The real reason Obamacare has Failed us all?

[GoodWitch58]

I'm not sure of the specific incidents that you are talking about, but my experience has been that insurance companies will pay for just about anything that can be reasonably justified. In a few cases this involves your physician speaking to the insurance company's physician. It usually works.

I am also unaware of any company that will not cover routine screens when they are performed consistent with a schedule that is accepted as being of benefit. Women actually have more screenings than men, and there are no screenings for heart disease for either sex, save an EKG done for a 'welcome to medicare' exam.

Well, maybe my current doctor and the one I had for 20 years before that, can talk with you about your experiences vs. theirs. And, the next time I have to spend 45 hours over a three month period on the phone with the insurance company representative to process a claim for a procedure that even they admit is covered, I will call you! I am glad that you and your patients (who include some of my family) are having a better experience.

 

[Winnie]

"catastrophic plans" are just regular health plans with high deductibles. My HDHC from BCBS of Florida was 110 a month, 7.5K deductible with 5 million in coverage beyond that.

Take a look at BCBS's options -

BCBSF - Health Coverage for Individuals & Families Under 65

Make the assumption that exclusions become outlawed and government regulation insures all insurers provide at least one low cost plan with basic coverage for the poor and I don't see why we need to change anything.

I just went through their screening and found an HDHC -

$124 a month
3.5K in network deductible
0% in-network copays after deductible is reached
coverage: up to 5 million

The only issue I could find with a plan like this is that it didn't cover maternity, but I'm sure there are plans out there that do. If not, maybe we could regulate that as well. Can anyone give me good reasons why a plan like this isn't acceptible for most everyone?

I have a friend on a similar plan with BCBS of FL. He hasn't ever met his deductible in a year yet. However, last year he had to go to the emergency room and BCBS negotiated the price down from over $4,000 to about $1,200.

 

[Dominoes]

Interesting information. Can you cite your source. (apparently your are an MD; I'm not questioning your opinion/professional thoughts, just would like to know the source of your data/statistics.)

The data on the uninsured came from a presentation I attended by the Florida Medical Association Council on Legislation. I must admit that I did not know the source, but that I tend to trust their research department.

The argument of performing procedures that may not extend life, but improve quality of life is pretty well established in the medical literature.

 

[GoodWitch58]

The data on the uninsured came from a presentation I attended by the Florida Medical Association Council on Legislation. I must admit that I did not know the source, but that I tend to trust their research department.

The argument of performing procedures that may not extend life, but improve quality of life is pretty well established in the medical literature.

Thanks.

 

[30ashopper]

I don't think the extreme scenario happens to everyone or maybe even most people. My problem is that once the care is provided, premiums escalate because the insurance company still needs to make a profit for the shareholders. And it's not much of a "free market" because for many people options are limited.

The only way to eliminate a need for profit in our system would be to convert to a full on government managed system. All medical professionals would become employees of the federal government, all hospitals and labs would be owned and run by government, etc..

 

[Dominoes]

And the premiums have gone up at least 10% each year, for at least the last 20 years, from what I read, the docs are not making that much more money--so where is the profit going?

US insurance premiums increased 3.6% from 2007 to 2008. The docs are not making that much more money, so I would like to know the answer to that question as well. By the way, I am in support of a non-government subsidised Co-op. plan that the Senate Finance committee is talking about. I do think that a not for profit plan should be allowed to compete with private insurers and it should help everybody.

The funny thing is that everybody thinks that Republicans are opposed to reforms when that is not the case. We just want thoughtful reforms that protect individual choice and do not break the bank.

 

[Beach Runner]

So sorry about your Dad, SSB. If I broke my front tooth on Wednesday from gritting my teeth because I was so mad at Medicare that gave us only four days notice that Mom would be kicked out of the nursing home, I can't imagine how sad and mad you were.

Yeah, the government does a great job at health care.:roll:

You probably have it, too. That isn't an insult, simply a reality as MRSA is now common skin flora.

That, and other infections. I know someone who went to the hospital with a high temp. He was given antibiotics and sent home with a diagnosis of acute bronchitis. The next day he had a higher fever, so he was admitted. Turns out it was staph infection, not bronchitis. The physician told him the infection was from a dental cleaning.

Can anyone give me good reasons why a plan like this isn't acceptible for most everyone?

It would be acceptable to the person I mentioned earlier; the problem is that the person wouldn't be accepted by BCBS because of taking antidepressants.

I don't understand this claim people keep making. When I have a medical issue, I go to my doctor, and he hooks me up with whatever treatment I might need if it's warrented. I have never in my life had to go through an insurance executive in order to get treatment. Can you cite some examples of how this manifests?

