Study: When Counting Premiums, US Workers Heavily Taxed

[Dan123]

Most US states do have an Insurance Commissioner or equivalent that is supposed to oversee the insurance companies doing business in that state. The problem is that not all of them (some would claim very few of them) actually provide real oversight and control.

And one of the proposals to ‘fix’ the system is buying over state lines, which means most companies will flock to the state that lets them get away with the most. Some states may have their own laws requiring minimum levels of care to operate in the state, but many won’t.

 

[PetraG]

That’s sort of the hard balance here, honestly, to strike with regulation. What do you do for people who are kind of at the edge of evidence-based medicine? I know I’m one of those people where many treatments - mostly drugs - don’t work the way the evidence says they’re supposed to work. There’s some very experimental genetic testing that might help, but really not much solid. Too much regulation runs the risk of not being able to figure out ways to treat people when we don’t have solid evidence. Not enough allows practices to flourish that may be hurting rather than helping.

Well, and yes, physicians do find “off label” uses for drugs, based on the theory of how the medications work as chemicals.

It’s a super fine line to walk. Some physicians, especially those who are hospital employees, are bound and gagged by protocol and insurance demands. I’m all for evidence-based care so long as there’s wiggle room to listen to each patient and treat each one as an individual.

In my experience, the best physicians are gifted with sharp listening skills and a strong intuition, and sometimes those Dr. House-types can successfully defy protocol with successful results. I’m not advocating for every Tom-Dick-Harry quack out there who marches to their own beat. I just think it’s important to strike a balance between the science of medicine and the art of medicine.

It is one of the difficulties of deciding how to deliver medical care: that is, that there is judgement involved. I know a doctor who often quips: “Unfortunately, the patient’s body didn’t read the textbook.”

Are bean counters whose priority is profitability in any business to make decisions on medical care with no training? These decisions can be life or death.

Is a person’s life of less importance than the profits of an insurance company?

First they have no training, second their priority is profit over lives.

I see a problem here.

The problem is that we also know there are unscrupulous medical practitioners who also pad their treatments for reasons of profit. That was unfortunately true before insurance companies were ever invented. People are willing to pay a lot for health and life, it isn’t something any of us can do without, and the most effective ways to deliver it are both a matter of honest debate and an opportunity for exploitation of a vulnerable client. Sometimes, even the best physician can try everything and spend a lot of resources, to no avail. This makes it really hard to tell who should be trusted or what is worth trying.

Here is one example from the Holy Scriptures, even: There was a woman afflicted with hemorrhages for twelve years. She had suffered greatly at the hands of many doctors and had spent all that she had. Yet she was not helped but only grew worse. Mark 5:25-26

 

[Balto1]

There is a faulty assumption that we are on an even playing field. That we consumers have a voice in how we want our healthcare.

It’s an entirely industry-driven misconception as well.

Opinion | How the Health Insurance Industry (and I) Invented the ‘Choice’ Talking Point - The New York Times

Medicare piggybacks off Social Security, so administrative costs such as enrollment, payment and keeping track of patients are still being incurred, but not counted.

Those administrative costs would still exist without Medicare unless you want to get rid of Social Security as well.

Private insurers also do more than pay claims and occasionally go after fraud (a hidden expense in medicare). They check its appropriateness, whether it is medically necessary and if it can be done is a cheaper way) outpatient vs (name removed by moderator)atient).

It’s so bizarre to watch people freak out because they don’t want government to interfere in their healthcare and then turn around and beg for-profit insurance companies to interfere in their healthcare.

Naturally there is significant state oversight. The conflict between insured and insurer is hardly a new thing.

So it’s okay for insurance companies to interfere in our healthcare because the government also interferes in our healthcare? Bizarre.

 

[Balto1]

Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses | PLOS Medicine

 

[Pattylt]

That was an interesting study. One idea that jumped out to me is to start with an experimental trial. I think starting with one state and implementing single payer would answer many questions. Of course, which state and for how long. One thing pointed out is that transition costs were not included but looked at were considered minor and recovered within one year. There were 22 single player scenarios investigated with average savings of ~4% in the first year and improving each year thereafter. Thanks for that link!

 

[Socrates92]

That would be a fun job!

 

[Theo520]

So it’s okay for insurance companies to interfere in our healthcare because the government also interferes in our healthcare? Bizarre.

