Health Care and the alternative point of view

[feh]

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

The insurance company isn't providing any care. They handle the money; receive it from patients, distribute it to health care providers.

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

Thanks for clarifying. I read your #1 as nationalized health care, which implies the care providers are employees of the government.

[disneysteve]

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

The insurance company isn't providing any care. They handle the money; receive it from patients, distribute it to health care providers.

Sorry, feh, but Jim has it right. The insurance companies make a lot of treatment decisions. They decide which doctors you can see. They decide which medicines you are allowed to take. They decide which lab you must use, which x-ray facility you can go to and which tests you are allowed to have done.

[feh]

Sorry, feh, but Jim has it right. The insurance companies make a lot of treatment decisions. They decide which doctors you can see. They decide which medicines you are allowed to take. They decide which lab you must use, which x-ray facility you can go to and which tests you are allowed to have done.

I guess we need to be more precise in our terminology. The insurance company is involved in many decisions regarding care, but they aren't providing it.

When discussing nationalized health care, that differentiation is critical.

[disneysteve]

I guess we need to be more precise in our terminology. The insurance company is involved in many decisions regarding care, but they aren't providing it.

Okay. They aren't actually delivering the care. They are just dictating what care can be delivered.

[jIM_Ohio]

I guess we need to be more precise in our terminology. The insurance company is involved in many decisions regarding care, but they aren't providing it.

When discussing nationalized health care, that differentiation is critical.

Read back on my experience with Synagis.

its an immunization for RSV with babies are at high risk for, and preemies are at much higher risk for.

Insurance company 1 administered shot one way
Insurance company 2 administered shot another way

If you want details, go back a few pages and check my posts...

but the decision was NOT made by me, it was NOT made by my doctor (insurance company 1 only needed my doctor to qualify them, then the administering of the shot went to a third party hired by insurance company). With Insurance company 2 their heads are so far up their ass, that I started to believe they made up their procedures as they went along.

So the insurance companies are making direct decisions on patient treatment. A single payer system then eliminates certain ways to give treatment? Or Nationalizing health care puts this decision out of my hands?

To me health care reform is reforming how people get treated, not reforming the costs or who is eligible for insurance.

[jIM_Ohio]

Okay. They aren't actually delivering the care. They are just dictating what care can be delivered.

Steve its a gray area because the doctors are dependant on the insurance companies to get a specific procedure to administer a specific type of care.

I assume you have examples where you give the same diagnosis to 2 different patients, and the solution is different based on the insurance providers- to me that means the insurance companies are administering care, even if they never actually "meet" with the patient.

A single payer system would not eliminate this issue, it would only "consolidate" the care given (the inefficient or costly methods would be removed from the system).

[feh]

Steve its a gray area because the doctors are dependant on the insurance companies to get a specific procedure to administer a specific type of care.

I assume you have examples where you give the same diagnosis to 2 different patients, and the solution is different based on the insurance providers- to me that means the insurance companies are administering care, even if they never actually "meet" with the patient.

A single payer system would not eliminate this issue, it would only "consolidate" the care given (the inefficient or costly methods would be removed from the system).

I think you're needlessly blurring lines here.

I'm not arguing which system is better or worse. I'm just pointing out that insurance companies and care providers are two different entities. While insurance companies are involved in health care decisions, they aren't actually providing the care.

For example, if you need a service/product that the insurance company has decided to not cover, you could still get that care provided to you. Of course, the payment would be out-of-pocket.

The only reason I brought up the distinction in the first place is because the phrase "nationalized health care" was brought up, which usually means insurance and care is provided through the government. This is different from "single payer" or "public option", which means the government handles the insurance, but care is provided by private industry, like Medicare.

[jIM_Ohio]

I think you're needlessly blurring lines here.

I'm not arguing which system is better or worse. I'm just pointing out that insurance companies and care providers are two different entities. While insurance companies are involved in health care decisions, they aren't actually providing the care.

For example, if you need a service/product that the insurance company has decided to not cover, you could still get that care provided to you. Of course, the payment would be out-of-pocket.

The only reason I brought up the distinction in the first place is because the phrase "nationalized health care" was brought up, which usually means insurance and care is provided through the government. This is different from "single payer" or "public option", which means the government handles the insurance, but care is provided by private industry, like Medicare.

I'm not blurring lines (IMO)... I am pointing out that the care given is based on procedural decisions made by the health insurance provider.

If decisions are being made, that is providing care. Especially if the decisions are rigid and there just to make rules, as in the case with my experience with Synagis.

Most of the decisions being made were being made by the insurance company as to when, where, and how the shots are given. The doctor in the first case was involved only to extent to qualify my kids for the shots, and in the second case the shots were given at doctor's office because the insurance was too rigid to use 3rd party suppliers/ nurses to give the shots.

To me its like a life insurance policy dictating how I spend the proceeds if I collect on my wife's policy. The health insurance companies are doing more than just paying the bills. They are administering health care without a license.

I agree the insurance companies are not on front line of administering care, but no one on the front line can adminster care (except in an emergency room) without approval and authorization and detail from an insurance company.


