Health care: costs are a problem, access a bigger problem…

It’s become an old saw that if the government were to offer universal health care there would be health care rationing.

Probably.

But health care rationing already exists. It’s called how much and what kind of insurance do you have or how much money do you have.

The pool of those not covered by employer-sponsored group plans and not eligible for government plans already offered to the poor and elderly or disabled is getting bigger in this distressed economy.

It is also argued that government-sponsored universal health care is terribly expensive – and the current system isn’t???

Back when the economy was humming along and larger numbers of folks had employer-paid plans the costs were high (and getting higher), but the employers passed much of those costs along to the public through the prices they charged for products and services. So nearly everyone was affected by health care costs even though not all enjoyed the benefits.

And I don’t dismiss concerns about rationing or increased cost efficiencies that would not be as consumer friendly as people might want. Some time ago I went through a round of chemo therapy. I was fortunate enough to have insurance. And I was also fortunate that the doctor’s office where I received my chemo was about a five-minute drive from home. I could easily see that under a government plan (this is just theoretical) it might be decided that it was inefficient to have too many chemo centers and that folks would have to go to one central one. I might have to drive, say, to Sacramento, which is about three hours away.

I also had a CT scan, again about five or ten minutes from home. And I think there is more than one facility here in town that does this. Under government insurance it might be decided that such was inefficient, again, off to Sacramento??

So, you see, I understand the rationing argument or concept. I would hope that universal health care could be offered that would be consumer friendly. I think current costs and the fact that so many people are being priced out of the market might eventually lead to more efficiencies anyway.

The bottom line should be to provide the best possible health care we can to all. I have also always written that I realize that there is no free lunch, or no free health care I should say. In some way it has to be paid for.

Interestingly the health care industry is spooked enough it is trying to jump on the bandwagon for health care reform (well in rhetoric at least). Apparently they see that public mood and political power is arrayed in such a fashion that the industry might not be able to forever forestall reform (make no mistake, it does not want reform – too much profit is involved) so it is going forward with the strategy that if you can’t beat reform, join the reform movement. I’d be a little suspicious of this.

It’s kind of like letting the bankers run the government bank bailout program (as they seem to be doing with their man Geithner in place).

If true reform and universal health care can come out of all of this, I say fine.

But I think everyone is making things too complicated. I say continue with private insurance for those who are willing and able to pay, military benefits too, and offer Medicare to the rest. The program is already in place and quite popular. And folks still buy private supplements.

Yes it will cost. It already does. But we either pay lots of money so fewer are covered or we pay lots of money so all are covered.

The reason health care reform seems to be getting more attention now is that so many folks who thought they would never have to worry since they had jobs and group plans that went along with them now are worried because they have lost their jobs (or fear they will) or health care plans or both or are just being priced out of the market due to never-ending premium increases.

If private enterprise could truly offer workable and affordable plans that would be good. But it’s hard to cover people via private plans if those people do not have jobs or high enough paying jobs to pay the premiums. And as I have blogged before, so what happens when you lose your job and still need the insurance you can no longer afford to pay?

I have always had moral misgivings about health care for profit. The ambulance rolls up and the first thing they need to see is your insurance card, not your condition (I’m not saying that really happens, but that is the bottom line, isn’t it? I have seen that much effort and expense in doctor’s offices and hospitals is expended in the name of medical insurance).

But there is also a contention that the profit motive in health care and medicine in the USA makes this nation a leader in innovation because of the incentive of profits.

Nonetheless, I think that it is only right that we come up with a universal health care system and I criticize all congressmen and senators for dragging their feet for so many years.

There does seem to be some real movement under President Obama’s leadership. While I applaud him for getting help (if it is help) from the health care industry itself, I hope he does not let them steal the show.

2 Responses to Health care: costs are a problem, access a bigger problem…

  1. doctorblue says:

    Bravo Tony!

    If health care is a right, it should be non-profit.

    You are also right about the quality/cost of insurance correlation. I had Cigna HMO insurance and had doctors, who dropped out of the plan for various reasons, tell me that having Cigna HMO insurance is like having no insurance at all. You have to fight the insurance to get nearly anything covered and the billing and coding errors were unacceptable.

    I’ve been disabled the last five years because the many providers I saw while insured by Cigna didn’t have time to read the test result reports. Cigna rewarded its providers with year end bonuses for having more healthy patients, so my doctors “saw” more patients as healthy regardless of the patients’ actual condition.

    On the other hand, using these same records and independent examination, the Social Security Administration’s employed physicians — whom, I suspect, have more time to read and analyze reports — found that I was disabled due to degenerative disc disease caused by untreated infections. Unfortunately, Social Security is only charged with determining if someone is eligible for disability benefits and not with securing patient care.

    Based on this experience, I assume that I might have a better chance of getting government paid doctors to listen to me and provide the needed care for a few reasons. 1. There might be more accountability for satisfactory patient outcome. 2. Doctors wouldn’t be paid based on the number of patients seen per day, but on the service provided the patients they did see.

    Obama could gain more support for his proposed health care reforms, if the government actually did something to enforce its existing laws.

