As announced yesterday, here are the new health care monthly premium rates available to the uninsured. Our poster gary noticed them here, and there’s also an Excel spreadsheet from the governor’s office.
Respectively, the three figures refer to the “Young Adults Plan”, the premium for a 35-39 year old, and a 56+ year old. I don’t actually know exactly how they’re splitting up the state into Eastern/Central/Western — where’s New Bedford, for instance?
Eastern Region:
Neighborhood Health Plan: $144; $175; $347
Fallon Community Health Plan: N/A
Tufts Health Plan: $206; $242; $461
Blue Cross Blue Shield of Massachusetts: $212; $275; $504
Harvard Pilgrim Health Care: $147; $288; $414
Health New England: N/A
ConnectiCare: N/A
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Central Region:
Neighborhood Health Plan: $126; $154; $308
Fallon Community Health Plan: $128; $176; $304
Tufts Health Plan: $192; $225; $428
Blue Cross Blue Shield of Massachusetts: $198; $256; $470
Harvard Pilgrim Health Care: $132; $257; $369
Health New England: N/A
ConnectiCare: N/A
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Western Region:
Neighborhood Health Plan: $126; $154; $305
Fallon Community Health Plan: N/A
Tufts Health Plan: N/A
Blue Cross Blue Shield of Massachusetts: $198; $256; $470
Harvard Pilgrim Health Care: $148; $289; $415
Health New England: $201; $238; $377
ConnectiCare: $202; $246; $379
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Anyway, without knowing exactly what care your premium gets you, it’s just a jumble of numbers until tomorrow, when we get more detail. One would hope that the Patrick administration has encouraged the Connector to bargain for real health care, without too much cost-sharing fakery.
We’ll see…
Is anyone else bothered by the discrimination that screams out in this approach? Look at each “option” and its 3 categories. I find that grostesque. Just as different classes of care for different classes of people on the macro policy level is a grotesquue moral outrage grotesque in our supposed caring, civilized (and wealthy) society. (This should clear up any uncertainties about my positions on basic health policy distinctions…:)
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I guess it really comes down to a few basic human and social values and what health policy those values lead one to, be you a nurse, a stock broker, maid, or a Governor. One set of values lead to treating health insurance as a commodity in the “marketplace” (a major facet of the approach here at present). Another set of values lead to treating it as a social good with both individual and shared responsibilities.
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Many of you know that my values combined with my understanding of healthcare clinical and policy issues gained through working in in the field for 30 years, and personal experiences (having a sister with schizophrenia), have led to a passionate embrace of health insurance & healthcare as a social good. BTW this is what EVERY OTHER industrialized country and its People have also embraced and they enjoy much better care at much lower costs. (see Manny Goldstein’s excellent BMG comments on this topic.)
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I want to give a hearty thanks to a previous poster who lets us know that others are thinking this way too
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I also hope this MA reform will serve to get us on track toward a smarter, more caring, civilized and cost-effective approach to sustainable universal healhtcare where everyone has the duty to contribute in a equitable manner and everyone has the right to benefit from universal health insurance. And I’ll keep taking action in concert with others who share this vision.
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And BTW I support a private delivery system. Learn more at
Obviously not at the ratios suggested, and this ignores the fact that lots of seniors are on a fixed income.
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But, if you’re going to talk about cost fairness, you can’t just argue that the price of this plan should be the same regardless of age, or of location — there are other inequities in the system, including the correlation of age to income, MA region to income, etc.
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I’d love to see single payer. In the mean time, I don’t think it’s fair to expect people of different incomes to pay the same — and to ask that young people (who will require far less in health services) to subsidize others seems unfair too.
the whole point of risk-sharing? Social Security works on that principle. I pay into the system from the first day I work, at the same rate as my 50-yr-olf couterpart, in the assumption that even though I won’t need SS for decades, I will get the retirement benefits eventually, when I need them.
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I hope that we spend the next two years replacing this silly, for-profit-based system (conflict of interest) with a true universal health care system based on human rights, not profit margins.
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Nope. The point of risk sharing is this: if each of us have a 0.1% chance of incurring serious medical costs, then it makes sense for each of us to pool our resources so that we ‘buy out the risk’. In other words, by each paying an equal premium, we can be risk averse by buying insurance against catastrophe.
