I think we've got several things we need to do to re-establish essential values and quality in health care.
First, we need to demand and enforce contract law instead of allowing large insurers to NOT deliver on their contractual promises.
See Linda Peeno, MD testified that SHE had often denied treatment JUST to save the insurance company money http://www.thenationalcoalition.org/DrPeenotestimony.html
"While growing into a colossus, UnitedHealth has repeatedly failed to perform its basic job of paying medical bills. UnitedHealth, which covers 70 million Americans, has been sanctioned in nine states for paying claims slowly; shortchanging doctors, hospitals, or patients; or poorly handling complaints and appeals.
One Nebraska woman complained to state regulators that UnitedHealth's computers had incorrectly rejected claims related to her son's surgery six times.
At one point, UnitedHealth owed Dr. George Schroedinger, an orthopedic surgeon, $600,000. He and his clinic sued UnitedHealth of the Midwest in 2004.
Deciding for the clinic, U.S. District Judge Stephen Limbaugh of Missouri declared that the company's claims processing systems were "flawed in many ways, denying, reducing, and improperly processing claims on a regular basis. And despite innumerable requests, United was unwilling to remedy the underlying errors in its systems" (Star-Tribune Dec. 12, 2007).
Payment troubles continued after the verdict, and Dr. Schroedinger filed a second lawsuit. "These people can never get it right, which says to me that they just plain lie," he said in an interview.
Failure to pay isn't the only complaint. The insurer also gives incorrect information on which physicians are in its network, creating enormous problems for physicians' staff.
The AMA said that no other insurer has prompted as many complaints as UnitedHealth about abusive and unfair payment practices. AMA officials have met with UnitedHealth executives 16 times since 2000, with little to show for it.
"They have always got a new plan to fix it," said Dr. William G. Plested III, past president of the AMA. But "nothing ever happens."
It seems to us that this case is just the tip of the insurance iceberg. More and more stories are appearing daily in the news media about how insurance company are instructing employees their jobs are to deny claims and/or delay payments.
With such a high percentage of medical premiums and other costs going to the legal profession, to maintain compliance with endless government rules/regulations and being hoarded by the insurance companies and executives — is it any wonder medical costs are increasing so dramatically?
It's time to take a closer look at the medical insurance companies.
UnitedHealth Group is not the first medical insurance company to rob patients, hospitals and clinics to pay obscene salaries to their executives.
It's a modern day robbing patients to pay pimps.
Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in economics and citizenship at the International Trade Education Foundation of the Washington International Trade Council.
Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.
"the vast majority of health insurance policies are through for-profit stock companies. They are in the process of “shedding lives” as some term it when “undesirable” customers are lost through various means, including raising premiums and co-pays and decreasing benefits (Britt, “Health insurers getting bigger cut of medical dollars,” 15 October 2004, investors.com). That same Investors Business Daily article from 2004 noted the example of Anthem, another insurance company. They said the top five executives (not just the CEO) received an average of an 817 percent increase in compensation between 2000 and 2003. The CEO, for example, had his compensation go from $2.5 million to $25 million during that time period. About $21 million of that was in stock payouts, the article noted.
We also need to enforce antitrust laws:
A 2006 article, “U.S. Health Insurance: More Market Domination, More CEO Compensation”
(hcrenewal.blogspot.com) notes that in 56 percent of 294 metropolitan areas one insurer “controls more than half the business in health maintenance organization and preferred provider networks underwriting." In addition to having the most enrollees, they also are the biggest purchasers of health care and set the price and coverage terms. “’The results is double-digit premium increases from 2001 and 2004—peaking with a 13.9 percent jump in 2003—soaring well above inflation and wages increases.’" Where is all that money going? The article quotes a Wall Street Journal article looking at the compensation of the CEO of UnitedHealth Group. His salary and bonus is $8 million annually. He has benefits such as the use of a private jet. He has stock-option fortunes worth $1.6 billion."
