What does the health insurance industry add to the equation?

[cmac2012]

Does the health insurance industry build hospitals, do they build universities, do they train doctors? The first is probably true to some extent but certainly not in all cases.

The spectre of HMO execs making 6 figure incomes based on their efficacy at denying claims is sorta grotesque.

Imagine some loose knit rural community whose members helped their neighbors out in times of trouble - now imagine that someone had the bright idea to set up a small fund to enable communication with each other about who needed help. Further imagine that the fund was expanded to provide travel expenses for them providing the aid.

How would members of this community and the fund react if they discovered that the people administering the fund were getting rich by keeping the funds rather than using the money to perform the services it was founded for?

That's not far from the setup we have now. The need for health care is so intimate and vital that people will jump through whatever hoops they can to get it. The HMO industry taps into this pressing need to get rich.

Bill Frist is worth some $400 million behind this as are his father and brother. Did they provide some $1 billion plus in value? You don't want health care rationed by some govt. bureaucrat? But a hundred milliionaire exec rations health care and that's fine and dandy??

HMO's most ardent defenders, aka Republicans, howl about how much money all of this will cost, as if the nation as a whole isn't already devoting massive funds and climbing to health care. Large administrative costs are currently required just to determine who is or is not entitled to care.

Pre-existing condition? Sorry, you may have been pre-existing in your life before you came under the umbrella or our insurance scam, I mean industry, but you're on your own pal. What? Did you think that by buying health care insurance that your health would be cared for? In some cases, maybe. Read the fine print, pal.

[tbomachines]

So long as we have private health insurance, there will be people making money. It is a function of commercial existence - can you expand on your point? I feel like I'm missing something.

[cmac2012]

Originally Posted by tbomachines

So long as we have private health insurance, there will be people making money. It is a function of commercial existence - can you expand on your point? I feel like I'm missing something.

I'm thinking that something like single payer, at least for the bottom 2/3rds of society, would be a lot more efficient.

I understand that Medicare is actually quite efficient.

A lot of time and money is devoted just to determining who is allowed care under our current system.

[MS Fowler]

As much as I am opposed to a national health care plan, the insurance industry deserves most of the blame if we get one. Its not that I object to people making money, but the poor service, the claims they deny so that the top execs can get fabulous wealth. I just see that anyone deserves that kind of money.

[tbomachines]

Originally Posted by MS Fowler

As much as I am opposed to a national health care plan,the insurance industry deserves most of the blame if we get one. Its not that I object to people making money, but the poor service, the claims they deny so that the top execs can get fabulous wealth. I just see that anyone deserves that kind of money.

Many good points in 3 sentences!
1. Unfortunately there is much more to the system than most people suspect. Part of the blame for sure though, no buts about it.

2. Service, always needs improvement, but it is on par with most companies handling the volume of customers/calls. Denied claims, 9 times out of 10 people who do not read their plan documents before scheduling an appointment.

3. Couldn't agree more. I work for a HI company and most the everyday people are overworked/underpaid while the execs get quite a bit. Profit margins for HI companies are extremely low however, despite popular opinion.

Disclaimer: I don't have ANYTHING to do with claims, money, service, etc. I help manage the website from an internal/business/database perspective and has nothing to do with the "important" stuff. So please don't flame me. FWIW I also personally/openly support healthcare reform.

[Hatterasguy]

Originally Posted by MS Fowler

As much as I am opposed to a national health care plan, the insurance industry deserves most of the blame if we get one. Its not that I object to people making money, but the poor service, the claims they deny so that the top execs can get fabulous wealth. I just see that anyone deserves that kind of money.

Thats about how I see it.

The problem with the government is they cannot run anything well. I don't want to have to deal with health cares version of the DMV if I need it, no thanks.

[mgburg]

The only way to get to the insurance companies (ICs) is to keep submitting your claim...

I had five friends and one relative...all in the insurance biz.

Their insight...

About 90% of the denied claims never are re-submitted for challenge...right there, the ICs saved a ton of cash...

Now, the fun part...

The remaining 10% just have to keep at it...re-submitting their claim, filling out more forms, listening to "shyster" pseudo-docs, that never have seen you, for "their" interpretation of why you should be dancing with the stars and that you're faking the amputated leg...

Through attrition, the ICs manage to get the "complainers" down to two or three folks...then the lawyers get involved...

The lawyers get their share, you get a bottle of asprin and a boot in the ass (You probably had to do a "copay" on the asprin... ) and the IC executives get a nice "bonus" for keeping the premium payout low.

Nice work, at the top, if you can get it.

What do you want to bet that "O" and the gang will get some sweatheart deals w/the ICs before all is said and done with this Health-Care crap?

THE NEW HEALTHCARE MANTRA FOR THE TAX-PAYING PUBLIC:

We the taxpayers, will support the few and tactless in their search and acquisition of healthcare and welfare for their own, while we, those same taxpayers, will scramble around, Canadian-style (think BACON), and hope our number comes up before OUR NUMBER comes up!

