heading without a doubt. Why this is not a proposal currently baffles me. Everyone is already familiar with it and it is overwhelmingly well thought of. It is also Red Scare (TM) proof and Government Run Healthcare (TM) proof just ask Joe the Plumber (TM).
Yeah, Medicare is real
Yeah, Medicare is real dreamy!
Fact is that Medicare is goin' bust, and with a bazillion graying babyboomers getting ready to reeeeeeally cash in on the benefits, something has to be done.
Oh wait. ., let's just rope in a bazillion more YOUNGER PEOPLE (who need less services), REDUCE the services available to the seniors, and impose a new tax on EVERYBODY to pay for the program in full.
Sorry. ., to me, it's quite transparent.
I have no problem with
I have no problem with paying for my healthcare directly to the doctor, and I have done so in the past. When I had my fourth child, I decided that I'd rather have a diamond tennis bracelet than an epidural, so we spent the money on that instead of painkillers. It was an informed decision that I made. I've been between insurances before and paid the pediatrician directly for well child visits and shots. My dermatologist takes no insurance. He is very reasonable in his rates. I've paid for my daughter's allergy shots out of pocket when I had a particular insurance.
But I wonder where in the Constitution we are finding the right to healthcare? I am saddened by the descent into feudalism in this country. The few elitists who are so much higher above us regular folks are to make our decisions for us and take care of us all because we are too miserable or incompetent to do so ourselves? Meanwhile, we pay our taxes to them so that they can sit in Washington and direct every aspect of our lives from what car we drive to what procedures we can have. No thank you. I believe most of our ancestors came to this country to escape this kind of system. If I wanted to be nannied, I'd still live with my mother or move to Europe. If the government can't even run Medicare and is in debt with it, how can they extend medical care to others?
health care
another full of shit republican insurance shill. the constitution doesnt have to tell us to have a healthcare system that everybody can afford and work with common sense and decency do. a healther population is a more productive population, not to mention happier. but i guess someone thats so supperficial as to need a diamond tennis bracelet than healthcare wouldn't understand common sense, what a fool.
...And again with the Red Herring responses...
Actually quite amusing, this is relatively consistent response across all sites that I read: When it comes right down to it - there is NO guarantee in life. Therefore 'you' collectively have no right to reach into 'my' individual hard earned livelihood and require me to pay for your hard luck (or poor choices, or multiple kids, or .... or ... or...). In doing so the collective is forcing each individual to take on more risk than may be in their best interest. How about this for a concept - single line on your tax forms that says 'yes, I'd like to participate in the universal coverage' (you get charged on your taxes so you know how much the system is costing you individually) and you receive a card in the mail that allows you to participate. Then, I can 'not have to' help pay for 'your' bad luck - and you don't have to pay for mine. Probably won't work - if we don't FORCE those who know better than to play into the system...
When ever did you think you were entitled to my time, money, or compassion? I don't know you from Adam...and it's probably best that way huh?
Maybe you should move to Europe
If you lived there, you wouldn't have to decide whether to buy diamonds for yourself or risk your childrens' lives.
Sounds like a win-win to me.
______________________________________________________________
If I would have known I was going to live this long, I would have taken better care of myself.
~~~ Eubie Blake, as attributed by Mickey Mantle, and many, many others.
The government will take care of us from cradle to grave!
You're right, because in Europe with its 50% tax rates they wouldn't be able to afford a bracelet. Or a car. Or a house. Rent for life, what's good for the other proles is good for you! The government will provide for you, worry not!
Medicare for All
You are indeed lucky.. and luck is the only thing between you and homelessness and poverty. One serious health problem for you or your child will end your smugness in a hurry.
Medicare, in spite of what the right wing is saying, is in very good shape. But let's not forget what it would mean for the entire private health insurance industry if Medicare did not exist. Imagine, if the private for profit health care insurance industry had to provide coverage for those 65 and older. I don't think any insurance company would want that demographic.
If you think that Medicare is a drag on your wealth.. think what it would be if your state and local governments had to care for the elderly's health care.
What is your recomendation? Let them die? You selfish people should take the time to think about what you are saying. You are not going to always be healthy. Sooner or later poor health gets us all.
Ummm...yeah, pretty much.
First things first: Health Insurance is a B U S I N E S S...
Businesses run for a P R O F I T....
