Who do you trust more to make healthcare decisions... (Page 3)

I trust the government to do a better job regulating private business, which is it's job, than regulating itself.

As for changing things. I sign a new contract yearly so I don't see annual changes to my contract as a loophole. If I don't like the changes, I'll switch to a different company. Also, in my experience, I have never had medicine denied though a private insurer, though I have had constant denials through Medicaid for my daughter. I am not saying that it doesn't happen in the private world but it certainly happens in the public.

As for reguatory oversight. I had a problem with a private company 6 years ago in which I filed a complaint with the state commission and it was resloved very quickly. I was very satified with the process. I have had absolute nightmares correcting with screw ups with the government with my daughters medicaid.

If you don't want to "jump through hoops" with the insurance company that I choose to contract with, then don't accept me as a client or tell me that have to pay cash for your services. I promise my feeling won't be hurt. You are also more than welcome to only accept medicare and medicaid patient if you feel it is such a hassle to deal with private insurers. From whatI understand is that you'll stay pretty busy because there is a short supply of doctors wilingly accepting government insured customers. I am rather confident that there are plenty of other doctors willing to take my business and the payments from my big bad insurance company.



 

Edited by Jackemy 2009-12-04 3:24 PM

Wow, that's selective editting.

How it actually went:

Aces:  90% or more of Americans who are covered have no real choice of plans

Rosshole:  So you're saying the government could do a better job?

You don't see this and why this is a problem?

In the clinic I work, it is all private insurance (the medicaid/medicare clinic is staffed by the new guys - before August, I covered that clinic too).  So all of the denials I deal with now are private insurances.  When I had a private practice, I did not work with most insurances. When I was the only guy left working in our hospital, rather than force patients to go out of county for inpatient, partial, intensive outpatient, or go without meds in the hospital's mental health clinic, I chose to serve the public in what I believed to be a better fashion.  Which means I am an employee of the hospital, and have no say in what insurances I am signed up with, or who I take on as a patient.

But I do the jumping through hoops not for my own sake, but to help ease things for patients and families.  It would certainly be a lot easier for me to simply tell people "here's what I am going to prescribe.  If your insurance doesn't like it, too bad - pay cash instead".  Some families have done that, but if the difference in out of pocket is a $10-20 co-pay or $100-200 for the months meds, what do you think most people want to do?

As for there being a lot of other docs willing to do things?  I'm a child psychiatrist.  For most of the last 5-6 years, I was the only one at our hospital.  There are none in the community who take insurance, and only one who accepts patients not a part of a clinic.  If I wanted, I could re-open my practice, charge $300 or more per hour, cash, and still have a steady stream of business.  But I do what I do because I also believe in the service.

So there may be plenty of primary care docs, but some specialists are rather rare.  Child psych, child neuro, and in our area, endocrinologists.

Here is where I see a problem.  I know some drugs are expensive, very expensive, but it seems a little crazy that we expect or rather purchase insurance to cover everything including meds.  I believe this is in part one of the reasons costs continue to rise.  To me its like purchasing auto insurance that would cover oil changes, wiper blades, etc.  Look around, for the most part folks can pay for what they want to i.e. cell phones, big HDTV, nice cars, well you get the picture. 

I think part of the reason the insurance companies are being blamed for it is some of their tactics.

(this is obviously a sample size n=1 and therefore applies to everything)
I have insurance through my Wife's job and we had BC/BS until July when we switched to PacificSource (one of the worst insurers I've ever dealt with). In August her co-worker had a problem with her gall bladder and was rushed to the hospital to have surgery. PacificSource at first refused to pay because they claimed she had a gap in her coverage in spite of having switched over just recently. So she proved that she did have prior coverage and then they tried to claim that her gall bladder problems were a pre-existing condition and so they weren't going to pay. I believe she is still trying to resolve this while getting collections calls for the $20,000 the surgery cost.

