Our medical system good? Think again

[Misty_Morning]

I called a friend who works for a health insurance company. This is what I understand...

The Insurance Company rates based on either
a) An individual or family's health record
b) On Group Insurance Experience.

That's all fine and good, except there is no explaination of how the rates are arrived at. As near as I can tell, the company determins they will make $XXXXXXXXXX in profit for the year. Then they factor in commissions, salaries, overhead and payouts. That gives them a total dollar volumn to submit as premiums to their customers. The problem is, the profit is extraordinarily high, their costs are generally overstated, as well as their expected payouts. This increases their profit margin even further.

Then the companies contract with providers (Doctors, hospitals, etc) to pay them at a flat rate for defined services. That means that the doctor, hospital, etc has to settle for what the company decides they want to pay. The effort here is a lower the company's payout by squeezing the providers, again increasing their own profits.

Keiser Health Plan is even more viscious, since they are not only the insurance company but also the provider. I'm not saying Keiser does not have good, qualified and knowlegable doctors, but their treatments are subject to review by "raters" who often change the patient's treatment for a cheaper drug or proceedure. This is what lead to the death of my elder sister.

Keiser Permanente is a bunch of motherfuckers and everyone knows it. Sorry about your sister.

 

[Jenny_Jackson]

Keiser Permanente is a bunch of motherfuckers and everyone knows it. Sorry about your sister.

I believe the Insurance side of Kieser are a bunch of fucktards. But I know some of their physicians, and they really are quite good. It's not the doctors, it's the fucked-up system. You can't be the Insurance Company and the Provider and not expect abuses.

As far as my sister goes, Keiser was her choice. She had brain cancer and was going to die anyway. With proper treatment she would have lived 18 to 24 months. With the re-perscribed treatement she died in under six months. That's a crime.

 

[Chantilyvamp]

Apparently American doctors need to run a battery of tests to diagnose conditions, preferring, if possible to run MRI scans and tests before simply asking questions and examining the patient. Like I said, this is all hearsay, but UK/Aus. doctors are much better at pin-pointing conditions without so many invasive tests and, AFAIK, they have no need for specific 'diagnostics' departments, because all the doctors have a better training in diagnostics...

OK. Now someone who knows more than me can back that up or tear it down.

x
V

All I can go on is experience. I'm in the Uk and spent from March until the middle of July last year having abdominal cramps that were horrendous and required quite a few hefty pain pills. It took them that long with a mirage of tests just to find out I needed a concoction of antibiotics. That was after various evasive embarrassing tests and it turned out to be an intestinal problem not where the bloody people kept looking

 

[rgraham666]

The biggest difference between private and public healthcare is their goals.

Public is about looking after people's health. Private is about making a profit. Nothing wrong with making a profit as long as you provide service as well.

The problem with public health care is that, as I pointed out, it may be controlled by people who don't believe in it. Also, as happens with large organizations, the organization may become more important than providing service.

The problem with private health care is it is more profitable to be paid for something you didn't deliver than for delivery. It also can suffer from the sclerosis that affects large organizations.

Shrugs. They're just tools in either case. The problem isn't with the tools but with their users.

 

[Trinique_Fire]

This scares me because it's very very close to where I live and because I have similar problems with my teeth and ....no insurance.

 

[Selena_Kitt]

I saw this article and thought of this thread...

 

[Liar]

The Medical System in the US IS the best in the world

The last I saw about that was a panel of surgeons and doctors from 37 western countries raking em, (based on medical capacity, not financial accesability) and the Dutch won.

But, although it's debateable if it's THE best or not, the US still have some Damn Fine Hospitals. (I just point it out because categoric nationalist superlatives is a pet peeve of mine.) Problem is, like you say, in the politics of how the health care is run and financed.

Problem here is the opposite, here the actual medical capacity is also top notch, but it's run by a poorly thought through mix of public and private health care in a symbiosis gone sour. A buerocracy patchwork that needs an overhaul, but that the people in charge every mandate period keeps postponing because it's an uncomfortable thing to do. Everyone can afford to get the good care, but there are now pitfalls in the system that might delay treatments, or let accountability slip between cracks.

