Submitted by Lawrence Rafferty-Guest Blogger
With the recent news of an appeals court decision that struck down the individual mandate portion of the Health Care Reform act, the problems with our Health Care system is on the front page again. While we hear politicians claim that the market place should decide all health care cost and access issues, millions are without coverage and the costs Americans pay for health insurance is staggering.
When I opened my business last Fall, I was shopping for affordable health care coverage. My wife teaches in a middle school here in Illinois and we eventually went with her School District’s cheapest family coverage. We joined a HMO which required us to change the doctors that we had both been going to for 20 years, but the cost concerns were overriding. Our cost for the coverage is approximately $550.00 per month for the two of us. Now, imagine my shock when I read that Florida Governor Rick Scott and other State legislators pay $30.00 per month for family coverage!
“Scott is among nearly 32,000 people in state government who pay relatively low health insurance premiums. It’s a perk that is available to high-ranking state officials, including those in top management at all state agencies. Nearly all 160 state legislators are also enrolled in the program that costs just $8.34 a month for individual coverage and $30 a month for family coverage. Brian Burgess, a spokesman for Scott, confirmed the governor and his wife are enrolled in the state health insurance plan, but refused to discuss why Scott signed up. He called the governor’s health care coverage “private matters.” The health insurance coverage provided to Scott used to be free for top state officials until 2010. Rank-and-file state workers pay $50 a month for individual coverage and $180 a month for family coverage. Married couples working in state government also pay the same amount as Scott and legislators.” Miami Herald
As you can see from the Miami Herald quote above, Gov. Scott is paying the same rate that state legislators pay for family coverage. I have no problem with an employer like the State of Florida paying for a nice health care insurance plan for its employees, but when the politicians on both sides of the aisle piggy back on that system and sometimes pay even less than full-time state employees, and then turn around and vote to deny other people the opportunity to obtain quality care at a reasonable cost, the morality alarm goes off in my head. (My morality alarm consists of visions of the good Benedictine nuns chasing me down a hallway with a yardstick in hand.)
You may remember that Gov. Scott has made a name for himself by refusing Federal Affordable Health Care Act funds for his state in the past. First Coast News Those are funds that would provide health care savings and access to his Florida residents who don’t have coverage, but what is good for the goose, is not good for this politician gander!
After reading the Miami Herald article it seems clear to me that my wife and I need to move to Florida and run for the State legislature and then present a bill to make every Florida citizen an employee of the State and maybe then Florida can get affordable coverage for all of its citizens without that evil individual mandate.
Submitted by Lawrence Rafferty-Guest Blogger.
This is the problem with private insurance; They have statistical analysis down to a science. When they have your complete medical record, they can predict what other conditions or medical expenses you may need in the future and pro actively bar you from those expenses.
It is why my thyroid will never be covered for ANY condition whatsoever, not just the original illness I had 30 years ago (Graves). If I get Thyroid cancer I am not covered at all, nada, nothing. There must be a statistic that shows people who had Graves to be at greater risk for thyroid cancer.
A good example from BC/BS. I have always had a rider on my policy for ‘accidental broken bone’. At least until I turned 50, when they sent me a huge stack of papers telling me how they were going to cheat me- Happy Birthday!. No one can read this gobbledegook, it written in the worst sort of legaleaze.
So 5 years later I broke my hand in the airport. thought I was covered, right? Nope, not covered AT ALL. But they were nice enough to tell me they got me a ‘coupon’
Otteray Scribe:
I have heard from my doctors that medicare and medicaid do not reimburse even half. Some of our doctors will not take those patients anymore.
The same is true for some private insurers as well and I have heard of more than one doctor refusing insurance altogether and charging 50-100 bucks for a 15 minute visit.
There are definitely problems but I think they are caused by government regulation of that industry. And there are many.
Anyway I know I wont change your mind. I guess we need to do it and see the results. I am betting it wont be pretty.
Woosty,
Thanks for the link!
I want to make one thing clear. It is not Medicare that is driving doctors from private practice. It is the private for-profit insurance companies and their anti-patient and anti-doctor antics. If doctors got paid a reasonable amount for each patient visit, then the costs would come down. What the general public does not seem to understand that the health care industry is asking doctors to subsidize those who cannot get insurance, or more likely those who think they have insurance, but it is not much more than a scam to get their money and then not pay.
A “Nigerian bank officer’s widow” with your $23,000,000 held in escrow for you could not do a better con job.
puzzling said “half of all doctors are now refusing new patients outright”.
if they have all the patients they can reasonably care for what else should they do? of course, the inverse is half of all doctors are accepting new patients.
whether you see the glass as half full or half empty is your perception. it doesn’t change the amount of liquid in the container.
i would suggest giving a subsidy to medical students so they don’t have overwhelming debt as soon as they graduate.
affordable healthcare benefits everyone. you never know, that little cough the cashier had at walmart might be drug resistant TB.
here’s you change and your receipt, sir. (cough cough)
Roco, I understand your perspective. BC/BS is either very good or most awful. There seems to be little in between. Oftentimes you will not hear the horror stories because your doctors and hospitals are not allowed to tell you when they have trouble with your account. At any rate, I am glad that your experience is better than a substantial portion of the public.