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What you’re suggesting is risk subsidization. You’re suggesting that even though some people have a 0.1% chance and others have a 10% chance, that the two parties pay the same. That’s not risk-sharing at all. In aggregate, the less risky people are guaranteeing a loss and the more risky people are guaranteeing a gain.
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Social security works on a somewhat related principle. It’s not pure socialism (we each work, and we each get what we need) because paying more in means getting more out*. It also works because it’s a national program, and an incredibly low percentage of Americans move out of the country permanently.
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The same can not be said for young people in Massachusetts. The argument that they should pay more now so that they can pay less later fails precisely because a very high percentage of MA citizens 21-35 years old aren’t likely to live in MA when they’re 65 — and therefore won’t reap the benefits of the system that they helped heavily subsidize at a time in their lives when they were earning far less.
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As I said, I’m for a national single payer universal coverage, paid for by taxes that are collected progressively as a function of income. But, the process of getting there shouldn’t go out of its way to discourage young people from living in MA because they’ve got to pay for way more health care than they need knowing full well that they’re unlikely to get it when they need it because they’ll have moved to NY or NJ or CA or TX or wherever.
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It’s true that if it’s all done “automagically through taxes” that young people will still be subsidizing the care of seniors. But, at least young high priced attorneys will be subsidizing the care a whole lot more than young artists, waitresses, or journeymen brickies. Why should a 22 year old making $26,000 a year subsidize the health care of a 58 year old middle manager making $85,000 a year?
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…the likelihood of the federal government instituting anything like “single payer” is between slim and none. Particularly after sHillary’s plan foundered in 1993-94. I doubt very seriously that either major national party will pick it up again any time soon.
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Regarding social security, your assessment of that program is a little off. It was originally intended to be an “income replacement” program to entice older people to leave the workforce to make way for younger workers. Hence the cap on the income that is taxed for SS, and hence the analogous limitation on the maximum level of SS benefits. And, furthermore, hence the fact that, if an SS recipient decides to continue working, the SS benefits are reduced by a percentage of the income–up to a particular age. That last wouldn’t happen in a pension system.
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Regarding medical insurance, I’d prefer a German system.
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(i) In Germany, the system is not “vom Staat” (from the state–i.e., national government) but is “staatlich” (organized by the state).
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(ii) Every legal resident is required to have not only Krankenversicherung (medical insurance), but also Pflegeversicherung (kind of like home care).
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(iii) People who are working and earn less that a threshold income are required to pay a premium that is a fixed percentage of his income, up to that threshold income level. Actually, it is considered part of the social security tax, which also includes old-age pensions. That means that everyone who is working and earning money in Germany pays into the system, unless they can opt out (see (iv) below).
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(iv) People who earn over the threshold income may opt out of the “staatlich” system, but if they do so they have to buy private insurance. There is a thriving private insurance market in Germany, and it is fairly affordable. My mother in law gets her Krankenversicherung and her Pflegeversicherung privat, largely because she–although she’s a German citizen–did not qualify for the “staatlich” program. Most people who qualify for the staatlich program apparently choose it.
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(v) Since there is a thriving private medical insurance program in Germany, there is also a thriving private health care system. The health care system in Germany doesn’t comprise just a set of state-run hospitals (although many of those are very good). There are a number of private clinics, doctors, etc., that, quite frankly would put US practice to shame. Public hospital administrators and so forth in Germany are considered “Beamters” (government employees) and receive salaries at levels that one would expect of a government employee. Not the huge multi-million dollar salaries of hospital administrators in the US (see (vi)). But, lest anybody wonder, the care in German hospitals is excellent. My partner was in Krankenhaus Muenchen-Pasing (a state hospital in the Pasing section of Munich Germany) for quite a while several years ago, and his care was at least on par with, if not better than, his care at Lahey Clinic for a similar affliction.
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(vi) I could go on, but this may be the most important point. Since University education in Germany is also subsidized by the state, it is likely that doctors who graduate from University in Germany are not burdened by the insanely high university debt that they’re burdened with in the US. Professional schools, such as law, medicine, pharmacy and so forth, that are attached to US universities are huge profit centers for the universities, and the universities milk them for all they’re worth. That isn’t the case in Germany.
