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US Healthcare is broken. How do we fix it?

Discussion in 'Issues Around the World' started by Mospaw, Nov 22, 2002.

  1. Mospaw

    Mospaw Sure is hot in here!

    Health care in the United States is very very sick. The problem is not Medicare, the insurance companies, the doctors, or the patients. It's all of them and more

    It reminds me of the old joke, "What's the difference between God and a doctor? God doesn't think he's a doctor." Sadly, that's merely the tip of the problem, though.

    Medicine is more complex than ever. My primary care physician recently gave up his practice because of his insurance premiums. They actually went down, but so did his liability cap from $3 million to $250,000. He took a job with his brother who owns a grave marker (tomb stone) company.

    Life is unfair folks. Some of us are going to get sick and die, sometimes very suddenly, sometimes over a very long period of time, and it's generally nobody's fault, even if the treatment doesn't go the way you hoped or planned. Doctors ARE human, and will make mistakes and overlook things. I would say the overwhelming majority of problems with treatment are NOT malpractice, but the results of a doctor being torn between seeing enough patients to make payroll (or a living) and having enough time to get in 9 holes this afternoon.

    Many factions are to blame.

    Insurance companies are to blame.
    Increasingly, they like to collect those premiums, but will use any and every means to NOT pay claims, even legitimate ones. This greed is evident not only in medical insurance, but other forms as well. Even 25 year customers are getting their auto insurance dropped for minor claims! Insurance companies are out of control and need to be regulated. Profitability is fine. Not meeting contractual obligations and hiding behind a team of is not.

    Lawyers. Ah yes, lawyers
    They're to blame. Why not sidle up to the trough of greed and gorge yourself on free money? It's a difficult temptation to resist, and it's a rare litigation lawyer who doesn't.

    The tort system is out of whack when the person who essentially does the paperwork and makes a few arguments can get one-third OR MORE of a settlement. Lawyers' fees should be capped to a reasonable amount, but certainly not a significant percentage of these multi-million dollar settlements. Take away the incentive to inflate judgments beyond reason and they will come down.

    Patients are to blame, too.
    Modern medicine is miraculous in its abilities, but it cannot cure every ill in every instance. Not even close. Some diseases are beyond our reach right now, and like I said before, some doctors will make mistakes. If we have a pain, we go to the doctor to get a pill. Pills are easy to prescribe and easy to take, so we get our pills and the symptom is gone.

    Never mind the new chemicals introduced into your body, and that they may cause new problems. And forget about the fact that the underlying cause hasn't been addressed, either by you or your doctor. As long as you are symptom free, you're healthy, right?

    Patients have forgotten that they are also part of the health care equation and need to take charge of their health destinies rather than accepting substandard care.

    Blame the doctors
    Sure, they want to make money. I would, too! Doctors have a huge investment in education, so they're entitled to go for the big bucks if that's what they want. Unfortunately, their time is as limited as ours 24 hours in a day. In order to make enough money (after paying employees' salaries, office rent, etc.) to support the Benz, the big house, the kids in college, they have to overbook their appointments and only see us for a few minutes, and generally throw some pills at us to squelch our symptoms and complaints. The underlying problems causing the symptoms are often difficult to address, and some patients simply refuse to take control of their health. Pills solve the symptoms, and there seems to be a pill for everything these days.

    Doctors are also under enormous pressure from the drug companies to prescribe the latest (profitable) pill for patients. Heck, the nice drug companies will even lure doctors with junkets, golf clubs, and other nice bonuses just for listening to their spiel! The theory of any care is better than no care it all seems to prevail. Removing symptoms takes precedence over treating the whole person.

    Blame the drug companies
    Profit is a good thing. More profit must be a really good thing! The chemicals that drug companies produce seem like they can cure anything. Taking a pill is a lot easier than living a healthy lifestyle and much less invasive than an operation or other surgical procedure.

    Sure, there are a lot of good drugs out there, but the drug companies are running unfettered, giving us incredibly strong chemicals delivered through a supply chain that is intentionally set up to favor them the entire way. They control the approval process, seduce the doctors and advertise to the patients, all with very little control. Patents, the gold mine of pharmaceuticals, are being extended for minor things like double coatings, so the extreme profitability of drugs can be continues nearly indefinitely.
    Combine this with many people going to several doctors, often having several prescriptions, and it creates and often-deadly and frequently harmful unique brew of chemicals for many patients! Yikes. I am highly suspicious of any drug that I should take as a preventative or one that I am given a permanent prescription for. Except in unusual circumstances, there are no drugs that normally healthy people with a reasonable lifestyle will need in order to live day to day. NONE!

