Oh, the healthcare debate. I just love listening to people talk that have absolutely no idea of the topic on which they speak. Since I haven’t been working, I spend my time watching CSPAN. I then go for comedy relief by watching FOX News, Glenn Beck, and the talking heads on the Sunday morning shows. It makes me wonder if they even listen to what they are saying. It truly is fascinating.
Before I go on however, I must provide full disclosure. I worked directly for the health insurance industry for 12 years (10 for Blue Cross Blue Shield, and 2 for Principal Healthcare). I have done research on health insurance issues for the State of Iowa, provided market research, and contracting services for several other companies. All in all I have over 20 years in the industry. Also, I am totally and completely for a national health insurance plan. I think we need to dismantle health insurance companies entirely, at least in their current form. And let’s be factual here. We’re not talking about healthcare in any way, shape, or form. The argument is health insurance, not healthcare. I have yet to see anyone, ANYONE, mention the actual cost for any health service, of any type. So where is this healthcare debate? I say if we are going to have one, then let’s have one. But really what we are discussing is health insurance, and the coverage of that insurance. If we were talking about healthcare reform, then we would be asking why when I go to the doctor without coverage it costs me $150.00 for a tetanus shot, but if I have insurance, they only pay $10.00 (It shouldn’t surprise anyone that the clinic makes a healthy profit even with the $10.00 option).
To begin with, proponents on the Hill have already lost the debate on the subject. They really should have gone after the health insurance companies, and coined it health insurance reform, and not healthcare reform. I guess they thought insurance companies wouldn’t notice. No one likes their premium payment. It’s no wonder however that people go bat shit stupid when you bring up the healthcare. Had they gone after the real culprit, instead of wimping out and talking about healthcare reform, then we wouldn’t be in this pickle. We would have reform. But legislators were more afraid of the health insurance lobby, than the AMA. So…there you go.
Opponents on the other hand are eyeball deep in the health insurance lobby. They know where they get their money, that’s for sure.
How we got here:
In the 19th century we had accident plans which basically covered you for injuries. If you had general health problems, you just paid the fee and went. By the 1920s hospitals started pre-paid plans which enabled you to get services in case you became ill. The fees were small, but if you went into the hospital, with say the flu, you didn’t have to come up with the cash all at once. By the 1950s companies started really sprouting up to take over the pre-paid plans, and just took premium payments as fees to cover accidents and illness.
In the 1970s, and maybe before, something happened. Insurance companies found that they were paying higher, and higher costs. Most, if not all the problems, stemmed from subscribers (plan holders) and care givers providing false and misleading information for coverage costs. Policyholders would have multiple policies and profited when they went to the doctor. Providers would hike costs, and add services so they could get a little more off the top.
Insurance companies, whose primary goals are to make money for their investors, found they needed to implement cost saving procedures to ensure their money was actually going to the care givers. Said providers were also losing money. Rather than being paid, the checks were going to the policyholders, and they weren’t getting a nickel. So over the course of a few years, they came up with a plan. Insurance companies would contact providers directly. And if providers agreed, payments would be made directly to them, at a lesser cost, but they would be guaranteed payment. At the time it was a great idea. Providers loved it since they no longer had to hunt down the people that owed them money. Insurance companies loved it because they could get a better handle on costs, and policyholders loved it since they didn’t have to deal with the hassle of paying the doctor. The people that didn’t love it were the ones ripping everyone off. But we don’t give a shit about them.
However, during that late 1970s and early 1980s, costs started rising again. Providers didn’t like the fact that their payments were being cut. So to combat this, they found ways around the system to ensure their payments were higher. Physicians and hospitals double-billed for services, or performed unneeded surgeries (True fact: in the 1970s it is estimated that 80 to 90 percent of all tonsillectomies, appendectomies, and hysterectomies were medically unnecessary). Today it is estimated that the total number of unnecessary medical procedures is around 60%.
To combat this, insurance companies started putting safeguards in place to ensure their money was being well spent. They created Managed Care, a nice way of saying that if you go into the hospital, and if I’m writing the check, I get to see, 1. If you are actually in the hospital, and 2. If what the insurance company is paying for is actually happening.
Providers didn’t like this one bit, but they like money better, so by 1985 we were off to the races. Each side, insurer, and provider, started battling it out to see who could make the most money. In the meantime, quality of care started to waiver, which brought in the lawyers for all sides. After that, it was Katie Block the Doors! In 1985, a 44 year old male could get a healthcare policy with no deductible for around $125.00 a month. You can’t get that policy today, but according to underwriters at Blue Cross of Iowa, the cost would be anywhere between $4000.00 and $6000.00 per month for the same coverage. With inflation at that rate, our current health insurance system is not sustainable.
The current plan.
From what I can gather, the current plan only puts some limitations on insurance companies from denying coverage. In addition, it forces people to pay for coverage who would otherwise not buy it. It’s nice in theory, but even I have a problem with forcing people to buy coverage. I think a public option that everyone will have needs to be on the table, and if you want more than the public option, you can buy your own coverage. Is this new? No. Medicare part A is hospital coverage, and everyone over 65 has it. If you want physician coverage for office visits you have to buy it. If you want drug coverage, you have to buy it. I have no problem with that. Provide a base, and then let others buy what they want after that.
Scare Tactics
Death panels. I love the death panel tactic. The bill states that if you are going to have a procedure that it will be reviewed for medical necessity. What gets played in the press and on conservative blogs is Death Panels. As if this review process is something new. Actually, as this article has shown, these reviews have been in place since the mid 1980s by EVERY INSURANCE COMPANY BAR NONE! The real scenario is not that we’re going to let grandpa die, but more that we’re not going to give grandpa a knee replacement if he lost both his legs in the war. That’s it. A more realistic example is that prostate cancer is a slow moving cancer…very slow. If you are 80 years old, and are diagnosed with a lesser form of prostate cancer, chances are you will die of old age long before the cancer becomes a problem. Why put you through chemo, surgery, and radiation therapy, which will definitely kill you, if there is no need? You might as well be happy, even if you pee a little slower.
