OUR COUNTDOWN TO FASCIST MEDICINE

@hamburgboy,

hamburgboy wrote:

foxfire wrote :

Quote:
Since insurance companies have paid me to explain it to their attorneys in advance of legal actions, however, I think I might know a bit more than the average bear.

i'm wondering how much chance an ordinary person - let alone a hard up , sick or poor person - having spenty much of their money for care , would have going up against the insurance company , their lawyers and SPECIAL ADVISERS ?
will they even have the mental/physical strength and the money for such a battle ?

i frankly have my doubts about that .

(i did work for a life insurance - also sold EHB [ extended health group insurance] - company most of my working life btw - but not in the rather small legal dept.
of course , paying for a life insurance claim is pretty simple compared to health insurance - the company does not have many reasons for not paying a claim .
but even EHB was pretty straight-forward ) .
hbg

But aren't you in Canada where the government controls it all? Folks here have a tough time winning an issue with our Federal government too. That's one of many reasons I don't want our government taking over health care.

But yes, I have won fights with insurance companies when a medication or procedure for a loved one was initially denied. If you can make a good case, the insurance companies will give in rather than incur legal expenses to fight it. Working work comp claims too, I myself denied a lot of prescribed medications and procedures and was quite often overruled by the court. And I have lobbied on behalf of some who were denied and have won some of those too.

So long as you leave it in the hands of private enterprise and the consumer, with enough law in place so that all parties are required to demonstrate good faith, the one with the better argument usually wins. With the government, it is usually far more difficult.

0 Replies

@Foxfyre,

Foxfyre wrote:

The laws and rules vary from state to state, but the very problem you point out re employer provided group policies would be multiplied many times over with a giant national government run plan. A la carte policies would have to be issued on an individual basis and would present problems for those in the higher risk categories.

No they wouldn't. The whole idea behind group coverage is that high risks can be pooled with low risks. Writing "a la carte" policies for people with high risk factors would just be culling the bad risks out of the pool, which is completely antithetical to the entire notion of group coverage. Clearly, you just don't understand this insurance stuff.

Foxfyre wrote:

Then again why should the healthy, low risk person be penalized for the health problems of the two fisted drinking, prime rib loving, couch potato? So that is one issue that should be thought through and solutions found. No solution will be available from a one-size-fits-all government program however.

If you're in a group plan, you're already paying for the two-fisted drinking, prime rib loving couch potato. And, I hasten to add, the couch potato is paying for your bad habits. THAT'S HOW GROUP INSURANCE WORKS!

Foxfyre wrote:

And I think there would be numerous suppliers for catastrophic illnesses/injuries only policies if enough people wanted that so that the risk would be spread. And I guarantee you that if most people were handed an itemized medical bill and could see what they are being charged for and what it costs, and they were paying for those routine things out of pocket, medical costs would come down.

A risk doesn't have to be spread to be insured. Given enough premium, a specialty insurer will cover practically anything, even a unique risk.

Foxfyre wrote:

And of course there remains the issue of tort reform that factors into a huge percentage of medical costs either through direct insurance costs, legal expenses to defend lawsuits or settle them out of court, and the vast amount of nnecessary expensive tests and procedures that are done as defensive, not necessary, medicine. Oddly, I don't think the President or Congress have addressed that in any of the five bills now being kicked around in Washington.

Tort "reform" is a separate issue. To avoid confusion, let's take the issues that you don't understand one at a time.

1 Reply

Fox herself, ironically, pinpoints the problems with our current health system, and she, herself, ironically also, was part of them. She says:
"But yes, I have won fights with insurance companies when a medication or procedure for a loved one was initially denied. If you can make a good case, the insurance companies will give in rather than incur legal expenses to fight it. Working work comp claims too, I myself denied a lot of prescribed medications and procedures and was quite often overruled by the court. And I have lobbied on behalf of some who were denied and have won some of those too."

