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]

Originally Posted by Name

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]

Originally Posted by tikiboy

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]

Originally Posted by €uroMeinke

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]

Originally Posted by tikiboy

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!)