Health Care and the alternative point of view

[jIM_Ohio]

As a doctor myself, I'll be the first to admit that doctors aren't always right and I have no problem with there being some oversight to see to it that doctors are making appropriate decisions and even to encourage/require doctors to practice cost-effective medicine. Doctors being pretty much in total control is what led to a lot of today's problems to begin with (which was all before my time but I've certainly heard stories).

Ultimately, though, what many insurance companies do amounts to nothing less than practicing medicine without a license. They make treatment decisions for patients that they have never seen or evaluated based on some cookbook list of criteria that may or may not have been met.

There needs to be less red tape and more communication between the doctor and the insurer, more of a collaboration and less of a confrontation.

Steve- know a good lawyer which will go after the insurance companies for practicing medicine without a license?

Sounds like a good made for TV movie.

[disneysteve]

Steve- know a good lawyer which will go after the insurance companies for practicing medicine without a license?

Sounds like a good made for TV movie.

Wish I did. Again, I have no problem with the insurers providing some oversight of the doctors because there are doctors out there who simply don't know what they're doing and need some looking after. If at the end of the day, though, the doctor strongly feels a treatment is needed and the insurance company disagrees, let them send the patient for a second opinion with an in-person exam by a qualified physician. Don't let the decision be made by some clerk in a call center somewhere.

[jIM_Ohio]

Wish I did. Again, I have no problem with the insurers providing some oversight of the doctors because there are doctors out there who simply don't know what they're doing and need some looking after. If at the end of the day, though, the doctor strongly feels a treatment is needed and the insurance company disagrees, let them send the patient for a second opinion with an in-person exam by a qualified physician. Don't let the decision be made by some clerk in a call center somewhere.

You hit my #1 concern with the insurance agencies- they are not ethically or legally doing what is in best interest of the patient.

I know doctors have a code of ethics they follow... yet the insurance companies are not legally held to same standard (IMO).

[geojen]

Wish I did. Again, I have no problem with the insurers providing some oversight of the doctors because there are doctors out there who simply don't know what they're doing and need some looking after. If at the end of the day, though, the doctor strongly feels a treatment is needed and the insurance company disagrees, let them send the patient for a second opinion with an in-person exam by a qualified physician. Don't let the decision be made by some clerk in a call center somewhere.

Steve, you make a good point that clarifies what my real intentions were. I have a big problem with insurance companies making unilateral decisions about people's health based on their "protocols" and what-not. Your idea of a second opinion is perfect. It has to be an independent doctor chosen by the patient, not an insurance company doctor. If the second opinion comes back in support of the first doctor, the insurance company should be legally required to provide that treatment to the patient. If the second opinion contradicts the first, then perhaps the insurance company should make the call.

jIM is also right, that insurance companies operate under an entirely different set of "principles" that are in complete contradiction to why the consumer sends them money every month. I don't know how far the new laws go towards fixing this problem.

[disneysteve]

You hit my #1 concern with the insurance agencies- they are not ethically or legally doing what is in best interest of the patient.

jIM is also right, that insurance companies operate under an entirely different set of "principles" that are in complete contradiction to why the consumer sends them money every month.

This is certainly true. No insurance company, health, auto, life or home, operates in the best interests of the customers. They are not in business to pay claims. They are in business to make money. Insurance companies do best when they maximize premiums collected and minimize benefits paid out. I don't see that business model changing.

[geojen]

This is certainly true. No insurance company, health, auto, life or home, operates in the best interests of the customers. They are not in business to pay claims. They are in business to make money. Insurance companies do best when they maximize premiums collected and minimize benefits paid out. I don't see that business model changing.

So what are we left with? If this country insists on keeping private industry involved in health care, then I don't see any alternative than to heavily regulate them as other countries that rely on insurance companies do. Perhaps if companies were not allowed to make a profit that would go a long way towards solving these problems. In those countries, companies still compete with each other, they just do it in other ways. For example, they compete to have the lowest administrative costs to attract customers.

[disneysteve]

So what are we left with? If this country insists on keeping private industry involved in health care, then I don't see any alternative than to heavily regulate them as other countries that rely on insurance companies do. Perhaps if companies were not allowed to make a profit that would go a long way towards solving these problems. In those countries, companies still compete with each other, they just do it in other ways. For example, they compete to have the lowest administrative costs to attract customers.

I agree. I think the entire system needs to be revamped.

[cptacek]

Insurance companies don't make that much of a profit. How much is too much? And why do you think it is ok to take that profit away?

