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food for thought about health care reforms

Posted: Oct 11, 2010

For those of you who condemn private insurers for denying coverages for particular visits, hospital stays, procedures, etc., think back to when this wasn't the case, when things were covered. Then think about who started the denial ball rolling. Yup, you guessed it. It was the government. Medicare was the bad guy here when they started paying those capitated payments, set amounts for services and set length of stay rules, and went on from there to find new and more exciting ways to make more and more cuts, etc., etc. The private insurers just followed Medicare's lead. But you all condemned the private insurers and turned around the gave the government control of America's health care. What were you thinking?

;

Sources, please. What years are you trying to - talk about? My memory

[ In Reply To ..]
goes back pretty dern far,and what I come up with is managed health care that emanated from (you guessed it) the health insurance industry, and was set in motion by the Health Maintenance Organization Act of 1973, brainchild of Richard Nixon, aimed specifically at maximizing profits for health care insurers. They have been making out like bandits ever since, haven't they?

Actually, last stat I saw showed profits fairly low when - KM

[ In Reply To ..]
compared to most other industries, 86th I believe. This thing about their huge profits is fabrication.

2009 premium hikes and drops in enrollment netted - and average 56 percent profit as follows

[ In Reply To ..]
Wellpoint increased profits 91 percent from 2008 with a decrease of 3.9 percent of its total enrollment. United HealthCare increased profits 28 percent while decreasing enrollment by 3.4 percent. CIGNA profit increased by a whopping 346 percent, decreased enrollment by 5.5 percent. Humana increased profits by 61 percent, while enrollment dropped by 1.7 percent. See link below.

Please provide sources that back up your claim that these profits are "fairly low" when compared to other industries. BTW, I am not saying other corporate giants did not post record profits in the middle of a recession, such as oil companies, banks, Wall Street, and telecommunications. That does not change the fact that healthcare insurers profits have been having a hey day ever since the 1973 HMO Act was passed, an observation I made to undermine the statement madein the original post that it was government healthcare programs that started denying coverage.

http://abcnews.go.com/Health/HealthCare/health-insurers-post-record-profits/story?id=9818699

profits - sm

[ In Reply To ..]
could someone please tell me what you all have against profits? like the original post said: no profit and you go out of business. You are all just jealous of anyone who makes money. My guess is if it went into your pocket you'd have no problem with it at all. This is all just sour grapes.

Not against profits - but I am against greed

[ In Reply To ..]
I am against paying health insurance premiums all my life, with the possibility of getting ill and getting my health care cut off because of lifetime limits, denials of care, termination of policies, exorbitant rate increases making it health care for the rich, etc, etc, while insurance companies are making 50% plus profits while spending huge amounts on lobbying against health care reform.

Bravo. Excellent. Straightforward and to the point. - nm

[ In Reply To ..]
nm

twisted into a knot? - Must not know what you really want.

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HMOs started the "managed care" thing. It is a totally invalid argument that health insurers do not limit your care. Insurance companies are the biggest interference in health care. Every day I transcribe about how patient B is not going to have this or that procedure, or is not taking drug as prescribed because their insurer is not covering it. I was working in a billing capacity in the 80s and the HMO's were deliberately trying to shift higher cost care to the government for the sake of profit.

Based on annual reports filed with the Security and Exchange Commission WellPoint Inc., UnitedHealth Group, Cigna Corp., Aetna Inc. and Humana Inc. posted combined profits of $12.2 billion, a 56% increase over calendar year 2008.

During the same period of time, the big five insurers covered 2.7 million fewer Americans.

I'm not really sure what people are thinking - sm

[ In Reply To ..]
If this healthcare reform is anything like Medicare, we are in big time trouble. People have no idea about the ways of Medicare until they are actually on it, and then they really start to realize how much out of pocket there is in dedutibles coinsurance, not to mention premium. This is one of the reasons I want the choice. My spouse works for a huge company, probably bigger than all of the MTSOs put together, so you can only imagine how many people they have insured. We have 0 ded and a premium of just under 250 a month for family coverage, so I sure do not want any part in what the government has to offer for health ins.

I'm sure a lot of people do not know what Medicare medical necessity is either. I'm afraid another government ran insurance would be the same. If you want an RA panel, there are vew few diagnoses that will cover it, and joint pain amazingly enough is not one of them, go figure. It is like this with a lot of the tests.

I think when all of this happens that you will see more of the doctor's office that are refusing to accept insurance at all. The patient's pay an annual fee and then also for their visits, but the doctors then see fewer patients which gives them time with the patients.

You have it good - better make sure is stays that way (for you anywa

[ In Reply To ..]
Congratulations! I hope you never get divorced, become a widow, or your husband becomes disabled or loses his job for some reason. What would you do then? Do you have any idea how much that policy would cost you privately? And you better hope/pray you don't develop a pre-existing condition, because if you get your way with repeal of health reform, you will be out of luck.

This has only happened in the last year - sm

[ In Reply To ..]
Up until this past January we paid over 600 a month with nice large deductibles, and I still did not want the health reform. If something happened that I could not be on my spouse's insurance, I would then get it through my company. Though, I feel that it is nice to have, I do not feel health insurance is a God-given right. I have had to have independent insurance before. I depend on the government for very little and would like to keep it that way. I feel I will be much more out of luck if this goes through as a lot of people will. Are you a transcriptionist? Where do you think your paycheck comes from? Do you not want all of the insurance competition we can get? I have worked different clinical and insurance jobs, and this is not a good for our occupation. Insurance payments go down, jobs get cut.