People have died here because of that. Something that pretty much never happened when it was a 100% public, government owned and controlled operation down to the last band-aid. That had other drawbacks, like a lot less helth care per Krona and a masswive strain on the national budget. And I'm not exactly proposing that system. Just that they get the current system right. And fast.

 

[WarLordwrites]

Well now, I;ve heard doctors debating this... just for the record I am in no way medically trained, just passing on what I've heard.

The US is not the best health care provider in the world - not just due to the whole health-insurance thing, but because of the extreme lack of diagnostic ability. Apparently the gulf between diagnostics in the UK & Australia and the USA is immense... An indication of this is House, the TV programme about a department of diagnostic medicine. V

Greeting

I've spent much time with doctors (sigh) usually lying down when they are in the room - that is over 30 years with a chronic condition..

Diagnosis is a "doctor" thing - some have it -- can hear feel and almost sense the bad stuff while others are artless[/] but thats in every job

I'll be blunt the healthcare system is badly broken and its mostly when we allowed "for profit' comanies to take it over. Now there profits depend on restricting your care to the cheapest outcome

Tthe dirty little secret is that the uninsured is what is breaking the system.

Hospitals that I know about that do treat uninsured then any bills they can't collect go to overhead ie room charge be paid by people who do have health care

The spike in number uninsured mean that the costs being shifted have become huge as people are getting care and simply disappearing

The system is broke badly time to go to single payer - if its good enough fo rmy congressman and senator good enough for me

OK rant over - at ease as you were smoke em if you got em

Enjoy the journey

WarLord

 

[Svenskaflicka]

People have died here because of that. Something that pretty much never happened when it was a 100% public, government owned and controlled operation down to the last band-aid. That had other drawbacks, like a lot less helth care per Krona and a masswive strain on the national budget. And I'm not exactly proposing that system. Just that they get the current system right. And fast.

But atleast now we have FREEDOM! Glorious, wonderful FREEDOM! Freedom to choose which doctor/dentist we can't afford to go to!

 

[elsol]

Does this actually say anything about our medical system?

To me, it says being poor in the US sucks... just like it sucks everywhere else.

Okay; the kid's death was preventable... but so are the deaths of thousands who die of what amounts to poverty around the world.

Being poor can get you killed... I got the memo a long time ago and coming to the US didn't change the contents of the memo.

 

[Roxanne Appleby]

We interrupt this round of satisfying U.S. bashing for some reality. The link has gone dead, but there is a huge hole in this story: Medicaid covers children in households below 200 percent of poverty level, and would have covered this. If your earnings are above that and you have a certain amount of assets above a fairly low level (homes are excluded) then you have to "spend down" (pay the medical bills) until you get to that eligible level. It's an ugly choice, but the ugliness is of a completely different order than "kids die because their parents don't have insurance."

As usual, don't take at face value news stories that spin narratives the reporters already have in their minds before the event even takes place. There's more going on here than has been revealed. My guess is as good as yours, but I would start with some tough questions for those parents.

 

[elsol]

We interrupt this round of pious U.S. bashing for some reality. The link has gone dead, but there is a huge hole in this story: Medicaid covers children in households below 200 percent of poverty level, and would have covered this. If your earnings are above that and you have a certain amount of assets above a fairly low level (homes are excluded) then you have to "spend down" (pay the medical bills) until you get to that eligible level. It's an ugly choice, but the ugliness is of a completely different order than "kids die because their parents don't have insurance."

As usual, don't take at face value news stories that spin narratives the reporters already have in their minds before the event even takes place. There's more going on here than has been revealed. My guess is as good as yours, but I would start with some tough questions for those parents.

This is the washington post article.

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html

I especially like that the system could have saved $250K by paying $80 dollars sooner. The post article seems fairly unbiased to me, even sparse.

