Due to a pulmonary condition which has lasted over a month now, I got to experience what it's like to be a hospital patient in America today. I'm not glad to report that I wasn't the only ailing entity.
All over the hospital - a world-class cancer treatment facility, although that wasn't why I was admitted - there were signs of shortage and neglect. The staff was repeatedly having to locate working equipment in order to conduct the specified tests, and it would take several tries with the available equipment to find the ones that worked. In addition, single-use components, like external pulse monitors, were re-pressed into service when safely possible. Any bets I got charged for new ones anyway?
Then, there were the surprises from my insurance company. In addition to paying significantly higher premiums, all my deductables and co-pays went up.
If I had to blame anyone for this situation, I would begin with Hillary. Her bungled opportunity to revamp America's health care system into something new and improved began the slide toward a complete collapse of that vital service. But she isn't to bear the blame alone.
Several years ago, My family discovered to our shock and dismay that all - that's 'A' followed by an 'L' and again by another 'L' - all of our doctors were no longer accepting us as patients. It wasn't that we were deadbeats. We paid our share of the fees up front and never carried a tab.
What changed was they were no longer accepting patients covered by our insurance provider.
We could tell that our doctors were extremely harried by the huge workloads they took on. They would run long office hours, but there was always a crowd in the waiting room. Even with an appointment, it would be between one and two hours before you would get called, just to wait another hour in the examination room to see the doctor for no more than ten minutes, no matter what your condition or ailment. They had no time for their patients, and they would shotgun your problem and tell you to make another appointment (2-4 weeks later!) if their solution didn't work.
It turned out that the doctors were getting low-balled by the insurance companies. The doctors were mad as hell, and they were not going to take it anymore. The only way they could make up the difference was to increase their patient load. The payments for services and treatments were cut so low that a breaking point was reached, and they would resign membership with one company in favor of another that was more fair to them. They were tired of being denied the means to practice their professions in order to maintain corporate profitability.
Article comments
1 - Bliffle
Alas, there is no solution available through the traditional political means that you've considered. Why? Because the medical insurance companies are supreme in politics. Any political maneuvers you devise will be expertly circumvented by their superior legal resources and their superior funds available to bribe politicians.
Since everything has been monetarized, even your health, they are threatening you with your very life so that you must pay them to enter the treasured realm of the Properly Insured. Rather like a Highwayman on the road who demands "your money or your life". Isn't this the natural and desired endgame of unfettered exploitation?
IMO, there is no traditional solution through traditional political means: one is forced into guerilla methods of personal health insurance.
So what means are available to the guerilla healthcare seeker? Here's my list:
1-self-insure. This gets you out of the insurance system entirely, just like many doctors who no longer accept ANY insurance companies. This is surprisingly easy, since it only requires a couple million in spare cash to finance even catastrophic medical conditions. And you'll be admitted to the privileged circle of patients who KNOW, contractually, what facilities and providers will be at your disposal should you need it.
2-scam the government. Find a way to claim eternal and extensive medical care thru a government, like workers comp., county or city government, etc.
3-scam your employees. You're the boss, so buy an employee medical plan that favors you, the boss, at the expense of all employees. After all, you are the most important single person in the company, right?
4-scam the insurance company.
5-move to a country with universal healthcare. Maybe you'll be cold in Norway, but you'll be covered.
6-marry someone with good health insurance. Possibly a corporate exec or a public employee with good coverage.
7-bribe the providers. Everybody is flattered by an expensive gift and everybody likes cash. You get lots of mileage out of expensive imported flowers sent to the nurses and the office staff. If the doc is harried and overworked then buy a weekend voucher at a nearby luxury spa for doc and Sig. Other. Offer it as a token of appreciation for past service.
Maybe this sounds mercenary, even immoral to some people. But if a monopolist uses your actual life and health as hostage to his profit you might consider extraordinary means just to survive: maybe you can live long enough to get forgiveness from your priest in the confessional. Clearly, traditional Market Forces have failed, since you no longer are Free To Choose when laying on the operating table and your insurance company has just decided to renege on the coverage you thought you were paying for.
2 - handyguy
We're the only rich country in the world without a centralized health care system administered by the government.