Actually, the govt should spend more effort ‘interfering’ in what’s going on

Pharma rep rips off the system Social Justice

This is one reason why drugs costs in this country are so high…big pharma reps who rip off the system. Seems like their should be maximum penalties for this sort of crime.

 

[Peeps]

nationwide postal delivery, interstate freeways and other public works projects such as running electricity out into rural areas where it is not “cost effective.”

The Post Office and a system of roads allowing transportation of goods and services as well as citizens is guaranteed by the U.S. Constitution and has been from the beginning of the United States under the Constitution.

Article I, Section 8, Clause 7 of the United States Constitution , known as the Postal Clause or the Postal Power, empowers Congress "To establish Post Offices and Post Roads ".

 

[Peeps]

Who are the ones checking for the appropriateness of a medical procedure? Are they medically trained or are they bean counters with no medical training?

I suspect the latter.

I am very bitter over this.

The organization overseeing clinical laboratories are medical professionals who have left actual health care and are holed up in a fancy building and are obviously living in the past. They still…giggle…think labs are adequately staffed and that we have all the time in the world to fill in charts signifying that that we cleaned the counter tops etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. hours and hours of extra work on top of the patient care testing that we are supposed to be doing…overtime overtime overtime$$$$$$$$$.

Get rid of stupid inspections. Replace them with intelligent inspections that actually spot real deficiencies and, rather than imposing a hefty fine, instead prevail upon hospital administration to clean up those deficiencies, many of which would be fixed If the labs were adequately staffed so that people have time to do more than just rush to the bathroom and rush back again to the mountain of patient testing.

 

[PetraG]

The Post Office and a system of roads allowing transportation of goods and services as well as citizens is guaranteed by the U.S. Constitution and has been from the beginning of the United States under the Constitution.

Article I, Section 8, Clause 7 of the United States Constitution , known as the Postal Clause or the Postal Power, empowers Congress "To establish Post Offices and Post Roads ".

The Constitution didn’t require particular projects like the interstate freeway system or running electricity to rural areas.

Besides, it is easily within “promote the general Welfare” to agree to establish a minimal degree of health care. We already have rules that forbid turning people away from hospitals for reasons of ability to pay. OK–who pays for it? The federal government shouldn’t be able to require anybody to do work without paying them for it.

 

[Pattylt]

Get rid of stupid inspections. Replace them with intelligent inspections that actually spot real deficiencies and, rather than imposing a hefty fine, instead prevail upon hospital administration to clean up those deficiencies, many of which would be fixed If the labs were adequately staffed so that people have time to do more than just rush to the bathroom and rush back again to the mountain of patient testing.

Word, girl. I miss the lab but I sure don’t miss inspections! I’ve always felt that each new set of stupid rules that DO NOTHING to improve care are just a way for inspectors to justify THEIR jobs. We have checklists to say we checked off the checklist!

Then, we decide to get all computerized with it. Every single procedure, every checklist, every QC, every calibration has to be detailed into a computer with the process listed for every extenuating circumstance! Like we can predict EVERY one of those. It too weeks of work, off bench, to do these. It’s supposed to make inspections a breeze! Nope. Now they want examples of the documentation of an unusual event and how it was handled. The procedure saying what we do isn’t enough…so, we’re digging through paper files that we were supposed to be able to get rid of to find the failed QC on sodium eight months ago and showing that QC is fine after recalibration…which we can show with in the instrument itself! Sorry, ya got me going on that one!

 

[Peeps]

Word, girl. I miss the lab but I sure don’t miss inspections! I’ve always felt that each new set of stupid rules that DO NOTHING to improve care are just a way for inspectors to justify THEIR jobs. We have checklists to say we checked off the checklist!

Then, we decide to get all computerized with it. Every single procedure, every checklist, every QC, every calibration has to be detailed into a computer with the process listed for every extenuating circumstance! Like we can predict EVERY one of those. It too weeks of work, off bench, to do these. It’s supposed to make inspections a breeze! Nope. Now they want examples of the documentation of an unusual event and how it was handled. The procedure saying what we do isn’t enough…so, we’re digging through paper files that we were supposed to be able to get rid of to find the failed QC on sodium eight months ago and showing that QC is fine after recalibration…which we can show with in the instrument itself! Sorry, ya got me going on that one!

You get it!

If I could speak with Pres. Trump and have his ear for a few minutes (although I’m guessing that he is easily distractible), after encouraging him to stay the course against legal abortion, I would beg him to put these Professional Inspectors out of business, and figure out a way that various health care departments can be held accountable to do high quality work without a “Professional Inspection” bureaucracy.
THAT would be one way to reduce some of the high cost of healthcare.