If I have insurance, it is my expectation it covers most needed medical care. I do not believe the insurance provider should be micro managing care to level of telling me the exact procedure to get the care done (that is between my doctor and myself).

However that "theory" is not reality, the insurance companies (IMO) have way too much control over healthcare, to point where it can be stated the insurance companies are providing me health care, just not doing it directly.

there is also a difference between

health care provider
and providing health care

I believe the term above was "health insurance companies provide health care"
and that does not mean a health insurance company is health care provider

[feh]

I'm not blurring lines (IMO)... I am pointing out that the care given is based on procedural decisions made by the health insurance provider.

If decisions are being made, that is providing care.

I don't understand why you say this. I don't see how "giving an injection; performing a physical; performing surgery" is the same as "making decisions as to which products/services will be paid for by insurance".

They are completely different in my mind. But apparently we can't bridge this gap, so I won't discuss it any further. The horse has been beaten to death.

[jIM_Ohio]

I don't understand why you say this. I don't see how "giving an injection; performing a physical; performing surgery" is the same as "making decisions as to which products/services will be paid for by insurance".

They are completely different in my mind. But apparently we can't bridge this gap, so I won't discuss it any further. The horse has been beaten to death.

Health care is not that simple.

Because to get certain items you need to qualify for them.

That role is OK, or every mother would be ordering Synagis at a cost of $1000-$2000 per shot for 6 shots which we all have to pay for.

But how far should they go?
Should they tell me where to go get the shot?
Should they tell me who is going to give the shot?
If one method is more efficient for the patient, and less risk, shouldn't that be the method which is used? Who has control over that decision?

In my experience, the health insurance company micro managed the process to extent they provided more health care by requiring a very exact procedure (as in go to doctors office, have kid weighed, send the weight to insurance company, they order the shot, send it to doctor's office, 45% of the dose shipped gets thrown out, and I am billed more than I needed to be billed for because of this inefficiency.

That is a detailed procedure to be given a shot

The alternative is a nurse can come to house, weigh my kid, measure the serum in the needle, give the shot, wait 30 minutes, then leave my house. No wasted dosage for me to pay for either.

The second is clearly more efficient, but the insurance company required the first detailed procedure to be followed to cover the expenses. That makes no sense, and in my interpretation, the health insurance company is providing more health care advice and more health care than the person giving the shot.

[cptacek]

jIM, it sounds like you never want to deal with that insurance company again. I agree, they sound like they are horribly inefficient and wasteful and not responsive to your children's needs at all.

Why don't you switch? (rhetorical). You can't switch because they are tied to your other insurance, which is tied to your job. They don't have any incentive to get better, either. You are locked in with them and they know it.

Some think having the government step in and take over for this horrible insurance company is the answer. But, what if the government does the exact same thing as this bad insurance company? You have no recourse. You, as an individual, can't sue the government. You can't switch to another plan in a "single payer" situation.

The best thing, IMO, would be for jIM to tell that company to stick it and find another one. If insurance wasn't tied to your job and you could shop around to meet your needs, that insurance company wouldn't last long.

[jIM_Ohio]

jIM, it sounds like you never want to deal with that insurance company again. I agree, they sound like they are horribly inefficient and wasteful and not responsive to your children's needs at all.

Why don't you switch? (rhetorical). You can't switch because they are tied to your other insurance, which is tied to your job. They don't have any incentive to get better, either. You are locked in with them and they know it.

Some think having the government step in and take over for this horrible insurance company is the answer. But, what if the government does the exact same thing as this bad insurance company? You have no recourse. You, as an individual, can't sue the government. You can't switch to another plan in a "single payer" situation.

The best thing, IMO, would be for jIM to tell that company to stick it and find another one. If insurance wasn't tied to your job and you could shop around to meet your needs, that insurance company wouldn't last long.

Maybe

Health care reform can mean many things

According to Obamacare, it means getting insurance to as many people as possible.
The price tag (for a person) was not a major discussion point.

According to me, it means improving the efficiency of the current system. "How" this occurs could be any one of 10-100-1000 different ways. More government regulation (price setting, price disclosure), more patient rights (patient bill of rights, ability to sure employer and insurance company, ability to see plan documents.

According other theories, it could mean free market- make the insurance companies compete for business more (means they would have to lower premiums to earn business).

There are so many more issues which add onto the problem

1) how do people which do not work get insurance in any of the above systems?
2) how is care rationed?
3) who manages quality of care?


I am not convinced giving more people insurance fixes the current system. I started this thread to see what liberal minded people think, so I could see if I was thinking about problem wrong.

When I started this thread I did not know what "single payer system" meant. I do now- I don't agree that's a good solution, but I digress on that.


I like to focus on the tasks and processes and procedures which are inefficient and improve them- its what I do for a living, and its how my brain works... adding more people to current system (to me) makes it more inefficient. When I need health care, I want it quick- never had to wait more than 12 hours for a doctor's appointment, and 12 hours is considered LONG for me to wait. If my primary care now added 500-1000 more patients maybe those times and expectations are no longer valid. This is my biggest fear.