It's understandable that Americans are skeptical about that kind of system, but what we have now - insurance administered by employers (but not all employers!) - makes no sense at all.
A single-payer system doesn't have to mean the end of free enterprise, which is the way insurance companies and free-market ideologues will portray it. But at any rate, something has to be done. Our current system has huge holes in it, and gets massively more expensive every year.
Look for John Edwards to push this as a big issue during the next year or so. If his presidential campaign gains traction, health care might finally get the full public discussion it deserves. The one that started in 1993-94 was short circuited by the insurance lobby and by the Clintons' heavy-handedness, which may have been well-intentioned but was a bad miscalculation all the same.
3 - Clavos
A single-payer system doesn't have to mean the end of free enterprise, which is the way insurance companies and free-market ideologues will portray it.
You're right, Handy. Medicare is the closest thing we have to a single payer system now, and the carriers for it are private insurance companies.
We have another major problem with our current healthcare "system:" the way in which we handle medical malpractice. I believe doctors and other care providers should be held responsible for their actions, but the way that we currently adjudicate and award malpractice decisions leaves a lot to be desired, IMO.
We need to at least limit the amount of money attorneys can make in this kind of litigation, or even eliminate the participation of attorneys altogether, and set specific penalties for malpractice, with set fees for litigators.
Because of the cost of malpractice insurance, some specialties (OB-GYN, e.g.) are losing practitioners at an alarming rate.
Unfortunately, the trial attorneys have a very strong lobby, and most politicians are lawyers, so reforming that part of the system is not going to be easy.
4 - PeterJ
Medicine is absolutely the most important thing that insurance companies are gouging the public on but it's surely not the only industry.
The automotive industry is being taken over by what insurance companies like to call pro-collision shops. It's the next best thing to owning their own shops without the hassle of the legalities of collusion.
Insurance companies strike a deal with shops who are willing to basically "open their books" and use the insurance companies own estimating software. This will make determinations on body, paint and mechanical 'labor' hours, which will be substantially lower than the "OEM" (original equipment manufacturers) prices and parts designated by, for instance GM. Basically, the body or mechanical shop agrees to cutting their prices in exchange for the insurance company funneling business to their doors. Technically, this would be illegal but the insurance company never actually demands that customers use their facilities but they have an agreement with the shop that all of the workmanship will carry a lifetime guarantee for as long as the customer owns the vehicle. The insurance company will either write the estimate themselves and reccommend the shop or send the customer to the shop for the estimate.
Now, naturally, the body shop is taking a hit on the cost but so are the workers.
When a body work estimate is written it assigns what's called 'labor hours' to the job. In other words, change the fender is 3.0 labor hours. That's what the body man will be paid, no matter if it takes him 5.0 hours or 2.0 hours, if he's average it will take him the allotted time. If he's an experienced and hard worker he can do the job in 2.0 hours. The insurance company's labor hours for the job will be lower than the OEM estimate thereby lowering the body mans pay by one hour. Another way the insurance co will cut cost is to use 'aftermarket' parts rather than the 'OEM'. These parts may be inferior in quality and fit and if you don't know what to look for you may not know it until a year later when your fender begins to rust.
The bottom line is that the insurance company will pay less to have your car repaired than you would if you walked in off the street.
The insurance co. wins.
They will use these same methods on your medical bills.
If you buy a prescription , without insurance, the pharmacy may charge you $75.00. If you have insurance the insurance company will only pay the pharmacy say, $50. and your co-pay of $10. So, the pharmacy is discounting cost to the ins. co. but will charge you full cost.
Again, the insurance co. wins.
Of course the ins company has to make money, no one would begrudge them that much. For that matter, If everyone being paid on the body work is satisfied and the job is a quality repair I see no problem there as long as the customer is aware of the transaction but when it comes down to health ins. there is no room for games. Insurance companies want the whole pie. They insure lives, homes, property, vehicles almost anything that can be owned and they make a fine amount of money doing so. They even go as far as pulling their companies out of a state where they've had a year where claims went over their 'projections'.When a hurricane hit Homestead Fl. a few yrs ago some of the major companies wanted to pull out of Fl. It's not that they didn't earn money that year it's that they didn't make their 'projected' earnings. In some cases the government involves itself and dis-allows the pullout but this is the manner in which they conduct business.
