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December 26, 2006
Going Universal
I've got a new LA Times op-ed on the reemergence of universal health care as a national issue. Check it out.
Update:
•Abstract Nonsense has a very trenchant response to my piece arguing that reform is, indeed, quite a bit less than inevitable and the options for change remain unacceptably fuzzy and disorganized. I'm sort of Marxist about health care: The cost trends, the employer trends, and the coverage trends all suggest to me that the pressure for universal care will grow screamingly intense over the next decade and no politicians will be able to escape it. In part, that's because providing health care is something we already expect the government to do: Through Medicare, through Medicaid, through the VA, through the Indian system. We give them a pass because most folks have private care, but when that becomes untrue or unaffordable, the leeway will rapidly end.
As for the options being too numerous, that may be right. On the other hand, the first steps may be taken by individual states with federal support, leading to a mishmash of different options. It would be annoying, but not surprising.
• Meanwhile, Mort Zuckerman is onboard. And when you've got Mort, anything is possible.
December 26, 2006 | Permalink
Comments
Great idea. Perhaps we can insure 1/2 of Mexico too!
Posted by: Bob Delle | Dec 26, 2006 8:16:59 AM
Mr. Klein, Respectfully since you put great effort into your piece I must reject what you say. Universal coverage will not provide universal care anymore than private insurance provides private care now. Perhaps you are not familiar with the disenfranchisement of the diagnosis of Borreliosis or Lyme Disease in America. 500 American citizens lost the right to health in the Carolinas this summer. I understand WHO ratified a treaty in 1948 that the US is breaking while stopping the care of sick and disabled human beings with a known spirochete infection. Last time this happened in America, the Tuskegee Experiment was the name of the rights violation . It produced the Belmont Report which PROMISED to never allow what is currently happening in Health(care) again.
The Infectious Disease Society of America wrote some very restrictive and inhumane treatment guidelines for Lyme Disease. The IDSA allowed 15 men to use the organization's name to render research obsolete. The 15 men used 2% of the NIH research to write the guidelines, many of these papers are opinion papers. They ignored the conflicting 98% of research.
It is reminscent of Nazi Germany's doctors and their outright inhumane practices of watching people suffer.
The International Lyme and Associated Diseases Soceity or ILADS, wrote a rebuttal that not a soul will read or argue aloud, because they can't.
So Universal Care where mean cruel humans are in charge will be no better than what we presently have. I have Medicare that I fought for over five years. I went without care those five years waiting on insurance only to have the ability to go buy it taken away.
The people running this country are sick. They are cruel and we are going backwards in time to third world medicine. Hope your pets never get ticks... cause if you get Lyme you are as screwed as the rest of us.
Liz Shepherd RN Columbia SC
Posted by: liz | Dec 26, 2006 10:15:32 AM
"Great idea. Perhaps we can insure 1/2 of Mexico too!"
This is not an argument. Just thought I'd point that out.
Posted by: RW | Dec 26, 2006 10:57:28 AM
Knock on wood, but there have been so many false Springs before. Here's hoping this time it's for real.
Posted by: Steve Smith | Dec 26, 2006 10:59:29 AM
The question now is what replaces it.
I'm truly angered that the Democratic Party hasn't even attempted to come up with a plan or set of proposals on how to move from where we are today to a better healthcare future. Most Dems stammer even saying 'universal' and even more are tongue-tied on the phrase 'single payer'.
If the insurance industry and the GOP do their usual jump in bed together ritual, we will be stuck debating and trying to put down proposals that have the odor of inevitability because they are the starting place for discussion.
Just listing the major ideas shows how far we are from consensus:
- Insure all children first (Kerry, etc.)
- Medicare for all (in several flavors)
- VA care for all
- Big Medicine's plan to institutionalize current insanity 'foreva'
- Congressional-type private insurance for all
- Wyden's Hillary-care-light for all
- State proposals of various flavors aiming for universality
- BushCo and others: Health Savings Accounts for all (even if you have no savings)
The Dems are inviting irrelevance on this issue by not even internally trying to sort out a few good options.
