IT'S TIME FOR UNIVERSAL HEALTH CARE

Miller, Good on ya, and congrats on your accomplishments.

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georgeob1 wrote:

Cycloptichorn wrote:

You truly believe that the problems we face in the health care industry are caused by governmental distortion?

Cycloptichorn

Yes. Do you offer an alternative explanation?

Sure. As the problems we face focus almost entirely around the insurance aspect - I haven't noticed that the quality of overall care is low, and it's reportedly quite high - I would say that the fact that a huge percentage of the health care industry (the insurance companies) actively profit by denying payment for care, there's a definite negative incentive for the industry to actually help people get well.

Cycloptichorn

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Miller wrote:

Quote:
I think you would have a very hard time demonstrating that government itself has significantly improved education in this country - at any level.

At any level? For sure the US government has played a major role in education at the graduate and postdoctoral levels for many universities. Where else would the funds for academic research come from?
In graduate school, I never spent a cent for tuition as I was supported by fellowships for the whole 5 years.
Then as a postdoctoral fellow I was supported by more fellowships until I was able to fund my own research through NIH grants.

With respect to the funding of research at major universities, you are certainly correct. In addition, as you noted, the government finances a good deal of tuition for advanced education (My graduate studies & PhD were entirely financed by the government). I suppose one could also make a case that the establishment of the Land Grant public universities were also a big step in promoting the availability of education.

I would, however, make a distinction between education, in the sense that I was using the term, and government financed research, even that done at universities. As you undoubtedly know, many aspects of this support are incompatible with the educational function of these institutions and many have created separate divisions just to limit them. This government activity is certainly a boon and stimulant to the knowledge business generally, but its effects are small on education as it touches the great majority of people.

Certainly no sensible person would like to see a medical establishment imbued with all the client-oriented agility, professional accountability, dedication to effective outcomes and the economic use of available resources that characterize our public school system.

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I think you guys are focusing too much on this "insurance gets rich by denying" thing. That is a very cynical way to look at it. If insurance companies didn't deny many of these claims, they would go bankrupt and we'd all be screwed. There are [usually] good reasons claims get denied. You need to remember that this is a business. And for all the people you claim that it hurts, it also benefits a huge number of people as well.

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USAFHokie80 wrote:

I think you guys are focusing too much on this "insurance gets rich by denying" thing. That is a very cynical way to look at it. If insurance companies didn't deny many of these claims, they would go bankrupt and we'd all be screwed. There are [usually] good reasons claims get denied. You need to remember that this is a business. And for all the people you claim that it hurts, it also benefits a huge number of people as well.

Cynical, yet accurate. I would like to see your sourcing/reasoning behind this statement:

Quote:

There are [usually] good reasons claims get denied.

I predict that you will provide none.

I believe that it is possible to have an industry which does exactly the same thing as our current health care industry, yet exists on a not-for-profit basis.

Cycloptichorn

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Cycloptichorn wrote:

USAFHokie80 wrote:
I think you guys are focusing too much on this "insurance gets rich by denying" thing. That is a very cynical way to look at it. If insurance companies didn't deny many of these claims, they would go bankrupt and we'd all be screwed. There are [usually] good reasons claims get denied. You need to remember that this is a business. And for all the people you claim that it hurts, it also benefits a huge number of people as well.

Cynical, yet accurate. I would like to see your sourcing/reasoning behind this statement:

Quote:
There are [usually] good reasons claims get denied.

I predict that you will provide none.

I believe that it is possible to have an industry which does exactly the same thing as our current health care industry, yet exists on a not-for-profit basis.

Cycloptichorn

Can you provide me of a case where a claim was denied that you think is unfair? I don't think there are nearly as many instances of the big bad ol' insurance company killing people as you would like to believe.

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USAFHokie80 wrote:

Cycloptichorn wrote:
USAFHokie80 wrote:
I think you guys are focusing too much on this "insurance gets rich by denying" thing. That is a very cynical way to look at it. If insurance companies didn't deny many of these claims, they would go bankrupt and we'd all be screwed. There are [usually] good reasons claims get denied. You need to remember that this is a business. And for all the people you claim that it hurts, it also benefits a huge number of people as well.

Cynical, yet accurate. I would like to see your sourcing/reasoning behind this statement:

Quote:
There are [usually] good reasons claims get denied.

I predict that you will provide none.

I believe that it is possible to have an industry which does exactly the same thing as our current health care industry, yet exists on a not-for-profit basis.