    The drug companies would have us believe otherwise.

    Blame the medical schools
    Teach some theory. Let the drug companies get to the young minds. Teach a little care. Throw the kids into the antiquated, cruel internship system, and give 'em an MD. Oh yeah, remind them about that Hippo-, er, Hypo, um, oath thingie. Don't forget to make sure they're in about $200,000 of debt when they get out so that they'll have to suckle any financial teat they can.

    Blame the government
    Medicare is only one part of it the government's failure in medical care. Medicare limits what the doctors can charge. Under that kind of pressure, frauds will happen, or worse, substandard care. The shame is that we CAN afford good health care in this country. And we can afford it for everyone. But it will come at the expense of long established and entrenched systems of care, billing, and treatment.

    I guess legislative ignorance and hands off is the way to regulate medicine in this country. I don't suspect maliciousness or laziness on the part of our leaders so much as I do a constant and concerted effort on the part of those who profit the most from keeping the status quo. Lobbyists (and through them their employers, the insurance companies, drug companies, etc.) are much more to blame than those being lobbied. Soft money is everywhere. The interests of those who can afford to have their voices heard are being met. Those who do not form a voice, or who do not hire lobbyists do not have the attention their representatives. We may elect Congress, but the special interests buy it. Day in. Day out.

    We need to wrest control of the legislative process form those currently strangling this country and making us unhealthy and tell our leaders that we want a pragmatic approach to medicine based on wellness not on profits and taking pills.

    The guilty will fall
    Many of the greedy companies, insurance, HMO, and even drug companies will perish before the system turns around. Many will flourish as well. It won't happen overnight, or even in a few years. A concerted effort on the part of everyone who is a part of the system is necessary. So is a lot of sacrifice, and, sadly, we're not a country that does that any more.

    Health care is broken. The way it is delivered is broken. The way it is financed is broken. Our expectations of it are broken.

    With all that said, how do we go about fixing it?
  2. ethics

    ethics Pomp-Dumpster Staff Member

    Wow, a power post!

    I will need to actually print this one and read it on the commute home. :) Thanks for some good material.
  3. Misu

    Misu Hey, I saw that.

    Don't get me started on premiums and insurance companies trying to weasel out of paying what they should...
  4. Mospaw

    Mospaw Sure is hot in here!

    Actually, Misu, painful as it may be, I'd like to hear what you have to say. I've had a few issues myself with "reluctant" insurance companies.

    The system is woefully broken. Airing grievances is the best way to start the ball rolling. It's hard to fix something when we don't know the specific reasons it's broken.

    I have simply posted a very general overview of SOME of the problems with health care in America. The system can be fixed, but it won't be easy, quick, or cheap.
  5. rowd

    rowd Spark Maker

    how do we fix?

    In a word or two....................<small>I never thought I'd say this</small>..........
    National Healthcare Insurance


    Big Time Major Investigation of the healthcare industry..........make em quake in their boots and plenty of jailtime for the doubledippers.:mad: :mad:
  6. Misu

    Misu Hey, I saw that.

    Ok well for starters, the fact you have to get everything APPROVED before you go in for something like surgery is insane. I almost wasn't able to have my back surgery in May because the insurance company waited until 8:30 am that morning to approve the procedure - nevermind the fact I was already inside, getting prepped, with needles sticking out of me, ready for my surgery at 9am. Had they not approved, I still would have gone through with the surgery, as I was suicidal because of the pain - but I would have been stuck with a 15k bill, payable in 30 days.

    And that's that I have my husband's insurance, which is through his job, and is supposedly a really good package. And in truth, compared to what my MOM has gone through, it's a walk in the park.

    My mother, who is a widow raising a 6 year old child alone, and basically lives off my dad's retirement money, has to pay around 400/month for basic health coverage - for herself ONLY - with something like a $3500/year deductible. However, this current year my mom has paid close to 5,000 out of pocket because the insurance company took their sweet time in approving procedures she needed done ASAP. So since she had the procedures done before getting the approval, they come out of HER pocket and don't count towards the deductible. She still has an almost intact $3500 deductible to pay.

