Why do we need healthcare reform?

I recently went from having insurance through my work to becoming self employed. I have had some weird experiences that make me feel really bad for anyone that has ever had to apply for insurance on their own.

First, my husband had a dentist appointment the day after my last day at work. I did not know prior to quitting that my insurance coverage would terminate my last day of work rather than the end of the month. When we spoke with our dentist office about the fact that we no longer had insurance, we asked if they provided discounts to people without insurance (this was after reviewing our bill from the last time I had gone in, and seen that they gave us a 60% discount for our prior insurance). Their answer? No way, no how. Not even if we paid for services at the time of service with cash. I personally think this is really crappy - if they don't have insurance claims to file they are saving money on paperwork, plus they could get their payment right away instead of waiting a month or however long for the payment from the insurance company. I realize not all offices might be like this, but it just seems kind of ridiculous (we will be looking for a new dentist of course).

Second, we applied for a new health insurance. I was denied, because I was taking a drug in an effort to conceive. Now I get that being pregnant would cost a lot of $$ for an insurance company, but this one doesn't cover maternity expenses unless you add a maternity rider. Instead of saying "we'll cover you, but no maternity rider" they totally denied me. I am a very healthy person, I never get sick, I go to the doctor one time per year for my annual and that is it. Any insurance company that covered me would bank my premiums. Plus our policy had like a $5,000 deductible, so...yeah. So I have appealed the decision (no longer on the drug and not pregnant), and I have to wait 30 days for underwriting to make their decision. I quit my job in November, it is now March, and I still don't have health insurance.

It just really made me think - if I can't get coverage, and I am a healthy 27 year old at an ideal weight with an active lifestyle, then what about the people who have diseases like cancer or diabetes or other stuff?

I don't know what the answer is, and I don't like a lot of things about the bill that is being discussed right now. But it just seems like there has to be a better way.

I think we need health insurance reform. Healthcare reform is another matter entirely.

Without health insurance, access to medical care is greatly curtailed or non-existent. This is counterproductive to having a healthy and, by extension, productive workforce. Health insurance costs are prohibitive for the self-employed, under-employed, low income earners, and unemployed. Lowered insurance costs = better access to medical care.  Better access to medical care = healthier population. Healthier population = more productive workforce.

Also, since health insurance choices are, by and large, in the hands of employers rather than the people who actually need/want/use the health insurance, people have little control or leverage in how those policies are writtten. The deck is stacked heavily in favor of the insurance companies, rather than the actual consumer.  Lose your job and you lose your health insurance - a double whammy. Change your job and you might lose coverage for a pre-existing asthma condition, or depression, or cancer. Does that make sense? Of course not. It only makes sense if you are preoccupied with ensuring that the insurance company's profit overrides your or your child's health concerns. We have a tendency to fetishize capitalism and profit-taking; there are some concerns like basic health/welfare that supercede this fetish for profits.

What I'd like to see is better access (affordable rates, take your insurance with you if you move) and fewer punitive, benefits-denying insurance practices. It that means the government steps in and provides a health insurance plan option, much like our government employees have access to, then I'm all for that. Private health insurance companies are not interested in my health; their primary goal is to make money and make their shareholders happy. My primary goal is to have access to good medical care. We have competing interests that act at cross-purposes. With a public option, this would not be the case. I trust the government waaaaaay more than I trust insurance companies.

Edited by Renee 2010-03-07 8:18 AM

x1000 on insurance reform

When DH was in the Army I was covered by Tricare.  However because I didn't live near a base/post I wanted to go to a local Dr.  I found that many of them would NOT accept Tricare.  How can you refuse to accept my insurance but my gov't insurance?!?  Easy.  They are paid the same amount as medicare and the dr's office thinks that amount is too low.  They are paid more for the same procedure for private insurance companies so they didn't want to bother with me.

Healthcare is not the problem.  Insurance companies are the problem.  The billing system is the problem. 

Kaiser Family Foundation did a study and sent out 2,000 applications for health insurance for ficticious people--varying situations including yours--completely healthy and ALL of them were denied. ALL. There is no viable marketplace for individual health insurance.

