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meh56
Guest
I think it would be great if each diocease would offer its members the same great coverages they have. All you would have to to is to give them a voided check and they could take the primiums
- Status
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SFTor
Guest
I think the same goes for Congress, meh56. If it’s good enough for them, I’m sure it’ll be good enough for the rest of us.
Best,
Tor
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SFTor
Guest
jman:
Health care is not about pooling resources, it is about pooling risk. Public health is a public good and an economic good. It is a necessity to provide all other public goods.
Health care is not a market. When we aren’t sick we are not “health care consumers.” jman, I would bet that you don’t know the particulars of your health insurance plan—your copays, what’s covered, what isn’t, etc.
When we are sick, we are not “health care consumers” either. We’re just sick, and we need treatment. I would bet my bottom dollar that if for instance you, jman, came down with a melanoma or some form of liver disease, you wouldn’t go to your doctor and say “I’m considering hiring you for a project, but of course we need to discuss price first.” You say “help me. I’m sick.” If the condition threatened your life, you would say it more than once. If it threatened your child or your sister or your brother, you would move heaven and earth to get them the necessary care. Take a look at my next post to see how that would play out in Harris County, Texas.
No one who is experiencing heart disease, kidney failure or cancer—not even you—is going to act differently in any way because “they don’t feel the real cost of the treatment.” You want to get back to full health, and your loved ones and your community want the same thing because they need you. Your health affects all of us, not just the person who sits next to your bed, reads to you and wipes the sweat off your forehead.
jman, we don’t live in an economy, we live in a society.
Public health, that means the health of all of us, is too important to be left to an industry that is failing patients the way it is happening in this country. We need a system that addresses the need, not the profit opportunity.
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SFTor
Guest
My apologies for pasting the text. There was no practical way to post a link.
Health Insurance Companies Failing Patients, Survey Shows
By JENNIFER SNYDER
Harris County Medical Society
All six of the major health insurance companies operating in Harris County are failing patients when it comes to patient care, payment and customer service, said physicians in a survey conducted by the Harris County Medical Society and the University of Houston-Clear Lake Master’s Program in Healthcare Administration.
“We asked the physicians of Harris County to evaluate the health plans, and the results were dismal,” said Harris County Medical Society President Michael V. Kelly II, M.D. “The survey shows that the six largest health insurance companies are providing mostly mediocre service to our patients. Frankly, this is unacceptable. They’re failing our patients, they’re failing physicians and they’re failing the businesses that pay big dollars every year for their products.”
Kelly said the survey results should be a wake-up call to Harris County’s major health insurance companies. For many years, the Harris County Medical Society has been meeting regularly with health insurance companies to resolve patient and physician issues.
“Through our current meeting process, we do not get information on the overall performance of the companies or on the processes that are functioning well,” said Kelly. “Therefore, our physician members decided to rate the six largest health insurance companies in Harris and surrounding counties. Our initial goal with the survey was to recognize the areas of good performance and uncover issues that need to be addressed by the health insurance companies.”
“Additionally, we are hoping that this information will assist our physicians and the business community in making their contracting decisions, since there is no formal rating of health insurance companies in our area,” said Kelly.
Four hundred eighty-seven Harris County Medical Society-member physicians responded to the survey, which evaluated Aetna, Blue Cross and Blue Shield of Texas, CIGNA, Humana, Unicare, and United Healthcare. Results of the survey were compiled by the University of Houston-Clear Lake. Harris County Medical Society distributed the survey to 5,708 of its member physicians in July. The survey respondents came from all areas of the medical profession throughout Harris County: primary care, hospital based, medical subspecialties, surgical, and surgical subspecialties from solo practices, single specialty groups, and multispecialty groups.
In respect to patient care, survey results show:
• The largest health insurers are failing the public when it comes to preauthorizing medical services for Houston patients. More than 65 percent of the doctors surveyed reported they have experienced difficulty getting their patients’ medical services approved.
• The six major health insurers in Harris County were reported as denying payment for medically necessary care. Seventy percent of doctors surveyed said that health insurers denied payment of medically necessary care.
• Seventy-four percent of physicians reported that the major health insurers used prescription lists that limited the medications a doctor could prescribe for treatment.
