Author Topic: health care should be between me and my doctor  (Read 1545 times)

timfogarty

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health care should be between me and my doctor
« on: July 25, 2009, 07:25:19 PM »
taken from kos

Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries. I believe healthcare decisions should be between myself and my doctor.

Well, that is not strictly true. I believe healthcare decisions should be between myself, my doctor, and my insurance company, which provides me a list of which doctors I can see, which specialists I can see, and has a strict policy outlining when I can and can't see those specialists, for what symptoms, and what tests my doctors can or cannot perform for a given set of symptoms. That seems fair, because the insurance company needs to make a profit; they're not in the business of just keeping people alive for free.

Oh, and also my employer. My employer decides what health insurance company and plans will be available to me in the first place. If I quit that job and find another, my heath insurance will be different, and I may or may not be able to see the same doctor as I had been seeing before, or receive the same treatments, or obtain the same medicines. So I believe my healthcare decisions should be between myself, the company I work for, my insurance company, and my doctor. Assuming I'm employed, which is a tough go in the current economy.

Hmm, but that's still a little simplistic. I suppose we should clarify.

I also believe my healthcare should depend on the form I fill out when I apply for that health insurance, which stipulates that any medical problems I ever had previously in my life won't be covered by that insurance, and so I am not allowed to seek further care for them, at least not at my insurance company's expense. That seems fair; otherwise my insurance company might be cheated by me knowing I needed healthcare for something in advance.

And if I didn't know about an existing condition I had, but I could have known about it, had someone discovered it, I suppose it doesn't make much sense for my insurance to cover that either.


But let us assume that all hurdles have been cleared and I am allowed to see my doctor, chosen from a list of available doctors, about a health problem, except health problems I have previously been treated for. After that, I believe my healthcare decisions should be between myself, my insurance company, my insurance plan, my employer, and my doctor.

Oh -- and the doctors at the insurance company, of course.

They will never actually meet me, or even speak to me on the phone, and in fact I couldn't tell you the name of a single one of them, or what state they were in, or whether or not they've just all been outsourced to a computer program somewhere in Asia at this point -- but they're in charge of determining which treatments might be "effective" for me, and which will be a waste of money, er, time. They do this by looking not at my case, which is individualistic and piffling and minor, but at the statistical panoply of treatments on the insurance company spreadsheet and their statistical cost vs. effectiveness. My doctor may think one treatment or another might be effective for me in a particular instance -- but he may be a little too closely involved with my personal case, and unable to make these decisions nearly as well as my less involved, more dispassionate insurance company can.

And then there's the claims office. When my doctor sends a bill to my insurance company, it must travel through a phalanx of people and departments and procedures in order to determine whether or not it is, in fact, a valid medical complaint to be treated for, done the right way, at the right time, by a doctor on the right list. If the paperwork is not done on time, or not done completely, or not done to the satisfaction of the right people, or if I did not receive the proper prior approval for the medical treatment administered, or if that approval expired, or if the insurance company rescinded the approval months after the fact, my medical care will not be covered. While my doctor has had to sometimes forgo payments because the 30-day window for receiving "all requested documentation" somehow slipped by, I myself have received notes from the insurance company denying coverage for treatments from twelve full months beforehand. It can't be helped: sometimes it takes twelve months for their computers to process the paperwork and determine that I owe them more money. They like to be thorough.

So that's getting a bit more complete. I believe my healthcare decisions should be between me, my insurance company plan, my statement of preexisting conditions, the claims adjusters at my insurance company, my insurance company's doctors, my employer, and myself.

And the separate claims review team that will be looking over my treatment.

My health insurer might have flagged me as someone who needs a lot of healthcare, and who is therefore costing the company money. Needing to use the insurance you paid for is naturally a suspicious activity: that means that a special review team will look over my paperwork, seeing if there is any vaguely plausible reason for the company to be rid of me. They will look for loopholes in my application, irregularities in the paperwork my doctor filled out or any other situations which, like magic, mean that all the money I have paid for health insurance premiums was in fact irrelevant, null and void, and they don't have to pay a single cent of claims because I defrauded them by neglecting to remember that I had chicken pox in sixth grade, not fifth, or that what I presumed was a bad cold in 1997 was in fact maybe-possibly-bronchitis, and I can't possibly expect to be covered for any lung-related complaints since then. I suppose I cannot complain too much; after all, this is a crack squadron of employees whose pay is determined by how much they can reduce the healthcare costs incurred by the company. It would be irresponsible for them to not look for such loopholes.