The journey to single payer doesn’t have to happen in one step. I’ve described a long term method to get to single payer by expanding Medicare over time, specifically by age groups (cover more and more of the young and the old).
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That may have been an effect of OASDI, but most would point to the fact that the poverty rate among seniors in the early 1930s was in excess of 50% as the stimulus for the SSA.
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That’s right — its not a pension system (and I never claimed that it was). It’s an insurance system, designed to make sure that Americans who are Old Aged, Survivors, or Disabled have Insurance so that they can maintain a bare minimum standard of living.
That may have been an effect of OASDI, but most would point to the fact that the poverty rate among seniors in the early 1930s was in excess of 50% as the stimulus for the SSA.
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It should be recognized that the poverty rate among most age groups in the 1930s was pretty high, for obvious reasons. The high poverty rate among seniors in the 1930s may have been the excuse, reason, whatever that FDR used to institute an old-age income supplement system, but the reason for the structure of the system (as opposed to the reason that Bismarck had used for his social security system in Germany, on which the US system was allegedly based) is along the lines that I have described.
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It is highly questionable whether FDR could have gotten social security through the US congress–even in the 1930s–if it had been fashioned as a welfare program, which is what you are suggesting. I suspect, but do not know, that is why FDR fashioned social security along the lines that I have described, and sold the system in part as a means to benefit the entire population (including younger workers), not just the elderly.
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/my Lakoff moment
I didn’t call it a pension system, and I didn’t call it a welfare system. It’s neither: in a pension system, you get back the return on your share of investment; in a welfare system you get what you need regardless of how much you’ve contributed in taxes earlier.
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SS is neither. It is, however, exactly what I called it: insurance. It’s mandated government insurance.
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Insurance against old-age poverty (due to any number of factors), insurance against disability, insurance against death/dismemberment of a parent or spouse.
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I’ll write it again: insurance.
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So please, knock it off. Quit “framing” my statements with words that mean something quite different.
…I take issue with you calling it an insurance system. I have described it the way that it was apparently conceived. If you want to find various buzzwords to avoid calling it welfare for the elderly feel free. I prefer my formulation, you prefer your’s. Mir egal.
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But, let’s understand something. What risks are social security supposedly insuring against, and how are the rates that are charged supposedly related to the risks insured against? Getting old? It seems to me that “insurance” implies those issues, and what you are implying is that social security’s “insurance” is none of these.
This differentiating costs by age/region is another instance of the insurance companies externalizing their risks. When it comes to the basic human right to health care, it’s unacceptable.
…could you take a moment to explain what you mean when you write that an insurance company is “externalizing its risks”? I presume that “externalizing its risk” is a term of art, but I’ve never seen it before.
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TIA
in a number of posts.
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Externalizing risk means getting some other entity to “own” risk that you previously owned. Sometimes this is done financially, other times through changing law, etc.
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An example: GM is making cars right now in tUSA to sell in Europe at a later date (3 months, 6 months, etc). GM is paying USD for labor and materials, but will get paid in Euros. In addition to all the auto risks GM must deal with (labor issues, supply chain issues, marketing, etc.) GM must also own another risk — the risk of exchange rates changing unfavorably.
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But GM isn’t in the business of playing with exchange rates. They’re in the business of making cars (and selling car loans). So, they externalize the exchange rate risk through options trading — they effectively buy insurance against an ugly change in the exchange rate.
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Which brings us back to MA insurance. Insurance companies charging rates in positive correlation with their expected risk isn’t “externalizing the risk” — it’s correctly pricing the risk. An example of “externalizing the risk” would be if insurance companies could get the state of MA to pay for any really expensive operations instead of the insurance company doing so.
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Now, we as a society may decide that people living in different parts of MA or of different ages shouldn’t be paying different amounts for insurance — but that’s got nothing to do with “risk externalization.”
…Actually, most insurance companies do indeed “externalize the risk” via re-insurance (large “wholesale” insurance companies that effectively insure the retail insurance companies).
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In addition, large multi-national corporations such as GM do, indeed, play the currency exchange-rate game. I would not be surprised if much of the profit and loss of companies such as GM (which has owned a German car maker, Opel, since 1929) make a significant amount of its profit, or suffers a significant amount of its loss, from currency fluctuations. Recall that GM, as a corporation, is required to report its P&L on an accrual basis, regardless of the monies in vs. monies out.
