Without Health-Care Reform, the Customer Is Always Wrong

Your basic point is flawed. You are correct that an insurance companies incentive is to make money...but you cannot do so by denying claims.

If a company denied all claims, they would lose all their customers who would then seek out another insurance company. This would cause them to lose profit. This is why nationwide, the average insurance company only denies 3% of their claims (meanwhile, the gov't run option in Mass denies 23% and Medicare denies 11%): http://www.mackinac.org/10987

Meanwhile, a politician's incentive is to get re-elected. This often means violating the rights of companies in order for his own gain. And when politicians run health care, their incentive will also be to control costs.

All humans are evil, and if you think a politician is less evil than a CEO, I believe you are mistaken.

Good question. We need to get some research on that. Although before any sociologists went in we would have to set up opinions for how we're broken and they're not. I know how we're broken, but I don't know anything about their systems.

Good question. We need to get some research on that. Although before any sociologists went in we would have to set up opinions for how we're broken and they're not. I know how we're broken, but I don't know anything about their systems.

I grant you that Denmark is a lot smaller, though I think you're confusing it with Norway if you're thinking oil wealth is paying for health care. But larger European countries--the UK, France, and Germany--also have effective, government-run and taxpayer-financed health systems of various kinds.

I'd be more able to discuss your "statistics" if you could reference some.

How does the size of a country matter? And Britain started the NHS right after WWII--when they were almost as badly off as Iraq is now (without the oil). Developed nations of all sizes and politics have universal healthcare systems provided by private or public providers and they don't have people dying because they waited to see a doctor because they wanted their kids to have good, fresh food. In Canada, we don't have death panels, my mother-in-law with heart disease Alzheimer's was dragged through every medical treatment and ambulance trip to the Emergency Room for trouble breathing to the very end, all because my father-in-law wanted it that way. We have state-of-the-art medicine, and if you don't like it, the frills are available at private clinics, just like face-lifts. But no one here EVER worries about medical bills. There are much better ways to improve health care, and politics. We are praying for you.

How does the size of a country matter? And Britain started the NHS right after WWII--when they were almost as badly off as Iraq is now (without the oil). Developed nations of all sizes and politics have universal healthcare systems provided by private or public providers and they don't have people dying because they waited to see a doctor because they wanted their kids to have good, fresh food. In Canada, we don't have death panels, my mother-in-law with heart disease Alzheimer's was dragged through every medical treatment and ambulance trip to the Emergency Room for trouble breathing to the very end, all because my father-in-law wanted it that way. We have state-of-the-art medicine, and if you don't like it, the frills are available at private clinics, just like face-lifts. But no one here EVER worries about medical bills. There are much better ways to improve health care, and politics. We are praying for you.

Who has suggested that it does?

"Who has suggested that it does?"

It's often implied by the authors and many of the bloggers here. It also hurts the "cause" for reform because it's much easier to see things in black and white. If one is against reform, than you trot out crazy ideas like death panels. If one is for reform, you don't want to hear about individual responsibility. Which is why Sojourners will never blog about personal sin, unless it has to do with a conservative.

The system may be rotten, but as Matthew Pearl wrote to Lavonne Neff, the individual insurance companies and the people who work there also bear responsibility for their actions. In the case of Guardian Insurance, the company that is taking away coverage from Matthew's brother Ian, they were profitable already, to the tune of hundreds of millions of dollars a year. Yet, they had been looking for an excuse to cut Ian and other people like him off for years, going so far as to hire a private investigators to try and find grounds to cut off care for people who need round the clock nursing care.

The people who lead insurance companies a moral responsibility to put human life before bigger profits. They are abdicating that responsibility, and people are suffering.

Yes, your system is screwed up. But that doesn't excuse people from the individual responsibility for their own moral behaviour.

Who has suggested that it does?

I see your point, although I'd be careful about saying "never." Personally, I'd love to see greedy insurance company executives get their feet held to the fire - even if they're liberals. :-)

If insurance companies weren't so big, if they were more of a local entity, there would be more public accountability. The people making the decisions at the insurance companies may even be personal acquaintances with the insured, making it more difficult to be so heartless.

Why are insurance companies so big? I'd have to research it more, but I'd wager it's because numerous gov't regulations in the past have made it impossible for small companies to survive. That's how the system works. Big companies lobby congress to pass "regulations" which favor them at the expense of their competitors. Eventually the little companies die out and the whole system becomes so impersonal that it's actually possible for some insurance company employees to behave heartlessly at work and still sleep at night.

My understanding of the way gov't works will never allow me to support the Public Option. I wish more people would educate themselves. It is so naive to think a gov't run system will improve our predicament. Part of the problem we have now is that too few people understand the details of our current gov't involvement in health care. We didn't get here over night. It's been a long journey. Here's the history of it:

http://mises.org/story/3613

I see your point, although I'd be careful about saying "never." Personally, I'd love to see greedy insurance company executives get their feet held to the fire - even if they're liberals. :-)

I have a friend who has Klinefelter's Syndrome. His HMO and Medicare wouldn't pay for him to have a breast reduction because they considered it to be merely cosmetic surgery.

But, several years later, lumps were found in each of his breasts and they did operate.

If he had been given the surgery in the first place, he might not have had lumps removed at all.

