Health Care

[Gemini Cricket]

Can anyone explain to me why our health care system in our country is so flawed?

I just spent a week with Ralphie's Canadian relatives and I feel our system just isn't working.

:(

Deducatbles, no deductables, HMOs, existing conditions, universal health care, etc... my mind's spinning...

[Name]

because to allow nationwide healthcare is a socialist idea.....

and socialism is evil....

[€uroMeinke]

What's so hard to understand? Got Money - Get Health Care

[LSPoorEeyorick]

Imagine! Today I was just thinking about starting a health insurance thread. I was trying to settle on a variety of titles:

Blowing the whistle before I blow my stack
How I became a cog in a robot that went evil
Bottomless pit: insurance in canon and fugue

But now I don’t have to use any of those. Because you so kindly started the thread for me.

Anyway, I work in insurance. I don’t work for one of those big Fatcat companies. My company does. I won’t tell you which one (or my last name, and doom to all who post it here—and no, I don’t ever post from work.) because as much as I’d really rather dispose of my job, I’m stuck in it if I want to make rent. And I do. I do want to make rent. But not this way.

I was able to hold my head up once. When I hired into my company, I could proudly say that I was improving the world and making life better for the people with whom we dealt. We’re a negotiation firm. This means that when a patient chooses to see a doctor that isn’t in cahoots with Fatcat, we take their claim back to the doctor and say “you’re overcharging by yea much, and if you’ll agree to bring your price down a bit, none of us will have to charge the patient extra money.” And doctors like that, because most of the time, they don’t want the patient stop coming to see them. And patients like that because who wants to pay extra money for their angina? And Fatcat likes it because, hey, they get to pay less money to everybody.

When I arrived back from vacation on Tuesday, I was greeted with an interesting memo. Over the weekend, Fatcat had decided not to use my company’s full services anymore. Instead of negotiating the claims, they now want only to find out what the “reasonable” amount is. And they’re only going to pay that. And the patient gets to pay the rest.

This might be a good thing if a patient is choosing a doctor who’s committing fraud. But what about when a woman has a knife wound in her stomach, and if she doesn’t get to the nearest possible hospital she’ll die? That’s right, friends, if that hospital isn’t in league with Fatcat, Ms. Knifewound McWoulda-Died gets to pay the remainder of whatever Fatcat says is reasonable. And let me tell you: what Fatcat says is reasonable ain’t a lot.

Overnight I turned from Helper of Humanity to Hand of the Devil. Thank you, so much, bossman Fatcat.

Of course, working indirectly for Fatcat, I get to see firsthand what kind of Shi’ite goes down. And not in the good way.

For instance, I was assigned a new project that helped handle claims that were being negotiated before the patient goes in for services. This is usually for patients with serious trauma or chronic or terminal diseases. People who really need our help. And I was the only one in charge of making sure these claims were actually coming in and being handled correctly.

So in the first month I noticed that a bunch of them weren’t being paid correctly. So I told somebody up the ladder. They brushed it off, “fix that claim, I’m sure it’s just an isolated incident.”

So I fixed that claim. And the next month there were even more. So I said again, to the next dude up the ladder “there’s something wrong with the system.” And they put me off again. “Get the handful of claims fixed, and it’s probably not really a problem.”

Except that every month it got worse, and every month I yelled “help!” until my company believed me. But then Fatcat didn’t believe me. “It’s your company’s problem, they’re doing it wrong.” It took me weeks of making reports and connections to prove to them there was, in fact, a system error. And just today, as we’re finally getting the 100+ claims fixed, we’re getting new messages. “Why does this have to be done? What is this?”

AUGH. If I, in the infinitesimal portion of claims I handle, am seeing this much error and this much passing the buck, what for the rest of the people? What for the other Fatcats? What for our poor, poor country as health problems soar and health insurance says, for the umpteenth time, “What? It’s not my problem.”

[Prudence]

Health care is monitored in large part by health insurance companies. Publically traded companies. Companies whose "clients" are not the patients, or even the doctors, but rather the shareholders. Their goal is not to provide you with access to care, or even to "manage" care. Their goal is to make and keep the shareholders happy. If care were "managed" so that profits stayed constant, shareholders will not be happy. Profits must increase. If care costs also increase, less care will be covered. Thus I pay for more and more of my health care, so that investors will continue to get dividends.

[PanTheMan]

There is a GREAT website called www.opensecrets.org that lists who gives what to who. Check out How much the Health/Pharmasutical Industires give Political parties each year. The Ammount the "Hospital Bizz" makes $$$ is staggering. Above and beyond any other country with Public Healthcare.