Goodwitch58, it sounds like you've had some bad experiences with insurance companies. The only thing I've had a problem with is insurance not paying for my infertility treatments. So they won't pay for Pergonal if a woman's reproductive organs don't work properly, yet they'll pay for Viagra if a man's organ doesn't work.

If people have trouble with insurance companies being the stumbling block between them and good health care because of denial of benefits, think about how bad it'll be when the government is added to the mix. The government doesn't give a darn about people IMO -- that was confirmed to me by the way my Mom was treated this week. I mean, doesn't a family need at least a week or two to make arrangements to move a sick person and interview and hire CNAs to take care of the person? I'm certainly not qualified to take care of a person in Mom's condition, plus I can't give up my job to care for her because then I'd lose MY health insurance.

 

[TooFarTampa]

The only way to eliminate a need for profit in our system would be to convert to a full on government managed system. All medical professionals would become employees of the federal government, all hospitals and labs would be owned and run by government, etc..

Do you really think so? There are great companies like USAA that share profits with its members and provide excellent auto, life and homeowners insurance as well as great banking and credit card options. USAA isn't government run. It's not a bunch of bureaucrats.

A 1999 editorial in the New England Journal of Medicine said studies show that for-profit hospitals don't necessarily give better or less expensive care than non-profit hospitals. I just never understood the reason why these companies went for profit anyway. The existence of "shareholders" when it comes to managed care has always seemed to me to be at the root of the problem.

Edit to add that I guess "profit sharing" is different from "non-profit" and I suppose the former is what makes more sense to me.

 

[Winnie]

Do you really think so? There are great companies like USAA that share profits with its members and provide excellent auto, life and homeowners insurance as well as great banking and credit card options. USAA isn't government run. It's not a bunch of bureaucrats.

A 1999 editorial in the New England Journal of Medicine said studies show that for-profit hospitals don't necessarily give better or less expensive care than non-profit hospitals. I just never understood the reason why these companies went for profit anyway. The existence of "shareholders" when it comes to managed care has always seemed to me to be at the root of the problem.

Edit to add that I guess "profit sharing" is different from "non-profit" and I suppose the former is what makes more sense to me.

Is that different than buying shares of an insurance company? Sharing profits with members vs sharing profits with investors.

 

[GoodWitch58]

BeachRunner, I really have not had any seriously bad problems; all of the ones I mentioned were issues that came up, but I happen to have a lot of information available to me about insurance laws in Florida, so I have been able to get my issues handled eventually. Some of the ones I mentioned are from friends/family, etc.

My point is that, in my experience, given the choice, the insurance company will rule against the consumer every time...they will sometimes pay up if pushed far enough (I would hate to total up the amount of income I have lost by time spent on the phone with an insurance company) but the system is designed to profit the insurance company, not provide the best health care to the consumer.

I have no problem with the companies making a profit--although I do like TFT's profit sharing idea, just as I like credit unions, instead of banks--I just have a problem with them making HUGE profits, at the expense of the people least able to contribute to that HUGE profit.

I would like to see a competent system that treats most people fairly, including the doctors...I do not see that at the present time from the insurance companies, and there really is no reason other than profit that prevents them from doing it, IMO.

Consumer Reports this issue has an interesting report.Not sure it is on their website Find Product Reviews and Ratings from Consumer Reports., but it may be. Take a look hhttp://www.consumerreports.org/cro/magazine-archive/may-2009/health/health-insurance/overview/index.htmere:
Some points:

1. Only 64 percent of readers said they were very or completely satisfied with their plan; down from 67% from the 2007 report;
2. In terms of service rated by CR, that puts satisfaction with health insurance plans above satisfaction with cable TV, but below pharmacies and real estate agencies;
3. $500 is the median increase in what readers paid for annual premiums since 2006; 38% increase from two years ago;
4. Choosing an HMO over a PPO is apparently better now;
that is a change from the last survey;
5. Rating of PPO health plans puts Anthem BC/BS (Ct) at the top; BC/BS Fl is #11 on a chart of 41 rated;
6. Rating of HMO health plans shows Group Health of ID and WA at the top; Humana Medical Plan of Florida was #23, out of a possible 35 rated

This article points out just how difficult and time consuming it is for a consumer to "figure out" insurance--the sad part of this is that the people least able to "figure it out" are the ones most often hurt the most.

Given my choice, I would vote for the compassionate family doctor who charges a reasonable rate for his or her services, and has at his/her deepest level, the desire to serve and to heal; and I would eliminate insurance companies! LOL. But, as some on this board will quickly point out that is idealistic...and unreasonable. And, of course it would also necessitate the elimination of trial lawyers--the infamous tort reform! So, I will continue to be thankful that I am healthy and informed about how insurance companies work--and not think about how much time I have wasted on the phone with the insurance claims departments over the years! Now, that I have more time to give, I will work relentlessly for a better system.