Now, that said - what would be soooo terrible if there was no-one willing to take the risk of being an insurance provider? At one point in time there WERE no health-insurance providers...
Taken that way - what gives the collective 'us' the right to EXPECT to be taken care of? YES - one bad break could ruin a person (or family, or community, or...) are we to then Guarantee every person in the country Car, House, Marriage, or 'Job' insurance? No-one is entitled to be taken care of - plain and simple. And no - that position does not mean people 'shouldnt' or even 'wouldnt' be taken care of - just that they should not EXPECT to be...and they should be GRATEFUL when they are.
I paid my doctor "out of pocket"
I paid my doctor "out of pocket" too. I paid the doctor. Then I had to fill out the insurance forms and submit the invoices myself. The insurance company reimbursed me minus copay and deductible. So I really didn't pay "out of pocket".
But this allowed my doctor to hold costs down. He had no receptionist, no office staff to process all the paperwork. Just him in the office. He was able to "avoid insurance companies and HMOs" as he put it. Few doctors are able to do that, and these days most doctors offices have a single doctor with 4 or so staffers for administrative paperwork.
Some rights are universal
Your eloquently circular reasoning has lots of tiny holes in it. If the elitist who run our country and tell us what to do and dictate evgery element of our lives were so cunsumed with making you kiss their feet and jump through hoops, where did you get the time,freedom and money to buy a diamond bracelot, have a fourth child and pay out of pocket for health care?
BTW, does every human right have to spelled out in the Constitution? I don't need the constitution or any other piece of paper to tell me WHAT I HAVE A RIGHT TO. Health care will be reformed, with or without the knuckledraggers who philosophize about survival of the fittest.
No one has the right to steal...
And in your desire to be coddled and taken care of, you feel entitled to steal from your neighbor. That the fruits of his labor in some way SHOULD be distributed to you in the form of guaranteed health care. Why not throw in a car, or food? Because your parents saw fit to bring you into this world >I< have to (in any way) take care of you?
What a monstrous pile of cummunitarian bulls---. I have NO ENTITLEMENT to that which you earn, you should be allowed to expend the fruits of your labor as you see fit without me telling you that you have to give any portion of it up for any reason (regardless of its direct or indirect benefit to you).
By the same measure - you have no right to use the FORCE of government to reach into my pocket book and STEAL from me because of some 'bad luck' or 'bad genes' or even 'bad choices' that you (or your ancestors) made...
...and people call conservatives mis-guided.
No surprise the left hates the Constitution
It's no surprise the left hates the Constitution. It's highly informative that many leftists/socialists in this forum are openly attacking the Constitution. It's the only thing stopping them from implementing total Socialism/Communism here.
The Constitution puts limits on the federal government because the government that ignores universally agreed-upon limits to provide "health care", can take all your other rights away.
The Constitution is not a declaration of rights. It's a limitation of the government's powers and a definition of its purpose.
Unless government is strictly limited, history shows us again and again that unlimited power will be abused to the detriment of all.
i couldn't agree with this
i couldn't agree with this more. One problem though is that the insurance industry in addition to being populated by many rich CEOs and other fatcats also employs many other people making far less whose lives would be drastically affected if the companies went out of business or were significantly reduced in size. I think this is an argument though for making the disruption a little less abrupt (i.e. public option instead of immediate single payer) not for stopping the needed disruption.
That;s why we need a plan that works now!
We can get single payer NOW. Here's how:
1) Restructure Medicaid, Medicare. Instead of fee-for-service, which is riddled with waste and led to the gov hadning hundreds of millions of dollars in subcontracting to big insurance companies to handle paperwork, Medicare and Medicaid could pay each doctor and each hospital in the plan a flat rate to cover a certain number of patients. This will save billions.
2) Adopt The 5 Dollar Revolution for the uninsured.
Check out www.The5DollarRevolution.com for more info. It pays doctors and hospitals directly, doesn't raise taxes or increase foreign debt and only affects those under the plan.
Adopting these two single payer systems will give the insurance co's the competition they need. They were either have to change or die.
Which one do you think will happen first??
I've wondered this all
I've wondered this all along. Other than people who work for the insurance industry, why should anyone care what happens to the insurance companies?
people don't bash Canadian healthcare - insurers do!
It's not "people" who routinely bash Canadian-style single-payer healthcare systems - it's the lobbyists for the big private insurers and their lackies in Congress who do! In case you haven't heard, they are currently pouring millions and millions of dollars into a full-fledged media campaign blitz in order to obfuscate the issue, define the terms of debate and once again block any true reform of the healthcare industry in this country.