As for publicly managed insurance, you theorize that, “It will be a disaster in my opinion.” Sorry, but your theory did not work out in practice. It already exists and works fine. It is called Medicare/Medicaid. As I said above, Medicaid does not work as well as Medicare, but both do work better than any private third party payer.
Let me give you an example of my experience with managed care several years ago when I was accepting insurance. I was approved for doing a lengthy and expensive evaluation procedure on a patient. Estimated cost was in four figures. With the approval letter in hand, I literally closed my office for two days and had a technician assist me in the extensive evaluation of this one person. I then spent another day writing a 25 page detailed report of my findings and had to pay the transcription service 13 cents per line. The scoring services and consumable materials used also cost a lot of money. When we submitted an invoice to the insurance company, we got a rejection letter saying that they had reviewed the invoice and despite the fact they had given us prior approval, payment was denied. Their reason given was that after review, they did not feel the evaluation they had already approved, was necessary. They refused to tell us why it was, in their opinion, not necessary, despite the fact our findings were positive for the condition we were looking for. In bold letters it added that under the provisions of our provider contract, we were not to bill the patient or tell them payment had been denied.
If that had been a single incident, I would have called it a fluke. It wasn’t. It started happening with increasing frequency. The final blow to make me decide I was in the wrong business was when I got a frantic call from a doctor at a local psychiatric hospital. He wanted a test immediately. I told him I would put it on my schedule. That was unacceptable to him–he said that he wanted it NOW, as in the next hour. I said OK, dropped everything I was doing and hurried over. He was appreciative, but wanted the results within another hour because they were going to staff the patient for discharge. I asked when he was admitted, and was told the guy had come in with an overdose at 7:00 PM the evening before. I asked, innocently enough, why the hurry since he had just been admitted. The psychiatrist told me he had come in with an overdose the night before, had a cocaine habit, was suicidally depressed and had tried to kill himself, but the insurance company would only give him one day in the hospital. They had to “cure” his cocaine habit and suicidal depression by seven that evening. We were not allowed to tell him that the insurance had cut off his treatment–we had to tell him he was better and could go home after 23 hours in the hospital. I was told he killed himself a few days later.
Welcome to the world of for-profit insurance where profits come before people.
BC/BS…..Not for Profit….People might be amazed at how many different business interest these folks are into….But they need to raise rates…the executives need the bonuses…
Good article raff….
Otteray Scribe:
My child and I have never been denied anything we legitimately need, we have Blue Cross/Blue Shield. They have been more than accommodating and we have been allowed to talk to a patient advocate on more than one occasion when we were not being treated fairly. The patient advocate worked for Blue Cross/Blue Shield. We had Aetna before that, they treated us the same way.
We have fought a little bit over hospitalizations for my child but for the most part they have provided everything our doctors have asked for.
From my perspective I have not seen what you have seen. We have been dealing with health insurance companies for 20 years and have had pretty much whatever we have needed. Although we do pay anywhere from $300-700 per month for medicines and doctor visits even with co-pays. But if we had to pay without insurance we would be broke.
I dont think government insurance will be as good and it will have to be rationed, my child and I will be on the short end of that stick.
Puzzling is showing you that Mass. is already rationing health care.
I trust the free market far more than I trust government to provide for my health care needs. It will be a disaster in my opinion.
thanks rafflaw for pointing to the hypocrisy that is Florida Governor Rick Scott … I bet we will find it anywhere in government a teabagger serves
Sherrod Brown always has, and still does, refuse to opt into the less expensive government provided hospitalization option until all citizens have such an option. He has long been an advocate for healthcare for everyone and isn’t a hypocrite.
OS,
Coverage by insurance is not the same as actually being able to get care. Ask anyone in Massachusetts, where half of doctors are now refusing new patients outright. Primary care physicians are changing to practice as specialists, and even with that shift the wait time for specialists is now measured in months in many cases.
Medicare is solvent in the same way social security is solvent: if we can coerce enough young, healthy people to heavily subsidize the baby boomers (and pay back tens of trillions of existing baby boomer debt on top of it), today’s youth will pay years of taxes into a system to pay for others to receive benefits they will never see themselves.
The $50 trillion gap between government entitlement promises and structured receipts in the coming decades cannot be solved by expanding entitlements even further. The total value of the stock market is $15 – $20 trillion, so seizing all paper assets wouldn’t even get you there.