This kind of "service" is what gives insurance companies a bad name.

This user's post has been ignored.

Edited by AcesFull 2009-12-04 5:00 PM

Agreed, It drives me nuts seeing people without insurance because they can't afford it affording all other types of things, but there is an issue with these drug companies when my medication for asthma/pet allergies costs me $300 month after insurance!!

And drug companies are the ones in bed with the governement!

Edited by Rosshole 2009-12-04 5:01 PM

My point is that not everyone needs the same type of coverage.  I obviously don't need the coverage your family does.  However in the infinite wisdom of gov., I will be forced to pay for the same insurance as you.  When this happens my financial burden increases and the control of my care decreases. 

How do you know that?

Insurance is designed to cover the unpredictable, not the predictable. You can't have any idea what your health will be like in 6 months.

Economics 101: a company's primary motivating reason to exist is to maximize profits.  For health insuance, that means (a) charge the highest premium possible and (b) deliver the fewest benefits possible.  Every pill, procedure or claim paid means less money in the CEO's pocket.  Thus, health insurance companies act economcially rational by denying coverage and delaying coverage.  Even better: collect premiums and then deny coverage for a preexisting condition.  Total scam if you ask me.

Here's an example: I herniated a disc this summer and my health insurance denied coverage for PT saying "no objective symptoms."  I happen to be a lawyer so I got on the phone and made the idiot "health reviewer" look at my MRI... her response "oh, you had an MRI?"  Yes genius.  Got the PT my doctor said I needed.  The fact is that the company likely intentionally kept the information from the line staff and if you are not persistent and prepared you can easily get worn down.  (don;t even get me started on the kept doctors health insurance companies pay to deny claims).

My vote: kill the health insurance industry.  The gov't may suck but at least some a-hole fraudster CEO will not get his/her pocket lined.

I have catastrophic coverage, everything else is pay as I go.  My deductable is very high, about that of a fancy car.  We have saved money to meet that if we need to.  Last year I had surgery that was pricey but below the deductable.  I negotiated with the Docs, lab, hospital etc. for a price that was greatly reduced from what was billed.  A year later they were paid off.  If people would do things for themselves such as negotiating fees, they could bring down their costs. But people have no faith in their own ability and allow another party negotiate what is "best".  Insurance is a game where you are betting against yourself.  The insurance co. has greater faith in your health than you do.  They are betting you will need very little healthcare services and you are betting that you will.  If people want/need a "gold plated" plan than they should be willing to pay for it.

On a personal level, I find it insulting and degrading to hear people tell others (esp. me) that they canot do something, whether it is provide healthcare, education, or be employed without the help of the gov. 

We live together in a "union" to provide for among other things "general welfare".  We cannot be loners and expect to have any quality of life.  Can I fight with healthcare companies, yes.  However, I certainly did not pave the road I drove on today. 

First of all the preamble give the government zero power. Second of all it is not to provide but to promote general welfare which is a big difference. Third of all, we as a group of individuals grouped ourselves together as people to form a more perfect union. We who are are each unique individuals, not a collective, have agreed to forgo some of our natural rights which are specifically spelled out in the document after the preamble in order so that things will go better than they did as a confederation. 

Using the preamble as a basis for constitutional authority for government to do something is a favorite of the left but a completely bogus argument.



Edited by Jackemy 2009-12-04 9:13 PM

I loved my NHS care in Scotland and in Northern Ireland. My electronic records and being able to call NHS24 whenever I wanted was great. I never had to worry if I was going to be covered for a trip to the podiatrist (which is the reason I had never seen one until I moved to the UK...despite being diabetic, it wasn't covered). I knew I could get a flu shot. I knew that my medicine was covered and paid for (medications for chronic patients was paid for, if not, then the cost was 5.25 GBP, which has dropped to I think 5 GBP even, and will eventually be zero for everyone). It was liberating to know that I wasn't going to be bankrupt if I had an accident on my bike or, like my unfortunate roommate, had a stroke at the ripe age of 22 (this condition and the NHS coverage, incidentally, is a large reason that she has remained in the UK and is seeking to become a British citizen). I could self-refer myself to any one of a number of specialists. I could chose from any GP within my geographic area, and if I wanted to go to another one, then I could if I filed the right paperwork. It was great. I felt like my doctor and I had more of a direct control of my health because I didn't have to worry about fussing with an insurance company and hoping and praying that they'd cover what the Dr decided. And there is a codified right to privacy, so it isn't like Gordon is peaking into your health records.