And then there is the board of directors at the insurance company, of course. My personal healthcare is irrelevant, when considered in the abstract; a health insurance company exists to make a profit, and the pay of every executive in the company and every board member is dependent on squeezing out the maximal amount of profits from every dollar.

This is where "experimental" and/or "preventative" treatments come in. New-fangled treatments, things that have only been around for a decade or two, are usually the most expensive. For example, when I complained of chest pains I could have had an CT scan to determine the state of the arteries around my heart, and it would have shown exactly where the problems, if any, lie. This is what the specialist recommended -- but using a CT scan in this way is considered "preventative" treatment, not "diagnostic" treatment, so it is not covered, and I am not allowed to have one. Instead, less accurate tests were used to get a "feel" for what the arteries might look like; these tests are covered. Problem solved; as it turned out, my chest pains were probably a preexisting condition, most likely caused by me having bones. And if it's not, I suppose we'll find out in another ten years or so, when no doubt I am covered by another insurance company and not this one.

These may seem like arbitrary determinations, but they are not. They are based on a rigorous study of how well the treatment works, how much it costs, and how likely it is that the company will have its corporate ass sued off if they do not provide it. This is weighed against the desired profit announcements for the insurance company during that quarter in order to determine how much care must be denied to customers, in aggregate, in order to meet the appropriate financial goals.

Let us not forget the obligations to the stockholders, after all.  Of every dollar paid in premiums, currently eighty cents it paid back out for actual medical claims; the rest is administration and profit-taking. Fifteen years ago the number was 95 cents: in other words, the insurance companies themselves have gone from taking five cents of every healthcare dollar to taking twenty cents of every dollar, all since the Clinton presidency.

The stockholders require healthy profits. The executives require personal profits for providing those profits. And since people for some reason aren't getting any healthier, those profits can only come from one place -- reducing what the company pays out when people do become sick.


I recently heard a radio interview with a health insurance company whistleblower; he was describing his trips on the company jet. Gourmet meals were served on china, and the forks were gold plated.

I was pondering this, while looking over the letter from my insurance company informing me that they were switching the coverage of my most expensive monthly medication -- those expensive allergy/asthma shots now count as a "procedure", not as "medicine", and so therefore those vials are not covered by my pharmaceutical plan anymore. It must be very difficult to balance all the tasks of an insurance company CEO. If the corporate jet has inferior place settings, imagine the corporate shame. If a new medication or treatment is no longer considered "experimental", or a treatment classified as actually useful, as opposed to "preventative" nonsense, consider how many millions of dollars the company would have to pay out to give people that treatment. It seems reasonable indeed for the president of my insurance company to have personally pocketed a few hundreds of millions here or there -- I cannot imagine the stress of keeping up with proper utensil etiquette during a time when those you insure are doing you the constant insult of actually getting sick.

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company's list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company's claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company's crack cost-review and retroactive cancellation and denial squads, my insurance company's executives and board of directors, my insurance company's profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.


24KT

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Re: health care should be between me and my doctor
« Reply #1 on: July 25, 2009, 07:39:39 PM »




That is pure gold! Only in America!
w

Hugo Chavez

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Re: health care should be between me and my doctor
« Reply #2 on: July 25, 2009, 07:46:24 PM »
spot on...

MM2K

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Re: health care should be between me and my doctor
« Reply #3 on: July 25, 2009, 08:36:23 PM »
Yeah, that is priceless. Someone from Daily KOs who thinks he is writing a cleverly ironic letter. The quintesential liberal. It is BECAUSE of government that employers are involved in our healthcare. Yes, unforunately healthinsurance companies will have to be somewhat involved in the decisions of catasrophic surgery. In the end you have to ask yourself who decides when you die. Becuase sometimes we have to die. Trust me, you dont want a government beaurocrat who doesnt know you, who can put a gun to your head and take your money away from you to decide that. The government beaurocrat doesnt have as much knowledge nor as much of an incentive to allow you or your family members to live as long as possible.
Jan. Jobs: 36,000!!