    Once she started using her insurance, the insurance company threatened to cancel her policy. WTF?? My husband was actually defending the insurance company, saying that when a person gets health insurance you're not really expected to use it as often as my mom did. Well sorry Mr Insurance Company, but people can't help that they get injured or sick - and this past year has been a doozie for my mom. And that is still taking into consideration that we STILL don't know the results of her mammograms. Her doctor found a lump and initial mammograms don't look good, but the insurance will not approve any further testing until at least 1 full year passes between mammograms. Great. So if it IS something bad, we're wasting a year because the effing insurance company won't pay for it.

    I've had my battles with the insurance company reps on the phone, to the point that reps have HUNG UP ON ME because I was trying to convince them that the procedures they were 'reviewing' for coverage were necessary. Upon calling back, I would be informed the c**ts would be on their lunch break. RUDE TO BOOT.

    To the insurance company, we're nothing but numbers. They've got NO PROBLEM taking your monthly premium, but you better not get sick. If you do, you're likely to have your file "pending", as they had my mom for 6 months until just last month, when they FINALLY started cutting checks for all the procedures she had done. Of course, all her doctors ended up sending her to collections because they weren't getting their money.

    The the little game that doctor's offices and insurance companies play gets old REAL quick. For my back surgery, my doctor's insurance department actually had to call me to tell me to call the insurance company, because my insurance company had told them that I needed to authorize them to contact my insurance company!!!! I had to call them up and tell them "yes expect a call from dr's so and so's office because I need SURGERY!!!!!"

    *breath* I'm dizzy I'm so mad now. When I think of all the hoops and rings of fire I had to go through, and I supposedly have a GOOD insurance company. It's almost not worth getting insurance.
  7. rowd

    rowd Spark Maker

    how do we fix it?

    Put Real teeth into campaign finance reform...........
    For profit companies should not be allowed to contribute to any politicians campaign.
  8. ShinyTop

    ShinyTop I know what is right or wrong!

    I would like Mospaw's post starting this thread for post of the week. I have included reasons in the Post of the Week Thread below.
  9. Sierra Mike

    Sierra Mike The Dude Abides Staff Member


  10. fritzmp

    fritzmp Fire Fire For Effect

    I'll third that along with Ultaman LMAO. Not at the post.

    We need to do something about Hospitals and yes we have gone down this road before. How can we let them absorb the poor and illegals and not pass along the cost to those who can.

    Insurance is slammed and the bean counters can't see the end to malpractice and fraudulent climes.

    The pill rollers are getting paid enormous amounts of money on patents they have recouped their R&D 100 fold.

    National Health Care is not the answer. The military invented the concept HMO and that sucks. Health care was OK 25 years ago. We need to see what was working then to get an Idea of where to go from here.

    This is a problem that would make Solomons head spin and I think I would opt for cutting the patient in half.
  11. ethics

    ethics Pomp-Dumpster Staff Member

    Health insurance premiums are rising at <a href="http://sacramento.bizjournals.com/sacramento/stories/2002/11/11/story1.html">double-digit rates</a>. Drug prices are skyrocketing.

    And the latest, and most unsettling trendis that healthcare insurance is being <a href="http://www.nytimes.com/2002/11/25/national/25INSU.html?ex=1038978000&en=80a8ed62c3e9dfb0&ei=5062&partner=GOOGLE">priced out of the reach of the middle class</a>.

    According to recently released Census Bureau figures, 1.4 million Americans lost their health insurance last year. This brings the ranks of the uninsured up to 41 million people. Of the newly uninsured, the largest group - some 800,000 people - had incomes in excess of $75,000. Henry J. Aaron, a senior fellow at the Brookings Institute states: <blockquote>'No one should be surprised if 50 million people are uninsured by 2005.'Aaron goes on to say: '...cost-conscious businesses and tough rules under Medicare and Medicaid are narrowing the financial capacity of hospitals and physicians to offer free or discounted care to the uninsured. These market-driven developments threaten to give a new and terrifying meaning to being without health insurance.'</blockquote>

    Elizabeth Moore wrote an interesting tidbit about 10 things you should know about your HMO:

    1. Tell me exactly how you reward your doctors for cost containment. I want to be sure that your system won't keep me from having needed tests or seeing a specialist.