I would not change insurance plans with my employer- the current HDHP gives me a tax benefit and is low cost. Its like taking a member of the cheerleading team to the prom, never met an ugly cheerleader, you need a date, so get the lowest maintaince/lowest cost date you can find which is good looking.

[disneysteve]

Health care reform can mean many things

According to Obamacare, it means getting insurance to as many people as possible.

According to me, it means improving the efficiency of the current system.

Jim, this is a huge point that doesn't get nearly enough play. There is so much waste in the current system that eliminating even half of it would probably free up enough money to turn around and insure most of those who are currently uninsured. Computerizing everything would help a great deal, but that's a slow and expensive process and lots of doctors, my partner and I included, are very resistant to doing this. If the government would spend their money to speed along that process, they would do far more good than much of what they are doing now.

[markusk]

When I started this thread I did not know what "single payer system" meant. I do now- I don't agree that's a good solution, but I digress on that.

I like to focus on the tasks and processes and procedures which are inefficient and improve them- its what I do for a living, and its how my brain works... adding more people to current system (to me) makes it more inefficient.

jIM, if your main focus is to improve inefficiencies, then a "single payer system" may be the answer. We currently have a fragmented/disjointed system populated by too many parties talking different languages and not knowing (or caring) what other parts of the system are doing. A single payer that pays for all the tests, doctors' visits, surgeries, hospitalizations, etc, can (force?) standardize and streamline everything. For example, one thing this single payer can do is mandate some type of a national EMR (Electronic Medical Records) -- which for me as a physician is a big deal.

Most labs, MRI/CT suites, doctor's offices notes, hospital charts, insurance invoices are still done on paper.

Before having an EMR, I saw inefficiencies all the time. An MRI result read by a radiologist or blood lab results are sent either by mail or fax to the ordering physician printed on a piece of paper -- which must be collected and placed into a physical box called an "in box" (of course). The physician then looks over the paperwork and either place it in a another stack of paperwork "to be filed" in the chart (assuming that the patient's chart can be found). A letter is often dictated and sent to the patient or other physicians. If a patient was admitted to a hospital, their physician has no way of knowing why/when or what happened during the admission unless the patient brings the paperwork to the office.

Sometimes, the patient's chart can not be found! This happened to me quite often when I did not have EMR so I usually have to start "from scratch."

Sometimes, I can't read someone's handwriting in the chart or it may take me a long time (time I don't really have) to decipher the notes. If I can't figure out what was already done, I have to repeat what may have already been done -- this happened more times than I care to remember.

Because of our fragmented system, some hospitals (or systems of hospitals) have some form of EMR but they can not talk to other hospitals in the same city (different hospital system) and are completely incompatible. Some large hospitals actually brought (at millions of dollars) two incompatible systems at once, one for outpatient care and another for inpatient care. A pediatric hospital may have one EMR but the adult hospital down the street has a different one. Your OBGYN may still do everything on paper and so does your primary care physician so communication between them is via fax or snail mail.

I would love a robust EMR: over a secure server I can access all the patient's labs, imagining studies, inpatient, outpatient doctors notes all on the finger tips. For patients maybe you can email your physician with simple questions, book your own appointments online or look up your own labs yourself. Things would not get "lost in the mail" or "we never got the fax." And you will not get lost in the endless phone message loop asking for lab/imaging results, appointments, etc. By the way, it has already been shown that when patients set up their own appointments, they are more likely to show up for the appointment. Most physician I know don't like gaps in their schedule due to "no shows."

When I need health care, I want it quick- never had to wait more than 12 hours for a doctor's appointment, and 12 hours is considered LONG for me to wait. If my primary care now added 500-1000 more patients maybe those times and expectations are no longer valid. This is my biggest fear.

I would not change insurance plans with my employer- the current HDHP gives me a tax benefit and is low cost. Its like taking a member of the cheerleading team to the prom, never met an ugly cheerleader, you need a date, so get the lowest maintaince/lowest cost date you can find which is good looking.

Ahhh, you have voiced the fear many are thinking (I include myself here) -- not the fear of dating the only ugly cheerleader in school, but the real fear of the unknown. Many people are comfortable with the system we know how to (somewhat) navigate. If your current healthcare thru your employer is at a reasonable cost to boot, there is more to fear. So you may be passionate about encouraging efficiencies and stamping out inefficiencies but what if this costs you more in terms of more taxes OR, God forbid, a single payer system? No easy answers here.

[jIM_Ohio]

Jim, this is a huge point that doesn't get nearly enough play. There is so much waste in the current system that eliminating even half of it would probably free up enough money to turn around and insure most of those who are currently uninsured. Computerizing everything would help a great deal, but that's a slow and expensive process and lots of doctors, my partner and I included, are very resistant to doing this. If the government would spend their money to speed along that process, they would do far more good than much of what they are doing now.

Thanks for the reply
put a smile on my face

in this regard, we think very much alike.

I believe Hillary Clinton used this as her position when running for the presidential nomination.