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CreativeDominant -> RE: Hipocracy is in the House... literally (1/5/2011 8:35:33 AM)
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Speaking from the perspective of someone involved in delivering health care, let me say this.
HMOs are a part of the problem to be sure. In negotiating with physicians, they came to us and said "if you pay a fee to us, we will allow you to join our group. We will pay you more than we pay other physicians who are not part of the group (at the start, they did pay all physicians but then began paying only their physicians) but it will be less than your normal fee. HOWEVER, to make up for the lost fee, we will steer our customers towards you such that you will not lose money...even though you are working harder for the same amount...but hey, it beats being excluded from being paid at all, does it not?" They became so exclusive and wieded such power that it was either join their groups or be left foundering for patients whose insurance companies recognized the doctor. When you add on that the insurance companies were able to go to the state legislatures and strike such phrases as "must pay any recognized provider" from the statutes, they did a great job of fucking up the system.
But let's look just a bit closer, shall we? Ever taken a look at who sits on the medical advisory boards of these HMOs? Medical doctors. The great majority of whom belong to the A.M.A., whose stated goal is to make medical doctors the "gateway" to any other health care provider. In other words, you have to see "Daddy M.D.'s" approval to see a Doctor of Chiropractic or a Doctor of Naturopathy or a Doctor of Optometry rather than a Doctor of Opthalmology. And anyone in the business of health care knows just how much M.D.s like any alternative provider as compared to their providers. Do you suppose this might have had an effect on the health care costs...when you steer people to providers who charge more for the same...or less...services but who carry M. D. behind their name? But at least the laws were not...and could not...be changed to deny access to providers who were willing to ante up the fee to join.
Medicare? Government-run. Fees set by the Federal Government which have nothing to do with the realistic fees of providing the services they are paying for. Limitations on the amount of care a patient can receive from any provider. That all sounds reasonable, doesn't it? Until you begin to look at the administrative personnel needed to tend this mess. I have yet to call my local Medicare unit that I deal with and talk to the same person twice in 5 years. And I call them quite often. And they want to let the Government run a single-payer system? And tell me...my fees and other doctors' fees have been cut again and again over the last 10 years to the point where I now make 2/3 of what a "normal" patient pays, even with the supplementary pay. And yet...the cost for Medicare keeps going up. If they are paying physicians less...then where IS all that money going? To the ever-expanding personnel department?
So when the government talks about how the healthcare bill will save costs, it is all indeed smoke and mirrors. As for believing what insurance companies tell you...yeah, they lied. They told customers that if they pay this, they will get that. What they neglected to state was that the X, Y, and Z the customer was paying for was mainly to cover the costs of administration, not healthcare fees. But part of that came about from the government telling insurance companies that they needed to hold the costs to consumers down and yet not deny them services.
And finally, let's look at this part of the problem. Why is it that so many people will go to the store and KNOW that they cannot walk out without paying for groceries and yet expect to be able to walk out of their doctors' office without paying anything at all? Because they have insurance? Even the dumbest among us must realize that insurance does not cover everything...never did. Yet I...and many other doctors...have had patients become resentful at us when their insurance company laid their bill off to deductible or "unnecessary procedures" and they wound up having to pay more than they thought they should.
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