Unrealistic documentation. I heard this when Managed Care started in the 80s. “Physicians now, and all of a sudden, have to start making notes to justify what they were doing.” This argument is bullshit! Bullshit, bullshit, bullshit. Any medical student will tell you that providing quality care depends highly in part on how good you are at keeping medical records. If you don’t keep track, you might just cut off the left leg of the person who should lose the right leg. It’s happened…more than once. Not only that, what if your doctor croaks? I would hope someone could read my medical record and know that I’m a type B blood type and not a type A. You can’t ask the dead guy. Also, medical review is performed by hospitals as well. If the documentation isn’t there, then the least of their worries is the insurance company. Physicians lose jobs for sloppy record keeping. Currently, when procedures are denied, it is often due to poor documentation. More often than not, the provider will add the needed documentation to prove medical necessity. It’s a bogus argument.
Coverage will cost more. No…it won’t. There are so many hidden costs with healthcare that it’s hard to cover them all. A huge part of what we pay is in direct relation to others not paying for services they receive. Let me simplify it. If you have ten people in a group, and the coverage for the group is $1000.00 a month, that’s $100.00 per person. Now let’s change the field a little bit. Let’s say that only six people can pay, but everyone gets covered. That means that six people will now have to pay $167.00 to cover the cost for everyone. This is what is happening today. We have a group of billions, and 40% of them aren’t paying. If everyone pays, it’s cheaper for everyone.
The real flaws.
Hidden costs come from legal fees, cost overruns, people not paying, etc. Just look at lawsuits. If you compare the legitimate suits from the not so legitimate, and numbers are about 1 to 100. Just in case you are wondering, the specialty most likely to be sued for malpractice is orthopedics. Obstetrics is about third or fourth on the list the last I checked. Most of the experts thought obstetrics would be first. However, let’s just say that we were having babies for millions of years before we had doctors.
Having babies brings up a great flaw in healthcare. If it’s in the room, you pay for it. This is not true for any other service. If you take your car to have the brakes fixed, you don’t have to pay for the transmission flusher in the garage. So why, if all the doctor did is hand daddy the scissors to cut the umbilical cord, did you have to pay for all those other machines and people in the room? It looks to me that all the doctor did was sat on his ass. Mom did most of the work, and dad just smiled like an idiot when his kid came out. The doctor didn’t even cut the damn cord!
In other services you have to have an estimate before services are provided. Medical professionals don’t have to live by this. If you go in for a physical, all of a sudden you have bills from everyone in the office, and every lab that exists in the community. All you wanted was a physical, but all of a sudden you have bills from people you have never met, and for services you never agreed upon. This really should be illegal, but guess what…it’s not. “Are you really comparing a mechanic to a physician,” you ask? Yes. I am. Too often doctors are thought of as god-like creatures by others, and in many cases by themselves. They are schooled professionals, no more, or no less than any other professional. Show me one that walks on water, and I might change my mind.
None of what is on the table now will prevent insurance companies from limiting coverage. Just because you cannot be denied coverage does not mean that an insurance company cannot put a waiting period on a pre-existing condition. If you have an illness, and are given six months to live, what’s the point in having coverage if you have a waiting period? Believe me, companies will find ways around this issue. Also, even if they do close that loop hole, it won’t prevent companies from saying that they will only cover say 500.00 for a specific procedure. This is true today. You may think you have a plan that has a two million dollar limit, but they will still only cover up to 10,000 for a kidney transplant. Insurance companies will find ways around anything. Even today you have to add up all the coverage limits to actually get to the two million mark.
We have the best healthcare in the world, why screw that up? Actually…no…we don’t. We rank 37th in the world. Also, the United States has the highest infant mortality rate in the world. We are dead last in ensuring our children live. The chief cause: lack of health care and health education. You are almost 100% more likely to have a healthy baby, if you have prenatal care and education.
Abortions, abortions, abortions. I don’t care whether you are pro life, or pro choice. Personally, I think everyone is pro life. I won’t debate the issue here. I agree that the government shouldn’t pay for them. It’s not in the plan, nor was it going to be. However, I still see stories on it just to get people riled up.
Illegal aliens. Anyone who knows me knows that I think the illegal alien argument is a joke. If they are paying taxes, then they get services. If they are breaking laws, they go home. Nuf said.
Taxing Cadillac plans. Ok, this is ridiculous. They need to just smack the moron that came up with this. I think there is no such animal, but even if there was, it’s a bad idea. The argument I heard today was that “if they have a tax, then maybe they will spend less on coverage.” WTF? The point is to ensure people have the best coverage, not punish them for having it. The cost should be spread equally. I’m sorry if this sounds socialist. I don’t care. I see no reason why the guy who works at the 7-11 should have crappy coverage while the guy who works at Goldman Sachs gets great coverage. Look at it this way. Why should the 3 year old child of one person die because they don’t have coverage, and another live? If saving them both is socialism, then mail me my little red book please!
Not necessarily the news.
If you watch the talk shows, or listen to the AM radio, you will hear all kinds of horror scenarios, and “experts,” on health insurance. I will tell you that 99% of these experts are only experts because they got on TV or the radio. Sara Palin is not a health insurance expert. Joe the plumber is not a health insurance expert. Even Jon Stewart is not a health insurance expert, although I am a fan.
But guess what? I am an expert. But I guarantee you that none of them would ever put a microphone in front of me. No one wants the facts. Facts never sell ad space.