Hugo Chavez

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Re: health care should be between me and my doctor
« Reply #4 on: July 25, 2009, 09:04:19 PM »
Yeah, that is priceless. Someone from Daily KOs who thinks he is writing a cleverly ironic letter. The quintesential liberal. It is BECAUSE of government that employers are involved in our healthcare. Yes, unforunately healthinsurance companies will have to be somewhat involved in the decisions of catasrophic surgery. In the end you have to ask yourself who decides when you die. Becuase sometimes we have to die. Trust me, you dont want a government beaurocrat who doesnt know you, who can put a gun to your head and take your money away from you to decide that. The government beaurocrat doesnt have as much knowledge nor as much of an incentive to allow you or your family members to live as long as possible.
He makes some great points.  You may think the solution is different but the points made in what this guy says won't go away.

timfogarty

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Re: health care should be between me and my doctor
« Reply #5 on: July 25, 2009, 09:30:43 PM »
Yes, unforunately healthinsurance companies will have to be somewhat involved in the decisions of catasrophic surgery. In the end you have to ask yourself who decides when you die.

you must be 100% healthy.  my $500/month Aetna insurance requires 'managed care' approval for pretty much everything outside a regular checkup.

big L dawg

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Re: health care should be between me and my doctor
« Reply #6 on: July 25, 2009, 09:43:12 PM »
DAWG

24KT

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Re: health care should be between me and my doctor
« Reply #7 on: July 26, 2009, 12:07:44 AM »
you must be 100% healthy.  my $500/month Aetna insurance requires 'managed care' approval for pretty much everything outside a regular checkup.

Tim,

Who is that in your avatar, ...and do you have a larger picture of him you could post?  :D
w

Hugo Chavez

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Re: health care should be between me and my doctor
« Reply #8 on: July 26, 2009, 12:14:35 AM »
Tim,

Who is that in your avatar, ...and do you have a larger picture of him you could post?  :D

24KT

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Re: health care should be between me and my doctor
« Reply #9 on: July 26, 2009, 03:03:41 AM »


{blink} {blink}  Oh my! Thanks Hugo!

...ya know, ...he fits the description of a perp... I think I need to get a positive id... maybe pat him down.
You never know, ...he could be carrying a giant concealed weapon ...better safe than sorry...  :P
w

Hugo Chavez

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Re: health care should be between me and my doctor
« Reply #10 on: July 26, 2009, 03:31:33 AM »
{blink} {blink}  Oh my! Thanks Hugo!

...ya know, ...he fits the description of a perp... I think I need to get a positive id... maybe pat him down.
You never know, ...he could be carrying a giant concealed weapon ...better safe than sorry...  :P
I'm not getting involved past copying and pasting his avatar for you... ;)

drkaje

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Re: health care should be between me and my doctor
« Reply #11 on: July 26, 2009, 06:02:15 AM »
Will someone please name 5 well run U.S. govt programs that require more than simply sending a check.

It'll be interesting to see what happens when people find out how expensive this will actually be. Right now, people know the president is lying but they really want to believe it can be accomplished with no cost to the middle class.

24KT

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Re: health care should be between me and my doctor
« Reply #12 on: July 26, 2009, 06:41:06 AM »
I'm not getting involved past copying and pasting his avatar for you... ;)

You mean you're going to make me do ALL the dirty work?  I suppose you're gonna make me put my hands down his pants, patting, pressing, squeezing, probing and feeling around his fleshy bits for a giant concealed weapon huh?