My Highmark care...not so much. After my accident, the explanation of benefits was enlightening to say the least. True story about how your left acetabulum costs $25,000. We're fortunate to have the coverage we have, and the benefits we have, because there's no way we could afford them on our own, and no one would cover it for me, even if we sacrificed more than we already have (not really sure what else we can give up, aside from eating and electricity). My medicine (per vial) costs about $100 (and I go through one about every week and a half to two weeks), give or take, but then the syringes and my insulin pump supplies cost around $1k a month without out insurance. With our insurance, I pay $40 for a 90 day supply for insulin and $40 for the pump supplies. I get worried whenever a Dr "diagnoses" something because I fear that Highmark would revoke my coverage using recision. I don't feel as in control here, because I feel like I have to stress about every single little clerical thing and if x y or z will disqualify me for coverage. Surely, the capitalist model works in the "I pay you money for x service/product, you give me x service/product for my money"...but in healthcare the model works, "I pay you money for x service, and you find ways to prevent me from having x service". It just seems...odd? To me.

RE: cost of prescription drugs. I would love nothing more than to see the end of direct to consumer advertising. That happens only in the US and New Zealand (I think?). Surely, if your product is so good, you can rely on its scientific and medical merits rather than some commercial with a woman talking about how she needs longer eyelashes? It's also a waste of billions of dollars a year. You want to do R&D? Can the advertising and put that cash in the lab. I don't need an arbitrarily named drug to make me better, I and others need drugs that work that we can afford.

this is one example and the premise is essentially what I was speaking of.

Insurance was designed for everyone to pool their money for the poor sucker who needs it - ie homeowners, fire insurance etc.  but healthcare is different - we expect to use it.

so insurance companies collect the premiums - rates for which have gone up astronomically and the deny coverage, delay or try shady practices to avoid paying claims.

The number of times we have had to fight for payment is unbelievable  and in primary care we have a very thin margin keeping us afloat... - I get paid more for a 5 minute procedure than an hour preventative visit where I take a thorough history etc.  and then I have to pay an extra staff member just to  deal with the insurance companies so that I can paid for the work I did!!!!

that is evil pure and simple.

As a previous poster mentioned the gov. is to promote general welfare not provide.  Gov. was never intended to be a Nanny to everyone.  Big difference between roads for a nation and gov. run healthcare.