I fear we are destined to end up with a plan written by Pfizer, United Health Care, and the AMA because they are going to be organized and they have the big money to propagandize the public and buy the Congress.
Posted by: JimPortlandOR | Dec 26, 2006 11:20:09 AM
While I fully support the goal of universal health insurance, and I hope we can achieve it sooner rather than later, I also hope we maintain a strong role for private insurers as opposed to pushing for a single payer, Medicare for all system. Even if administrative costs would be slightly higher, I believe it is important to preserve competition in the marketplace for insurance so people can take their business elsewhere if not satisfied. I also believe a single payer system could result in less innovation across the system.
Furthermore, while finding an equitable way to finance universal health insurance is, of course, important, I think we have enormous room to safely reduce healthcare utilization. The following strategies to do that might be worth pursuing: (1) malpractice reform to break the culture of defensive medicine, (2) develop a system of interoperable electronic medical records which could reduce costs, especially in hospitals, by drastically reducing duplicate testing and adverse drug interactions, and (3) developing a more sensible approach to end of life care, in part, by encouraging more widespread use of living wills, advance directives and medical powers of attorney. Development of robust price and quality transparency tools would be helpful in making people more aware of costs which can differ materially among providers in the same area. Finally, unbundling the price of insurance into a catastrophic coverage piece ($5,000 per person deductible and 100% coverage beyond that) and a prepaid healthcare piece (20% co-pay on the first $5,000 of charges) would be useful information to consumers and could sharply increase interest in high deductible health insurance plans.
Posted by: BC | Dec 26, 2006 11:34:20 AM
Jim
Proposals 2,3, and 5 are the same. Proposals 4 and 8 are pretty close to the same.
There were a staggering number of health care plans in 1994 -- Hillary care, the Stark plan (expand medicaid to cover the uninsured), the Mitchell/Breaux "trigger" plan that finally got to the floor (facilitate the grouping of purchasing power and then impose an employer mandate if it didn't get to universal coverage in a few years), single payer, and the Cooper bill (voluntary grouping of purchasing power, portability, HSA's but no coverage for abortion). I dont think that that was the problem. When there was one big target at the beginning (Hillary/"managed competition") the insurance parasites had their PR goons all over it, ie the Harry and Louise commercial. I don't recall that all of the other proposals were successfully painted with the same brush, although the historical record may show otherwise. I remember the "take this pen" threat from the state of the union going over fairly well (roughly: "I am open to any plan that meets three goals, it must cover everyone, it must control the cost of health care, it must preserve doctor choice. If you pass a bill that does not meet these criteria, you will force me to take this pen and veto it"), but again I may be wrong.
My recollection was that health care reform/universal health insurance generally remained popular through the summer of 94, and that the problem was the fillibuster.
I don't know that we've solved that problem.
You're right, we do need to get organized, and start the ad wars now.
Posted by: RW | Dec 26, 2006 11:48:16 AM
BC
In what universe would anyone ever be more satisfied with a private insurer than with Medicare, or whatever the government insurer would be? Insurers make more money if you don't get health care. Medicare does not. Anyone who thinks a private insurer is going to fund something that Medicare is not is either a) buying a supplemental insurance policy or b) desperate and delusional.
In the literal sense of the word, insurance companies are parasites. They take money from the health care system and offer no benefit. Their financial strength depends on not paying for health care -- they reduce the health outcome of the host. There is no reason anyone should make a profit off of spreading risk, the only reason they are able to do so is because some people are not compelled to share risk with others. Why should we pay anyone's share-holders to perform what is essentially a bureaucratic task? Private insurers run at 12% overhead. http://www.citizen.org/pressroom /release.cfm?ID=1623. Medicare runs at 4%. The extra 8% is waste. As is the money and resources spent by health providers attempting to master multiple sets of reimbursement forms, which would not be necessary under a Medicare for all plan. The money spent fighting over claims that will never be paid is also waste, as is the money and resources spent by employers attempting to figure out what plan to buy. As is the time and headaches of individuals with individual coverage trying to remember to pay their premium on time rather than lose coverage. As is every penny of insurer profit.