• While Texas struggles to improve its immunization rates, only 15 percent of the physicians surveyed reported that the major health plans always pay for the cost of immunizations.
In respect to payment, survey results show:
• In 2003, the state legislature passed a law requiring health insurers to pay doctors in a timelier manner. However, according to survey results, 69 percent of the doctor respondents still have problems with the largest health insurers paying them on time. Sixty-four percent of the doctors surveyed said they are paid less than their contracted rates with the health insurance companies.
In respect to customer service, survey results show:
• The six major health plans are failing to educate their customers about the coverage they have. Fifty-nine percent of the physicians surveyed said that their patients rarely or never understand the benefits, co-pays, deductibles, and limitations of their coverage.
• It is widely accepted that activities focused on general wellness are some of the best ways to lower health care costs. However, 67 percent of the physician respondents stated that their patients rarely or never understood the preventive services, care coordination and other lifestyle modification services available to them.
• Health insurers are forcing doctors to employ more staff to handle the extra paperwork that comes with filing claims with the health plans. In fact, 83 percent of Harris County
doctors surveyed said they had to hire one or more full-time employees per doctor just to deal with the extra paperwork.
• When health plans deny coverage for a procedure or a prescription medication, physicians have to spend time advocating on behalf of their patients. However, the major health insurers do not respond promptly to telephone calls, the survey showed. Only 29 percent of the doctors surveyed said the major health plans frequently responded to a phone call promptly. Even worse, the survey stated that there was very little chance that issues, questions and complaints could be resolved with just one call. Fifty-six percent of the doctors surveyed said they never or rarely resolved an issue with one call.
• Only 24 percent of the doctors surveyed said it was easy to find important information on the major health insurers’ Web sites.
“Far too often, the health insurance companies impede medically necessary care for our patients by denying payment and preauthorization of services,” Kelly said. “If the plans offer wellness services, neither our offices nor our patients know about them. Payments are wrong or late or both. The plans expect physicians to absorb far too much of the cost of providing care. And their customer service is intolerable.”
“Having results such as these for companies that are supposed to be industry leaders is shameful,” said Kelly. “In any other field, with this kind of customer service, the company would soon be out of business. It’s time the health insurance companies raise their standards for our patients. As physicians, we take an oath to first, do no harm. I would like these health insurance companies to follow along our (physicians’) guidelines of care. Hopefully, through this survey the medical society physicians can begin a dialogue with the health insurance companies on areas to transform. We would like to work together to provide the best health care possible for our patients and start lowering the cost of health care that is crippling many businesses.”
Health Insurance Companies Failing Patients, Survey Shows
By JENNIFER SNYDER
Harris County Medical Society
All six of the major health insurance companies operating in Harris County are failing patients when it comes to patient care, payment and customer service, said physicians in a survey conducted by the Harris County Medical Society and the University of Houston-Clear Lake Master’s Program in Healthcare Administration.
“We asked the physicians of Harris County to evaluate the health plans, and the results were dismal,” said Harris County Medical Society President Michael V. Kelly II, M.D. “The survey shows that the six largest health insurance companies are providing mostly mediocre service to our patients. Frankly, this is unacceptable. They’re failing our patients, they’re failing physicians and they’re failing the businesses that pay big dollars every year for their products.”
Kelly said the survey results should be a wake-up call to Harris County’s major health insurance companies. For many years, the Harris County Medical Society has been meeting regularly with health insurance companies to resolve patient and physician issues.
“Through our current meeting process, we do not get information on the overall performance of the companies or on the processes that are functioning well,” said Kelly. “Therefore, our physician members decided to rate the six largest health insurance companies in Harris and surrounding counties. Our initial goal with the survey was to recognize the areas of good performance and uncover issues that need to be addressed by the health insurance companies.”
“Additionally, we are hoping that this information will assist our physicians and the business community in making their contracting decisions, since there is no formal rating of health insurance companies in our area,” said Kelly.