Private insurance companies make money when they deny coverage. She apparently helped them deny needed coverage to policy holders. She decided when it was needed coverage, not the doctors. She also found it necessary in other cases to fight to get needed coverage which had been denied. That drives doctors crazy, which is why they spend so much of their time fighting insurance companies.
For her to talk about single payer systems rationing healthcare and restricting choice is ironic, since she appaarently participated in rationing care herself, and at the same time claims to have fought against private systems rationing and denying care.
In fact those disincentives to care exist in the private systems, not in single-payer systems, which have much higher user satisfaction indices than our system does.

1 Reply

@joefromchicago,

You are obviously arguing something different than I am arguing Joe. I wasn't referring to group coverage which is what I intended for my initial two lines (which you quoted) to convey. I also was thinking through the built in problems of the more difficult to insure people if a la carte policies were sold in lieu of group policies. I am fishing for solutions here while you are berating me for not knowing anything about insurance.

I am guessing that there would not be more than a half dozen insurers in the world who would write custom health insurance policies for those who wanted something different from what a lot of other people are getting. And fewer than that would write custom catastrophic coverage for a high risk individual who would be excluded on a group policy if they could get away with it. So, in order for catastrophic policies to become the norm, rather than the exception, a lot of folks would have to have them in order to spread the risk enough for insurance companies to write them.

As it is insurance companies, as much as state laws will allow them, will write only so much coverage for any high risk area no matter what kind of insurance we are talking about. And if states make it difficult for insurance companies to spread their risk sufficiently, insurance companies will pull out of that state. (It took the New Mexico legislators awhile to figure out why so many insurers were leaving New Mexico, but they've sort of cleaned up their act now and the companies are coming back in.)

I disagree that tort reform is a separate issue if the issue is to find a way to insure all those who wish to be insured at a cost that they can afford.

That is the issue for me.

What is the issue for you?

2 Replies

@MontereyJack,

MontereyJack wrote:

Fox herself, ironically, pinpoints the problems with our current health system, and she, herself, ironically also, was part of them. She says:
"But yes, I have won fights with insurance companies when a medication or procedure for a loved one was initially denied. If you can make a good case, the insurance companies will give in rather than incur legal expenses to fight it. Working work comp claims too, I myself denied a lot of prescribed medications and procedures and was quite often overruled by the court. And I have lobbied on behalf of some who were denied and have won some of those too."

Private insurance companies make money when they deny coverage. She apparently helped them deny needed coverage to policy holders. She decided when it was needed coverage, not the doctors. She also found it necessary in other cases to fight to get needed coverage which had been denied. That drives doctors crazy, which is why they spend so much of their time fighting insurance companies.

When an opportunistic doctor prescribes Viagra for a patient with a broken wrist as necessary to treat that injury, yeah I who am contracted to look out for the interest of the insurance company will probably deny that. (I've won that one every time it came up.) But there is a sticky wicket that work comp lawyers use in other cases: "Except for 'this' happening, 'that' would not have been necessary" and though the lawyer, the injured worker, and the adjuster, and probably the judge all know that it is a total crock, I have lost some of those. And when I am representing an insured when the offending party's insurance company denies coverage, I will fight for the prescribed treatment. And I've won most of those.

And these kinds of fights don't drive the doctors crazy at all. You might not be aware that there are dishonest doctors out there who pretty much depend on P.I. lawyers to furnish their clientele. Some of these don't give a damn about their patients but they sure milk the system for all it is worth. You might even point that out as an arguing point for your side if you want socialized medicine. Meanwhile, it is being handled with varying degrees of success by honest insurers and the people they contract with to represent them.

Quote:

For her to talk about single payer systems rationing healthcare and restricting choice is ironic, since she appaarently participated in rationing care herself, and at the same time claims to have fought against private systems rationing and denying care.

In fact those disincentives to care exist in the private systems, not in single-payer systems, which have much higher user satisfaction indices than our system does.