[geojen]

Insurance companies don't make that much of a profit. How much is too much? And why do you think it is ok to take that profit away?

Right now, the way insurance companies make profits is to deny coverage, rescind policies, raise premiums in the double digits every year, etc. Why should the "gatekeepers" of a large majority of Americans' health care be allowed to treat us this way? Are profits so sacrosant that they trump ethical behavior and our national health? That is what we have to ask ourselves.

By the way, I am not strictly advocating that we take away profits. I brought that up as an example of how other countries make private insurance work. There may be other ways as well.

[jIM_Ohio]

This is certainly true. No insurance company, health, auto, life or home, operates in the best interests of the customers. They are not in business to pay claims. They are in business to make money. Insurance companies do best when they maximize premiums collected and minimize benefits paid out. I don't see that business model changing.

There was a reason Hillary Clinton's main push when she attempted health care reform 10-20 years ago that she included a patients bill of rights.

The companies can stay in business and operate to make money. But give me rights. This includes an appeal process if I disagree with what was authorized or rejected, the ability to SUE my insurance company and/or employer if they are making my care difficult, and other rights I am sure I do not know I need, but do.

[jIM_Ohio]

So what are we left with? If this country insists on keeping private industry involved in health care, then I don't see any alternative than to heavily regulate them as other countries that rely on insurance companies do. Perhaps if companies were not allowed to make a profit that would go a long way towards solving these problems. In those countries, companies still compete with each other, they just do it in other ways. For example, they compete to have the lowest administrative costs to attract customers.

There are 3 directions one could take in a pure sense

1) Goverment run and managed health care
this is socialism in its purest form.

2) Private run health care (private corporations)

3) Health insurance providers need to be non profit organizations


Each will have pros and cons

My issue with the current reform is that it addressed getting insurance, but did not assure quality of care or control over who is making decisions.

My thought is the government cannot (EVER!) make a decision for me regarding my health, lifestyle, religion etc... and if the government could forseeably have this control, government run anything is a bad idea.

Private health insurance is the current method, the biggest issue is I have few rights and its corporation controlled.

My thought on that is reform should be about the patient and not the system... but that is not what Obamacare is all about.

I have read articles suggesting health care providers be labeled and formed as non profit organizations. I see loopholes in this as well, but at same time REITs are profitable, and their formation requires X% of revenues or profits be paid out to share holders, so maybe some regulation in that regard makes the companies easier to deal with.

[feh]

There are 3 directions one could take in a pure sense

1) Goverment run and managed health care
this is socialism in its purest form.

2) Private run health care (private corporations)

3) Health insurance providers need to be non profit organizations

4) Government run health insurance; private industry delivers health care.

AKA single payer. This is what many other countries do and seems like the best solution to me. It should at least be an option for people.

[geojen]

4) Government run health insurance; private industry delivers health care.

AKA single payer. This is what many other countries do and seems like the best solution to me. It should at least be an option for people.

I agree that if people want to rely on the government for health care, why can't they choose to buy-in to Medicare? Why is it that we ALL have to work and pay taxes so that SOME of us can get really good health care. If you work and cannot get insurance on the private market, why is it that some of your money goes each month so that SOMEONE ELSE can have insurance but not you? That seems patently unfair to me.

I just read the senior citizens in the U.S. are the only segment of our population that compares favorably health-wise with other countries. I wonder why that is? Could it be that they get guaranteed health care provided by an entity that is not concerned with profits and does not discrimminate against them based on age? This is what we need to be striving toward for all our citizens.

[jIM_Ohio]

4) Government run health insurance; private industry delivers health care.

AKA single payer. This is what many other countries do and seems like the best solution to me. It should at least be an option for people.

The health insurance provider is providing as much care as the doctor...

whether its single payer or not (to me) is not the issue, the issue is more of who controls the decision making- if insurance companies exist, there will be inefficient decisions being made.

your option 4 is my #1

[jIM_Ohio]

Right now, the way insurance companies make profits is to deny coverage, rescind policies, raise premiums in the double digits every year, etc. Why should the "gatekeepers" of a large majority of Americans' health care be allowed to treat us this way? Are profits so sacrosant that they trump ethical behavior and our national health? That is what we have to ask ourselves.

By the way, I am not strictly advocating that we take away profits. I brought that up as an example of how other countries make private insurance work. There may be other ways as well.

If they were regulated like REITs (for example) which are "required" to pay out a specific percentage of profits as dividends, maybe they would manage themselves better.