Four hundred eighty-seven Harris County Medical Society-member physicians responded to the survey, which evaluated Aetna, Blue Cross and Blue Shield of Texas, CIGNA, Humana, Unicare, and United Healthcare. Results of the survey were compiled by the University of Houston-Clear Lake. Harris County Medical Society distributed the survey to 5,708 of its member physicians in July. The survey respondents came from all areas of the medical profession throughout Harris County: primary care, hospital based, medical subspecialties, surgical, and surgical subspecialties from solo practices, single specialty groups, and multispecialty groups.
In respect to patient care, survey results show:
• The largest health insurers are failing the public when it comes to preauthorizing medical services for Houston patients. More than 65 percent of the doctors surveyed reported they have experienced difficulty getting their patients’ medical services approved.
• The six major health insurers in Harris County were reported as denying payment for medically necessary care. Seventy percent of doctors surveyed said that health insurers denied payment of medically necessary care.
• Seventy-four percent of physicians reported that the major health insurers used prescription lists that limited the medications a doctor could prescribe for treatment.
• While Texas struggles to improve its immunization rates, only 15 percent of the physicians surveyed reported that the major health plans always pay for the cost of immunizations.
In respect to payment, survey results show:
• In 2003, the state legislature passed a law requiring health insurers to pay doctors in a timelier manner. However, according to survey results, 69 percent of the doctor respondents still have problems with the largest health insurers paying them on time. Sixty-four percent of the doctors surveyed said they are paid less than their contracted rates with the health insurance companies.
In respect to customer service, survey results show:
• The six major health plans are failing to educate their customers about the coverage they have. Fifty-nine percent of the physicians surveyed said that their patients rarely or never understand the benefits, co-pays, deductibles, and limitations of their coverage.
• It is widely accepted that activities focused on general wellness are some of the best ways to lower health care costs. However, 67 percent of the physician respondents stated that their patients rarely or never understood the preventive services, care coordination and other lifestyle modification services available to them.
• Health insurers are forcing doctors to employ more staff to handle the extra paperwork that comes with filing claims with the health plans. In fact, 83 percent of Harris County
doctors surveyed said they had to hire one or more full-time employees per doctor just to deal with the extra paperwork.
• When health plans deny coverage for a procedure or a prescription medication, physicians have to spend time advocating on behalf of their patients. However, the major health insurers do not respond promptly to telephone calls, the survey showed. Only 29 percent of the doctors surveyed said the major health plans frequently responded to a phone call promptly. Even worse, the survey stated that there was very little chance that issues, questions and complaints could be resolved with just one call. Fifty-six percent of the doctors surveyed said they never or rarely resolved an issue with one call.
• Only 24 percent of the doctors surveyed said it was easy to find important information on the major health insurers’ Web sites.
“Far too often, the health insurance companies impede medically necessary care for our patients by denying payment and preauthorization of services,” Kelly said. “If the plans offer wellness services, neither our offices nor our patients know about them. Payments are wrong or late or both. The plans expect physicians to absorb far too much of the cost of providing care. And their customer service is intolerable.”
“Having results such as these for companies that are supposed to be industry leaders is shameful,” said Kelly. “In any other field, with this kind of customer service, the company would soon be out of business. It’s time the health insurance companies raise their standards for our patients. As physicians, we take an oath to first, do no harm. I would like these health insurance companies to follow along our (physicians’) guidelines of care. Hopefully, through this survey the medical society physicians can begin a dialogue with the health insurance companies on areas to transform. We would like to work together to provide the best health care possible for our patients and start lowering the cost of health care that is crippling many businesses.”
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cynic
Guest
And it’s unlikey that you could take your ‘business’ elsewhere if you’re not satisfied half way through the treatment.
O
Oscarthecat
Guest
No, SOME taxes are part of the cost of living in our society- roads, stoplights, police, etc-and it is even debatable as to whether the government is the best or most appropriate means to provide those services- but that is a topic for another thread.
Other taxes are the cost of electing politicians who abuse their power.
Still other taxes are the result of socialist projects growing out of control and becoming a burden on society.
Taxes are a little more complicated than just being a "part of the cost of living in our society.
O
Oscarthecat
Guest
Although I found your “Columbo” style approach amusing, I see you have finally moved into the final stage of the 6 part process I detailed earlier.
You have become so blinded by bureaucratic systems that you can not possibly conceive that anyone else could reasonably or intelligently believe that human life is possible outside of those systems.