[jlomon]

Originally Posted by mgburg

THE NEW HEALTHCARE MANTRA FOR THE TAX-PAYING PUBLIC:

We the taxpayers, will support the few and tactless in their search and acquisition of healthcare and welfare for their own, while we, those same taxpayers, will scramble around, Canadian-style (think BACON), and hope our number comes up before OUR NUMBER comes up!

A foolish statement. Your knowledge of our health care system is clearly flawed. These erroneous beliefs seem quite entrenched with a certain portion of your population. This has allowed large and profitable health care interests to equate Canadian-style health care with an attack on your freedom, which always resonates with a large portion of your population, and profit immensely in the process.

I always stay on the sideline with these discussions until invariably someone uses the "C" word and uses false information about Canadian health care to turn it into some sort of bogeyman to scare people into continuing to embrace a health care system that puts profit ahead of patient care. I'll be the first to say our system isn't perfect. It is far from perfect and it needs to be improved. But I wouldn't hesitate to choose my system over yours in a heartbeat.

[DieselAddict]

Originally Posted by jlomon

A foolish statement. Your knowledge of our health care system is clearly flawed. These erroneous beliefs seem quite entrenched with a certain portion of your population. This has allowed large and profitable health care interests to equate Canadian-style health care with an attack on your freedom, which always resonates with a large portion of your population, and profit immensely in the process.

I always stay on the sideline with these discussions until invariably someone uses the "C" word and uses false information about Canadian health care to turn it into some sort of bogeyman to scare people into continuing to embrace a health care system that puts profit ahead of patient care. I'll be the first to say our system isn't perfect. It is far from perfect and it needs to be improved. But I wouldn't hesitate to choose my system over yours in a heartbeat.

I can sympathize with how you feel. There's a tremendous amount of ignorance and misinformation out there on this topic, mostly thanks to Fox News and similar-minded talking heads. If more people traveled the world or at least saw some unbiased documentaries on this topic like Frontline, it would help us have a meaningful discussion, rather than constantly having to debunk right-wing myths and fantasies.

[tbomachines]

Originally Posted by jlomon

A foolish statement. Your knowledge of our health care system is clearly flawed. These erroneous beliefs seem quite entrenched with a certain portion of your population. This has allowed large and profitable health care interests to equate Canadian-style health care with an attack on your freedom, which always resonates with a large portion of your population, and profit immensely in the process.

I always stay on the sideline with these discussions until invariably someone uses the "C" word and uses false information about Canadian health care to turn it into some sort of bogeyman to scare people into continuing to embrace a health care system that puts profit ahead of patient care. I'll be the first to say our system isn't perfect. It is far from perfect and it needs to be improved. But I wouldn't hesitate to choose my system over yours in a heartbeat.

Couldn't have said it any better!

A lot of people see the need for a "bad guy" to place the blame and usually health insurance gets it. Fair enough, but at least educate yourself (I mean this in a GENERAL sense, not an attack on anyone here) about the workings of the system before preaching.

mgburg: your friends are probably in the insurance biz, not HEALTH insurance biz. I base this on the advice you received. The Health Insurance industry is a lot more challenging since people's lives are at risk. That being said, if insurance companies started approving every claim that was outside of the plan coverage, they would lose billions of dollars. 90% of resubmitted claims for appeal are settled after a call to the providers, who VERY often have bad billers/coders (anyone else see those commercials on TV advertising a "great career" in billing/coding?). That is a huge expense labor-wise, and mostly infuriates the customers. Since you'd see it in the claim, blame is placed solely on the insurance company when it isn't proper (just one example). The ones submitted for appeal and denied again are most often things that are not covered by the plan. IMHO someone who pays out the butt for health insurance (and face it we all do, those who have it) should at least know exactly what they are buying. Overall profit margins are in the vicinity of <1% for many of the better HI companies.

Kuan: If you were right then I wouldn't have a job.

The whole system is inheirently flawed. I can only hope that we come to a conclusion that isn't biased by any pressure by lobbyists, nor a lack of knowledge on our politicians' part. A lot of things would work in a nice rosy perfect world but there are many hidden nuances and elements that have only partially been taken into consideration up until now. Luckily my job has mainly to do with transparency rather than any of the evils, but it has painfully made me aware of the gaps in the system as well.

Sorry for the tl;dr post

[mgburg]

Originally Posted by jlomon

A foolish statement. Your knowledge of our health care system is clearly flawed. These erroneous beliefs seem quite entrenched with a certain portion of your population. This has allowed large and profitable health care interests to equate Canadian-style health care with an attack on your freedom, which always resonates with a large portion of your population, and profit immensely in the process.

I always stay on the sideline with these discussions until invariably someone uses the "C" word and uses false information about Canadian health care to turn it into some sort of bogeyman to scare people into continuing to embrace a health care system that puts profit ahead of patient care. I'll be the first to say our system isn't perfect. It is far from perfect and it needs to be improved. But I wouldn't hesitate to choose my system over yours in a heartbeat.