Now I'm not in favor of 'socialized' medicine and I don't have answers, only suggestions and ideas but somewhere in this great land there must be someone intelligent enough to figure this out. I'd much rather see insurance companies come together with each other, the medical professions, pharmaceutical co.'s and people's employers(when involved) to hammer out a solution where everyone will have sufficient coverage to get them through an illness. Naturally, if someone can afford and wants premium service that would be their prerogative but in the greatest nation in the world there should be some responsibility on the part of the medical and insurance professions to be sure that no one suffers for medical treatment because of lack of money. Christ, this is "America, the Greatest Nation on Earth".
5 - Bliffle
Clavos' concern about malpractice is misplaced. SSA asserts that malpractice is less than 2% of medical cost. The rest is a red herring, designed to distract from the real problems.
6 - Clavos
Actually, Bliffle, I'm not trying to distract from anything, although my gastroenterologist brother in law's $200K a year insurance premium is somewhat shocking to me.
I was trying to point out the inordinate power of trial attorneys in our society, which is a real problem, IMO, though admittedly not exclusive to medicine.
7 - Bliffle
Actually, medical costs would be reduced more by booting bad doctors than by limiting greedy lawyers. Most malpractice suits are against a small number of doctors, but the AMA and state licensing boards are reluctant to take action. Good doctors would be more effective if they were willing to can bad doctors, but I guess it's easier to complain about lawyers.
8 - Clavos
Good points all, Bliffle.
One result of the malpractice issue is the endless (and mostly needless) application of expensive tests, which certainly raise the cost of medicine for relatively little good in many cases.
My wife is seriously and chronically ill. She's on Medicare, and has received over over $500,000 worth of medical services in the past 18 months.
She and I carefully review every invoice and Explanation of Benefits (EOB) that we receive, (because often they are full of clerical errors), so I'm intimately familiar with what's being done and what it costs. As her case manager and advocate (and EVERY patient needs one), I've also become fairly sophisticated about the medical issues she has, and about the effectiveness of the care she's getting. I can tell you unequivocally that her bills could be halved with no loss in quality of care.
Just one example:
Medicare paid $4,500 for her wheelchair and waited eight weeks for delivery. I went on the manufacturer's web site, built the identical (same brand) chair for $2100, and the site promised delivery within ten days.
Private insurance companies are doing the same thing, though they do have better control than the govt.
THAT'S where a lot of the expense is -- inefficiency and bureaucracy, with too little accountability. Typical of just about everything the government does.
A single payer system is urgently needed, but it absolutely needs to be run better than Medicare.
9 - Bliffle
So the ins. co. is squeezing doctors, too. Why not? They are oligopolies if not outright monopolies. It's so easy to make an agreement to divide up the territory in an informal agreement. Most states have poor insurance regulation enforcement, the feds are in a de-regulate mode that promotes oligopoly, and the fines are trivial, if caught.
The Free Market is subverted by monopoly and oligopoly, and the market becomes controlled by vendors, the insurance companies. And the threshold for new companies to enter the market and challenge the oligopoly with low prices is very very high. In fact, ins. cos. are among the few businesses with liquid and near liquid assets to start a business, and they are probably already in that market. Why cut your own throat?
The pretty notion of being Free To Choose in a free market system is methodically undermined by ins. co. execs who have big vested interests in suppressing competition. They are not deterred by the feeble anti-monopoly laws, and they are Free To Choose which politicians to bribe by our lax campaign finance laws.
You, the ins. co. client, are Free To Choose one time: when you signup with a company or employer. You get a chance to predict which disease you might get and bet your assets and future earnings on that choice.
The ins. co. is Free To Choose at any time to cancel your policy or change it's terms. You can read about it in the Fine Print. So what then? Try to negotiate a change in policy? You are not Free To Choose the terms of your policy. You can't even write your own policy and go shopping for an ins. co.
10 - Arch Conservative
As usual everyone's placing all of the blame on the medical system.
