Wednesday, November 12, 2008

The Essence of "HEALTH" Insurance

Yesterday I visited my cardiologist for a regularly scheduled exam. It was thankfully uneventful, and since I was her last patient of the day, I was comfortable making some political/medical chit-chat. This was prompted by our review of my ever changing meds, which change not because my health changes, but because my carrier regularly switches presciption plans in an ongoing effort to save (their) money (undoubtedly at the expense of MY health and convenience).

I asked her what direction she thought Obama and the Democrats would take health care. I must admit, I expected her to talk about the dangers of "socialized medicine", so before she answered I threw in a preliminary "what we have been doing is not working".

She said, "You know which health insurer I find the best to work with, as a doctor?"
I said, "No, which one?"
"Medicare", she replied.

"How could that be?"
She answered, "Basically, they have a fee schedule and it is what it is. When we submit a claim, it seems to me they process it and pay it, efficiently. They seem to have very little waste, and studies have shown this is true. They are not being run "for profit", so they don't nickel and dime the doctors, and force that game where you put in high claims knowing they are going to be knocked down. It also burns me up when I see a retired doctor sitting as chair of Aetna, making $12 million a year. There's something wrong with that."

Wow! I asked if she thought nationalized health service would work, and whether quality of care would suffer. She did not favor nationalizing it, but said she felt strongly that McCain's talk about "the private marketplace" were the wrong way to go.

After I left, I could not stop thinking about this.

What really bothers me is the feeling that health insurance has nothing to do with health. It's strictly business. Do you ever feel they would "err on the side of caution" and approve something? Without a fight?
Would premiums ever, EVER go down? Even if profits went up?
Have you ever looked at the game that goes on between doctors and insurers? The one where various bills are submitted for say.....$4300, and the doctors are paid $382.....when you know you had high level tests and were attended to by at least six highly trained, caring, competent health care professionals?
Should health insurance be adversarial? Damn, it always is.

I'm usually not big on conspiracy theories, but I sense that these problems do not only rest with the health insurers. Am I the only one who thinks there is something fundamentally wrong with our "pharmaceutical" system? Well, it has something in common with the insurance industry....a profit based system based on OUR health.

Gee, I feel like half a socialist having said that. Let me go one step further....Would anyone argue that food and nutrition have at least SOME effect on health? The disrespect of the nation's health by our food purveyors is another example of profit and health not mixing.

Uh - how about cigarettes? Yeah, that too....profit and health not mixing. BTW, many are aware (and many are not) that President-Elect Obama has struggled with cigarette addiction for many years. I'd love to see him kick it for good and take a real stand against the industry. It's hard to imagine he didn't smoke during the campaign

In one of the debates Obama spoke in some detail about healthcare, concluding with "prevention". He is so right about this, but he will be fighting strong entrenched power. When the time comes, this issue can be taken in the right direction, and it will not come from the government, though they can lead, it will come from all of us.

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