I know the government is trying to sell you on this magnificent plan, but you need to really do your homework. Learn about the billing community, hospital account, etc before you decide on that. I do not see this being a good thing at all for the healthcare community.

Transcriptionists should want - all people to have access to health care

[ In Reply To ..]
in purely selfish terms, if all people were covered, there sure wouldn't be any problems with running out of work. (Unless, of course, the Chamber of Commerce and Republican party get their way on continued outsourcing). However, I believe I AM my brother's keeper and that we should look after the poor and sick. Its one of those real Christian things, you know.

Okay, let me share my real feelings with you - sm

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First off, the main thing that would keep me from voting for a liberal democrat would be because of "Christian things". I am all about helping people. I just don't belive that we depend on the govenment to do it. There is a difference in being your "brother's keeper" and having government insurance forced upon everyone. By the way, we do already have Medicare for disabled people, and if they make under a certain amount, they are also Medicaid eligible. My state has a Medicaid plan. It is supposedly for the sick and indigent, but unfortunately you see more of the drug abusers and young mothers (not working of course) having the kids left and right on it than sick people.

Your prejudice is driving you to make unfounded ASSumptions. - sm

[ In Reply To ..]
Once again, poverty is not the only qualification for Medicaid. Take some time to become familiar with what ELSE is required before Medicaid coverage is authorized. Your comments about drug abusers and young mothers are ill informed at best, mean spirited and (dare I say) grounded in ignorance.

Call it what you want - sm

[ In Reply To ..]
This is how I was raised. I am 29 and have a 13-year-old child if that tells you anything about how I feel about young mothers. I worked 2 jobs and went to night school (they allowed me to bring my daughter) to get my diploma. I got married at 16, and my husband and myself have worked ever since. I was raised by conservative parents who brought me up to believe that nothing is owed to me. You work and save, the later I have not done so good at. I worked in a rural area doctor's office for years and have called in to our Medicaid office on a "pain patient" who failed their drug screen missing their hydrocodone an benzo but of course have cocaine and PCP in their system. Nothing was done. They still received insurance. This is just one of many people that failed drug screens. I could go on and on. The young mothers I am referring to are the ones on their 3rd or 4th child looking at me like I'm an idiot for asking them if they send their child to daycare. Of course not, they don't work!

My husband and I could have received every kind of government aid possible when we were younger, but that was a lifestyle that was unacceptable to me. I'm not sure how may healthcare offices you have worked in, but I have worked in a couple, and I have seen a lot

Evidently the pain had an etiology that Medicaid covers. - Are you suggesting that

[ In Reply To ..]
patients testing positive for drugs should be denied medical care for serious conditions under chronic pain (in quotes, no less) management? Which ones? Only the ones being covered under Medicaid, or should we broaden that scope to include all folks covered by group and private plans as well? What about alcoholics? Deny care? Obese food addicts? Deny care? Diabetics who continue to gouge on sweets and carbs? Deny care? Mentally ill who refuse to take their meds? Deny care? Heck, lets just deny care to all noncompliant patients while we are at it.

How many children should we allow poor stay-at-home-moms with Medicaid QUALIFYING medical conditions to have? One? Two? Three strikes and she's denied health care? Ration medical care contigent on mandatory sterilization?

I don't care how you were raised and how you choose to run your own life vis-a-vis government help is your business. Denying medical care based on your beliefs to OTHER people is not. As for me, I have been working in health care longer than you have been alive, in office, clinical and hospital settings as well as outsourced IC and employee positions. My guess is that if your husband, your child or you ever receive a serious diagnosis, traumatic injury, develop a disability or encounter any number of curves life has a way of throwing at you, you will use any and all means available to you to negotiate the challenge.

Obviously, we do not see eye to eye - sm

[ In Reply To ..]
I never said anyone should be denied care. Everyone deserves medical treatment. I just don't happen to think that the tax payers should have to foot the bill. That doesn't meant that they can't go to an ER and get treated. They just have to pay for.

Now, the drug abusers. There is a huge narcotic problem pretty much all over the country. What the person was doing I mentioned and many more we caught was getting prescribed certain narcotics and selling them for their heavier drugs or just for cash. One 120 count bottle of hydrocodone 10/500 would get you about $1200. I do not think that my tax dollars should have to pay for that. Another instance, I do not think my tax dollars should be paying for people just being released from jail, but it does.

You would actually be surprised. I actually have less of a problem with a Medicaid program than you think for people with conditions that truly qualify. In my state, it doesn't seem to happen that way. I just noticed where a young girl that was our patient no longer has her insurance that just had a heart transplant from a congenital defect. I would have no problem with her being on it. How is it that a person selling narcotics can get it but someone with a heart transplant can't? There are having to set limits on how many they can accept, and if they would take some of these off that are abusing the system, maybe more of the sick could get on. That being said, that does not mean that I believe we need anymore government-ran insurance. The one we have now is not very good.

We are raising a government-dependent society. I actually see it as child neglect when a mother is not trying to get a job or at least go to school for her children. I really consider it neglect when a parent will not provide even food or housing for their children. It is like we just keep rewarding them. They can't afford to get a job because they loose all of their aid.

I actually am afraid if this health reform goes through and the government is keeping the bill that they may come in and starting banning things. No tobacco, no alcohol as it is raising health costs out of the roof. It is opening doors. I have seen a Medicare patient have a hopspital inpatient denied because they felt a pulmonary embolism should have been handled in a 24 hour observation. Seriously? That's what I am afraid we are looking forward to and then will have no choice but to have that insurance. The government dictates enough in my life. The last thing I want them involed in is my healthcare.

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