--Save America, Save the World by Cassandra Nathan pp. 127-128
We need to go with what works--in this case, the free market, which we only have TINY little pockets of because of the large insurers and the meddling government:
A doctor owned and run hospital that sees everyone gets care, no matter what happens to the bottom line.
a doctor-driven group where reasonable rates are charged.
Note you can go to a walk-in clinic at Wal-Mart or CVS or the like in many cities and get many of the most typical reasons for seeing a doc addressed for under $100.
The price of LASIK has DROPPED dramatically over a decade. Plastic surgery is CHEAP. Compare a major procedure like a tummy tuck with the bill an uninsured patient will get for a medically necessary appendectomy WITHOUT complications.
When given FREEDOM, practitioners will deliver quality at affordable prices and patients will choose those who give the best care and best deal.
We need to REJECT the notion that ANYTHING goes to let those who do not even CONTRIBUTE to the system to reap HUGE rewards. What is up with this admittance of PREDATORY LENDERS into the field?
Hospitals especially and some docs have become so aggressive about medical bills that that bankruptcy issue is likely to get worse http://www.businessweek.com/bwdaily/dnflash/content/nov2007/db20071120_397008.htm
We also need to stop taking advantage of doctors:
In the US, Medicare is going bankrupt. In 1998, Medicare premiums were $43.80 and in 2008 will be $96.40--up 120?"Medigap" insurance is common because of the 20?o-pay required for service. Medicare HMOs are common because they reduce that burden without an extra charge in many cases. HOWEVER, many procedures which used to have no or a low co-pay NOW cost the full 20?or the HMO Medicare patient. ALSO the prescription coverage they tended to offer has been REDUCED in many cases to conform to the insane "donut hole" coverage of the feds. Doctors are leaving Medicare because of the low and slow pay AND because the crazy government wants to "balance" their Ponzi scheme on the backs of doctors.
"That dark cloud lurking over the shoulder of every Massachusetts physician is Medicare. If Congress does not act, doctors' payments from Medicare will be cut by about 5 percent annually, beginning next year through 2012, creating a financial hailstorm that would wreak havoc with already strained practices.
Cumulatively, the proposed cuts represent a 31 percent reduction in Medicare reimbursement. If the cuts are adjusted for practice-cost inflation, the American Medical Association says Medicare payment rates to physicians in 2013 would be less than half of what they were in 1991."
Medicaid is even worse.
The list goes on, really. What we have is a massive deterioration of a system which basically worked decently 30 and more years ago by the MEDDLING of those who couldn't even get accepted into med school so retaliated with lies (look at the history of managed care and how they got their hooks into the system swearing docs overcharged and if we let LAWYERS and "Businessmen" run health care we'd all be so much better off) so they could reap millions in blood money.
The list of MORAL violations as well as legal ones is long in the field and the government just sits on its hands screaming they should be given MORE money and that will fix it all.
Quality suffers as well when red tape binds providers hands.
Right now for the uninsured, so long as they're not illegals who skip out with impunity, you run the risk of bankruptcy if you need an appendectomy even. For the insured, their insurance is not much protection if they get really ill. More than half of the bankruptcies are over medical bills and most of the folks have insurance. Right there you know all you need to know about "essential values"--insurance is NOT supposed to be a moneymaker for the CEO, but rather bankruptcy protection for the policyholders.
We also have BS from "medical bioethicists" and their love of killing off the too expensive for everyone's good. WHERE did that insanity come from? Welcome to "futile care" which is the kissing cousin of euthanasia. Once that garbage comes in, no one is safe, even if he does have money.
Oregon's at least honest about the FACT that ALL government health care IS RATIONED care:
"But the real-life story of 18-year-old Brandy Stroeder may come to embody a harsher truth: namely, that even as we perfect more and more advanced medical procedures, not everyone is going to have access to them. And, as Americans struggle to come up with an equitable health care system, that even the best-intentioned system can seem heartless when forced to balance the good of thousands against an individual's suffering.