Private insurers cannot ration healthcare and I certainly had no such power. They can only specify what they will or will not pay for. That guy wasn't told he couldn't have Viagra for instance. He was just told that the insurance company responsible only for his injured wrist wouldn't be paying for it.

In a single payer system, if it is structured as some envision it, he could be told that he couldn't have it at all and he would have no place at all to go.

From time to time I or members of my family have been prescribed something that insurance didn't cover. The doctor advised us there wouldn't be coverage and if we wanted it anyway, we took the prescription to the pharmacy, got what we needed, and paid for it ourselves.

That isn't denying anybody healthcare. That is simply limiting what insurance is obligated to provide.

1 Reply

Frankly, Fox, I find the concept of a private system in which you, Fox, are in a position to determine whether or not I will receive coverage, rather than my doctor,( i.e. ratiioning healthcare, which you claim is the bugaboo of public systems) rather scary and an example of why private systems just are not working.

1 Reply

@MontereyJack,

MontereyJack wrote:

Frankly, Fox, I find the concept of a private system in which you, Fox, are in a position to determine whether or not I will receive coverage, rather than my doctor,( i.e. ratiioning healthcare, which you claim is the bugaboo of public systems) rather scary and an example of why private systems just are not working.

Then why do more than 80% of Americans believe they are working? If you are honorable, not attempting to cheat the system, and understand the limitations of what insurance can and cannot do, you have no problem. As an adjuster or advocate for the insurance company, it is my job to adhere to the contractual agreement in the policy and the law. I cannot let either the injured party or the insurer violate either without informing them of the consequences.

And after the President has spelled out some really scary scenarios that he sees that will be necessary for the government to enforce once it has the power, I can't see how you could be so gullible that you think healthcare will be 'rationed' less when you give the government power to do it.

1 Reply

@Foxfyre,

Quote:

Then why do more than 80% of Americans believe they are working?

Is this that hard to figure out, Fox?

Those same Americans will give high marks to their own Congressmen and Senators - but rate Congress itself really low, all at the same time. It's psychological.

Cycloptichorn

0 Replies

@Foxfyre,

Foxfyre wrote:

You are obviously arguing something different than I am arguing Joe.

I'm not arguing anything, except perhaps that you don't understand insurance.

Foxfyre wrote:

I wasn't referring to group coverage which is what I intended for my initial two lines (which you quoted) to convey. I also was thinking through the built in problems of the more difficult to insure people if a la carte policies were sold in lieu of group policies. I am fishing for solutions here while you are berating me for not knowing anything about insurance.

Well, if you're fishing for solutions, you should at least know what sort of fish you're trying to catch.

0 Replies

@Foxfyre,

Foxfyre wrote:

I am guessing that there would not be more than a half dozen insurers in the world who would write custom health insurance policies for those who wanted something different from what a lot of other people are getting.

Wrong guess.

You can do such which nearly all of the 193 insurance companies in the mandatory health service in Germany.
(They offer, however, more or less only the products - there may be more, but I didn't look at all the products of all companies - 48 German private health insurance companies. And from those 48 companies, you can buy coverage for all and every medical and health problems.)

1 Reply

@Walter Hinteler,

Walter Hinteler wrote:

Wrong guess.

You can do such which nearly all of the 193 insurance companies in the mandatory health service in Germany.

The best offer i've found is by the Roland Insurance (a private insurer): a "pre-trial custody package" ('U-Haft Package'), which includes - besides others - "indoor medicament service" and "prison daily benefits" ... which can be used for a cure in a 5* sanatorium afterwards and for paying some specialists (from outside the German system) privately.

If I hadn't seen and read that today, not on April 1, I would be quite sceptical.

0 Replies

Our fearless leaders at work, and some still wonder why we are so nervous about what our benevolent government intends to foist on us by rushing headlong into healthcare reform:

Quote:

CNSNews.com
Conyers Sees No Point in Members Reading 1,000-Page Health Care Bill--Unless They Have 2 Lawyers to Interpret It for Them
Monday, July 27, 2009
By Nicholas Ballasy, Video Reporter

(CNSNews.com) - During his speech at a National Press Club luncheon, House Judiciary Chairman John Conyers (D-Mich.), questioned the point of lawmakers reading the health care bill.

