The random political thoughts thread (Part Deux)

[Alex]

The evidence that malpractice claims are a significant contributor to medical costs or inflation is spotty at best. And the evidence that capping malpractice awards reduces the rate of inflation ("tort reform" is the buzzword on that) is even spottier.

But there's definitely a perception that it is a problem and that affects how and where doctors practice.

[BarTopDancer]

Humm. I just know what my mom pays as an R.N. with no claims against her and over 35 years of experience. Insanity.

[Alex]

Oh, doctors and nurses certainly pay a lot for malpractice insurance. But that doesn't mean it is a major component of total cost or inflation.

It's kind of like most CEO's caught up in the outrage over bank failures. Sure they may be paid too much and that may be a moral outrage. But paying Dick Kevocovich $15 million to be chairman of Wells Fargo is not a significant drain on the bottom line.

Or the impact of earmarks on the federal budget. Most are outrageous but they don't do serious damage to the bottom line and eliminating them won't help at the macro level.

[scaeagles]

OK - my bad. I thought "them too" meant they were paid too much, not that you equated them with the doctors that you don't mind what they make.

What should the CEO of an insurance company be compensated for? This is where what GD brought up applies. They are a business. They were set up to make a profit. Some don't think that's OK. 252 million people currently insured would therefore not be insured if those companies did not exist.

[BarTopDancer]

Originally Posted by scaeagles

What should the CEO of an insurance company be compensated for? This is where what GD brought up applies. They are a business. They were set up to make a profit. Some don't think that's OK. 252 million people currently insured would therefore not be insured if those companies did not exist.

I do not have an issue with a CEO being compensated for running a business. I do have an issue with Executives receiving bonuses that are tied to the amount of money they save by denying coverage/care to people who are covered by their insurance.

[alphabassettgrrl]

Originally Posted by Betty

So - I'm all for not slowing down. Give me access to staying alive thank you very much.

I'm with you. I don't have insurance, either, in large part because it costs so dang much, and doesn't cover anything anyway. So I can spend a lot of money for useless "coverage."

Originally Posted by scaeagles

what I think what frustrates me in this whole national debate is the way the insurance industry is viewed. They came into existance to make a profit, so I don't know why they are slammed for trying to do so.

I guess I don't mind if their profits were reasonable, but they're ENORMOUS, and based on how much they can keep down the claims costs. Which means denial of care. They deny things that seem perfectly logical, and needed, and the conversation is along the lines of "if they really care they'll resubmit it." This is really wrong.

[Ghoulish Delight]

Yes, Leo, that's exactly what I'm advocating.

[Ghoulish Delight]

Just for the record, I don't imagine that there are people at insurance companies wringing their hands thinking, "Muuahahaha, whom can I deny coverage to this week to earn my bonus?"

They are not evil people. The decisions they make are not evil. They are prudent. They are rational and reasonable business models. They are the right decisions to make to make the numbers come out right. It just happens that some of those numbers represent money saved by not allowing real human beings access to medical care that can save their lives. When they cut costs to appease their stockholders and maintain their profits, someone down the line is put at risk of death.

Yes, it works for the vast majority of people who are lucky enough to have it. I'm one of those people. But just because I happen to be in the majority for the system was designed to benefit doesn't change that fact that it's a system that does so by treating people's lives as a commodity to be invested in and traded for profit, and I find that appalling. People's lives should not be measured by how much money they can afford to spend, and it is my belief that a government should do what it can to ensure that its citizens are on equal footing when it comes to access to that which protects their lives.

[BarTopDancer]

Here's a good example of an insurance company wasting money:

When claritin, zyrtec and some other allergy drugs showed up on the market not all of them were covered equally. My doctor gave me samples of each and told me to let her know which one worked best and she'd write me a script for it.

I tried them and determined that zyrtec was the best. I went to fill my script and was told that my insurance would not cover it unless I first had a prescription and tried all the other allergy medication out there, including nasal spray which I cannot take at all. So instead of covering zyrtec, which I knew worked I they would pay for 4 or 5 other prescriptions that I knew wouldn't work or I wouldn't even take before just covering the one that did work.

My doc, who is awesome, went to the insurance company and got them to over-ride it. Thankfully.

[Ghoulish Delight]

Originally Posted by BarTopDancer

Here's a good example of an insurance company wasting money:
...

Actually, they're trying to save money. That Zyrtec prescription could very well cost the insurance company 10, 15, 20 times as much as any of the other brands or generics. So even if they make you go through 4 or 5 other ones and you still end up with Zyrtec, the cost to make you go through that is a drop in the bucket compared to what they stand to save in the long run on the gamble that you'd be happy with one of the other ones. If even 5% of people choose the cheaper drug after that process, they'll have made their money back on those 4 or 5 trial prescriptions they gave to everyone by the time that 5% has come back for the 3rd refill of the cheaper drug.

And anyone can come in and claim they've tried all the others, so yes, it would take a call from the doctor to get around that.

But to me, the fact that this wasn't a waste of money is even worse. This isn't an example of an insurance company throwing money away. It's an example of a very smart business practice, a cost-saving measure that takes very little for them to implement and can save them millions in the long run. But it's at the expense of patient experience and adequate access to benefits.

It's a relatively minor inconvenience. And, in all honesty, probably something a socialized system (assuming medical providers remain privatized) would also engage in to some degree. But it's a good example of how profit-motive from an insurer puts their bottom line, not the health of patients, first.