    2. Describe how you ensure that I will always be treated by a competent, well-trained physician with no black marks on his/her record.

    3. Let me know up front who decides what is "medically necessary" in my case.

    4. Tell me how I can appeal a medical decision that I don't think is correct, and tell me how soon I will get your answer.

    5. Assure me that I will have free choice of physicians within your Plan. Also tell me who pays if I want to see a doctor outside your Plan.

    6. Tell me what percentage of your revenue actually goes to treat patients as compared with marketing, administration and profit.

    7. Describe how you decide what drugs to provide for your patients. I need to be sure that I can get the best drug for my particular medical problem. I have heard that generic drugs and other substitute drugs can be dangerously inadequate.

    8. Tell me how you decide when I get to see a specialist.

    9. Give me an easy way to let you know what I think about the quality of care your staff provides. Reward those who get high ratings.

    10. Describe to me how I will get prompt care in a medical emergency. Tell me whether you will charge me if I have to go outside your system.

    She goes on to suggest that before singing up with an HMO, you should ask them all of these questions. While I'm not sure I'd do so, I think #10 is an important point. The issue here is not just that the monthly cost of medical insurance is increasing, but that the coverage is often somewhat slack.
  12. Allene

    Allene Registered User

    I'm also for making this the Post of the Week.

    Greed seems to be at the bottom of everything. I've had my share of problems with slow-to-pay insurance companies too. But, having grown up in Canada, I don't think their health care system is the answer. In at least some areas of Canada, physician shortages are so severe that hospital emergency departments have to limit their hours.

    As others have pointed out, we need better campaign finance laws, and we need to get back to the basics. This won't be easy to do. I particularly worry about what will happen to Medicare when all the Baby Boomers retire.

  13. Stiofan

    Stiofan Master Po

    Since I'm in the middle of this industry, I see everything you all see, and much more. I can 100% agree about each point mospaw expanded on, as well as give many logical reasons why each of the parties act exactly the way they do. But based on some of your posts, I'm afraid some of you won't care to listen.

    Without insurers, the very sick wouldn't be able to afford the costs involved. We're talking about hundreds of thousands of dollars for major surgeries or cancer treatments. Only by pooling premiums for the healthy can the sick be treated. If costs aren't controlled, then premiums must rise, and then more of the healthy population will go uninsured. Then you have to raise rates again. You can't have it both ways. Insurer's also have hundred of thousands of employees to pay wages and benefits to, buildings to maintain, advertising costs, etc. Plus, your grandfather's mutual fund probably invests in insurance stocks, and expects the insurer to turn a profit and pay a dividend, as well.

    The amount of money those rich doctors charge, well, does anyone realize the cost of the equiptment, most of which is leased, just in the offices of the smallest practices? Then you also have to pay wages and benefits to the bookkeepers and nursing staff. Try paying two or three hundred thousand dollars overhead each year, before bringing home any money for your family. This, with the insurers cutting their reimburments all the time.

    I'm an advocate of tort reform, still, do you want to live in a society where you have no access to the courts for redress when you get screwed by the doctor, insurer or hospital? Law firms have big overhead as well. They want their cut of the pie.

    We all know the drug companies are making unheard of profits, but they take enormous risks with their capital. Should the government step in and say how much they can profit? Unfortunately, if saddled with unlimited risk, they won't settle for limited profit. Might as well be making breakfast muffins or something.

    Hospitals. Let's not go there. They charge $40 for a couple of aspirin. Of course they are forced to give free service to thousands of people each year who would rather spend $120 each month on cable, internet and home delivery of the newspaper than buy health insurance.

    The only thing I can say with absolute certainty, is that you can't "fix" one of the parts without addressing all the other parts as well. With our political enviroment in this country, I really don't see that happening anytime soon.
  14. ShinyTop

    ShinyTop I know what is right or wrong!

    InsAgt, I will not argue with any points you make. But we have way too many not able to afford insurance to not start fixing the problem. But one point you make is way off. The $120 a month you stated is only 20% of what you pay if you are not offered insurance through your work. And many employers are skipping that to increase profits. And those that still pay part are increasing the copay every year.
  15. Domh

    Domh Full Member

    The insurance industry in America illustrates very clearly the critical faults of capitalism.