A little too much in the 'want of a nail' for my taste as an article but not histrionic.

It's informative though... didn't know that toothache could kill me. Gonna make damn sure, I visit the dentist every six months from now on.

 

[elsol]

*burp*

The actual scary part is how many people have been that close.

Bacterial pneumonia for me; there but for a doctor giving me 'pharmaceutical samples' could go I.

 

[rgraham666]

The important thing to remember is that the poor are not just poor, they are sinners. They act against the dictates of the Faith.

If they acted according to the tenets of the Faith; went to the right schools, worked hard, showed up on time, dressed properly etc., they would not be poor. The everyday success of the Faithful proves this.

So, to support them in anyway whether through welfare, a public school system or health care would simply be rewarding them for sinning.

Throughout history the Faithful have never allowed that.

 

[jomar]

Well now, I;ve heard doctors debating this... just for the record I am in no way medically trained, just passing on what I've heard.

The US is not the best health care provider in the world - not just due to the whole health-insurance thing, but because of the extreme lack of diagnostic ability. Apparently the gulf between diagnostics in the UK & Australia and the USA is immense... An indication of this is House, the TV programme about a department of diagnostic medicine.

Apparently American doctors need to run a battery of tests to diagnose conditions, preferring, if possible to run MRI scans and tests before simply asking questions and examining the patient. Like I said, this is all hearsay, but UK/Aus. doctors are much better at pin-pointing conditions without so many invasive tests and, AFAIK, they have no need for specific 'diagnostics' departments, because all the doctors have a better training in diagnostics...

OK. Now someone who knows more than me can back that up or tear it down.

x
V

I think the main driving force in over testing is lawsuits. Increased malpractice rates have actually driven some docs out of medicine. Me PCP called me on a Sunday about an x-ray. He said in the good old days, some blur wouldn't even be mentioned, but now, get it checked to CYA, rather CHisA.

S-Des mentioned increased revenue as one reason. That's probably true in some cases, but a lot of tests are outsourced. The patient is sent to a specialized facililty, bloodwork to a lab, MRI's in a hospital where the doc doesn't get any of it. In fact, most docs are probably not sensitive to how much you're paying unless you bring it up (dentists too, but that's another rant).

 

[jomar]

The Medical System in the US IS the best in the world, there just happen to be these so called Insurance Companies between us and it.

These insurance companies are not really selling insurance so much as a medical cost payment system. With most big companies the Insurance Carrier is just an administrative mechanism to distribute payment to the Medical System. The Employer actually pays those charges. The premium they collect from the employee and the portion they kick in are actually just fees for admin costs of the plan. So this is not, in a true sense, insurance.

And if the it were insurance it would be more like you auto insurance. You would get quotes from different companies and choose the one you like the best and it would stay with you as long as you lived. When you changed employers the policy would follow you, it's your's, not the companies.

Also, the amount the doctor, hospital, ECF(emergency care facility) charge is negotiated by the "Insurance Company". There is a big difference between what is charged and what is actually payed.

A typical office visit for me is $150.00 US but the Doctor only gets $20.00 from me for my co-pay and $78.46 from the "Insurance Company". So that's a discount of $51.54 from the Doctors charges.

At the same Doctor a self-pay patient is billed $75.00 US.

As for Medicaid and Medicare patients, god only knows what the government is being charged as the patient pays nothing.

In the US Provider reimbursement used to be (and still is to some extent) based on a regions "usual and customary fee." Costs were spiraling out of control so Hillary helped fuck things up and managed care arrived to cut costs. These are the guys that play both ends - they sqeeze the provider by contracting for low payments (and place a shitload of barriers so payments are delayed - probably so they can collect more investment interest) and charge ever increasing premiums.

Did manage care work? Yes, for the folks who made millions and got rich. Costs are still out of control, providers still get lower payments while premiums keep climbing. What happens is that docs have to see more people to make the same money. Because they're so busy they can't spend as much time with patients, so order more tests (another reason), which costs insurance companies more, which results in premium increases, which.....sucks.

