Posted on 02/21/2007 7:39:44 AM PST by Rick Vassar
The real problem is that we ask health insurance to do too much, in the process handing over all our decisions and autonomy to them. Why do people need their insurance to cover regular doctor visits? Do people have their car insurance pay for oil-changes?
What we seem to want is for the medical community to provide us, on demand, the highest standard of care, without us having to pay an amount even close to what is commensurate with that standard of care, i.e. reimburse for the costs of all the employees, equipment, time, training, beds, and insurance involved. In fact we refuse to even look at the price (does anyone "shop around" based on price? no, we shop around based on doctor reputation, if anything), and to help us in this denial, we have our insurance hide the true costs of everything we choose from us, by covering or having "co-pays" for virtually everything from a lengthy hospital stay down to a tongue suppressor. And then we wonder why the market seems to fail in keeping prices down?
Infinite demand running up against finite supply is going to be rationed somehow, the only question is how. We could let the price do rationing. We could nationalize the entire industry and have the government do the rationing. Or we could do something in between - like the system we have, where prices don't really work and rationing is done through intermediaries based on statistics (and some government lobbying..).
In any event, rationing is inevitable, so whining about some of the symptoms of rationing (which is essentially what this/ese article(s) are about) is futile, if not utopian. So you want to "let doctors" make all healthcare decisions? Fine. Will you pay for the ramifications of whatever they decide, whatever course of treatment they propose? "Of course not", you say. Who then? "Insurance is supposed to pay for everything"?
Insurance is not a charity. They have to at least break even to continue to exist. If you take away all insurance companies' options which allow them not to lose money hand over fist, insurance companies will simply cease to be. There is no sense being in denial about this.
This article does not describe my experience, at all. I think it misperceives problems. Read the Cure.
Everything is designed by and for the new corporate monarchies. It does not matter whether it is health-care, banking, insurance, farming, manufacturing or politics. People no longer have any standing in world affairs. Everything is all about corporations. It is like the plot of an low budget science fiction movie, where the robot computers have taken over and enslaved the humans.
Removing the patient's control from his/her healthcare IS part of the problem.....just more of the socialization of America.
We let insurers "be the doctors" because if we don't they won't go into business.
Then why do we need doctors?
The insurance companies have it both ways. They can make standard of care decisions by withholding funding, and then state they had no impact on the level of treatment. If they are held to account, they hide behind the ERISA shield.
The point is that the doctors have been taken out of the decision making process by the insurers, and when the smoke clears, the doctors are held to account.
If you take away the ERISA shield, and allow patients to hold insurers accountable under state laws, the market will still work, but the insurers' actions would change dramatically.
Utopian? No. Reality? Yes
Typical lefty mentality. Whenever something seems to need "fixing," you would call Big Brother to the rescue! And that, in turn, would only make the system much worse than it is now.
The fact is that the Federal government is already too much involved in the health care system, and is itself responsible for many of the problems you mention.
When you use the word "insurer," you probably don't think even think of Medicare and Medicaid, I'd bet. Yet private insurers frequently follow the lead of Medicare in determining which medical treatments they will fund and which they won't. Decisions on patient's health and even life are all too frequently made from following a bureaucratic cookbook.
The whole system of "private" medical insurance in this country is largely an unpleasant consequence of the federal tax code.
The solution is not completely socialized medicine nor is it more government involvement, but rather an insurance system where more medical spending decisions are made by the patient and less by the insurer, public or private. This would include encouragement of a wider choice of insurance policies, including individually controlled health savings accounts.
As Ronald Reagan would say, government is the problem, not the solution!
Americans are too stupid to remain free.
When we go into an automobile showroom we don't let the salesman decide what we need and what we will pay.
But when we go into the doctor we let them decide everything and then blame insurers if turns out we didn't have coverage.
In my travels as an attorney I was shocked to find out that a medical tool company actually had a representative IN THE OPERATING ROOM telling the doctors how to use certain tools.
She was not a doctor, she had no training beyond the pharmacuetical company (she did have an MBA!) however the doctors were dependant upon her for the specialized tools.
It was little wonder there was litigation involved.
Doctors administer care and advise of potential treatments. Some potential treatments cost a lot of money. Someone has to pay for them. Yet nobody wants to pay for their own treatment.
So, we have set up, over the years, a system where "insurance" (it's not really proper insurance, it's something else) is expected to pay for everything (except in the case of the poor/old, then the government picks up the tab). This is an article complaining about insurance policies which are, basically, an inevitable outgrowth of having insurance companies participate in the system to the extent that they do.
You don't like this symptom, fine, then scale back what we use insurance companies for. Remove the tax-credit to employers for providing health insurance - decouple employment and health insurance altogether (it is really stupid, and a historical accident, that they are so linked). Have insurance be true insurance - that is, for actual catastrophes; get rid of this stupid expectation that insurance should cover everything on down to the tongue suppressors. Have people pay for most routine things out-of-pocket, 100% - stop hiding the costs of their care from people.
When that's been done maybe I'll listen to complaints about how the system could be improved further. But first things first.
The insurance companies have it both ways. They can make standard of care decisions by withholding funding, and then state they had no impact on the level of treatment. If they are held to account, they hide behind the ERISA shield.
By all means, get rid of the "shield", pass more regulations, force insurance companies to cover everything you think they should cover - knock yourself out.
Then watch as our premiums, particularly on middle-class people, rise and rise and rise. There is no free lunch.
The point is that the doctors have been taken out of the decision making process by the insurers, and when the smoke clears, the doctors are held to account.
Insurers tell doctors what they cover and how much they shall reimburse. If you're on an "insurance plan", don't be surprised that the care you are given corresponds, to some extent, to what your "insurance" company reimburses for. If you wish treatment in addition to that, pay for it!
If you take away the ERISA shield, and allow patients to hold insurers accountable under state laws, the market will still work, but the insurers' actions would change dramatically.
Sure. So would premiums. And then there'd be FR posts whining about that.
Essenitially "Duty to Die" has arrived.
"I am sorry the cost of your treatment and cure exceeds the good to society, you now may be afforded your choice of cost effective means of suicide for the benefit of society and Nancy Pelosi's Jumbo Jet expenses."
BTW..I'm not a medical company rep. Although I do happen to work in a hospital.
Just to clarify - I pay for my health care. Therefore, I will try to impact standard of care decisions because of the contractual relationship I have with the health insurer. Once it comes to litigation, the deck is stacked against the patient, and they know this.
I agree with you about ERISA. It a violation of states rights and should be changed to delete that interference with state insurance, tort, and other laws.
" It makes me wonder how much confidence they had in a drug that was touted as "100% effective""
Is that the only interpretation you can think of? Or even the likeliest?
No, but that's how it's been reported...
http://www.kvoa.com/global/story.asp?s=4928488&ClientType=Printable
Lorraine Rivera Reports
New vaccine said 100% effective against cervical cancer
That's an excellent rhetorical question. The same applies in many instances to physicians as well as hospitals. And that question has been relevant to HMOs ever since Kaiser (the "pioneer" HMO) was founded in the (c.) 1940s.
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