A friend of mine lost her health insurance because she was in traction for a week in the hospital undergoing emergency treatment as a consequence of her total lower body paralysis. She missed a payment and the insurance company was thrilled to tell her that none of her health bills were thereafter ever going to be their problem. Another friend had ovarian cancer and was arbitratily denied reimbursement to have it removed. Every time she called the insurance company they would hang up on her or give her a false name -- when she called back and they asked who she spoke withm they accused her of lying because no one of that name ever worked there. My contract with my insurance company states that they will not insist on pre-clearance of any procedure other than mental health-- when they nonetheless instituted such a policy with respect to radiology, they told me that they would pay if the provider insisted on the performing the procedure without pre-clearance but that the provider should not expect to get any of their health care business the next year.
If there is any profit to be made by doing so, these companies will find ways, legal or illegal, to avoid insuring sick people, and pay for as little care as possible. The ones that don't will not be able to compete and will go out of business or lose market share. The market is efficient and relentless. When it is structured to increase social utility, it procudes it efficiently and relentlessly, and when it malfunctions, it malfunctions efficiently and relentlessly.
Private insurers should have no role in a new health plan. Doctors should compete on the basis of quality and accessibility, which is what would happen if the government simply reimbursed them when patients visited them. We can decide democratically how much health care we want, and what kind. If you want utilization controls, we can include copayments on a sliding scale.
I understand that single payer plans encounter political obstacles, in spite of their wild popularity with the public at large. But if we are talking pure policy here, this is a no brainer.
Posted by: RW | Dec 26, 2006 12:18:28 PM
RW,
Obviously, we are in complete disagreement. Neither Medicare nor Medicaid have shown any ability to control costs whatsoever despite very low reimbursement rates (especially for Medicaid). Why? Probably because they can't control utilization. Despite all the liberal ranting against for profit drug companies and device manufacturers, they only account for a bit over 15% of healthcare spending combined. About 85% of hospitals, by contrast, are non-profits, and virtually all doctors work in either a self-employed or non-profit setting. Hospitals are the biggest single healthcare cost component while doctors drive virtually all healthcare spending through hospital admissions, ordering tests, prescribing drugs, consulting with patients and doing procedures themselves.
Medicare Part D, despite a bumpy startup, has over an 80% satisfaction rate while costs came in over 25% lower than Congressional budget experts estimated. Why? Because insurers and PBM's know how to save money by driving up generic utilization, not by denying care. Insurers also know how to save money through disease management which Medicare doesn't do unless it contracts with an insurer.
If you read the Lewin Group report on Senator Wyden's reform proposal, you would see that large, self-insured employers run their plans (through administrative services contracts with insurers) for less than 5% of total spending. Wyden's plan, by organizing everyone into large groups, would save $29 billion net on administrative costs. While that's a positive, it's only 1.5% of total spending.
The current Medicare program also has some significant gaps in coverage including an approximately $900 deductible for each hospital admission and 20% co-pays for other charges with no out of pocket maximum.
I conclude with two bottom lines. First, you say insurers are parasites and add no value; I believe they add lots of value. Second, I just don't think a single payer system is consistent with our culture. Even most of the Democrats who unseated Republicans in the last election are centrists from Republican leaning districts. In the Senate, it only takes 41 votes to block legislation. So, if you really want universal coverage and you want to bring healthcare security to the middle class and lower middle class, I think you will find it will be much easier to enact a system that preserves private incentives and is more consistent with our market economy than with the European and Canadian Socialism / Nanny State model.