The story began last fall when doctors told Brandy, who lives with her single mother in a weather-beaten farmhouse about an hour south of Portland, Ore., that she was likely to die within a year unless she got a simultaneous lung-liver transplant, an operation that has been performed fewer than a dozen times in the United States.
Under Oregon's unique Medicaid system, which openly rations healthcare in order to provide basic care to as broad a population as possible, Brandy was eligible for a liver transplant or a lung transplant, but not both. In January, and again after a review in May, the state-run health plan said no. There wasn't enough data to show the $250,000 procedure was worthwhile, the health plan's administrators said, and the plan didn't cover experiments.
But Brandy wouldn't take no for an answer. A tough, determined young woman who had managed to work part-time at a photo studio, baby-sit her boss's children, coach the high school football team and maintain a 3.2 grade point average between numerous and prolonged bouts in the hospital, Brandy wasn't about to give up her life without a fight. She sued the state of Oregon, charging that it was making a flawed moral choice in refusing to save her life. Since then her caustic, articulate criticisms of the Oregon system have given a vivid sense of the obstacles any universal healthcare plan for the nation would face.
"They'll pay for an alcoholic to get a liver transplant because they've been drinking all their life," she says, sitting with her mother at a rickety picnic table under a cherry tree by her front door. "They'll pay for a heroin addict to get cured, to help someone kick the cigarette habit. Those are things people do to themselves. If you put it to a vote the people would say pay for some girl's operation instead of some alcoholic's liver transplant or some crack head's needles. I just think it isn't very fair.'"
Texas has also been the boldest in supporting the growing-in-popularity "futile care theory":
"Texas, however, has become ground zero for futile-care theory thanks to a draconian state law passed in 1999 — of dubious constitutionality, some believe — that explicitly permits a hospital ethics committee to refuse wanted life-sustaining care. Under the Texas Health and Safety Code, if the physician disagrees with a patient's decision to receive treatment, he or she can take it to the hospital ethics committee. A committee hearing is then scheduled, all interested parties explain their positions, and the members deliberate in private.
If the committee decides to refuse treatment, the patient and family receive a written notice. At that point, the patient/family has a mere ten days to find another hospital willing to provide the care, after which, according to the statute, "the physician and health care facility are not obligated to provide life-sustaining treatment."
Since the patients threatened with death by ethics committee are often the most expensive to care for, it will often be difficult for families to find other institutions willing to accept a transfer. But the futility deck may be especially stacked against Houston patients. Many city hospitals participate in the "Houston City-Wide Guidelines on Medical Futility," raising the suspicion that participating hospitals will not contradict each other's futility decrees.
If so, this would mean that patients seeking refuge from forced treatment termination will have to be transported to distant cities, as has already occurred in a few futile-care cases, perhaps even out of state. Illustrating the level of hardball some hospitals play against patients and families, the Clarke family's lawyer Jerri Ward told me that St. Luke's agreed to pay the $14,806 transportation costs to transfer Clarke to a hospital in Illinois — more than 1,000 miles away — if the decision to transfer is made on Thursday (4/27). If the family doesn't decide until Friday, the hospital will pay only one-half of the cost of transportation. Thereafter, it would pay nothing."
Good question: Who are all these JERKS who keep inserting themselves between physicians and patients to decide who lives and dies, picks pockets, and prevents physicians from having a decent living condition or a decent salary? It's bureaucrats, lawyers, and politicians--not a one of whom contribute ANYTHING to health care. When did the public go brain dead and decide THIS was a good idea? WHY do so many want to surrender and give it ALL to the government and insurers (and that is BOTH sides of the aisle, Gov. Mitt!).
How you re-establish values and quality is you put the QUALIFIED back in charge. That would be doctors. Then you institute PRICE TRANSPARENCY so people know what things cost. Then you ENFORCE contract and antitrust laws so the free ride for insurers is over. Then you offer CATASTROPHIC HEALTH CARE which is cheaper anyway that actually is built to prevent bankruptcy. Then you reduce government meddling. And voila, something that finally looks like a free market with people who have the TALENTS to run the system.