As for the System, you find out when you need it if you come down on the "Have" or "Have Not" side.

My Mother-in-law is a nurse and says that in many other countries becoming a doctor is a "Calling" to help others. In this country, it is a calling to the Country Club.

[tikiboy]

because to allow nationwide healthcare is a socialist idea.....

and socialism is evil....

We don't have nationalized health care because no one wants the same people who bring us the post office and the DMV to be running our health care.

Does the healthcare industry need a makeover? Yes.
Will the market take care of it? Yes.
Will government make it all better? Heck no.

Also thank the religious hospitals out there. They take care of a great deal of the destitute out there who would have no where else to go. This is all in the face of politicians telling them "We like what you do, but we don't like why you do it."

[€uroMeinke]

Does the healthcare industry need a makeover? Yes.
Will the market take care of it? Yes.
Will government make it all better? Heck no.


While I know this is just bumper sticker philosophy - it's simplicity really irks me as the reality is both have to work together. The market is a powerful tool, but it's focus is profit and the creation of wealth (usually more short term these days) - and not necessarily the health and well being of it's citizens/market pool.

Likewise, while the government can be a cumbersome impedence, it is the tool we have to make sure our needs are met in the long-term.

Both have to play and striking the balance and division of duties is really the hard work that nobody wants to do.

[Ghoulish Delight]

The market is a powerful tool, but it's focus is profit and the creation of wealth (usually more short term these days) - and not necessarily the health and well being of it's citizens/market pool.Also, in pure market terms, pricing large portions of the population out of health care is a perfectly viable, and likely, option. They don't need to be affordable to everyone to make a profit. I'm kinda of the opinion that one's financial standing should have little to no bearing on one's right to receive medical care.

[PanTheMan]

We don't have nationalized health care because no one wants the same people who bring us the post office and the DMV to be running our health care.

I believe EVERY American should have health care coverage. Be it a basic plan, a plan none the less.

From there if a person does not want the "County Hospital Experience" they can add to their coverage by personally paying a premium.

What many people dont understand, is when people, a VERY MANY PEOPLE, use the system and have no insurance, and no money, (Often the same people living 'High Risk' lifestyles who end up at the hospital more often) we forget it is US who flip the bill by higher costs passed onto us!

Due to the high cost of Health Care, MANY employers dont even offer health care to thier employees, or only do so for "Full Time" employees, and then have them work 39 hours a week and call them part time.

But yes...socialism bad....bad, bad, bad....(Cheers heard from the GOP convention floor, those wal-mart workers in the corner cheering for the Millionaire on stage....good for them!)

[MouseWife]

You surely did hit upon a point.

I know of people who do not have health coverage but are always in the ER, Intensive Care, etc. With health problems that they bring on to themselves. Drugs, alcohol, etc.

And, what totally TOTALLY makes me want to throttle them is that they complain about the care they are given, like they are being mistreated. Of course, this is the addiction talking but still.

Yep, we pay for their care in higher premiums or limited coverage.

I know that health coverage is a rare thing or hard to get. Some places have a minimum number of hours to work to be covered and by golly, they don't always get those hours. Go figure.

[Ghoulish Delight]

Our current employer-provided health care is a bad model. HMOs are somewhat of a failed experiment. They've been used in ways that were never really intended and it's driven costs out of control.

What I'd like to see is, as Pan suggested, a minimum level of coverage provided to all citizens, and with the ability to pay for "better" services. And I see that ability to pay taking the form of pre-tax medical expense accounts, and a system that I don't know the name for but it's essentially a collective bargaining arrangement where several businesses get together and instead of providing insurance for their employees, they negotiate with health care providers for heavily discounted services. This way, no one is paying premiums, you simply pay for what you need, but the guarantee of business lets the providers keep the prices down.

[alphabassettgrrl]

Why does our healthcare suck? Malpractice suits (and the required insurance), for one.

HMOs used to work. They don't anymore. I was raised within the HMO system, and I always got what I needed. I guess that was before the greed took over. As noted in a previous post, shareholders get upset when the cycle of ever-increasing profits is interrupted. "I know people aren't getting the care they need, but darn it, the share price went down!" Um, nobody but you cares about that? The rest of us just want to be able to see a doctor!

Stock price *will* go up and down. Deal with it.

We have the best health care that money can buy. :: sigh ::

I saw something once on tv about a group of doctors that priced themselves at a reasonable rate, and refused all insurance. You go in, pay your $25 and you're good. It was working for them.

I do like the idea of medical co-ops, where the group of docs bands together. I don't think doctors are any happier with how difficult our system is to operate.

[PanTheMan]

You surely did hit upon a point.