“I love these members, they get up and say, ‘Read the bill,’” said Conyers.

“What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?”
http://www.cnsnews.com/public/content/article.aspx?RsrcID=51610&print=on

0 Replies

@Foxfyre,

Foxfyre wrote:

Private insurers cannot ration healthcare and I certainly had no such power. They can only specify what they will or will not pay for.

It really is amazing what sort of undiluted nonsense you're willing to digest.

Of course private health insurers ration health care when they refuse to pay for certain treatments. For instance, if the insurer isn't going to pay for the $50,000 course of treatments, the insured probably isn't going to pay for it either. The remarkable thing is that you're quite happy having your insurance company dictate those kinds of decisions but not your democratically elected government -- and that despite the fact that you have as little understanding of the way insurance works as you do of the way government works.

In any event, no one is suggesting that, under any possible government health care reform, the government will prevent someone from getting treatment that is not authorized by the government. In other words, if the government doesn't pay for a treatment, the patient still has the option of paying for it out of his/her own funds. That's how it's done in countries with single-payer plans, and I don't see how that's any different from what you describe as a system where insurance companies don't ration health care. And since that's the case, I'm sure you'll agree with me that there wouldn't be any kind of rationing of health care, no matter what kind of health care reform we eventually get.

1 Reply

In what way are the millions of daily acts of kindness and care which go unrenumerated any different from an economic point of view to those similar acts undertaken for financial reward in institutional settings?

1 Reply

@joefromchicago,

joefromchicago wrote:

Foxfyre wrote:
Private insurers cannot ration healthcare and I certainly had no such power. They can only specify what they will or will not pay for.

It really is amazing what sort of undiluted nonsense you're willing to digest.

Of course private health insurers ration health care when they refuse to pay for certain treatments. For instance, if the insurer isn't going to pay for the $50,000 course of treatments, the insured probably isn't going to pay for it either. The remarkable thing is that you're quite happy having your insurance company dictate those kinds of decisions but not your democratically elected government -- and that despite the fact that you have as little understanding of the way insurance works as you do of the way government works.

The warranty on my HD TV or my new Laptop Computer specifies what it covers. The fact that it does not cover every problem I might have with these is not rationing repairs. It is simply specifying what you are purchasing with the product. It does not prevent me from obtaining whatever service or repairs I might need and pay for myself or through some other service.

My auto insurance does not cover oil changes or windwasher fluid and won't replace worn out or damaged tires. That doesn't mean it says I can't have such things. It only specifies that it will not pay for them.

Health insurance spells out what medications, procedures, and services it will pay for. It does not say that you can't purchase anything outside of what it will pay for or purchase other products that it will.

In no case is anybody 'rationing' anything. In every case, the contract spells out what is expected from the parties who enter into the contract.

If you see health insurance as anything other than a contractual agreement between the Insurer and the Insured, it is YOU who does not understand how insurance works. At least a private Insurance company cannot change the rules in the middle of the game without incurring risk of liability for breach of contract or bad faith. In my opinion, the government has no such restriction on how it does business, but perhaps sometime you could educate me sometime on how government works so I will be as smart as you..

Quote:

In any event, no one is suggesting that, under any possible government health care reform, the government will prevent someone from getting treatment that is not authorized by the government. In other words, if the government doesn't pay for a treatment, the patient still has the option of paying for it out of his/her own funds. That's how it's done in countries with single-payer plans, and I don't see how that's any different from what you describe as a system where insurance companies don't ration health care. And since that's the case, I'm sure you'll agree with me that there wouldn't be any kind of rationing of health care, no matter what kind of health care reform we eventually get.

As long as it is a combined government and private system, you are correct. There is no way the government can ration healthcare. But, as has already been explained, private healthcare providers will not be able to compete if the government creates an unlevel playing field.