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It’s doubtful that GM ships many Pontiacs or Chevies over to Europe for sale there.
A flat rate is NOT what’s advocated by me nor any other of the 90-plus organizations or individual members who belong to MassCare (of note: Health Care For All has been a member since MassCare was formed in 1995 and it would be great if they worked to support the legislation, “An Act to create the Massachusetts Health Care Trust”).
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To repeat from above
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This is why the words “equitabley financed” are two of the excrutiatingly carefully chosen words in the recently proposed citizens’ Health Care Constitutional Amendment
The Gov is doing what he said during the campaign, which is to try to make the plan work.
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Unlike at the national level, where I think Congress agreed specifically NOT to press drugmakers for volume prices, DP is phoning health care CEOs and negotiating directly….seemingly with some success.
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Even if you’re skeptical of the plan (I confess I am), doesn’t he get some credit? Wouldn’t it be politically easier for him to distance himself?
The Globe details the deductibles.
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For a healthy person, the benefit is little more than catastrophe insurance. We are now seeing the folly of enacting law before the details are worked out. This plan should be scrapped. Start over.
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We’ve already seen a reduction of choice in health insurance where I work (a few thousand employees). I don’t know if this prediction will come true:
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It could be that health benefits become a bargaining chip for employees, but this provides an advantage only when the labor market isn’t so tight. If it does become a bargaining chip, it’s going to be small business that is hurt the most.
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We also need is a requirement that public employee’s health insurance benefits are no better than the regional standards. It would be interesting to what percentage of public employees choose to insure their spouse/family through the public plan and how this compares to the public sector.
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Now hang on there. You say ‘castastrophe insurance’ like it’s a bad thing. For some people, it’s just the thing. Of the 47 million people in the US who are uninsured, 17 million of them make over $50K per year–they’re what the industry calls ‘free-riders’.
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The castastrophes that free-riders incurred are borne by ERs.
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A young, healthy guy making $50K might rightfully seek castastrophe insurance. His or her contribution into the system of $175 per month is affordable and the right choice.
I didn’t make my point clear enough.
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Catastrophic insurance may be the right type of insurance for some people. My concern is that the Connector came out with only this one option. Why not more plan types at different price ranges? Allow the individual some choice as to what works best, so that those who use more pay more.
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Could they lower this mandated cost further by raising the deductible to $5,000? $10,000? With a $2,000 deductible, a low-use person is already paying a sizeable amount of insurance AND out of pocket expenses.
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Do ERs really bear the cost? Don’t they bill people? If people don’t pay, don’t they make attempts to collect? At what point can a person avoid paying? At bankruptcy? Just wondering if there is a false belief out there. I’ve had family members who have slowly paid off medical bills. Been doing it for years.
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Where does personal responsibility come into play? I’m talking about people who use the ER for non-emergencies, or people who go to the doctor with every ache and sniffle. Or the doctors who refer patients to specialists for the slightest injury. I’ve had it happen to me. And I’ve also had doctors who weren’t so quick to refer.
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Hospital and medical bad debts are very high. Example:
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Source
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Law-abiding residents of MA will purchase insurance. The rest will continue to be uninsured, racking up fines (will these be garnered from wages?), and will continue to seek medical care. This doesn’t even begin to address those who don’t reside in MA (or who reside but hide their residency status for any number of reasons).
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Any business has risks. Hospitals are no exception and many (most?) still operate in the black. Mandating insurance protects hospitals against the risk of uncollected payment, but I am not convinced it protects the consumers.
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At the beginning of this debate, Romney made the argument that the law requires drivers to purchase auto insurance. He then used that as a reason why residents should be required to purchase health insurance. But, with auto insurance, the protection is to another party who may be killed or injured. With health insurance, this “other party” are hospitals.
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By this logic, why don’t we mandate “credit card” insurance to protect those companies against unpaid bills?
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I imagine hospitals can protect themselves from this risk by passing on part of the costs to those who do pay the bills. They could enforce rules that deny care for non-emergencies via their ER. They could require credit card authorization. They could sue for non-payment. They could eat the loss.