Cycloptichorn

Can you provide me of a case where a claim was denied that you think is unfair? I don't think there are nearly as many instances of the big bad ol' insurance company killing people as you would like to believe.

Sure. Google took .00032 seconds to bring me hundreds.

here's one

http://www.smartmoney.com/consumer/index.cfm?Story=20020509

Quote:

BACK IN 2000, Ginny Akers had a magnetic-resonance-imaging scan performed on her knee. About a year later, Akers, 59 years old, received a phone call from a collection agency. She was told that she had 30 days to pay a $900 bill since her insurance company had refused to pay the claim. "This was the first I heard about it," Akers says.

When Akers called her health plan, Capital Administrators, she was told that the claim was indeed denied because she had gone to an MRI center that wasn't part of its network. Akers quickly pointed out that the facility was listed on the plan administrator's Web site as part of the network. The company still refused to pay the bill, and the collection agency was breathing down her neck. After three months, many phone calls and the help of CareCounsel, a patient-advocacy firm employers hire to help their employees deal with insurance problems, the claim was finally paid. "I just didn't know what my rights were," she says. The company makes it a priority to fix claim errors, says David Reynolds, president and chief executive officer of Capital Administrators.

Speaking from personal experience, my father went through cancer surgery about ten years ago. He's doing great now, but my family went through hell trying to get the insurance company to pay for things they had to pay for.

A short list of problems we dealt with:

- Doctors who had nothing to do with my father were billed to him by the hospital, and then paid by the insurance, who then claimed they didn't have to pay the doctors who actually did work on my father. We eventually proved that two of them weren't in the state that week (the doctors themselves were quite helpful in this process) and it still took 6 months to sort it out, the whole time being threatened with collections.

- the anesthesiologist we used was in-network, but then switched jobs after the surgery and became out-of-network - claim denied. Once again, took months to sort out.

- the insurance company/hospital refused to send an itemized bill, and when they did, there were over 6k in 'sundy expenses' that they refused to itemize, yet claimed we owed.

- The insurance company denied to pay for my father's morphine drip after the operation, saying it was 'optional.' I'm not kidding at all here. We ended up paying for that, it was too difficult to fight.

You do understand that this is exactly how these businesses work, right? They bill for each and every little thing they possibly can, even things that are blatantly false, and hope that people don't have the time or patience to check out whether or not they should be paying. And the more they pay, the less they make as a company - so they pay as little as possible, all the time.

Have you read about the California Blue Cross scandal? You know, the one where certain trigger words automatically sent your claim to be denied, whether it was valid or not? You should read up on it...

Cycloptichorn

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When my wife's parents were alive, she took care of all their necessities from verifying hospital billings, getting their meds, and taking them to their appointments. The hospital bills were inflated like crazy, and my wife being a nurse questioned most of them, and got them to reduce it.

Most people do not understand medical terminology, and wouldn't know what or how to question their bills. It's a nightmare for most aged people.

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Pretty much everything you've said can be explained by clerical error. There really isn't much you can do about that.

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USAFHokie80 wrote:

Pretty much everything you've said can be explained by clerical error. There really isn't much you can do about that.

Don't you get it? They weren't errors. When something happens, systematically, over and over again, to the benefit of the company in question, it isn't an error.

Cycloptichorn

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A clerk stting at a desk at the insurance company makes the decision to approve or deny medical procedures or meds. What's wrong with this picture?

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As for the claim of "billing for every little thing": the insurance company doesn't bill. That is the hospital. So that entire argument is pointless. If the hospital makes a mistake, the insurance company might refuse a claim. That is the fault of the hospital - NOT the insurance company. Further, would you rather them only bill for "the big things" and then just eat the cost of the rest? Is that their responsibility? No. Bills generated by hospitals come directly from the patient chart. Now maybe you got some screwy hospital, but most major hospitals derive charges directly from the diagnoses and I&O of a patient chart. Again, this has absolutely nothing to do with insurance.

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Cycloptichorn wrote:

USAFHokie80 wrote:
Pretty much everything you've said can be explained by clerical error. There really isn't much you can do about that.

Don't you get it? They weren't errors. When something happens, systematically, over and over again, to the benefit of the company in question, it isn't an error.

Cycloptichorn

Your assertion cannot be proven... This is just your belief.