While I really should not indulge you by responding to your antagonistic post, there are a few of points i thought I’d take on,
as they are they only points you present that I haven’t addressed in another context or to another member of the forum.
I give this comment a “B-.” It doesn’t really add anything to the discussion, but I think the “Ever.” comment really gives it that extra “oomph” that matters more than actual content to so many people. Still, can’t give you the whole “B” because the statement was ultimately lacking in real substance- unless, of course, you are actually from the future.
By the way, I’m curious…Which social model are you referring to, specifically? Because I have been accused of promoting everything from anarchy to fascism. I’d just like to know where you think I stand…
This was a good dig. I laughed out loud. Total personal attack, but I’m trying to be a good sport.
A for effort, B for delivery-
I give you a B+ here because you manage to continue on for quite some time with a string of unsubstantiated statements. I’m sure some folks found them very rhetorically satisfying–unless, of course, one has read previous posts where almost every single one of your examples was used by me or someone else opposed to UHC to demonstrate how inept the government is at doing, well, just about everything. I would have given you the “A” if you had actually realized that your examples of “good” government were also examples of “bad” government.
You see, when I cut through all of your personal attacks and empty rhetoric, your basic premise is that the government is doing a good job, and that we should jump at the chance to hand it a new project like UHC.
Your critical flaw, in this debate anyway, is that you have convinced yourself that the government is so great at doing everything, that you can only conclude that those of us who don’t want the government to help people must just not care about people at all.
So there you have it. You haven’t added anything to this discussion that hasn’t already been addressed ad nauseum.
I suggest you make some reasonable attempt to accept that those of us who disagree with your ideas about the role of government in healthcare are not simply selfish, crazy, unenlightened, uncaring, or whatever else you need to convince yourself of about people who don’t fit into your paradigm of what intelligent people should think.
*Respectfully, *
Oscarthecat
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Oscarthecat
Guest
that’s odd- you should meet my uncle, my mother in law, my father, my brother, and, well, me…
we have all taken the time to find the right physician when we have become very ill at different times in our lives. My dad went to three different cardiologists before getting a triple bypass, and 5 different oncologists when he was diagnosed-of those 8 physicians, he chose to reject 3 because their fees were out of proportion with their demonstrated competence. My mother-in-law, in the midst of a medical crisis, told the ambulance drivers that she would refuse to be admitted at the hospital they were heading toward, and made them drive to the hospital she believed would provide better care.
You may have a “take what you can get” attitude about your health, but many of us take it a little more seriously than you do, apparently.
O
Oscarthecat
Guest
Uh, this happens all the time-
- in fact, I’m going in for a minor, but necessary, surgical procedure tomorrow that i wouldn’t be going to if I hadn’t decided to drop my previous doctor in favor of one I feel is more compatible with my needs.
You should try it sometime- you don’t have to buy everything they’re selling you, even in healthcare.
Well, I guess that doesn’t apply to UHC, since everybody is selling the same thing, and it all comes from the same place- the government.
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cynic
Guest
The critical flaw here is that you can’t demonstrate how impartiality can exist where private industries regulate themselves For eg how do consumers make informed choices when there’s no requirement for labelling on food.
//You drive cars made safe by public agencies, on roads built with public funds, eat your hamburger that was made safe by another public agency, and have your wallet and home property being held safe in the meantime by public agencies such as police departments, fire departments, and public courts//
You can’t tell us how the market will provide low cost education for poor families children. If there’s little money to be made, how will that happen.
You can’t tell us how the market will pay for the police and the courts without a kind of user pays system that undermines their purpose - impartial application of the law.
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SFTor
Guest
Now he’s grading me…OSCAR! PLEASE!!!
No Oscar, I don’t think you are crazy, and I don’t think you are selfish. I think you are a Libertarian.
I recognize that my post was somewhat terse in tone, and used some characterizations of you as living in a fantasy world etc.
First of all, I am not blinded by the efficacy of bureaucratic systems, anymore than I trust you are not blinded by private solutions to everything.
In full conscience I was treading close to the edge of proper debating form, but in the end I just felt it was proper to make this discussion sound less like an economy textbook, and deal directly with the issue at hand: to attack the myth that health care is only an economic issue, and to attack the myth that it fits in a free-market model.
