2 posts tagged “doctors”
Talking about health issues is tough for anyone. It is especially tough for me, for personal reasons. I won't espouse about any recent goings-on, but I will lament the experience afterward. I think that by and large, the medical community has changed from an entity that's purpose was to provide the best possible care to its patients, to a business that is more concerned with maintaining relationships with insurance companies, the government agencies that pay out claims, and the bottom line. (Jesus, this is horrible. But it's 3:30 A.M...)
I am not an idiot, and I am perfectly aware that hospitals have to make a profit. I am with them on that front. I contend that the real problem is the insurance industry. With the advent of medical insurance, costs have risen at a very healthy rate for many, many years. While I find the entire concept flawed, I will play devil's advocate here for a second. In theory, you pay an insurance premium every month as protection against some catastrophic illness or accident. Should such a thing occur, you pay a deductible, and the insurance company pays the remainder. In practice, it NEVER works this way. In practice, you pay a premium that rises astronomically if you have ever been very ill/hurt, your deductible is an enormous amount, and the insurance company pays only X% of the costs. The problem is that if you have to have heart surgery, and the cost of the operation is $225,000 and your deductible is $1000 (if you are lucky), your insurance will likely pay either 70/80% of the cost. So what does that translate to? How about $46,000 out of your pocket not accounting for any costs post-op. I know that there are some people who can afford this, but the reality is that the vast majority of Americans cannot afford such things. At this point, the person or family is left facing an unpayable medical debt either way. What is the way out? Bankruptcy. Over 60% of U.S bankruptcies are attributable to medical debt. Ask yourself what the real difference is between a $225,000 debt and a $45,000 one. It's likely that you wouldn't be able to afford either one.
It gets worse too. The people whom are all-too-happy to take our money are rather stingy when it comes time to pay out. Consider the recent discovery that health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.
At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
The star witness at the hearing was a former public relations executive for major health insurers whose testimony boiled down to this: Don't trust the insurers.
"The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable -- publicly accountable -- health-care option," said Wendell Potter, who until early last year was vice president for corporate communications at the big insurer Cigna.
Potter said he worries "that the industry's charm offensive, which is the most visible part of duplicitous and well-financed PR and lobbying campaigns, may well shape reform in a way that benefits Wall Street far more than average Americans."
Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged, Potter said.
The report released yesterday alleges that insurers have systematically underpaid for out-of-network care. The issue had been brought to light previously in litigation, committee hearings and other investigations, including a probe by New York Attorney General Andrew M. Cuomo. But as politicians and interests groups clash over the current effort to overhaul the nation's health-care system, it took on new relevance.
Cuomo described it last year as "a scheme by health insurers to defraud consumers by manipulating reimbursement rates."
Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said.
Wash Post: Senate Hears of a Raw Deal
In an upcoming post, I will discuss Obama's health care initiative and see what it does-and doesn't-do to solve some of these issues. And in a follow-up post, I will analyze how the organ transplant process works as it pertains to patients and those with significant financial means.
The problem with Washington is that it is controlled by special interest groups. They are entrenched in the fabric and operations of this country. What upsets me about all of this is that it prevents (at worst) - hampers (at best) - any sort of reform to the operations of the government. A government that is clearly in need of changes to its modus operandi.
The latest example of all of this comes from Obama's recent meeting with the American Medical Association. He was at the meeting to promote his health care reform initiative. On one side, there was the AMA, representing 200,000 doctors in America. They want limits on how much money a patient can sue them for for medical malpractice. Doctor's pay an exhorbitant amount of money for malpractice insurance, and naturally, they would like that lowered. Obama wasn't necessarily keen on that idea, and when he expressed such:
Obama and the AMA
"I want to be honest with you. I'm not advocating caps on malpractice awards," the president said, greeted by a smattering of boos, a remarkable public response to a popular president accustomed to cheering audiences.
The group actually booed him. While I find it remarkable that a group consisting of 0.07% of the population (roughly-considering rough total pop. estimates) can get an audience with the President (groups like that certainly donate heavily...), I must admit that it takes some large cojones to push forward your interests at the expense of those of the populace. It is this discourse however, that makes this country great. Understand that I feel that they pay too much for insurance as well. I feel that the real problem lies with the insurance companies however.
On the other side, we have the scums of the earth. I am sorry, I mean trial lawyers. Though he offered no support for limiting lawsuits, Obama raised the antennae of trial lawyers' groups just by mentioning the issue. These plagues upon modern societies had issues with anything that may potentially close the vent on their bread and butter. To be fair, I hate lawyers, so it is impossible for me to be impartial in this. I can't stand groups that segregate themselves from society, protect themselves, and change the laws of this country in such a way as to force their existence (Christ, have you read something as "simple" as a website terms of service? Something that should be 3 paragraphs, but is actually 48 pages of fine print!?)
The Center for Justice and Democracy, which says it advocates for injured consumers, attorneys and others, released a letter to Obama signed by 64 survivors of medical malpractice saying they were "extremely concerned that the rights of medical malpractice patients may be stripped away as part of your national health care proposal."
"The notion that 'defensive medicine' is leading to higher health care costs is not supported by empirical data or academic literature," Les Weisbrod, president of the American Association for Justice, the main lobby for trial lawyers.
I can't stand that reform is being halted (not even reform that I completely agree with, mind you) by special interest groups. Change needs to happen. I am not saying that Obama's plan is some cure-all, in fact I most certainly don't think that,- but the bottom line is that something has to be done. And his something is better than the status quo. I don't want the same things out of Washington. Obama instilled a sense that change is on the horizon, in Americans. I don't want it squandered by the entrenched bureaucracy.