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USAFHokie80 wrote:

As for the claim of "billing for every little thing": the insurance company doesn't bill. That is the hospital. So that entire argument is pointless. If the hospital makes a mistake, the insurance company might refuse a claim. That is the fault of the hospital - NOT the insurance company. Further, would you rather them only bill for "the big things" and then just eat the cost of the rest? Is that their responsibility? No. Bills generated by hospitals come directly from the patient chart. Now maybe you got some screwy hospital, but most major hospitals derive charges directly from the diagnoses and I&O of a patient chart. Again, this has absolutely nothing to do with insurance.

MD Anderson in Houston - best cancer hospital in the world.

It had everything to do with the insurance company... the hospital sure didn't make them refuse the anesthesiologist, or the morphine, didn't make them refuse to pay for my father's doctors for months. And if you think that bills are generated straight from a patient's chart, you're out of your mind.

Can't have a discussion with someone whose head is firmly planted in the sand. Here -

http://www.badfaithinsurance.org/reference/General/0534a.htm

Read for yourself. The insurance industry in America profits off of denying as many claims as they can.

Cycloptichorn

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From Wiki comparing the US and Canadian health system:

[edit] Insurance Waiting Lists and Comparisons to US Health Care
Waiting lists in Canada are essentially different for each hospital system. There is no true system-wide average wait time, as wait times change on a daily basis as patients come in to receive services, and waiting lists are different for each hospital. A Canadian patient has the choice to visit a different hospital system if the primary care they received at the original hospital is found to be unacceptable. For example: If hospital A has a waiting list of five weeks for a surgery, the patient can go to hospital B that may have no waiting list at all. It is important to note that only elective surgeries, such as hip replacement, have waits associated with them. Emergency procedures are performed as soon as medically necessary, based on doctor opinion. This triage system is essentially the same as used in American hospitals where PPO, POS, and HMO managed-care plans may schedule elective surgeries several weeks or months out, but emergency procedures are carried out as soon as medically necessary based on doctor opinion. The American and Canadian systems are more similar than many people realize, and in effect only different in how the majority of insurance claims are paid.

This triage system is the primary cause for concern in the Canadian system. Certain doctors and hospitals, in rare cases, have placed people on waiting lists for highly medically necessary procedures. The United States system has the same problem with rare cases where insurance companies deny a procedure and refuse services to patients. HMO and POS insurance, in particular, are known for scheduling medically necessary procedures many months out, or possibly denying care. PPO managed care is mostly known for denying claims for non-network doctors that don't accept the PPO's insurance plan; however, PPO is generally considered the best alternative to the POS and HMO model in the United States. Canadians generally believe the triage system with waiting lists are a better option than to have significant portions of the population denied coverage in order to provide fewer waiting lists for people with ability to pay and good insurance; however, most Canadians still feel their system needs reform and better access.

Both the Canadian and American health systems are undergoing major debate for each respective system in order to get more access to health care for the people who need it, in order to lower mortality rates. Each system has unique problems that need attention, mostly dealing with funding and insurance issues.

Canada has a slightly lower mortality rate on average, particularly when involving HIV mortality. The US rate for HIV mortality is approximately 4x higher; however, there are not 4x more HIV cases per capita in the United States.

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Cyclo,

Don't suppose that Government operated programs are any better than the insurance fiasco you described.

While doing the lab tests associated with a recent annual physical. I recall a very tedious conversation with a not-very-bright billing clerk at the laboratory where the various tests were performed. If I understood the issue properly, Medicare was (online in real time) rejecting the cost of the PSA test (a routine test for males over 50 years) and Blue Cross was following the Medicare screening decision - neither would cover the cost. I was annoyed because this is an utterly routine test, and quite willing to pay the cost just to be free of all the BS. A billing supervisor intervened and quickly discovered the problem - the numerical code assigned by my internist translated to "screening for malignant neoplasm" (which is exactly why the test is performed). However if they changed the numerical code to something that translated to "general screening" (or something like that) it sailed through. A quick call to the internist and some not very subtle coaching changed the numerical code and solved the problem. I was left with a sense of dread for the future actions of the mindless bureaucracy behind all of this -- something that your story excites in much more vivid detail.

I find it interesting that Walter, old europe, hamburger and the other non-U.S. advocates of what they call "Universal Care" have nothing but praise for their own systems and offer us very little in the way of tales of the annoying failures and irritants that inexorably accompany government managed and rationed systems. Despite this we know that underfunding, rationing, and long delays have indeed become major political issues for governments in the UK and Canada, and that very high (and perhaps unsustainable) levels of taxation and income redistribution exist in many of the countries employing such "universal" systems. The Germans here are utterly silent on such difficulties. It may well be that they have developed a system free of defects (I certainly hope it has fewer defects than the electronic issues in the Mercedes I just sold). If so they are fortunate indeed.