I think we need health insurance reform. Healthcare reform is another matter entirely.


This is the real problem. Healthcare in the US is the best in the world. We have the best doctors, best hospitals and best equipment.

health insurance in the US is as close to a disaster as there can be.

In canada, there is no health insurance it is a "free service" - they may pay 5x the taxes we do, but it is a "free service".

What needs to happen here is a version of that where insurance can be had, regardless of "pre-exisiting" situations. It needs to be affordable - much like car or home insurance.

I've been thinking about this whole heathcare thing and I am sure there are no simple cost effective solutions or we wouldn't be in the boat we are in now.

I have a question though which may sound silly but humor me if you will.
Did anybody watch the show Northern Exposure in the 90s?  The doctor that worked in the small town in Alaska was paying his dues after the state of Alaska paid for his medical school.  He was obligated to work in this town for X number of years to pay back his tuition.  Otherwise he would not have been able to afford medical school.

I haven't researched this myself but have heard that doctors graduate medical school and complete their residency with tens-hundreds of thousands of dollars in student loans.  I wonder if there couldn't be some kind of program similiar to Northern Exposure and even the G.I. Bill where doctors would work for the government/state at a set salary to have their education paid for.  I wonder if this wouldn't help with the folks who have no insurance.  They would be seeing doctors who are paying back their student loans.

Obviously this doesn't help with the current insurance issues.  I have worked in billing in the medical field and gone most of my childhood without insurance so I know there is much work to be done.
However, it seems like these are two separate issues - Those who need some kind of health care without insurance and those who pay a lot of money for insurance getting quality health care.

x1001

I agree 100%.  I think we need health insurance reform and torte reform because I see them at two big industries which are over-inflating the costs of healthcare. 

Same, need health insurance reform... health insurance costs 2-3 x my motgage payment for my family and it goes up by 20% annyally typically. 

I am retired and we face the same problem Tricare does not pay as well as Insurance companies do.  Now follow me on this Tricare is Government insurance (it pays less so it is not accepted as much) When we put this Government insurance plan into action more and more Medical facilities will not accept it.  So Insurance companys are not the problem or least not the problem of acceptability. Insurance company's pay more to help insure clients will have coverage isn't that what we want them to do? 

Do you pay a monthly premium for Tricare? Would you mind telling us what your monthly premium is? What I'm wondering is whether it's an entitlement or a policy you would buy, just like buying into BC/BS.

Also, the bolded part of your statement - that's just a negative forecast of a very nebulous plan. You don't actually know what will happen under a plan that is yet to be determined. 1) What plan? and 2) I don't think hospitals (medical facilities) will be able to simply deny hospitalization based upon insurance carrier.  Hospitals take your insurance; it's between you and your insurance company as to how much of your hospital stay is reimbursed. There is a big distinction between healthcare facility and a doctor's practice/business. Yes, a physician's practice/business can make the decision not to see patients if they don't like the terms of the insurance company that insures that patient.  They already do this with insurance companies when they negotiate (or fail to negotiate) reimbursement rates.
 

Sadly, this is not even close to being true, which is why reform is needed.  The United States is merely mediocre (and even that is debatable) in terms of health outcomes among other developed nations, yet the US pays 2-4x PER PERSON what those other nations do. 

Just to give a different side. Just applied for health care for myself (self employed 27yr old with no medical issues). My wife is pregnant which makes my rating suck. Got denied totally by some, but was able to get a $2000 deductible PPO with co-pays, and a script plan for $100 per month.

Lots of words on both sides, yet no numbers or references here.

There used to be a program (pre-Reagan) that basically paid for people to go to med school in exchange for service after residency.  The budget was significantly cut in the Reagan years (when I went to med school), leaving only the military option (sign up for service after residency in exchange for med school and living expenses being paid for).  There is periodically talk about doing some sort of debt forgiveness in shortage areas, but it is not universal. 