Here's a novel idea? Why don't we as citizens decide to take a little more responsibility for our own health. Many health costs incurred often stem from the individual's lack healthy living style. Example: it is common knowledge that cigarette smoking substantially increases you risk of developing lung cancer. So if you want to smoke three packs a day for twenty years and then get lung cancer and have difficulty paying for treatment that's your own damn fault. Another example is how obese Americans have become and don't give me that it's genetic it's not the indviduals fault bullshit. This epidemic is not geentic because only a generation ago this epidemic did not exist and genetic epidemics don't arrive suddenly and entirely in one generation. It's us overeating and being lazy and then having all kinds of health problems due to our obesity. How many of you have heard about the two fat kids whose families wanted to sue Mcdonalds for making them fat? Are you fucking kidding me? The kids ate at mccdonalds every day, never exercised and it's mccdonalds fault they're obese?
I am not saying that a civilized society does not have an obligation to provide critical healthcare. Obviously if someone is crossing the street and gets hit by a bus but has no health insurance the hospital should treat them to save thier life anyway. But the hospital also has a right to expect financial compensation for that treatment.
I believe that healthcare for the most part is not a right but a commodity. Why should people employed in the healthcare industry be forced to provide their services for free? No other industry does. Why should they're salary potential even be arbitrarily dictated and limited by the government? Why should provide non-life saving care for illegal aliens when we know we will never recover the costs?
Of course there are many things that need to be addressed in our system to lower costs for the average consumer but there is also a wealth of free information available to the average consumer to help him live a healthier lifestyle and reduce his medical costs. But most people don't want to here this... they just want to blame insurance companies and drug manufacturers.
11 - Clavos
@9:
Nice essay, but not a response to my #8.
12 - Bliffle
The administrative overhead for Medicare is about 3% while that of the private system is about 30% (oofta!).
Overcharging for services is very common, as you point out with your example of the wheelchair. Where is the fault for that, where can we look to save money? You may have noticed those TV ads for electric scooters for disabled people, and that the ad brags that they will get Medicare to OK the scooter if you want one. The reason is that the company that makes them has gotten their congresscritters to incorporate into the law that Medicare cannot refuse to furnish a scooter! I suppose they did this the same way they got that outrageous non-negotiation clause put into the Plan D Drug plan: by bribery through lobbyists, masquerading as campaign contributions. It's not the patients fault, it's not the doctors fault, but it is the fault of the scooter manufacturer and the ins. coc. that support it because they know they can raise their premiums with a fat surcharge. The insurance buying public is a captive: they HAVE to buy.
As to tests, one hopes that tests turn out to reveal nothing, and thus have been unnecessary.
When the "HMO" concept was being sold to us back in the 70s, the idea was that by having regular tests and physicals that medical problems would be discovered and dealt with early, thus reducing expensive catastrophic care. It really was about "Health Maintenance" through pre-emptive care, including stopping smoking, exercising, improved diet, etc. Those of us who were in major corporations took this seriously. We quit smoking, we started exercise programs at our offices, we had showers installed in company bathrooms, we installed "par courses" and gymnasiums on company grounds. Indeed, none of these things existed before the HMOs appeared. That's why you young guys have such facilities now. They did not exist before then.
After a few years (during which we DID improve our health by quitting smokes, improving diet, exercising, regular checkups, etc.) No kidding. There were a couple guys who didn't change and one died of heart disease and another of emphysema (we all remember well the last 2 years of his life with his trusty green oxygen bottle by his desk and plastic tubes in his nose: he still cheated and smoked occasionally). Then the HMOs declared that our regular checkups and early diagnosis were in the nature of "nuisances" because we weren't sick! So they started to disallow them. In spite of the proven fact that these tests and checkups significantly reduced their payouts. Only an ins. co. can be that venal and stupid.
Tests and checkups reduce outlays. They're an investment.
Aside from the huge admin overhead of the med system, the biggest hit is fraud. Good old fashioned fraud. It's not nuisance tests for patients who run to a doctor with a cough. It's not ambulance chasers looking for trouble.
Fraud is practiced by both 'providers' and 'recipients' of med care, and so extensive and costly that searching for it in med records is like looking for straw in a haystack. Every state that uses Medicare is required to have a computer fraud detection system. A salesman demonstrating such a system to a prospect typically uncovers live fraud in live data while making a sales call or a seminar.