I know of people who do not have health coverage but are always in the ER, Intensive Care, etc. With health problems that they bring on to themselves. Drugs, alcohol, etc.

And, what totally TOTALLY makes me want to throttle them is that they complain about the care they are given, like they are being mistreated. Of course, this is the addiction talking but still.

Exactly. I have an alcoholic neighbor who is a one man health care crisis. He has drank himself into pancreatic failure, a fractured skull, a really bad car accedent, and numerous other health problems. His Pancreatic Failure I.C.U. experience cost almost $1 Million (He is now Insulin Dependant) His car accedent, Cost OVER 1 Million for him and another 1/2 Million in damage to the city (Thank God, he missed several oncoming cars, and only took out street signs, the front of a building and a telephone poll going 50+ in a 25, passed out, foot on the gas) How he lives is beyond us all. Was sentanced to "Rehab" lasted 2 weeks...

Everytime his now mended broken back gives him trouble, he WANTS TO SUE. Everytime he needs to inject insulin HE WANTS TO SUE, because he convinced the Hospital screwed up, and the list goes on... (All Doctors are A-Holes, The Nurses are B*tches...)

Guess what folks, WE ARE RESPONSIBLE FOR HIS BILLS! We also need some sort of 3 strikes law for those bent on drinking or drugging themselves to death, but that wont happen.


Then my Mother wonders Why she has to pay $600 a MONTH at age 72 for Kaiser. :mad:

[tikiboy]

The healthy paying for others' misfortune or irresponsiblity is how the health care industry has always worked. It always will.

I also feel that everyone regardless of how much they make should recieve some form of health care. But the proposals that have been brought forth so far by the California legislature or by proposition haven't been the solution.

A couple of posts have made light of people's fears of socialism(i.e. socialism...bad). The fact is we already live in a "mixed economy" where socialism is present(i.e. Medi-Cal)

The govt has shown me that it is not capable of taking on something as important as health care. I feel it is best left to private industry where the search for the almighty dollar will foster change. We're already seeing it now. In my health care options at work the HMO and PPO options are being priced out, but new and innovative health care solutions are appearing that most people take part in(Ex: Lumenos (http://www.lumenos.com))

That's the beauty in trusting the market. When a service becomes overpriced or burdensome(PPO and HMO respectively) there will always be something to compete against it.

[alphabassettgrrl]

Yeah, something will replace it. I just hope it works better.

[MouseWife]

....Everytime his now mended broken back gives him trouble, he WANTS TO SUE. Everytime he needs to inject insulin HE WANTS TO SUE, because he convinced the Hospital screwed up, and the list goes on... (All Doctors are A-Holes, The Nurses are B*tches...)

Guess what folks, WE ARE RESPONSIBLE FOR HIS BILLS! We also need some sort of 3 strikes law for those bent on drinking or drugging themselves to death, but that wont happen.


Then my Mother wonders Why she has to pay $600 a MONTH at age 72 for Kaiser. :mad:

Hey, I thought for a moment we were discussing the same person! :eek: But, no. This guy doesn't have a car. Thank God. Same type of story. He has been through rehab so many times. He is so lucky that the Homeless shelter takes him back. When he is in the hospital, he complains and complains. This after being brough out of an alcohol induced coma of about a week.

I wonder what his bills are.....

I worry about people who depend on what types of medical coverage has been promised to us, etc.

I've understood this always about how those that have take care of those that don't. Just hard to swallow when all of the working people I know try to stay healthy and well and not miss work, going even when they feel ill or struggling with child care. I've been jaded by seeing the people on the opposite side of the coin.

A very heartwrenching show I saw this week on Oprah. People surviving on $60 a week? This market said that 80% of its customers were on food stamps?

Oh, sorry for going off on a different thought.....

[PanTheMan]

It is a truly unfortunate fact that mixed in with the hard luck cases of people willing to work, willing to try an improve their lives, and people just the victims of a run of bad luck having been dealt a crappy hand, there will be mixed in with them, the trash of the the human race just looking for a free ride.

It is the trash that gets the headlines, the hardworking single mom, gets overlooked. Poverty's victims are once again victimized by some of the scum who really seem to enjoy living down there. They bleed and abuse the system, so when those in real need come along, they all are greeted with cinical eyes.

Society is being ripped apart by so many things, it is hard to point exactly to the cause. I feel personal accountabilty is a cancer eating at the core though. From childhood on- pointing the finger at others for ones own stupidity and poor life choices seems to be where it all starts.

Funny thing though, I Have always noticed a complete lack of personal accountability among the drunks, druggies, lazies, and slackminded, but now i see it within the ranks of the incredibly wealthy and powerful too. Must be something in the air.