One has to wonder why they're going to all the trouble, since there is no "single-payer" option in Obama's reform initiative - it mandates 100% medical coverage but offers no strong alternatives to using private, for-profit insurers AND it promises Pharma & the big insurance companies not to use the government's power to negotiate lower prices... no wonder Harry and Louise are all for it!
The parade of folks leaving
The parade of folks leaving their country to receive better or more timely healthcare doesn't run South to North. That should tell you something.
Insurance by it's very definition is to protect you from complete financial ruin should a catastrophic illness or injury occur.
And for the idiot who claimed health insurance companies simply take a bill and mark it up--what a dolt. They collect premiums, are required by law to set aside a govt mandated percentage of assets to cover what they pay out. They invest the rest of the premiums in the Stock Market hoping to remain pofitable.
Now we all know how our Govt is with setting aside anything to pay for future needs. Your healthcare funding would be about as secure as your Social Security.
No thanks for me. Not good enough. I'll take the plad lawmakers created for themselves. Nothing less.
whaat???
Um. That is socialized health care. And I hear no complaints from our congress.
Thanks for a fact-free post
Does your post have a point? I can't find it.
Your "parade" seems to imply that there is or should be a "parade" of Americans going to Canada for health care or vice versa. Why would you think that? It doesn't exist.
I grew up in a border town and I can tell you for a fact it doesn't exist. Canadians are very proud of their health care system. They'll let the Yanks have there's, thank you very much.
______________________________________________________________
If I would have known I was going to live this long, I would have taken better care of myself.
~~~ Eubie Blake, as attributed by Mickey Mantle, and many, many others.
The parade of folks leaving
The parade of folks leaving their country to receive better or more timely healthcare doesn't run South to North. That should tell you something.
Insurance by it's very definition is to protect you from complete financial ruin should a catastrophic illness or injury occur.
And for the idiot who claimed health insurance companies simply take a bill and mark it up--what a dolt. They collect premiums, are required by law to set aside a govt mandated percentage of assets to cover what they anticipate paying out. They invest the rest of the premiums in the Stock Market hoping to remain profitable.
Now we all know how our Govt is with setting aside anything to pay for future needs. Your healthcare funding would be about as secure as your Social Security.
No thanks for me. Not good enough. I'll take the plan lawmakers created for themselves. Nothing less.
Lawmakers Healthcare Plan
I agree. Why all the fuss? Simply allow us to have the EXACT plan that our prestigious lawmakers have and I will be happy. I have emailed and asked my Senator's if a bill is finally passed if they are going to give up their plush coverage and join the plan enacted for us. To date I have not received a response. Gee I wonder why?
BRAVO!!! YOU CAN QUESS THEY
BRAVO!!! YOU CAN QUESS THEY WOULDN'T TOUCH THE HEALTHCARE REFORM PLAN FOR THEMSELVES AND THEIR LOVED ONES BUT SAY THAT IT IS FINE FOR JOHN Q. CITIZEN. WHY DID WE VOTE FOR SUCH CORRUPT HUMAN BEINGS? IF I SEE THEM IN HEAVEN YOU DARN WELL KNOW THEY WILL TURN IT INTO HELL!
Wow, what a complete lack of
Wow, what a complete lack of common sense exhibited in your argument. I hate to be so antagonistic, but where in your treatise is the allocation for the massive profits being made by these companies and their abhorent policies? When money is introduced as an incentive, the real goals are removed, or at least hugely diminished. My employer wanted to insist that I see a "recommended" doctor on their list when my wrist went banko (I was doing intense data entry, also goaded by a monetary incentive by people who don't care about my well-being). I went to my own doctor instead, who immediately recognized that my tendonitis was created by working 8 hours a day doing nothing but 10-key. A fellow worker who had a similar problem went to the employer-advocated doctor, who informed her that her condition came from doing 1-2 hours of gardening on the weekend.
For profit organizations like my work and the current HMOs do not have anyone's best interests at heart, which would seem to defeat the purpose of healing people, or at least taking care of them. To hell with the insurance companies; they would have screwed me if they could, and have done so to millions of people. The government cannot possibly do worse than they have. I'd rather give the government at shot at doing this than allow the same corrupt system to continue.