*sigh* It's a dirty job, I know, but if you won't help me, ...I guess somebody's gotta do it, {pout} ...why am I always stuck doing the dirty work? Next you're prolly gonna tell me I'm stuck rubbing baby oil all over his chest, torso, and lower ab muscles too aren't ya? Hugo, ...you're just plain mean.  :P  Who is that a pic of anyway?
w

Hugo Chavez

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Re: health care should be between me and my doctor
« Reply #13 on: July 26, 2009, 06:46:04 AM »
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX
STOP STOP STOP STOP....  :-X

timfogarty

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Re: health care should be between me and my doctor
« Reply #14 on: July 26, 2009, 01:32:43 PM »
Will someone please name 5 well run U.S. govt programs that require more than simply sending a check.

well, let's see.  there's the military, and the post office (yes it is well run), NOAA, the CDC, NIH, FEMA prior to it being stocked with cronies,

grab an umbrella

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Re: health care should be between me and my doctor
« Reply #15 on: July 26, 2009, 01:39:16 PM »
well, let's see.  there's the military, and the post office (yes it is well run), NOAA, the CDC, NIH, FEMA prior to it being stocked with cronies,

Post office?  They've been doing well?  The military?  You can't be serious about that.  FEMA?  That post must have been a joke.

headhuntersix

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Re: health care should be between me and my doctor
« Reply #16 on: July 26, 2009, 01:45:47 PM »
Yeah...we're the most well run organization in this country and the best military in the entire world....
L

drkaje

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Re: health care should be between me and my doctor
« Reply #17 on: July 26, 2009, 02:02:28 PM »
well, let's see.  there's the military, and the post office (yes it is well run), NOAA, the CDC, NIH, FEMA prior to it being stocked with cronies,

Those have tons of waste. Tricare (military HMO) can/has been up to three years behind in paying claims, LOL! Find any business capitalized to a point where it can afford waiting that long. Could you wait three years? :)

People below the top 1% are being lead to believe healthcare reform will be painless. It's not a matter of stupidity, people just don't understand (intellectually) that delivering care has real costs. The typical office runs at about 50% overhead. "Typical" assumes the doctor isn't a specialist or OBGYN.

Ultimately, the president is too smart to believe this will work as advertised. There's no way to tell what he's up to. Maybe it's one of those Clintonesque "I really fought hard for this but evil Republicans hate poor people" things.

It just can't work.

Soul Crusher

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Re: health care should be between me and my doctor
« Reply #18 on: July 26, 2009, 05:18:41 PM »
well, let's see.  there's the military, and the post office (yes it is well run), NOAA, the CDC, NIH, FEMA prior to it being stocked with cronies,

Post office loses billions a year. 

FEMA sucks and did a bang up job with Katrina right?


tonymctones

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Re: health care should be between me and my doctor
« Reply #19 on: July 26, 2009, 05:22:34 PM »
the post office is in horrible shape, understaffed, overworked, operating in the red and getting worse and worse.

Soul Crusher

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Re: health care should be between me and my doctor
« Reply #20 on: July 26, 2009, 05:31:23 PM »
This letter is utter nonsense. 

1.  If this guy wants the insurance company out of the picture, then he should negotiate with the doctors himself for the price of care and treatments.   

2.  Since the third party and the employer is paying the bills, of course there is going to be some interference.  Insurance is just that, insurance.  Homeowners polcies dont cover everything, auto, surety, etc,  No policy will cover anything and everything unless the person or their employer wants to pay a huge premium.

3.  Does this fool think that if the govt takes over health care he will not be dealing with the same issues?  In fact, it will likely be far worse when the govt takes it over since the govt answers to no one and the consumer will be left with on crap option, Uncle Sam.  When uncle sam denies care, the taxpayer will have to sue the govt for treatment.  Under the system now, a person can change insurance carriers and pay a higher premium, but still get treatment.

The bottom line is that this guy is a whiner and does not realize that things will get far far worse when the govt takes over health care.
 

drkaje

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Re: health care should be between me and my doctor
« Reply #21 on: July 26, 2009, 06:34:33 PM »
It'll be interesting to see what happens when people realize it's not free. :)

Straw Man

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Re: health care should be between me and my doctor
« Reply #22 on: July 26, 2009, 10:08:50 PM »
This letter is utter nonsense. 

1.  If this guy wants the insurance company out of the picture, then he should negotiate with the doctors himself for the price of care and treatments.   