Posted by: BC | Dec 26, 2006 1:14:46 PM
The biggest problem with malpractice in this country is how the conservatives and insurance companies have been able to convince so many doctors that they are in constant danger of a frivolous lawsuit even though that simply is not true. Doctors practice defensive medicine because they've been convinced that they need to, not because it's actually necessary.
So instituting any "malpractice reforms" will not only punish those who have legitimate complaints, but will also do nothing to stem the tide of defensive medicine, since the rate at which doctors practice it is not dependent upon facts anyway.
The other idea we need to fight is that consumers need to make "wiser" healthcare choices. Again, this is a victory for conservative propaganda over reality. In this view, people rarely get sick. They just enjoy going to the doctor and taking medicines with side effects so damn much that they need to be forced to abstain from medical care for their own good.
The people who declare bankruptcy because of their medical bills are not quite like those who declare bankruptcy because they maxed out their Macy's, Best Buy and Visa credit cards and bought the 2007 V-8 Cadillac Escalade POS while making $32,000/year.
Pharmaceutical innovation is taking place at the NIH, not at Bristol-Meyers-Squibb. Insurance companies save costs for themselves by transferring more and more work to the doctors and hospitals, while the VA and Medicare are able to operate on far less administrative costs.
The same industry that makes its money by forcing doctors to deny/delay treatments and tests for sick people is the one that then charges doctors exorbitant rates for malpractice insurance, just in case they get sued because some denied/delayed test or treatment results in significant injury or illness. Pretty slick deal, really. They can demonize lawyers while employing legions, scare people with the idea of bureaucrats making decisions for them while spending more on bureaucracy than the government. They can make their profits by denying needed care and delaying payments for services rendered while blaming sick people for being unwise consumers. If it weren't all designed to produce the maximum amount of misery in pursuit of profit they can get away with, our insurance industry would be a thing of beauty.
Posted by: Stephen | Dec 26, 2006 1:57:14 PM
Their financial strength depends on not paying for health care
You mention market forces that are problematic without giving any attention to market forces that might actually be helpful. The financial strength of insurers comes entirely from premiums. The incentive to provide bad service to keep more of that money is supposedly overcome by the incentive to receive more premiums in a competitive market, which ought to provide incentive for good service. That there is poor care suggests that people really aren't willing to pay for what they need; people get more or less what they're willing to pay for. The question is whether they'll be more willing to pay for it through taxes.
Medicare is a successful program, on the whole, but it requires supplemental policies. Medicaid is a basket case of different kinds of failure.
Most people barely have a clue what single-payer care would entail--they like the idea, with barely any knowledge of the implications. While I think single-payer might be the best way on the whole, if we were building from scratch, there is the practical problem of what to do with umpteen zillion insurance employees, and the question how much more in taxes people are really willing to pay all of a sudden, even if they're told they'll save money overall.
Posted by: Sanpete | Dec 26, 2006 2:12:59 PM
We have universal health care now. The only ones who
get it are illegal aliens. No premiums, no deductible,
no copays. Need a heart transplant? No problema.
It'll be given to you free of charge by the generous
American CITIZENS.
Posted by: zopilote | Dec 26, 2006 2:39:52 PM
Nothing will be done until the system collapses. That's the nature of American politics right now. Folks will say "In order for this candidate or that to win he (or she) can't come up with radical ideals." So they will tweak at the edges, and meanwhile my premium will increase by 13 percent this January, and that will continue for years, and finally it will just collapse somehow. So I agree with the diarist.
Posted by: akaison | Dec 26, 2006 2:41:34 PM
oh- lookie it's zop- wow- we got a zenophobe. Look at the lil zenophobe. Thats right y'all our healthcare problems are due to illegal aliens. I mean of the martian kind.zop is from another planet.