Give me assurance that a government that is convinced that they will do a better job than the private healthcare system will not create that unlevel playing field and in effect will not dismantle the private healthcare system. Show me that we will not wind up in a system like Canada with too few doctors, too few facilities, and noplace to go to get some procedures or treatments that have months or years of waiting on a list or can't get at all? Tell me that President Obama was kidding when he said that some folks that are too far gone should just be sent home with pain killers or that the government would decide if a kid needed his tonsils out.

Perhaps there are valid resolutions for some of these things, but they all need a good airing, a long, hard critical evaluation, and honest discussion and debate. It is not helpful for the blind partisan disciples to shrug it off by accusing those who question of being stupid and they don't understand anything.

2 Replies

And there seems to be a hell of a lot of people who 'don't understand insurance' out there. I think there are enough that our government should slow down long enough to make sure everybody is pretty much on the same page before it is a done deal.

Quote:

Just 23% Believe Health Care Costs Will Go Down if Reform Passes Congress
Tuesday, July 28, 2009

Americans are fairly evenly divided on the health care reform proposals working their way through Congress, but most remain convinced that the plans will raise costs and hurt the quality of the care they receive.

The latest Rasmussen Reports national telephone survey finds that 47% are in favor of the reform effort proposed by President Obama and congressional Democrats while 49% are opposed. Those figures include 25% who Strongly Favor the plans and 41% who are Strongly Opposed.

The specifics of what will be in a health care reform plan remains hotly debated in Congress at the moment. When a final proposal emerges, it is possible that support could move significantly in either direction.

Currently, 76% of Democrats favor the proposal and 76% of Republicans are opposed. Among the unaffiliated, 35% are in favor and 60% are opposed. Notably, just 16% of unaffiliateds Strongly Favor the legislative effort while 47% Strongly Oppose it.
http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/july_2009/just_23_believe_health_care_costs_will_go_down_if_reform_passes_congress

0 Replies

@Foxfyre,

Foxfyre wrote:

But, as has already been explained, private healthcare providers will not be able to compete if the government creates an unlevel playing field.

I must have mised the examples you gave, sorry.

But it works pretty well. In Europe. (Where insurance companies within the mandatory systems aren't allowed to make profit.)

1 Reply

@Walter Hinteler,

Walter Hinteler wrote:

Foxfyre wrote:
But, as has already been explained, private healthcare providers will not be able to compete if the government creates an unlevel playing field.

I must have mised the examples you gave, sorry.

But it works pretty well. In Europe. (Where insurance companies within the mandatory systems aren't allowed to make profit.)

If your system does not allow private insurance companies to make a profit then there is no free market in private health insurance there.

1 Reply

@Foxfyre,

Foxfyre wrote:

If your system does not allow private insurance companies to make a profit then there is no free market in private health insurance there.

Sorry if I wrote something like that.

Insurence companies within the mandatory health system aren't allowed to make profit - I know this 100% (since those laws are online and I looked it up) from Germany, Austria, Switzerland and France. (From other countries I only know it be hear-say or quoted on the web.)

Private insurers make profit. A lot actually. (Source here: my BIL, CEO/CIO in "Europe's No. 1 health expenses insurance group", represented in more than 40 countries worldwide. [He's CEO for the international business. But I admit that this is just anecdotal knowledge.])

Again those figures I posted already yesterday: we've got about 190 insurance companies within the mandatory system, about 50 in the private sector.

0 Replies

@Foxfyre,

Foxfyre wrote:

At least a private Insurance company cannot change the rules in the middle of the game without incurring risk of liability for breach of contract or bad faith.

You're fooling yourself. Plenty of people have purchased health insurance only to find out, when they need it, that their insurers rescind their coverage.

Foxfyre wrote:

In my opinion, the government has no such restriction on how it does business, but perhaps sometime you could educate me sometime on how government works so I will be as smart as you..

I don't think anybody has that much free time.

1 Reply

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