2.  Since the third party and the employer is paying the bills, of course there is going to be some interference.  Insurance is just that, insurance.  Homeowners polcies dont cover everything, auto, surety, etc,  No policy will cover anything and everything unless the person or their employer wants to pay a huge premium.

3.  Does this fool think that if the govt takes over health care he will not be dealing with the same issues?  In fact, it will likely be far worse when the govt takes it over since the govt answers to no one and the consumer will be left with on crap option, Uncle Sam.  When uncle sam denies care, the taxpayer will have to sue the govt for treatment.  Under the system now, a person can change insurance carriers and pay a higher premium, but still get treatment.

The bottom line is that this guy is a whiner and does not realize that things will get far far worse when the govt takes over health care.
 

think about this for a few seconds

nothing will change if you're rich and you can write the check to a doctor

the only possible change will be for people who depend on insurance to ENSURE they have care when they need it

it could get better or worse

for really wealthy people nothing will change at all in regards to their access to health care



timfogarty

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Re: health care should be between me and my doctor
« Reply #23 on: July 26, 2009, 10:31:50 PM »
1.  If this guy wants the insurance company out of the picture, then he should negotiate with the doctors himself for the price of care and treatments.   

the purpose of insurance is that no one person can afford to be completely self sufficient in a time of catastrophe,  but catastrophe doesn't happen to everyone equally.  so if a group of people pools their resources, those in need can be cared for.  and the bigger the group, the easier it is for the individuals to handle the burden.  you may not like paying for coverage you don't use, but you don't know whether a year from now, or 10 or 30, you'll have a life threatening disease.

Quote
2.  Since the third party and the employer is paying the bills, of course there is going to be some interference.  Insurance is just that, insurance.  Homeowners polcies dont cover everything, auto, surety, etc,  No policy will cover anything and everything unless the person or their employer wants to pay a huge premium.

most people buying medical insurance think the big things are covered, but the for profit insurance companies want to do their best not to pay for the big things.  when you or your spouse or child have a life threatening disease, you don't want to find out you've reached your limit for the year or your lifetime.

Quote
3.  Does this fool think that if the govt takes over health care he will not be dealing with the same issues?  In fact, it will likely be far worse when the govt takes it over since the govt answers to no one and the consumer will be left with on crap option, Uncle Sam.  When uncle sam denies care, the taxpayer will have to sue the govt for treatment. 

government does answer to the voters.  and if you do have to sue, what's the difference between suing the government, or suing an insurance company?

Quote
Under the system now, a person can change insurance carriers and pay a higher premium, but still get treatment.

not if you have a pre-existing condition.   and what if you lose your job and can't afford to pay the premiums for a while?  or what if you're poor?  is medical treatment only for the rich?

and what about in many, mostly rural, parts of the country, where United or Anthem has 80% of the market?  you can't take your business elsewhere when there are no other businesses available.

Quote
The bottom line is that this guy is a whiner and does not realize that things will get far far worse when the govt takes over health care.

the bottom line is that we pay much more for medical care and get much less than any other industrialized country.   One reason is that insurance companies make huge profits, yet do their best to force the really sick off of their policies.  some of those sick people end up on Medicaid, almost all old people are eventually forced off their private policies and end up on Medicare.   so the insurance companies make all the profits off the well people, and the taxpayers take care of the really sick people.

Soul Crusher

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Re: health care should be between me and my doctor
« Reply #24 on: July 27, 2009, 04:21:03 AM »
think about this for a few seconds

nothing will change if you're rich and you can write the check to a doctor

the only possible change will be for people who depend on insurance to ENSURE they have care when they need it

it could get better or worse

for really wealthy people nothing will change at all in regards to their access to health care

Wrong.  What is going to happen is that doctors are going to prohibited from taking on private patients for different rates like they already do on Medicaire.  Sure some docs will accept cash payments under the table, but is that what we want? 

Of course it is going to get worse.  Just look at Hawaii and MA where they tried this nonsense.  The govts are already drowning in debt over these schemes. 

The govt created this mess, not the insurance companies.  Do you even realize how HMO's came into existence in the first place???? 

Using the typical liberal boogie man argument that the insurance companies are alone to blame ignores the real culprit, the government. 

The govt is the main problem here, not the private sector.