Posted by: akaison | Dec 26, 2006 2:44:07 PM
Perhaps we can insure 1/2 of Mexico too! Bob Delle 5:16:59 AM
... The only ones who get it are illegal aliens….zopilote 11:39:52 AMThe bigot contingent shows up right on cue. It is helpful to point out that in all single payer countries, all people in the country are covered including tourists and aliens. The reason is simple: the coverage is paid by taxes collected from all, hence coverage for all. Private insurers add nothing of value to the healthcare system. They are gatekeepers, coverage deniers and profit makers pure and simple. Need so see a specialist? Wait for approval, and then see someone in the group despite you and your doctor's preference. Want to talk to your doctor? Sorry, he has a quota and has to rush to number next.
Posted by: Mike | Dec 26, 2006 2:52:32 PM
zopilote: Actually, there is very little truth to what you say. Emergency care and stabilization can't be denied in EDs but further treatment is frequently denied. No one would get a heart transplant. I did my residency a few years ago in a public hospital in southern California and we did sometimes arrange transport back to Mexico. I certainly took care of one very nice man who was in and out of the ED because he was illegal and had no funds to be placed in hospice care for his advanced lymphoma. The ED docs always wanted to admit him so that they would not be liable for malpractice when (not "if") he died and the hospital was always reluctant to admit while the medicine resident (me) got bashed about in the middle.
The one truth to your belief is that babies who are born to illegal moms are citizens (that old devil Constitution again) and eligible for Medicaid at birth. I don't remember the figure, but it isn't that high a number of births and costs but a fraction of, oh say, bringing democracy to the Iraqis.
Posted by: J Bean | Dec 26, 2006 3:17:17 PM
Let's compare the Swedish universal health care system with the US, line item by line item and determine whether this is a model, with modifications, that can resolve our immoral withholding of health care from 42-milllion of our citizens. I worked in Sweden for eight years and came to appreciate the system there, despite the inevitable complaints of a few who felt they had to wait too long for elective surgery or whatever. Yes, my taxes were very high, but I could accept a marginal reduction in standard of living when I knew that EVERYONE was being cared for. Private care is available for those who want to pay a premium. Now in retirement, I find it remarkable that my Swedish social security pension is more than my US social security, even after 25 percent tax is withdrawn by the Swedish government, and for only eight years of paying into the system there. I have noticed how much of Swedish medical research, pharmaceuticals, and surgical procedures, eventually find their way into the US and benefit us all. Rarely do I read of such coming from other countries, and Sweden's population is only the size of L.A. County's! Sweden's population over 65 is about 17 percent, the highest in the world, I believe. So they must be doing something right with their universal health care coverage. See www.sweden.se/templates/cs/BasicFactsheet____6856.aspx
Posted by: C R Carlson | Dec 26, 2006 3:32:24 PM
BC
Well, I am still tracking down information on Medicare costs (perhaps you would like to share your links?) but I can say that we do agree on one thing:
we can generate more health care than we can pay for.
No doubt about it, most of the growth in health care costs in the near future is not going to come from administrative overhead, or the profits of anyone. Its going to come from a widening array of available health services, some constituting major improvements, some providing marginal improvements, some of which will be positively iatrogenic. Its going to come from the aging of the population and rising public demand. Its going to come from the re-emergence of infectious disease.
If you want to call all this "utilization", I guess thats accurate in a sense, but not in the sense that patients are simply demanding health care for inappropriate reasons or that doctors are ordering it to make a quick buck even when there is no benefit to the patient.
In light of all of this, we clearly do need a mechanism to rank health services in terms of the value they produce.
But what incentive do private insurance companies have to exclude only those services that produce the smallest cost-benefit ratio? They have an incentive to exclude those services that produce the largest reduction in claim payment over the smallest risk of complaint/legal action. Sometimes, as in substituting generics for ordinary drugs, these categories will overlap, but they are not coterminous.
You claim that insurers have reduced costs (in Medicare D, the rare case where the government, rather than the individual or an employer has wielded the cost-containment cudgel) "not by denying services but by increasing generic utilization." But you don't provide any evidence that they are not simply denying claims, and I think the burden of proof is on the person suggesting that a party is behaving contrary to its incentives (more on Sanpete's argument in a subsequent post). Furthermore, the Medicare drug situation is unique because of the availability of generic substtitutes. In the drug context, it is much easier to reduce costs without impairing quality. There are no generic bypass operations.