To wit:
Any HMO or insurance company will need to keep the following two mission statements in its head at one time:
- The Hippocratic Oath
- A corporation’s fiduciary responsibility to maximize profits.
Next:
Pay as you go, as indiviuals or families.
Ditto. We can’t do this without pooling risk. I stand 100% by my statement that the only pool is the national pool, based on the obvious fact that health is a national issue of vital interest. It is also the only fair approach to health care. We don’t know who’s at risk for what, and we know that we have a duty for a whole number of reasons to relieve the suffering and promote the health and happiness of our fellow human beings.
This is about the moral and economic integrity of our communities, the viability of the same communities, and the competitiveness of our country. Not a candidate for fancy libertarian experiments with zero track record. Sorry.
Oscar, please admit this: no one has ever tried your suggested solution. Doesn’t that make you think?
Ever so respectfully,
Tor
P.S. Oscar, one last thing. As far as I’m concerned there is no need for me to be from the future to correctly predict that Libertarianism isn’t going to make it. But since I grew up in Norway which has UHC ($4,000 per year per capita—the most in Europe), and the U.S. will soon get it (no pun intended) you might as well think of me that way.
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SFTor
Guest
I applaud your family for being circumspect about their health care providers. I assume all of you paid out of pocket for the treatments?
Respectfully,
Tor
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cynic
Guest
And how can you, in all cases, judge how well you’re being treated? Particularly with serious conditions that require ongoing treatment (cancer). How well you respond is not neccessarily an indicator of the quality of care, and it’s unlikely that you’ll just drop one on course of action in the middle of it for another because the somewhere else is more ‘compatable with my needs’. There’s an element of trust that is neccessary.
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SFTor
Guest
Oscar,
the quality of national health care in industrialized nations is high. Not always quite as high on an individual basis as in the United States perhaps. But when it comes to general macro outcomes, it is higher. The difference is that everyone has access. That would make me sleep a little better at night.
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Cuddy_Duck
Guest
Apologies if this has already been posted. I haven’read both threads yet…
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SFTor
Guest
Oscar, one more thing: as far as I can see we agree that the government is better suited to take on certain jobs in society. Perhaps we both think this is especially the case when it is intended to meet the basic needs of the country, defense, security, education, and so on. For reasons I have clearly stated I consider public health (the best possible health for as many of us as possible) to be such a vital interest. I get the impression that you do not include health in these fundamental services. Please correct me if I’m wrong. I will note that your willingness to chance the health of your fellow citizens on charity is what I go by on this.
Respectfully,
Tor
Respectfully,
Tor
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SFTor
Guest
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BamaRider
Guest
A couple pages ago the financial mess of some banks was mentioned, and the thought of govt prop up.
I agree let them die, absorb the short term pain, for the long term good, which is better banking practices.
The libs are the first to jump up and down with, “banks make it too hard on the working poor to buy a house and its not fair.” So they come up with ARMS etc.
My son worked for Wells Fargo right out of college (2003) as a loan officer, mortgages to be precise. He told me recently he shot down loans routinely on questionalbe apps, those rejections were routinely reviewed by the chain of command. About half the time he was over ridden and the loan granted. Many times he called the clients in the office for the signing of the papers, and thought, “when this ARM fully plays out this guy’s payment is gonna jump 50%, even now his ability to pay this loan back at today’s payment is questionable. We’re gonna foreclose on this guy in 5 years.” Today, not only does he have a 60% higher house payment, but gas is 4 dollars a gallon and guess what?
But hey, times were good, and everybody deserved a house and banks did all they could to put ya in one, even if it meant throwing out good business practice. But libs were NEVER gonna allow the banking industry to that. “It’s cruel what y’all are doing to the working poor.etc.” Reject too many and Jesse Jackson will be leading a boycott of your institution.
He left banking after a year and went into that other evil industry-insurance, claims to be exact, but not health, he is in the auto division.
So how come SoCal and Tor not moved to Canada yet? Then they could get all the “free” healthcare they wanted, without dragging the rest of us such nefarious scheme.
