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Corporate vs. Government Run Health Care

By Ed Tubbs  Posted by Ed Tubbs (about the submitter)     Permalink

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The last few years, the matter of the United States healthcare delivery system has arrived front and center as a national debate. Over and over, two intentional catcalls emanate from the Right, in opposition to any alteration of our current broken system.  

The first has to do with quality of care: “the United States has the finest healthcare system on earth; it’s where folks from all over come to receive care they can’t get where they live.” Follows immediately are the World Health Organization’s national rankings. Go to the website proffered. Say whatever you want, but just don’t tell me that the country that spends twice as much per capita as any other country on earth and gets results that rank it no higher than 37 is a good system! 

World health Organization’s 2007 (most recent) Ranking of National Health Systems

1.                  France

2.                  Italy

3.                  San Marino

4.                  Andorra

5.                  Malta

6.                  Singapore

7.                  Spain

8.                  Oman

9.                  Austria

10.               Japan

11.              Norway

12.              Portugal

13.              Monaco

14.              Greece

15.              Iceland

16.              Luxembourg

17.              Netherlands

18.              United Kingdom

19.              Ireland

20.              Switzerland

21.              Belgium

22.              Columbia

23.              Sweden

24.              Cyprus

25.              German

26.              Saudi Arabia

27.              United Arab Emirates

28.              Israel

29.              Morocco

30.              Canada

31.              Finland

32.              Australia

33.              Chile

34.              Denmark

35.              Dominica

36.              Costa Rica

37.              United States of America

38.              Slovenia

39.              Cuba

40.              Brunei

41.              New Zealand

42.              Bahrain

43.              Croatia

44.              Qatar

45.              Kuwait

46.              Barbados

47.              Thailand

48.              Czech Republic

49.              Malaysia

50.              Poland

(more)

The second screeching howl is every bit as ignorant: it decries any amendment that brought the federal government into the picture as “Socialized medicine!”   To which any person with an intellect beyond a scratched 78 rpm phonograph record will reply: “SO WHAT?” (Of course, the respondent may prefer to insert a few choice, highly crude expletives between “So” and “what.”)  

The counter to my terse reply always seems to be something along the lines of care that is “parceled out” by the government.  

Well, I’ve been hawking health and life insurance products since 1994 for UnitedHealth, Blue Cross/Blue Shield and Aetna, as well as a few less than “choice” others. Thirty percent, or $30 of every $100 YOU PAY in premium — and whether you pay it directly, or indirectly via an employer, YOU PAY IT! — goes to administrative overhead, not a cent to YOUR healthcare; executive management salaries & bonuses, my  commission, advertising, the bricks & mortar offices, and the biggest part of all: clerks in cubicles whose sole job it is to save the corporation money by telling a physician that his or her recommended care is inapposite to the diagnosis!

Few are stupid enough to buy that line of excreta that argues your care will be doled out according to what the government stipulates . . . It’s being doled out now by a corporate clerk whose purpose it is, is to deny care to you.  

What real, effective difference does it make to you, who denies the care to you that your doctor recommends? On the one hand, you’re paying a ton less to not get the care, and on the other you’re being raped financially to not get the care, so executives can receive million-dollar bonuses. On the one hand, your employer may just be able to remain in business and you on the job.

On the other . . . Hey! Those folk in Mexico and Indonesia and China will be willing to take your job! ASK GM or FORD employees, or those non-union workers who used to work in the Lazy-Boy factories in North Carolina that opened after Lazy-Boy shut down its unionized plants up north, but that are today manufacturing recliner chairs overseas! 

My sole plea: DON’T BE STUPID! (And friends don’t let friends be stupid.)  

The excerpted article below is cogent. It summarizes just one other way insurance companies are ripping you off. (A technical note may be in order here, to bring the topic home, make it personal to you. Some plans, and almost all where the patient, for whatever reason may find it necessary to use an out-of-network physician, pay only 80% of what are known as “reasonable and customary” rates, leaving you the patient without recourse but to pay the balance.  

Permit me to provide an example how the scheme rips you off. In New York City, the typical office visit consultation hovers somewhere around $200.  But insurers rely on skewed and outdated data to contend the “Reasonable and customary” fee they will pay 80% of is $77; or an out of pocket to the insurance company of $62 and an out of pocket to you of $138! Or, as Will Hunting asked in the movie Good Will Hunting, “You like apples? How d’ya like them apples?”)    

February 18, 2008 New York Times Editorial: “A RipOff by Health Insurers?”     

Have health insurers been systematically cheating patients and doctors of fair reimbursement for medical services? That is the disturbing possibility raised by an investigation of the industry’s arcane procedures for calculating “reasonable and customary” rates.      

The investigation, by the New York State attorney general, Andrew Cuomo, and his staff, suggests that these procedures may be rigged to shortchange the beneficiaries.      

The numbers are mainly compiled by an obscure company known as Ingenix, which — as it turns out — is owned by UnitedHealth group.

   

Mr. Cuomo says that Ingenix pools the charges for services performed by low-paid nurses and physician assistants with those performed by high-paid doctors. And he says the company fails to account for the patient’s condition and type of facility where the service was provided. He also contends that Ingenix uses outdated information, which would guarantee that reimbursement rates will always lag behind inflation.

 

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