Saturday, March 13, 2010

Sick in America Part 2



My reflections:

The situation with Kent is another one that would be avoided if insurance wasn't linked to your employment, if you were able to join a risk pool that formed voluntarily. And Blue Cross had evidence that Kent had seen a doctor about the lump BEFORE he applied for insurance, and hadn't disclosed it. They're not doing a very good job of protecting honest customers if they don't investigate dishonest customers. And all this could be avoided in the first place if the risk pools weren't tied to work. Had Kent's insurance been portable, he'd not have had a lapse in coverage in the first place.

I hate the blanket statement that insurance companies (and HMOs) "suck". I used to have marvelous coverage with Keystone HMO. It was under BC/BS. They cut costs while increasing patient satisfaction by cutting waste -- wasted procedures, wasted time, wasted money. After hour acute care was started by paging the on-call doctor. She'd call and talk to the patient and decide on a course of action.

For the bacon grease spatter in my eye, she had me describe how it felt, and my husband described how it looked. She told me to put an ice pack on for 15 minutes and if it still hurt or didn't look better, page her again. Fifteen minutes with an ice pack did the job. Total cost to the HMO -- negligible. And absolutely ZERO wait an inconvenience for the patient.

For when my husband sliced his hand open, she had us meet her at the clinic. She unlocked, took us inside, got out a suture kit, cleaned and sutured the wound, and sent us on our way. Again, low cost -- no expensive ER visit. Just one doctor, not even a nurse. Just one suture kit. For us, no wait. Much better care at a much lower cost.

When the car fell off the jack and fell on my husband's foot, we met the on-call doctor at the ER. The HMO leased an exam room. We went straight to the exam room, no mucking about in triage or the waiting room. She examined his foot, sent him into the radiology department for an x-ray, looked at the x-ray, and sent us home with instructions for the bruising, since nothing was broken. Lower cost, less wait, very good care.

But when we needed a specialist, no problem. The PCP would refer us. We were always able to get the care we needed.

Before we start tinkering with the system, I want to know what happened to Keystone HMO and why it didn't become a model.

Now, back to Michael Moore. He wants to get rid of "private, profit making insurance companies". And replace it with what? Medicaid for everybody? It's unsustainable.

And there is nothing inherently evil about making a profit. Profit produces the capital necessary for research. ALL of us pursue profit for ourselves. And it's not like people working at nonprofits are somehow more altruistic. Look at what Snopes.com found when looking into compensation for CEOs of charities. "Nonprofit" doesn't mean nobody gets paid and nobody gets rich. And government sector employees make more than private sector employees. You can't eliminate greed by shifting people from for-profits to non-profits or to the public sector. Some people are highly skilled and will command high pay. Some people are greedy and will get more than they're worth. And shifting them from one category to another won't change that.

Back to Michael Moore on for-profit insurance companies: "In my perfect world, they wouldn't exist". Well, in my perfect world there'd be no abortion. In a neo-Nazi's perfect world there'd be no Jews. In a ten-year-old boy's perfect world there'd be no school. We can't live on unicorns and fairies. We have to deal with reality. And that includes basic economics and social dynamics. I'd say that one of the main things that drives me crazy about Leftists is that they expect the world to conform to their wishes, instead of working in the world, as it exists, imperfect as it is. You can't wish away cancer, and you can't wish away the fact that the cancer researcher needs some motive other than altruism to furnish the lab he needs to do his research.

Oh, yes, they want the government to take over health care. I had a baby in a military hospital. I'd rather have a taxi driver deliver my next baby than do that again. I was lied to, my baby and I were mistreated, and when we complained they snapped at us, "It's free, so shut up. You have no right to complain." Who the hell wants to sign up for THAT?

I work for an agency that operates under government regulations. It's flipping insane. The real life examples are too convoluted to explain, but I will give you a real life example of what happened when about a dozen rules all piled up one one client -- she was required to do at least 30 hours a week of approved activities, but was cut off from all activities except one, which she was forbidden to do for more than 18 hours a week. So she had to do AT LEAST 30 hours, but NO MORE THAN 18. Never mind that it's absolutely and by definition impossible, like a requirement to draw 5-sided triangles. The client had to comply with rules that required her to make 18 be equal to or greater than 30. A government that comes up with crazy shit like that, given control over your health care, will come up with rules that, in practice, mean things like you can't get a biopsy unless you're already diagnosed with cancer.

Cat ladies collect cats. Engineers tinker with stuff. And bureaucrats write labyrinthine and incomprehensible rules that are literally impossible to make sense of. I do NOT want those people in charge of my health. It's bad enough I deal with their crap at work.

The idea that health insurers are solely motivated not to pay -- Nobody will buy insurance from a company that doesn't provide any benefits. Allow them to compete and they'll be falling all over each other trying to provide the best coverage at the best price.

I have only once in my life had health insurance try to deny something. I brought my 15-year-old daughter to the ER with chest pains. They balked at paying for a cardiac assessment for a 15-year-old. My ex husband (whose insurance the kids were under) argued with them for two years but finally got them to admit that given a family history (an aunt who was hospitalized for a heart attack at age 9), it was perfectly reasonable to check for cardiac problems as the cause of radiating chest pain in a 15-year-old. I've been able to get all the other care my family and I needed.