I would very much like to see a program like this become better funded - it would help redistribute primary care docs to areas where they are needed, and could also be used to increase the numbers of people in shortage specialties in general (like child psychiatry and child neurology).

Ok, as somebody on the inside who can control some of the costs, I'll give an answer that would bring down costs (at least on my end of things).

Make it much harder to sue me as a doctor.  Let me use my clinical judgement, and don't make me continually be afraid of being sued for missing things no matter how rare they might be.  Let me not have to do a head CT on 98 year olds with altered mental status.  Let me not have to observe every single patient overnight who has any inkling of chest pain no matter how low risk they are.  I WILL order fewer tests.  I WILL NOT hospitalize people for trivial things.  I WILL bring down costs for my patients, the hospitals, and the insurance companies.

I don't think we should be immune from lawsuits for gross negligence, but I do think we need to stop suits simply for bad outcomes regardless of whether the care was appropriate or not.

I can see how doctors are basically forced nowadays to practice defensive medicine -- in the offhand chance they might get sued.  So what's the best way to deal with this?  Would it be possible to set up an independent arbitration board that decides if something was unfortunate/accidental vs. gross negligence, and sets reimbursement rates for the former?  Do any countries do something like that?

A friend of mine is on the board of a hospital, and the stories she tells me about lawsuits are enough to make your head spin.  Tons of frivolous suits.  And unfortunately, it's not always because people are being greedy -- in some cases, the patients are suing everyone in sight because they can't pay all the medical bills (though clearly, that still doesn't make it right).

I'm not trying to single you out, but don't you live in Texas? Hasn't Texas passed tort reform, similar to several other states in recent years? I agree that we should do what we can to eliminate frivolous lawsuits but I don't think there should be a hard cap on damages. If you do live in Texas, I would like to get your opinion as to how it has changed your practice. Again, this is a generalization and not targeting you, but I find it hard to believe that introducing tort reform will suddenly cause doctors to better control costs. Doctors, if I'm not mistaken, are paid on a per procedure basis - more tests, more they can bill insurance and more revenues for them to CYA which is the main arguement for tort reform. I doubt that doctors (in general) will suddenly say "I can cut my revenues by 25% (less tests) because my malpractice premiums have dropped" now that tort reform legislation is in place. And if tort reform is enacted across the board, that doesn't guarantee that a consumer's insurance premiums will drop, just that a doctors malpractice premiums will. If you listened closely to the Healthcare Summit, the Republicans made sure when they were talking about reduced premiums due to tort reform, they specifically said malpractice premiums would be reduced, not a consumer's health insurance premiums.

We have caps on non-economic damages.  That does nothing to prevent suits from happening if somebody's determined to sue.  You then have to put the fact that you were sued on everything you ever apply for again in the future EVEN IF YOU WIN.  Most insurance companies will simply settle because it's cheaper than fighting, and you'll have to report that as well.

The cap is a good idea though IMO.  If you make a bad mistake in your job, the worst that happens is that you lose your job.  We make a bad mistake, and we can lose everything.  You want your doc trying to make rational decisions regarding your health with that in mind?

Your views on how we billed aren't quite correct as well.  I don't do a single procedure, so none of my billing comes from that.  It IS true that I get paid more the longer people stay in the hospital, but I'm measured by my length of stay based on acuity of illness and medical necessity, and that negatively affects me when I fall outside of the standards.

I'm telling you exactly how my practice would change were frivolous suits eliminated.  That's not up for debate.  I won't speak for others, but I can assure you that I'm not alone.

Some states do that already, and it's a fantastic model that I wish we'd all adopt.  In Louisiana there is a 3 physician panel that reviews the merits of the case before it ever goes to trial.  One is picked by the plaintiff, one by the defense, and I believe the third is chosen by the first two docs.

There's nothing to prevent the case from going to trial even if they rule negatively, but it's a powerful tool for the defense to present as these aren't paid "experts" who specialize in testifying at trials.

I wish we had that everywhere.

Please forgive me for interrupting your scheduled broadcast, but I think Derek's excellent response deserves a {{{MELON PRESS}}}.

Carry on.