My understanding of the way gov't works will never allow me to support the Public Option. I wish more people would educate themselves. It is so naive to think a gov't run system will improve our predicament. Part of the problem we have now is that too few people understand the details of our current gov't involvement in health care. We didn't get here over night. It's been a long journey. Here's the history of it:

http://mises.org/story/3613

I have a friend who has Klinefelter's Syndrome. His HMO and Medicare wouldn't pay for him to have a breast reduction because they considered it to be merely cosmetic surgery.

But, several years later, lumps were found in each of his breasts and they did operate.

If he had been given the surgery in the first place, he might not have had lumps removed at all.

no the system can work it has before and it does now becasue not everyone is disatisfied with their insurance. you dont see those in congress and the government clamering about their insurance. Which by the way is what obama said he would give us. DONT be fooled by the retoric, we cant afford a single payer system, whcih is what obama wants dispite what he keeps spouting out. we need reform butg we need it done correctly.

Good news!

http://www.bloomberg.com/apps/news?pid=20601087...

Judiciary Committee voted 20-9 to repeal the health insurance anti-trust exemption. We can only hope that this measure gets onto the Senate and Congress floors, then to the President's desk -- and become law. It's not going to solve everything, but at least there might be some actions taken against the health insurance monopoly cartel --and we can have a true free market.

Basically, health insurance is a market in which the customer is always wrong - as soon as anyone files a claim for anything significant, that person becomes a liability for the insurer. It has every motive to deny care if it can, or at the very least discourage the sick person from staying on the plan. Doing this may be morally wrong, but it's literally the corporate executives' job. Dead-wrong incentives are built into the system.

AFAIK, laws are in place that forbid insurers from dropping people when they get sick, and rightfully so. Insurance is always a heavily regulated industry, and rightfully so because otherwise there are, as you note, all sorts of perverse incentives on all sides.

I know another popular proposal is to eliminate lifetime benefit caps - I wonder how often people actually run up against them. Of course, insurance is simply the spreading of pain; we need to seriously consider what needs to be done to reduce overall costs. No amount of insurance reform can make the unaffordable affordable, if "it" is unaffordable for everyone.

IMHO some serious standardization of claim forms and treatment protocols, as well as that of policies, can save a substantial amount of money.

I'd have agreed with you until I heard last week's "This American Life" broadcast. Their journalists/researchers/storytellers suggested that it's only the big insurance companies that have the clout to negotiate prices with the hospitals. And so the hospital corporations have grown to increase their negotiating clout...and so on. The story seemed to suggest that Maryland's example might be instructive: all procedures cost ONE price in Maryland, no matter the hospital, no matter the insurer. Now, wouldn't that be an interesting idea? Talk about transparency.

I'm not sure I buy the "we can't afford a single payer system" argument. A monstrous amount of money goes into the insurance business, and the health care system. Our businesses can't compete overseas or even domestically for the best workers because other industrialized nations (including where I live, Denmark) cover their citizens through taxes. I have a strong suspicion that everything would come out in the wash. If we paid for a nationalized government health care through taxes, then we would:

--not be paying any additional health insurance premiums (unless we chose to for extra special care, i.e. private rooms at hospital, etc.)
--receive higher wages as businesses no longer have to pay for insurance
--take care of the "free rider" system, where the young & healthy choose not to carry insurance (since all would contribute through taxes)
--have a more flexible, mobile workforce that could freely relocate to where the best wages & job growth are
--encourage entrepreneurs, who could cut loose and start businesses without worries for their families' health security
--reduce total health care costs since more conditions could be caught before they were catastrophic
etc etc etc.

I know this is a big leap for you, my American brothers and sisters. But I can promise you, for every one of you saying "God save us from European-style socialized health care," there are three Europeans saying "Thank God we don't have an American-style health care system"!

Elimination of lifetime benfits caps would affect a few people in each community, based on my 20 years of experience in health care. Some people with multiple complex conditions or who have had the misfortune of having a catastrophic condition more than once in their lifetimes do run into these caps, which are often set at $1 million. No one can predict who might need this extreme amount of health care; as often as not it can be a young person whose body is strong enough to stay alive during what must be an extended course of treatment. But when someone caps out their coverage, that's it. They end up with bills they can never hope to pay, and more often than not the care they receive is written off by the hospital providing the care.

Of course, the expenses written off on one hospital account are just shifted to the rest of the paying customers, and this cost-shifting is a significant contributor to the high cost of health care.

One positive effect of the public option already in place--Medicare--is that increased standardization of claim forms and other health records is occurring, driven by the clout of the Medicare program. Other insurers recognized that using CPT codes for reporting procedures and ICD codes for reporting diagnoses is a sytem that worked well and virtually all of them use this method now. They also recognize that the Medicare program draws from expertise in the various medical fields to determine best practices as well as procedures that are not yet proven effective. Often, insurers will cover the same procedures Medicare covers and refuse coverage for the same procedures Medicare denies.

Dealing with various insurance companies' guidelines and policies was a constant source of frustration for me and the staff in my department of the hospital, but we found Medicare to be straightforward and reasonable, and the patients got the treatment they needed. When was the last time you heard anyone say that about a health insurer?

A public option may come with some unintended consequences, so we need to move carefully. But if a Medicare-like option offers some real competition to the insurance companies, so be it. They have room for improvement.

The costs of a public option are a concern, but continuing to have 46 million citizens without adequate access to health care comes with enormous hidden costs of lost productivity, continued cost-shifting, a lowered standard of living and inefficient care delivery.