Surprisingly, the ins. cos. are not particularly sensitive to fraud since they, being an oligopoly, tack on a surcharge and pass it along to the premium payers. Voila! They make more money. Only premium payers are sensitive, and if that's just little you, you have no real recourse. But if you are a large corporation you have the alternative of self-insuring, which is exactly what a lot of large US corps did in the 70s and 80s. Given their auditing resources they could find the ins. co. excesses, and given their financial resources they could write and provide the insurance themselves, and then just subcontract the paperwork to existing ins. cos with fixed prices and fixed margins, thus eliminating a profit motive that lead to overcharging. Lucky for large corp employees, not good for individuals and small corps.
13 - Ruvy in Jerusalem
"(oofta!)"
You wouldn't happen to hail from Minnesota, would you, Bliffle?
14 - Ruvy in Jerusalem
Bing,
The author of this article went after the "health" insurance companies, not the doctors. And my experience in the States backs his comments and outlook up to a "T."
You complain about cigarettes - nicotine addiction. Well, you need to do something to insure that the cigarette companies do not get to advertise their product at all. You complain about over-eating. Put on the boob-tube, open a magazine or walk out the door, and somebody will be hustling some kind of shit designed to hasten your heart attack or stroke, wreck your liver, or overdose you with mercury. If you want to stop that, you get to put the tuna folks out of work, the fast food joints out of work, the liquor companies out of work. Are you getting the basic idea here?
Responsibility for health means getting to the root of the medical problems to prevent them. This means a proactive program to make sure that people do not use plastic to pack food (plastic leaches into food and water), that they avoid steak and red meat (cattle take away from the grain supply and cause starvation because there is not enough food to feed people, they fart like all hell and it is necessary to cut down trees so that they can graze), that people drink enough water (at least three glasses each morning to flush out the body BEFORE eating).
I've just gotten started, Bing, and I get the feeling that the more I kept going, the more likely you would respond with "I'll do what I damned please, and who the fuck are you to re-order my life anyway?"
So much for taking responsibility for one's own health...
Cheers
15 - Clavos
Bliffle,
You say:
You may have noticed those TV ads for electric scooters for disabled people, and that the ad brags that they will get Medicare to OK the scooter if you want one. The reason is that the company that makes them has gotten their congresscritters to incorporate into the law that Medicare cannot refuse to furnish a scooter!
Not true. I've tried to get my wife one, but because she has good upper body strength, Medicare refuses to pay for it, even though she cannot walk. Their reasoning is, with the good upper body strength, she can roll herself around OK, and doesn't need a self-propelled chair.
My point is, I believe, from my direct experience with Medicare, that the suppliers and the insurance carriers which actually pay the Medicare claims are systematically ripping off the government.
This is not unusual, the government is very easy to rip off (remember the $600 hammers?), but if we're going to go to a single payer system with the government being the administrator, IT NEEDS TO BE BETTER WATCHED THAN MEDICARE IS.
As to tests, one hopes that tests turn out to reveal nothing, and thus have been unnecessary.
Of course, but when the same test is administered by every doctor you see, and you're seeing 8-10 doctors, as my wife does, it's for CYA purposes on the part of each of those docs, who are thinking, when they order the tests, of possible future malpractice suits, not her health.
There ARE a few things the government does well (the NTSB and NWS come to mind), but for the most part, the government and its workers would have difficulty pouring water out of a boot with the instructions printed on the heel.
If you think medical care is screwed up now, wait until we hand it over to them (and we will) to handle, unless it is structured to avoid fraud and mis- and malfeasance.
16 - Baronius
If it weren't for the current medical establishment, I'd be insane, either homeless or dead. My father's heart would have exploded six years ago. The last two years of my mother's life would have been spent in crippling pain. My niece would have died in childbirth. You're right, though; it is kind of pricey.
17 - Bliffle
I if you don't mind, how was all that care paid for? Was it out-of-pocket, personal med insurance, company med ins., medicare, etc.?
I'm not trying to scope you, but trying to understand how effective and how expensive and how financially disturbing peoples med expenses are.