If you're poor here, we do have Medicaid, though people do slip through the cracks - make too much to get Medicaid and too little to afford insurance.

 

[shereads]

I Don't Want Health Care If Just Anyone Can Have It
By Jocelyn Chao

As a concerned citizen, I must voice my adamant disapproval of the "universal health care" proposals we've been hearing so much about. I don't have any gripes with expanding and improving health coverage, per se. It's the "universal" part that irks me. Providing health care for all would completely undermine the whole idea of health care. If every last one of the 40 million uninsured bozos in this country is going to get access to the vast, virtually unnavigable system of medical care we chosen few now enjoy, then I no longer even want it.

When hospital administrators see me flash my Blue Cross card, it means something. It tells the world, "Hey, look at me: I pay increasingly high monthly premiums, submit to annual exams, and claim any health-related expenditures over seven percent of my yearly income on my taxes, and you can't." But when this bill passes, they'll be handing out insurance cards willy-nilly, and nobody will be able to tell the difference between someone who's had health coverage for 20 years and someone whose boss was compelled by law to provide it to all full-time employees.

Then again, maybe they'll offer some sort of special Platinum Plus medical card. But I can't count on that.

Health care is all about exclusivity, pure and simple. It's for a group of like-minded people bonded by the dream of only having to contribute a portion of their weekly wages to ensure unfettered access to a number of licensed health care professionals. If we change all that, health care will be about as elite as a public restroom, open to any yokel who waltzes into an emergency room and can legally establish California residency.

Mark my words, this will completely destroy the allure of filling out all the necessary-but-time-consuming paperwork, choosing one primary care physician attached to one specific plan, and becoming eligible for prescription medications at a reduced rate.

The only reason this is even being considered is because a majority of voters want it. Well, of course they do—they don't have it! But you don't see 33rd Degree Freemasons letting any old average citizen into their inner sanctum just because he's curious. And you won't catch me sharing my God-given right to affordable lifesaving medical procedures with every bum who's got a jones for another hepatitis vaccination. It's undignified.

After all, how do I know I've made it in this world if I'm not able to enjoy something others can't?

Lack of access to health care is the seventh leading cause of death in the country, and that says something. It doesn't get much more elite than being part of a club other people are literally dying to get into. So what incentive would there be if everyone were guaranteed equal health care, regardless of income, age, or employment status? Who would be left to proudly tell their grandchildren about the glory days of PPOs? That is a future I'd rather not imagine, thank you very much.

So why the constant desire to guarantee basic yearly screenings and vital operations for all, thus creating some kind of ridiculous, unrealistic safety net? How will people fully appreciate the excellence of the American health care system without the constant threat of it being yanked away at any moment?

If middle-class children are given government-subsidized medical coverage from the beginning, they won't have anything to look forward to when they get older. Though my offspring will never have to worry about desperately trying to scrape together the money for a hospital visit, it doesn't mean we should do away with the millions of other uninsured Americans who show them how privileged they are to have it in the first place.

That's just a simple matter of respect.

I urge all citizens of good sense to reject any universal health care plan that gets put forward. It's time to stand up for what's right, and protect our most respectable institutions. If we don't do it now, what will they tell us next—that everyone deserves a free public education and "the right" to a fair trial?

March 7, 2007 | The Onion

 

[garbage can]

Unfortunatly, the drunken Senator from MA is right about a national health insurance plan. The way it is in this country, the insurance companies are collecting billions in premiums, while paying out only about 15% of the dollars collected. They are getting rich while raising their rates to the point where only a well-to-do can afford them. Then the cry and scream because they had to pay anything at all.

It's long past time for the social system to step in and make health care affordable to everyone.

Jenny, don't forget, the insurance companies are also paying out billions in liability. We need to get litigation under control. Bush tried to get a tort reform bill through congress, but failed.
If an ob/gyn has to pay $100,000.00 per year in liability insurance, you can bet the prices will go up.