I am not, as you say, ranting about drug and device profits. These companies create things that improve (usually) health outcomes. If they make profit, they will have an incentive to invest more and create better products. Markets and such. I am ranting about the profits of the insurance industry, thank you very much. I notice you didnt include any information minimizing their profits as a percentage of health spending.
There is not doubt that any expansion of medicare will have to include robust cost containment measures. More robust, likely, than those employed in the current system. But asked to choose between a company that makes more money every time it deploys the "no" stamp, and an agency that is charged with the duty of authorizing exactly those services that provide X amount of benefit/cost, and who gets paid the same either way, I will pick the latter. And even if we wind up spending too much on Medicare for everyone, we will be getting value for it, not lining profits, not running exaggerated overheads (how about the companies that don't self-insure? they dont run 5% overhead), not fighting over claims denied in bad faith, not hiring people just to figure out how to give people health care.
Just curious, this isn't an accusation, and you are welcome in the forum either way as far as I'm concerned, but do you work for an insurer, lobbying organization, public relations firm, or industry organization?
Posted by: RW | Dec 26, 2006 4:16:54 PM
you've got the politics wrong. the only people totally dissatisfied with the current system are those lacking coverage who, oddly enough, have no political clout. if they had clout, they'd be covered.
for the rest of us, we confront an imperfect system that we've learned to live with. that's better than a system that requires us to change our behavior and give up some of the things we're comfortable with now.
that's why the clinton plan failed and was the underlying message of harry and louise -- everyone with coverage would have to give something to provide a broader safety net to those without coverage --and to protect ourselves should we fall into the latter category. didn't sell then, doesn't now.
ultimately the society's either gotta spend more or figure out a more equitable way to cut back on services people are using. squeezing the intermediaties is fun, but doesn't produce the needed revenue. cutting back on unneeded procedures could. but defining unneeded is political impossible.
Posted by: jim jaffe | Dec 26, 2006 4:19:28 PM
okay- now is time to call bullshit- did someone just seriously argue that people who are insured are happy with the present system? are you serious?
Posted by: akaison | Dec 26, 2006 4:43:23 PM
Jim
Transparency would improve under single payer. Under the current system, we have to aggregate data from thousands of insurers and providers to determine what is being utilized.
Sanpete
You assume that plans that actually pay for what they promise attract more money in premiums. Is there any evidence for it? I think there are a number of problems with this argument. First, there is no real mechanism, other than vague consumer satisfaction surveys, by which patients who have been denied services have to compete with the next set of buyers. Second, there is little way for patients to know whether the services they have been denied would actually have been covered. Third, there is no way for patients, often to know, whether a service is being denied by the outright refusal of an insurance company to pay for it, or by the implicit pressure of providers not to order services they don't think will be reimbursed. Fourth, patients don't know whether they are being denied a service to which they are entitled, because they are usually not lawyers. Fifth, patients don't usually buy health insurance, employers do, and their incentive is to have a plan that looks good up front to attract good workers, but which controls cost -- once the employee gets sick/they can't leave without risking whatever coverage they have. Sixth, finally, insurers are willing to write off the premiums once its clear that the patient has entered a period of chronic illness because the premiums dont cover the outlays. The fact that the insurance company will lose the money they would otherwise obtain in premiums FROM THE PATIENT TO WHOM THEY DENY HEALTH CARE, is thus not a significant disincentive to the denial of services. To the contrary, they want the patient to withdraw, or, in the case of terminal illness, die cheaply.
Posted by: RW | Dec 26, 2006 5:06:47 PM
Woops.