Edited by NXS 2009-12-05 6:49 AM

For those who are thinking that the Federal government are the ones that are messing up Medicare and causing the costs overruns, oh my, if you only knew. The Federal Government sponsors the program, and assuming a state gets certified will pay the majority of the costs of the implementation of a new system. That certification means that the state system will have certain basic things in it, have traceability, etc. But, it is a STATE run program with state funds. Every single state is different and those differences cost millions and millions to implement and maintain. Having the federal government run the program, or at least better dictate how the programs are implemented, what they cover, and how they are run, would reduce costs so much it is not even funny. They are trying to get the systems more regulated (CMS) but so many people think that state run is best. Sigh... So Medicare is similar to a single payer system but not quite. I know this cause I have implemented many a Medicare system and watch states throw money away every single day. The states cause so many of their own problems. For example, they allowed one system to go live despite the fact it could not pay claims. What? That is the premise of the whole bloody system. No providers got paid for years, and they never did clear it up so just started paying providers a lump sum so they could continue to practice. They kicked that vendor out and hired another vendor that is in all kinds of cost overruns (which the state pays) and way behind schedule and from what I hear will be missing many of the things required for certification. State is on the hook for paying two systems in 5 years and neither will do what it should. Another state made a bad choice of vendor selection (hey, they picked the one that the state couldn't pay claims in) and due to political reasons they still have not kicked that vendor out after 5 years of implementation (3 is all it takes) with no end in sight.However, the one huge thing it has that those of us don't get on health insurance is that this concept of pre-existing conditions. You qualify for Medicare due to financial situations (or whatever state criteria is setup) and you get coverage regardless. If private health insurances could do this and yet be limited in how much profit they could make so that it is affordable then I am all for private health insurance. I am surprised that no one is getting their backs up about the fact that if you pay out of your pocket to the hospital/doctor directly you can get a lower cost then what they charge insurance. What? Why are these costs not the same? Hum, chance for reform right there me thinks. That is a whole lot of over "overhead" cost if you ask me.I have spent most of my life in a single payer system (I'm Canadian) and I'll take the higher taxes any day over the uncertainty of what the American system offers. Keep in mind that in the Canadian system not everything is covered (which is fine) and I do think it needs improvement. I am all for a co-pay so those who aren't really sick but just have a cough or are lonely stay the hell home and stop overloading the system. I don't know of a perfect system in the world, but I know when one is full of crap. It lines the pockets of hospitals and health insurance companies and doesn't give a crap about the person needing the health care.And for all those who keep saying that the government is going to mandate you have coverage, well, maybe they will, seems to be going that way, but they are not mandating that you have their coverage. They keep saying that but guess your missing that. You like your private insurance keep it. If everyone had health insurance (that would cover stuff) it would save everyone a lot of money in the long run cause there is a cascading affect if someone doesn't have coverage and cannot afford their medical costs if something should happen to them. Your paying for those folks now so I'd rather they suffer and pay their own just like I have to. IMO if the government is allowed to do a single payer system maybe those silly insurance companies will start doing customer service and treating us right. You can have a profit margin and provide the coverage you said you were going to as well. Reminds me of car insurance. Why do they always raise the price on your insurance after a small fender bender? What they all do with the money I gave them up to that point? Why is there no wait until they are a repeat offender before raising costs? Why buy car insurance? Just put the bloody money in the bank. (note, I have car insurance)

Look at it this way...   Private industry competition is what keeps quality of care as high as it is.  Competition for profits in almost every industry in the world drives product development...   insurance is no diffrent.  By getting rid of insurance companies, you are only taking one portion of the chain away, while leaving drug companies, medical supply companies, private clinics/hospitals, etc.

I am going to assume that you know what percentage of premiums goes towards CEO's pockets...   and why you aren't mentioning anything about drug companies or any other middle man who is making a buck.

I posted in another thread a little ways back that in the recent Forbes 500, health insurance companies ranked something like 35th out of 53 industries with a profit margin of 2.2%. Both drug companies and medical products and services were in top 10.

If the profit margin is only 2.2%, where are we going to see these premium decreases or coverage increases come from? What could the government do different to approve more claims without raising rate? There is only so much money to go around.

be very wary of what you read.  they put all sorts of things under 'direct medical care' that are not - including their CEO salaries.....

as to medical services - our salaries are our 'profits' not so in insurance.

The preamble is a statement of values, so I agreed it give no power but sets forth what the constitution is attempting to accomplish and that is far more than living as dissociated individuals. 

Well I think that the preamble wasn't a statement of the coercion of the individual by the will of the people.

It was a statement  that the pursuit self-interest of millions of individuals creates a better society in the end and that our new government should be established to promote that idea. "Cooperation without coercion". 

"It is not from the benevolence of the butcher, the brewer or the baker, that we expect our dinner, but from their regard to their own self interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages" - Adam Smith