My experience suggests to me that a government operated system in this country will inflict such horror stories as you described on all of us with great regularity - particularly on those at the economic margins, presumably those for whom the system is designed.. Moreover, in the long run it will likely cost more. I prefer to spend my own money and control (as much as possible) my own situation.

Free market systems at least provide the feedback signals to correct the defects that occur (as seen by the patients who pay for it all). Bureaucracies are notorious for preserving their defects in perpetuity.

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george wrote :

Quote:

I find it interesting that Walter, old europe, hamburger and the other non-U.S. advocates of what they call "Universal Care" have nothing but praise for their own systems and offer us very little in the way of tales of the annoying failures and irritants that inexorably accompany government managed and rationed systems.

george :
i really don't want to annoy you , but simply ask you to re-read my entries .
if i ONLY had "PRAISE" for the ontario system , someone must have altered my entries , i assume .
to sum up my thoughts : i'm generally satisfied with our system but believe it needs a good "tuneup" and a good shot of additional money - which i would willingly pay !
hbg

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georgeob1 wrote:

Cyclo,

Don't suppose that Government operated programs are any better than the insurance fiasco you described.

While doing the lab tests associated with a recent annual physical. I recall a very tedious conversation with a not-very-bright billing clerk at the laboratory where the various tests were performed. If I understood the issue properly, Medicare was (online in real time) rejecting the cost of the PSA test (a routine test for males over 50 years) and Blue Cross was following the Medicare screening decision - neither would cover the cost. I was annoyed because this is an utterly routine test, and quite willing to pay the cost just to be free of all the BS. A billing supervisor intervened and quickly discovered the problem - the numerical code assigned by my internist translated to "screening for malignant neoplasm" (which is exactly why the test is performed). However if they changed the numerical code to something that translated to "general screening" (or something like that) it sailed through. A quick call to the internist and some not very subtle coaching changed the numerical code and solved the problem. I was left with a sense of dread for the future actions of the mindless bureaucracy behind all of this -- something that your story excites in much more vivid detail.

I find it interesting that Walter, old europe, hamburger and the other non-U.S. advocates of what they call "Universal Care" have nothing but praise for their own systems and offer us very little in the way of tales of the annoying failures and irritants that inexorably accompany government managed and rationed systems. Despite this we know that underfunding, rationing, and long delays have indeed become major political issues for governments in the UK and Canada, and that very high (and perhaps unsustainable) levels of taxation and income redistribution exist in many of the countries employing such "universal" systems. The Germans here are utterly silent on such difficulties. It may well be that they have developed a system free of defects (I certainly hope it has fewer defects than the electronic issues in the Mercedes I just sold). If so they are fortunate indeed.

My experience suggests to me that a government operated system in this country will inflict such horror stories as you described on all of us with great regularity - particularly on those at the economic margins, presumably those for whom the system is designed.. Moreover, in the long run it will likely cost more. I prefer to spend my own money and control (as much as possible) my own situation.

Free market systems at least provide the feedback signals to correct the defects that occur (as seen by the patients who pay for it all). Bureaucracies are notorious for preserving their defects in perpetuity.

Well, the intelligent thing for us to do then would be to make the reforms necessary to have a market-based system that combined the best parts of the gov't-run systems with the innovation and flexibility of private ones.

But, the whole 'shopping around for the best health insurance' line is a real canard. The vast majority of people dont' have the ability to pick and choose from dozens of providers. For the most part, this is due to the idiotic marriage of health insurance and employment; there's no correction ability when you're stuck and forced to either pick from three bad options, or quit the job you rely upon to feed your kids.

Cycloptichorn

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Same here. Even though both my wife and I have Medicare, and get quality service from our HMO at Kaiser in Santa Clara (rated as one of the top hospitals nationally), I'd be willing to pay more to 1) provide health care for everyone, and 2) improve the service - universally.

I believe it is important to have good health care for all children irregardless of their ability to pay.

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hamburger.

OK you have indeed offered us some rather qualified and non-specific information on defects in the Canadian system. However they have been very few compared to the fullsome praise and criticism of our system. Please let us know when the "tuneup" in Canada occurs.

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IT'S TIME FOR UNIVERSAL HEALTH CARE

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