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I think everyone should have the ability to purchase affordable catastrophic health insurance. I don’t think it should be mandated.
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Credit card issuers have the means to protect themselves against bad debts. It’s called selection of those to whom they issue credit cards, “appropriate” fee and interest rate levels, and denial of bankruptcy in the event of bad debts (although, as my contracts professor wisely indicated, they can’t get blood out of a turnip).
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Same with hospitals. And, your correct I imagine hospitals can protect themselves from this risk by passing on part of the costs to those who do pay the bills in part. They do protect themselves in part on the costs to those who do pay the bills, whose insurers are not able, willing or interested in negotiating the charges down to avoid those bills. That last is the important point, that most people ignore.
I’m not wild about the mandate either.
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But, as has often been discussed here, there are plenty of Massachusetts state mandates. The one I use for comparison most often is the requirement that homeowner buy ‘replacement value’ insurance for their home, and nothing less.
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BTW, Hospitals do protect themselves from the risk by raising their various charge rates. i.e. the Medicare and Medicaid reimbursement rates have a component for ‘bad debt allowance.’
Hospitals aren’t allowed to turn potential “deadbeat” customers away. Credit card companies are. That’s an important difference.
I’m not talking about emergency treatment. I’m talking about discretionary care for someone with a history of unpaid bills.
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I think hospitals should be allowed to deny service. Maybe it’s a process that starts with collection/credit counseling. Or a referral to an agency that can help procure insurance (group pool for self-employed for example).
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It doesn’t have to be cruel or cold or blind to extenuating circumstances. But it does need to move people to take responsibility for their own decisions and actions.
I’m as ‘cold and heartless’ conservative as you’ll meet, and even I don’t think service denial is a good policy for a hospital. Just too much power over medical decisions in the hands of financial people–IMHO.
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Things like physicals, shots, and doctors visits for illnesses or aches, which help reduce the chances of expensive emergency care later, reduce the general publics risk of a disease outbreak, and help maintain worker productivity and hence income taxes instead of social security deductions?
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Hospitals do deny service now. Go into a hospital and tell them you’d like a nose job or a boob job, and that you’ve got no money. The question is about what kind of care they can deny. They can certainly deny elective cosmetic surgery, and they can’t deny emergency services. What about all that stuff in between? AnnEM, a little help here please…
and I’ll fill in what I’ve witnessed as a nurse and a family member related to needed care that’s not given; it’s a huge gray area… and one that’s all too vulnerable to insurance reimbursement regulations (instead of being more appropriately driven by wise clinical decisions)
NOTE: This is in response to gary’s Deny Service comment, but I didn’t want to get crammed into the skinny column.
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Wasn’t there an “HMO scare” 15-20 years ago? People worried that some pencil pusher in an office was going to be making decisions about their health care. What happened? At least in MA, HMOs cover almost everything.
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The doctor or hospital has little incentive to control costs because they bill insurance. The insurance companies have found that they can pass costs onto the consumer, and it hasn’t been until recently that there has been some resistence to the expense.
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It was the lack of consumer resistence (due to the availability of student loans) that allowed college tuition to rise at twice the rate of inflation for twenty years.
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The current law does NOTHING to address cost. It only relieves the pain. This is a temporary fix, and I believe a short-lived one.
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@stormv
Discretionary care is showing up at an emergency room for something that is not life-threatening, will not worsen with time, or cannot be addressed except by highly-trained ER staff. Discretionary care in a doctor’s office is an ailment that could have been cured by “take 2 aspirin and call me in the morning”.
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And again, I’m not talking about denying care for people who pay their bills. I’m talking specifically about the “free riders” gary referred to. Those who maybe need a little discomfort before they part with their cash.
It’s stomv.
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The problem is, how can we expect people without medical training to know the difference between (1) “take two aspirin”, (2) advil and stay off of it for a week, (3) wear this brace, take this anti-inflammatory, and stay off of it for a month, and (4) you need surgery?
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The example in my mind: a nasty twisted ankle. It happened to me 4 weeks ago. I’d had sprains before, but this felt worse, and it got swollen quickly. It was a Sunday around lunchtime.
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What should I do?