    As presently organized it does not work for all the people, all of the time - it works for less of the people day by day.

    Why cant the federal government step in immediately with massive federal regulations restructuring, not privatizing, this industry?

    Because our federal government isnt governing anymore, its doing business. The insurance industry is a damn good business, from which the feds profit far too much too meddle and muck it all about so that 'all americans can afford and have access to health care'.

    If there isnt a change within 25-50 years, I will be an old man sitting on my porch watching a violent revolution in this country, I guarantee it.

    The insurance industry is simply doing a spectacular job of riding the razors edge of the law while sucking this country dry.

    That the folks in Washington stand by watching and do nothing in between elections, and then cry foul JUST long enough to get elected and continue watching is enough to make any sane person stockpile armaments.

  16. Jedi Writer

    Jedi Writer Guest

    Did you all see the movie or read the book "The Rainmaker"? If you did you will remember the insurance company's letter denying the claim for medical treatment to a dying boy. The key part "You must be stupid, stupid, stupid!"

    I was in the legal field when that book and movie came out and everybody, and I mean everybody talked about that book and especially that letter. I don't recall a single person who didn't acknowledge that such letters exist and generally reflect, although in the extreme, the attitude of insurance companies.

    The "stupid, stupid, stupid" phrase as since become a recognized term within those very same legal circles.
  17. ethics

    ethics Pomp-Dumpster Staff Member

    Yah, I recall that, but never thought that any insurance company would be stupid enough to put something like that in writing.

    You telling me there ARE?!
  18. Jedi Writer

    Jedi Writer Guest

    I should have been clearer. Yes they exist but they with rare exception do not use that language but functionally say the same thing and deny the claim. It is the attitude of deny, deny, deny, by the insurance companies that everybody was talking about in the existence of such letters both literally but more often figuratively.

    I've done so much private investigation work for insurance companies that I can't even begin to estimate how much I've done.

    The examiners and adjustors vary in their skills and attitudes. But they almost to a person share one attribute in asking me to investigate the circumstances that have generated the claim, and that is see if you can find anything at all that can allow us to deny this claim and not be exposed to a bad faith lawsuit.

    What they should be telling me is do a thorough and professional investigation of the circumstances of this claim and report the facts to us. Those facts should speak for themselves as to whether or not this is a valid claim. We should pay all valid claims and deny those that are not---on the facts and merits, and nothing else.

    In fact I would venture an estimate that about 1/3 of all the investigations I've been hired to do by insurance companies in the past, on the face of the facts given to me the first thing I ask myself, "Why in the hell do they want me to investigate this? Given the undisputed facts alone this is a valid claim or it is a claim that would be absolutely impossible to prove not payable so just pay them you morons! You are wasting money having me investigate this!"
  19. ethics

    ethics Pomp-Dumpster Staff Member

    Jeez, that's just friggin sad.

    Thanks for a wonderful explaination. Sort of gives us a better understanding from within.
  20. Stiofan

    Stiofan Master Po

    Well, of course it'll depend on where you live, but if you're healthy (I don't mean perfect health, but average health) the largest health carriers in California (a very expensive state, BTW) offers PPO coverage, nine different plans priced $29 to $137 per month for people age 19-29. Even for those older, they still offer plans under this amount. A 64 year old can get a major medical hospital PPO policy for $112 per month, or a fuller middle range PPO for $238. If you want the low copay HMOs offered by most employers, yes you'll pay more, but not as much at the employer pays for the same coverage. The reason group insurance is more expensive is that the insurers are prohibited from denying coverage based on prior health history - individual policy underwriting allows this, and the coverage usually has very little if no deductibles. As the group policies msut take all comers with fuller coverage, the rates are really high.

    The point I'm trying to make is that if the healthy segment of our society was to buy insurance (usually those under age 30) for $29 or $50 per month, everyone else's coverage would cost much less. Still most people under 30 don't buy it unless they get it through work or they get married and start a family. But I would argue almost all of them have cable T.V.

    BTW, I have an individual policy, am in my 40's and pay $142 per month. Much less than a new SUV car payment. :)

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