    Under our current system, I believe medical insurance companies have vicarious liability for the negligence of their network providers. Calling the insurance companies to the carpet for the negligence of its providers would not only tie up the courts for a good while, but add tremendously to the cost of private for-profit health care.

    Insurers who advertise and promote a patient’s bill of rights in SEC filings shouldn’t get away with dismissing and ignoring member complaints, which is exactly what CIGNA did in my situation. I have written correspondence to CIGNA, my primary care physicians and referred specialists complaining about their failure to take my health concerns seriously. (Since I have been disabled the last five years, I think I have a point.)

    My blog http://doctorblue.wordpress.com #8 “Search For A New PCP” provides details about my experiences dealing with CIGNA customer care and the numerous, repeated phone calls it took to correct multiple billing and coding errors and to get approvals for CT scans and diagnostic procedures. Surely, insurers should be corporately liable for failure to properly oversee staff and correct quality related problems, and for breach of good faith and fair dealing in failing to provide the insured appropriate care, as well as for breach of fiduciary duty for failure to monitor, investigate and oversee its management system.

    Yes, I got my CT scans, MRIs, SBFT, colonoscopy, etc. — all showing abnormalities that the insured’s providers chose to ignore, overlook, downplay…What good are they if no one is there to read and properly analyze the scans to form a proper diagnosis?

    The referred specialists made mistakes and the referring doctors chose to side with the specialists without examining the evidence–the reports in my patient records. None of the doctors were receptive to my repeated attempts to convince them to reconsider their decisions. Try finding a medical malpractice attorney to represent the injured party once the patient is broke and disabled.

    Perhaps CIGNA is the anomaly among all the other more proficient insurers, but I think not.

    If you read my post #19 “Virginia Workers Compensation Claim,” you’ll see that I didn’t get the lifetime medical care and hand surgery I was awarded due to surgeons’ fear of 1) not being paid by the insurer under Workers Comp, and 2) differing opinions on the surgical procedure needed. Aetna was the employer’s insurance company.

    Many have told me to seek medical care through Medicaid or other public agencies set up to help the disabled and private non-profit groups, who surely must exist to help the disabled.

    If you do the research, you’ll find Virginia does not offer Medicaid for the disabled and that there are no social programs here to help those like me. Health advocates do many things, but they don’t find competent doctors and surgeons for patients. (I guess it’s too difficult.) If you know of someone who does, please let me know.

    Because scenarios like mine are, in reality, so depressing, the as-yet-unafflicted choose to believe in a society that “ought to be” rather than open their eyes to the truth and do something to make these beliefs a reality. I’d like to live in a world in which people live by the motto “do the right thing” too. Do you really think someone will reach out and help me get the medical care I need to again become a productive member of society? Do you — in your heart of hearts — really believe that anyone cares?

    We didn’t change civil rights until the courts got involved. We can’t legislate how people feel. But we can adopt laws that protect the rights of harmed individuals. Health care won’t change until the government mandates action through regulation. At least a government-run system would provide an option for obtaining competent medical care, which I don’t have now and didn’t have when I had medical insurance.

  2. jacksmith says:

    PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON!

    As congress debates fixing Americas current private for profit healthcare disaster, global embarrassment, and national disgrace. The question is not weather we will have a public option. But rather what kind of public option we will have.

    America is the only country in the developed world that has a GREED DRIVEN! PROFIT DRIVEN! IMMORAL! UNETHICAL! PRIVATE FOR PROFIT! healthcare delivery system.

    As a result, hundreds of thousands of you are needlessly killed by your healthcare delivery system in America every year. And millions of you are crippled and injured. America is the only country in the developed World that does not have a NOT FOR PROFIT, PATIENT PROTECTING, government managed healthcare delivery option for all it’s people.

    America currently has the most costly health care system in the developed world. And the lowest quality of healthcare in the developed world. And the most dangerous, deadly, and FEARED! healthcare delivery system in the developed world.

    America is the only healthcare delivery system in the developed World that does not cover all it’s people automatically. And America has the most difficult healthcare system to access in the developed World.

    Contact your representative and tell then that a single payer, government managed healthcare option is a must for everyone that wants it. Tell them that you demand that the public option be the finest in the World.

    Tell them it should be available to everyone that wants it as a HUMAN RIGHT! Tell them it should be the easiest to access in the entire world. Tell them it should have the highest quality, with the greatest patient protections in the entire world. Tell them coverage should be automatic for everyone that wants it unless they choose to opt out. Tell them it should be the most affordable in the World. And tell them that NO ONE in the public option is to be reported to a credit agency, or driven into bankruptcy for unpaid medical bills just because they got sick, for FREEK’EN SAKES!

    Tell them, none of the requirements above are negotiable. Tell them, that we are prepared to remove them from office. Tell them, we will rain down the political FIRES OF HELL! on any of them that would betray the American people. Or continue to compromise the life, health, safety, and National security of the American people for the GREED DRIVEN, PROFIT DRIVEN! private for profit Healthcare Industry.

    TELL THEM NOW! AND PASS THE WORD ON.

    God Bless You

    Jacksmith — WORKING CLASS

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