 

[Pattylt]

I agree. There has to be a chain of accountability but the current CLIA isn’t it. One of our smaller rural hospitals had their medical director banned from overseeing the lab for a year. Why? Because a tech on the bench…who had worked there for 1 month, made an error. He was doing a CLIA sample that was elevated and their patient protocol was to send it to another lab for dilution studies. Of course, with CLIA and ONLY CLIA, no CLIA specimen is to be sent to another lab. This didn’t involve patient care, it was the difference in how CLIA has you treat their specimens vs patient protocol. He felt terrible and the Medical Director, a Pathologist, was suspended for a year and will carry that mark on her CV. The hospital lawyers tried to protest…and failed. You mess with CLIA and forget about justice or mercy. That’s way too much power in an inspection agency. I told ya, don’t get me started!

Apologies to everyone for drifting a bit off topic but it’s things like this that cause your lab tests to cost too much!

 

[Peeps]

You mess with CLIA and forget about justice or mercy. That’s way too much power in an inspection agency. I told ya, don’t get me started!

Apologies to everyone for drifting a bit off topic but it’s things like this that cause your lab tests to cost too much!

This draconian approach might have been upsetting in the past, but at least the lab had enough people to do the work. Now if a lab loses even a few employees, it’s critical. For the last two weeks, our lab has had several nights (11:00 pm until 7:00 a.m.) with only 2 techs–the usual number is 5-6. Last week there was a trauma and the patient who needed a large amount of blood transfused had an antibody–it took the techs most of the night to work on it and get the blood flown in. When we came in the next morning, nothing had been done in our department, so we had to do the night shift’s work PLUS our own day shift work–it was pretty brutal.

And this kind of thing happens all too often–there simply is no one applying for our jobs. And what’s sad is that this is a profession that allows a “B” or even a “C” student to graduate with the Medical Technology Bachelor’s Degree and land a job before they are even out of school and…drum roll…there is an Associate’s Degree program that certifies Medical Laboratory Technicians–and in our hospital, these professionals will have their tuition reimbursed if they go for the B.S. in Medical Technology!

But so few high school kids learn that this field even exists! All they see on TV is doctors and nurses, and many kids will never be able to handle pre-med and medical school, and many people just aren’t suited for nursing (certainly not me!).

Sigh. I wish the weekend wasn’t over. I am at a point where I dread going to work. I’m doing a double shift tomorrow (Monday)–7:00 a.m. until 9:00 p.m. (I get to leave early because I have to be at work on Tuesday at 7:00 a.m. and I can’t do it if I’m up until 11:00 p.m…

And I’m 62, not 22.

 

[Pattylt]

This draconian approach might have been upsetting in the past, but at least the lab had enough people to do the work. Now if a lab loses even a few employees, it’s critical. For the last two weeks, our lab has had several nights (11:00 pm until 7:00 a.m.) with only 2 techs–the usual number is 5-6. Last week there was a trauma and the patient who needed a large amount of blood transfused had an antibody–it took the techs most of the night to work on it and get the blood flown in. When we came in the next morning, nothing had been done in our department, so we had to do the night shift’s work PLUS our own day shift work–it was pretty brutal.

Yep, I’ve done it several times myself! It’s awful on the night shift and awful on the next day shift. I worked evening shift which overlapped two hours with days and two hours with nights. I can’t tell you how many times we’d get a trauma and I’d stay in til midnight or later to help.

But so few high school kids learn that this field even exists! All they see on TV is doctors and nurses, and many kids will never be able to handle pre-med and medical school, and many people just aren’t suited for nursing (certainly not me!)

I feel this frustration, too. It’s a wonderful career in spite of the problems we faced. And the shortages are going to get worse before they get better. I remember the days where we wouldn’t accept an MLT. You had be an MT. Well, that flew out the window long ago. I will say that when nurses experienced severe shortages not only was there recruitment all over the place, their wages rose dramatically. Unless tech wages have risen dramatically in the three years since I retired, they should be getting much higher wages. Why be a tech with all the education and knowledge needed if you get paid less than nursing, less than rad techs and about the same as respiratory techs? Our nurses got special shifts with extra bonuses, bonuses for picking up hard to fill shifts, weekend only rotations that paid extra, etc…lab got none of these. We are so invisible! I’ll stop now…