(a) go to the emergency room, since it hurt, couldn’t hold weight, and was swelling
(b) go to the doctor tomorrow (Monday), and have her have a look
(c) go to an orthopedist or sports doctor
(d) self medicate
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I chose (b), but only because I’ve had sprained ankles before and knew that nothing was likely to be broken or torn. However, (a) would have been a good choice too. Incidentally, my doctor elected to then follow with (c), where I had a bunch of [thankfully negative] X-rays.
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Now, under your definition, this was discretionary. It would get (mostly) better on its own, as long as I iced it, kept it elevated, and put no weight on it. This was only established after two doctors visits two weeks apart, and two trips to get X-rays. It could not have been established by me, or even by a doctor within the first 10 days because the swelling was so bad. Furthermore, the anti-inflammatory drugs she prescribed me did help with the pain and swelling more than 12-18 Advils a day did.
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How many times does something seemingly minor turn out to be an indicator for a major problem — a problem that could have been mitigated with less pain and less cost had it been identified sooner rather than later?
From 2002 Press Release Screening on Capitol Hill to be followed by panel with Dr. Linda Peeno,
Former HMO physician who denied a heart transplant
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Former Humana Medical Evaluator Linda Peeno, MD, was so disturbed by what she experienced working for the giant HMO — including denying a young patient’s heart transplant — that she went into medical ethics and is now a vocal advocate for health care reform.
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A film based on the experiences of Dr. Peeno, called “Damaged Care” and including a scene showing her denying a patient’s heart transplant, will have its world premiere on Capitol Hill on Friday, May 10. Laura Dern (“Jurassic Park”) plays Dr. Peeno. Dr. Peeno testified before Congress in May of 1996 about her heart transplant case and has been outspoken about the right to health care ever since.
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“As a physician working for Humana, I denied a young man a heart transplant that would have saved his life, and thus caused his death,” testified Dr. Peeno. “No person or group has held me accountable for this, because, in fact, what I did was I saved a company a half a million dollars.”
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“Humana’s only concern was costs,” says Dr. Peeno. “The young man fit all the criteria, a donor had been found, his doctor was ready to do the operation. Meanwhile, behind the scenes Humana employees scrambled to find a loophole in the patient’s contract. When they did, I was the one who had to tell the surgeon that the operation would not be covered.”
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“The doctor asked me if I knew that the patient would likely die of his condition without the surgery, and I said I knew.” says Dr. Peeno. “When I hung up the phone my colleagues at Humana were thrilled, even joyful. I was sickened.”
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In addition to Laura Dern, “Damaged Care” stars James LeGros, Adam Arkin, and Michelle Clunie, and features Regina King and Dianne Ladd. It will air on Showtime at 8 pm EST May 26 and May 29.
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Dr. Peeno recalls that shortly after denying the patient their heart transplant, a gigantic piece of sculpture was purchased for Humana’s headquarters — costing about the same amount as the heart transplant she had denied.
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“When HMO’s came on the scene, we were told that they would eliminate only the ‘inappropriate care’ and they would reduce costs so everyone could have insurance. Exactly the opposite has happened. They deny and delay needed care with sophisticated techniques, consume enormous resources for overhead costs and profits, and health care costs are rising dramatically.”
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“Our corporate-dominated health care system is sick,” said Dr. Quentin Young, Past President of the American Public Health Association and National Coordinator of Physicians for a National Health Program. “It’s time to end the experiment with market-driven health care and adopt a non-profit national health insurance program.”
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“The US health system is the most bureaucratic in the world, wasting over $150 billion annually on excessive paperwork,” said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard. “Meanwhile, 600,000 retired steelworkers just lost their health benefits and joined the ranks of the 40 million uninsured. There is more than enough money in our health system — over $4,300 per person — to provide quality health care for all if we exclude the corporate middleman and implement single payer national health insurance.”
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When the film “John Q” came out — about a young man denied a heart transplant by his insurer — many people said that “it couldn’t happen in America.” “Damaged Care” not only shows that it is possible, but that because of the conflict between patients and profits, that it is inevitable.
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—
Anyone familiar with what Humana’s been up to lately in the realm of Medicare Part D and other elements of the Bushies’ mission to privitize/destroy Medicare? (ie Medicare HMO plans that have us taxpayer saps subsidizing these dastardly corporations)