As for Michael Moore's claim that he didn't confront the insurance people because he wanted the audience to do that themselves -- How many of us can get the kind of access he can? I think he didn't confront them because he knew the answers they'd give, and he didn't want the audience to hear them. That there is a claims denial rate of 3%. That's comparable to the complication rate for early abortions, as claimed by the National Abortion Federation. So if abortion complications can be pooh-poohed by the Left, then insurance denials can be, too. (And no "Oh, but it's so serious if your insurance denies a claim!" An abortion complication can leave you comatose, sterile, blind, crapping through a hole in your side into a bag for the rest of your life, paralyzed, incapacitated, or even dead. That's serious enough.)

I'd love to have seen Stossel go into this more -- Why are claims denied? Ought we not to investigate this before we make judgments? Were these cases where people got their claims denied when they had a burst appendix? Or were these Homer Simpson getting Minoxidil to keep his brain from freezing?

John Stossel then looks at some of the dynamics that drive health care costs up. These problems won't be fixed until the consumer has an incentive to shop around.

7 comments:

Kathy said...

The part in your post about stupid government bureaucracy reminded me of this video I just saw. Pretty funny, except that it's probably true.

GrannyGrump said...

Funny, but at least that approaches logic!

We recently got a directive that we're not allowed to grant excused absences for people in the Paid Work Experience. But they're only allowed to do 20 hours a week of PWE, so they CAN'T make it up the next week. They can't "bank" it by doing extra hours the week before. But we're also supposed to put as many people as possible into PWE because there's "stimulus money" for it.

So we're supposed to get as many people as possible into PWE (meaning putting them into an activity that as soon as they get sick, they're doomed to non-compliance), but we're also supposed to achieve maximum compliance.

So -- they set us up to make compliance as difficult as possible, if not downright impossible (see the woman who has to do at least 30 hour but no more than 18), then want us to maximize our compliance.

That's my job. Every week trying to at least document the efforts of my clients to draw the mandated five-sided triangles.

I do NOT want bureaucrats in charge of my health care. They screw up my job enough as it is.

OperationCounterstrike said...

If you don't want bureaucrats in charge of your health care, then anything is better than what you have now. Not just bureaucrats, INSURANCE COMPANY BUREAUCRATS, who get bigger christmas bonuses if they screw you over.

GrannyGrump said...

OC, if the bureaucrats at Acme Insurance are heartless jackasses, then consumers can tell Acme to get bent and go get their insurance at Better Insurance.

Once the government takes over, they're the only game in town and once the bullshit starts there's no escaping it.

OperationCounterstrike said...

GG that's very nice in theory but in fact the health-insurance "market" is totally dominated by a small number of players. Acme and Better both screw their subscribers over in the same ways, and Community and Delta are equally bad.

I agree with you that there will be problems with government health-care. The question is will they be worse then what we already have. The answer is, most likely not, because what we have is already so bad and only getting worse.

The fact is I have worked with people from such "socialized-medicine" countries as Germany, Switzerland, Holland, Spain, France, Sweden, Denmark, Norway, Finland, South Korea, Israel, Japan, and even the despised Canada and England, and everyone seems to think we in USA are nuts to put up with the non-system we have. For every complaint about having to delay specialty procedures (most of which, like bypasses and joint replacements, can be safely, if inconveniently, delayed) I hear SEVERAL stories about getting seriously sick, or suffering big-time injury, or giving birth, and getting full medical care with physical therapy and all the "extras", WITHOUT EVER HAVING TO THINK ABOUT MONEY AT ALL.

I'll take that one, please. My plans are already in place: the day after I get a diagnosis of serious illness, I will be on a plane to Copenhagen for an extended visit.

OperationCounterstrike said...

I have friends in Canada who refuse to visit USA even for a short time, because they know if they get sick or injured in USA their medical bills will bankrupt them. They simply cannot afford to play American-health-care roulette.

Kathy said...

The problem with health insurance is the way it is currently set up and currently operates. People are tied to their employers for their health insurance (even though statistically people stay at a job for less than 5 years). Companies get a tax break for offering health insurance, but individuals do not get the same tax break.

While some people point to health care insurance as a form of capitalism failing, I don't consider it to really be capitalism, since there are too many layers between the payers and the consumers (not to mention the regulations and the restrictions on competition — for instance, across state lines). People pay health insurance on a weekly/monthly basis (or have it taken directly out of their checks, or directly from their companies), so there isn't a direct "my money gets me this" feeling like when you buy a hamburger or a big-screen TV. Then when they go to the doctor or the hospital, they don't see the bills, because the insurance company pays them, so they again miss out on the tangible connection of money paid for the good or service.

And individuals usually cannot choose between two different companies, because their employer makes that decision. The employer may make a choice that would be different from the choice the consumer would make — he might choose merely the cheapest policy, while individuals may prefer one that covers more stuff, or has a higher or lower deductible. That leads to one layer of disconnect between what the consumer pays for and what he gets. Going to a doctor and not knowing the charges is another layer of disconnect.

If we could cut through some of that, perhaps people would make different and/or better choices about health insurance and health care if they were more connected as payer-consumers.