I use to get all worked up about this, till I saw a post Tor put out that said over 85% of Americans have prirvate health insurance. UHC is never gonna fly in this country, if the polticians follow the will of the people. I guess the California and NY delegates are gonna vote for it, (NY is gonna lose delegates in the next census) but the regular folks in flyover country? Nah. Can you imagine a politician in Omaha telling those folks, "vote for me and I’ll remove your private health care insurance and place ya in a govt scheme! LOL.
It was soundly defeated, in all places Oregon a few years ago when it was on the ballot. If it can’t pass there you can forget most anywhere else. But that doesn’t mean libs will stop trying.
I agree let them die, absorb the short term pain, for the long term good, which is better banking practices.
The libs are the first to jump up and down with, “banks make it too hard on the working poor to buy a house and its not fair.” So they come up with ARMS etc.
My son worked for Wells Fargo right out of college (2003) as a loan officer, mortgages to be precise. He told me recently he shot down loans routinely on questionalbe apps, those rejections were routinely reviewed by the chain of command. About half the time he was over ridden and the loan granted. Many times he called the clients in the office for the signing of the papers, and thought, “when this ARM fully plays out this guy’s payment is gonna jump 50%, even now his ability to pay this loan back at today’s payment is questionable. We’re gonna foreclose on this guy in 5 years.” Today, not only does he have a 60% higher house payment, but gas is 4 dollars a gallon and guess what?
But hey, times were good, and everybody deserved a house and banks did all they could to put ya in one, even if it meant throwing out good business practice. But libs were NEVER gonna allow the banking industry to that. “It’s cruel what y’all are doing to the working poor.etc.” Reject too many and Jesse Jackson will be leading a boycott of your institution.
He left banking after a year and went into that other evil industry-insurance, claims to be exact, but not health, he is in the auto division.
So how come SoCal and Tor not moved to Canada yet? Then they could get all the “free” healthcare they wanted, without dragging the rest of us such nefarious scheme.
I use to get all worked up about this, till I saw a post Tor put out that said over 85% of Americans have prirvate health insurance. UHC is never gonna fly in this country, if the polticians follow the will of the people. I guess the California and NY delegates are gonna vote for it, (NY is gonna lose delegates in the next census) but the regular folks in flyover country? Nah. Can you imagine a politician in Omaha telling those folks, "vote for me and I’ll remove your private health care insurance and place ya in a govt scheme! LOL.
It was soundly defeated, in all places Oregon a few years ago when it was on the ballot. If it can’t pass there you can forget most anywhere else. But that doesn’t mean libs will stop trying.
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SFTor
Guest
Hello Guy!
How are you keeping yourself?
Good to hear from you.
I’ll observe the following: the Fair Lending Act prohibits banks from discriminating against applicants based on race, ethnicity, creed, and sexual orientation. The libs are for that law. But that’s it, and it had nothing to do with the credit crisis.
The financial system got itself into trouble because it could issue loans to applicants who were totally unworthy and sell them off through a process known as “securitization.” They packaged up dubious loans into large batches and sold them off to other financial institutions. The financial instruments were so complex that even their fellow bankers were hoodwinked. Most people would call it fraud, and I applaud your son for standing against it.
The two guys who have the most to answer for in this mess is probably Alan Greenspan, Chairman of the Federal Reserve, who held interest rates too low for too long, and Phil Gramm, author of the bill (Gramm-Leach-Bliley Act, 1999) that repealed the Glass-Steagall Act and deregulated the banking industry. I don’t think any of them qualify as liberals, Guy.
Why I’m not in Canada yet? I know how much you need me here, Guy. Life wouldn’t be the same for you unless you knew that one day, you’ll have to come and put out a fire in my house.
Best,
Tor
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SFTor
Guest
Guy, you conservative stalwart you,
have you noticed how quickly Americans have reacted to four dollar gas? Now you can take SUVs on your lot and use them as boat anchors, and you can’t make enough smaller cars that get good mileage.
Health care insurance is getting more and more expensive, and more and more companies are dropping their coverage for dependents or even dropping employee coverage altogether.
Don’t be too surprised if Americans change their minds in a hurry on health care. They have done it before on other issues, and they could do it again.
Let’s not forget what Winston Churchill said: “America will always do what is right, after all other options are exhausted.”
Best,
Tor
- Status