I said "First, there is no real mechanism, other than vague consumer satisfaction surveys, by which patients who have been denied services have to compete with the next set of buyer"
I meant "by which patients who have been denied services have to COMMUNICATE with the next set of buyers"
I said "Second, there is little way for patients to know whether the services they have been denied would actually have been covered."
I meant "would actually have been covered UNDER A DIFFERENT PLAN."
The third argument is a punctuation disaster.
Note to self. Edit a little. Ok, I'm done.
Posted by: RW | Dec 26, 2006 5:27:44 PM
Yet another piece on our healthcare crisis. As a physician I am terrified of the prospect of government run healthcare. I imagine it would be modeled on Medicare, a great program for seniors but lousy for doctors. I treat very few Medicare patients as I lose money on those visits. Medicare reimbursement rates are the lowest of third party payors. The rules are cumbersome and difficult to follow. After reading your article I multiplied the number of office visits year to date times my Medicare reimbursement rate. I subtracted my yearly overhead. I arrived at a negative number. I consider my overhead to be below most other doctors. My rent is relatively cheap and, as my office is fully computerized, I work with only one administrative person for 3 doctors. The usual rule of thumb is one admin person per doctor. My practice has been in decline for several years. We are seeing more patients but being reimbursed less each year. Needless to say practicing has become less enjoyable. I also recognize that providers are the weakest link in this debate. Payors(government and big business) and patients(everybody) are far more powerful. We will be the losers in whatever plan is adopted.
Posted by: charles | Dec 26, 2006 5:57:55 PM
RW,
First, in the interest of full disclosure, I work for a large corporate pension plan. My employer has approximately 20,000 active workers in the U.S. and roughly 75,000 retirees including 15,000 pre-Medicare eligible. It self-insures, like most large employers, though I suspect it would love to get out of the business of providing employer provided health insurance. I would be interested in your perspective as well.
With respect to insurers, the two largest are UnitedHealth Group and Wellpoint. Combined, they insure approximately 64 million people. Between the two of them, they will probably earn a profit of $7 billion or so in 2007 which equates to a bit over 0.05% of GDP and 0.35% of U.S. healthcare spending. They creates value in all sorts of ways including disease management, pharmacy benefits management, and, currently in field test, real time claims adjudication. They can demonstrate that some providers offer above average quality care and average to below average cost while others provide below average quality at above average cost. Medicare just pays everyone the same in a given county. United's Evercare Division, which manages care for some of the sickest and most frail elderly Medicaid patients under state contracts, makes sure each patient has executed a living will or advance medical directive so doctors know what care the patient wants and doesn't want as the end of life approaches.
You say that insurers are always looking for any opportunity to deny care in order to maximize their profits, and they often do this in an arbitrary manner. I've worked for four employers over several decades and never had a problem getting a claim paid. I've had some pretty large bills including heart bypass, a stent and several other surgeries over the last dozen years or so. The problems you cite have sometimes occurred in the individual insurance market, and, in response to some of the recent publicity surrounding a couple of cases involving Wellpoint, I was sharply critical (on other blogs) of the insurer.
Of course, insurers are in business to make a profit. To continue to do that, they need to satisfy most of their customers most of the time or else they soon won't have any customers. If employees are dissatisfied with their insurance or how they are treated, they are not shy about letting their employer hear about it. If enough people complain, the insurer may well lose the account.
As is probably clear from my posts, I have a strong free market bias. While I know this is a liberal blog and I am in the distinct minority, I want to see universal healthcare that people can count on and at a cost that the society can afford and sustain. I am far from an expert on this subject and am always interested in learning more from others who know more. I offer my comments in a spirit of free and open debate, and I hope you (and others) take them that way.
Posted by: BC | Dec 26, 2006 6:09:18 PM
Read this:
http://tcf.org/publications/healthcare/wtprw.healthcare.pdf
I don't know where most of you are living in terms of reality, but its clearly not what most Americans on average are facing with the healthcare crisis in this country.
Posted by: akaison | Dec 26, 2006 6:31:08 PM
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