Roco, by “wild west” I meant that there are too few regulations, not too many. Insurers have too much freedom to abuse both patients and health care providers.
Roco, Medicare works. Medicaid does not work as well, but the point is that Medicare works. They pay their bills and pay them on time. I have more experience with private pay insurance than I care to think about. They are financial sharks, and provide nothing in the way of true services to their clients. Their function is twofold: 1) collect fees and 2) do their damnedest to keep from paying anything out to providers. The difference between fees collected and payouts is called “profit” and they see their reason for existence to be maximizing profits. It is NOT to help patients or their medical providers.
Some insurance companies have departments with specialists whose sole job description is to find a way to disenroll patients who are costing too much. I have some personal experience with that when our company health insurance disenrolled my (then) teenaged daughter when she needed life saving care. I sued them and they suddenly found a way to pay for her hospital stay, settling out of court.
Otteray Scribe:
There probably should be some sort of pool for people who cannot be insured.
But if there are only 5 major companies competing how could it be the wild west? They may be fighting regulations but they are also probably fghting new comers to the market as well. Lots of executives are not free market capitalists, they like their sinecure as you note. True competition would prevent this.
What would prevent a government executive from thinking the same way? He or she would have even less incentive to improve performance.
Also, to respond to your question, the health insurance industry is not all that regulated. In fact it is the wild west out there and they fight the few true regulations they have. They get paid for turning down people, not paying for services. They need to be nationalized and the profit motive removed completely, IMHO.
Roco:
The insurance company top executives make obscene salaries and bonuses. Stockholders do not see a cent of that money. Given we can hire top of the line public servants for a tiny fraction of what those executives make, you will have a hard time convincing me that someone is worth thousands of dollars an hour for their time. It is a sinecure for them and they are not going to give it up without a fight. Those insurance companies do nothing that adds to the quality or quantity of health care in this country. Those of us who have Medicare (I also have a “medigap” policy) have almost none of the problems people with private insurance companies have. I go to any doctor I want, get referrals to a specialist if needed, and the only thing I get in the mail is an EOB, not a bill. That is the way it should be for everyone. BTW, Medicare is a hell of a lot more solvent than the Chicken Littles in Washington and on Fox News would have you believe.
The fact that politicians have been bought off is seen in the law that forbids Medicare Part D from negotiating best drug prices with the drug manufacturers. That is another part of the problem–the big multinational drug manufacturers.
Otteray Scribe:
while I dont have the experience you seem to have with the medical profession, I have a good bit as a patient and father of a patient.
I also agree there is something terribly wrong with how medicine is paid for and it hurts patients and doctors. But the solution is not less competition.
In my opinion a good deal of the problem lies in the regulations insurance companies must follow and in the costs they incur for non-insureds.
I cannot buy an ala carte plan, deductibles are fairly standard and it takes acts of god to raise them.
Health care is no different in theory than hamburgers, competition does drive down price and creates better service and innovation.
Currently there are only 5 major insurance companies and they probably have a stranglehold on DC to prevent other entrants into that market. And DC obliges them because of the large amounts of money sent their way.
What is happening in the real world, thanks to “managed care,” is that doctors are either quitting private practice or moving from primary care to specialties. My son is board certified in family medicine. He quit private practice because, in his words, “I got damn tired of spending more time on the phone with some insurance clerk than I was seeing patients.” Another physician–a family friend–came to me madder than I had ever seen him. He had just had a patient admitted to the cardiac care unit. She had a massive MI (heart attack) and they gave her four (4) days in the hospital. The insurance clerk would not be budged off four days, despite the fact this woman was now scared to death that she would be sent home to die. Fear in a cardiac patient is never a good thing. The clerk had told the doctor, in so many words, that the actuarial tables showed that after four days the patient should either be better or die.
Along about that same time, while I was on the Ethics Committee of that same hospital, a memo was circulated. The largest managed care operation had sent a memo to the Utilization Review person at the hospital that henceforth they would only allow five days in intensive care for all patients. This decision was based on the company actuarial tables that showed 83% of patients who stayed more than five days in an ICU died. The memo went on to say that since only 17% of patients in ICU survived if the stay exceed five days, they could not justify paying for more than five days. Needless to say, there was a great deal of anger in the Ethics Committee and the hospital attorney was outraged. However, our contract with insurance forbade any of us from telling the families of this memo or making negative statements about the insurance company,which meant that we could not be called as expert witnesses.
jonathan, You made an important observation!
Illinois pays their state legislators about twice what their Florida counterparts make. $60K vs. $30K.
Maybe it would be better if the author of this blog article focused on his own house before looking inside his neighbor’s.
One thing often lost in discussions about benefits for government workers (health insurance and retirement) is that in the past, states have increased their portions of these benefits in lieu of pay increases. The two are obviously linked, so mentioning one without the other is a little disingenuous.