Sorry...my knowledge of our system is up close and personal...it was, both, the healthcare and insurance "system" that the "5 & 1" were showing me and if anyone thinks that healthcare, welfare, car, home, life or any other insurance company is run any different, they'd be fooling themselves...they all read from the same book, they're all cut from the same cloth and if you want even more proof of how the lemmings keep following each other around...pay close attention to what we think we're hearing from "O" and what the end result will be.

We (or at least the people we elected) are going to PATTERN our healthcare system like someone else's...we are TOO LAZY and in TOO MUCH OF A HURRY to come up with something that is fool-proof and will get everyone what they need, when they need it. Don't forget, "O" has a timetable to ram this crap through...you'd be better to take your healthcare-premium and put it all on either red or black, and that may even turn out to be a bad bet 'cause this plan that's getting rammed through Congress is bound to come up "0/00" on the table...

I'm assuming from your comments that you are with the Canadian Health Care System (CHCS)...how's that working out for you? Or...haven't you had to go through the meat-grinder yet? If not, congratulations on you, and yours, good health. I'm willing to bet that there are a few versions of bureaucratic misery that will come filtering down from the Nort' dere, eh...that will strip the skivvies off a moose...but until I've seen different and heard from better, I'm not buying into a taxpayer-subsidized system that's going to cherry-pick the best from the rest and treat them accordingly...as it is now, even Wisconsin State Employees get some BEAUTIFUL benefits that most other taxpaying, non-State-Employed workers have to pay for, but don't qualify for. Our "dinguss" Governor, "Diamond Jim" Doyle, has decided to expand healthcare, exponentially, to illegal aliens and to add adults to the child-healthcare system that was suppose to be set-up for kids under the age of 18...all for the sake of votes for him during the past few election cycles...and the State Employees, in most cases, don't have to contribute a dime towards their care...some of that may be changing...but I haven't seen it occurring as a whole-sale change...it appears to be only with "new hires" or in areas with "new job descriptions" where there's a "contributory" clause...but the unions will probably be able to wipe that off the books in short order...

We will end up with the Canadian-style, where we'll have to "take-a-number" and sit around waiting for a phone call to confirm when we can get in...if we're even eligible for the service to begin with.

If you don't think that's happening now in the States, just try to get an appointment with your current doctors down here. It's that way, right now, with the Mayo Healthcare System that I'm dealing with here.

The only way to see a doctor for something, immediately, is head for the ER, afterhours, and take a number there...

My X-MIL had to go through a similiar thing down in Central Illinois...she got moved ahead of a few people 'til they were able to determine the extent of the cancer she had...now she's been shelved and since then, it's been a waiting game...after the first round of kemo and the way it went for her, the treatment and such caused her to just say, "It's not worth the grief for a few extra months..." I don't care to go into the details, but to say there were a few eyes opened in how folks in Illinois have to deal with healthcare, that would be an understatement.

In the end, you have your system...we have our systems...and each has some good and some bad...

But, to completely toss the baby out with the bathwater is stupid...to whole-sale scrap a system and adopt another system is even more stupid.

To sit down and WORK OUT A PROPER SYSTEM THAT TREATS EVERYONE THE SAME, GIVES EVERYONE THE SAME CHANCE AND DOESN'T HAVE SOME "OMNIPOTENT DECIDER" MAKING LIFE/DEATH DECISIONS BASED ON SOME ARBITRARY THOUGHT PROCESS is going to take A LOT OF HARD AND FACT-BASED WORK.

Running some half-assed legislation through on an abbreviated time-table/time-line is stupid at least, deadlier in the long run and criminal at best.

Regardless how it's patterned and who it's patterned after...

Period.

[732002]

Originally Posted by Hatterasguy

Thats about how I see it.

The problem with the government is they cannot run anything well. I don't want to have to deal with health cares version of the DMV if I need it, no thanks.

Why pick on the DMV. Maybe gov health care will be like the gov run
ARMY,NAVY,AIR FORCE?

[Hatterasguy]

Doubt it. The armed forces atract a different type of individual.

[RichC]

Originally Posted by Hatterasguy

Doubt it. The armed forces atract a different type of individual.

Yup, the armed forces advertising campaigns target poor, undereducated, wannabees.

I think that is sad and disgusting.

The grandiose bull " Army of One " or " The few, the proud " kind of stuff really triggers the wannabees.

The talented and educated that want to serve the country go to work for defence contractors, wind up getting paid much better.

[DieselAddict]

Originally Posted by 732002

Why pick on the DMV. Maybe gov health care will be like the gov run
ARMY,NAVY,AIR FORCE?

I hope it's more like the DMV. The military hires expensive contractors and is not concerned with wasting taxpayer money. I'm sure the DMV's are more cost-efficient and I can go there any time, take my number, and be seen.

Some of you may not know this, but Medicare is actually remarkably cost-efficient. Its administrative overhead is only 3% compared to the 10-20% of private insurance companies.