Where does your candidate stand on who makes the medical decision?

[welshTerrier2]

we sure see a lot of polls posted in GDP. well, how about providing some actual information on your candidate's position on the following issue:

Should the decision as to what medical procedures are reimbursed or covered (and to what extent) be decided by people working for "for profit" companies or should it be decided by a board of medical professionals who are independent of the profit motive? Where exactly does your candidate stand on this potentially life and death issue? Please identify who your candidate is and exactly what their position is.

Thank you.

[Maribelle]

1. Health Insurance coverage varies widely.

Health Insurance varies widely. For instance if your employer provides coverage through, let's say, Blue Cross Blue Shield, you are more than likely in a 'group'. The insurance committee for the 'group' will negotiate with BCBS all aspects of insurance coverage: out of pocket expenses; co pays; maximum life time coverage; all medical procedures; and so on. The results of the negotiations translates into the premiums the employee will need to pay for the plans offered, for instance coverage of just the employee, employee and spouse, and various entire family plans.

So in this instance it is the insurance committee formed by the employer that makes the decisions. BCBS will only administer those decisions, and will approve or disprove procedures based on the 'group's' contract.

[welshTerrier2]

2. well, that really doesn't address the candidates' positions

If I'm understanding your point, the insurance committee would be made up of people representing private, "for profit", commercial interests. Is that correct?

That's exactly the kind of system I think we need to get rid of. I'd like to see autonomous medical professionals deciding what procedures are and are not provided and to what extent they will be paid for. Once you introduce the profit motive, you're talking fiscal care; not health care.

[Maribelle]

3. No. the insurance committee would be made up of people representing the employee.

They would be duking it out with BCBS to get the best coverage for the money the employee would need to pay.

[welshTerrier2]

4. let's try a different approach

your doctor says you need a full knee replacement. BCBS says they won't pay for it and that you just need some physical therapy and a few anti-inflammatory pills.

how does the difference of opinion get resolved?

[Maribelle]

7. BCBS can only say they won't pay if it's not in the contract.

It's black and white.

However, what I hate is how they give the health care providers the run around with the pre-approval requirements. Sadly, however, that is also in the contract.

We need universal coverage for everything - -such as what was manifested in France and England in SICKO.

[Maribelle]

5. Perhaps I should have told you ....

I don't think the candidates should necessarily have a position on this. However, I would expect them to have a stand on a new type of universal coverage.

[welshTerrier2]

6. i disagree completely but let's take your line

a new type of universal coverage. what does that phrase mean? does that mean anything and everything and anyone and everyone is covered.

does that mean if my doctor recommends a procedure, he can't be overruled because I have universal coverage.

"universal coverage" means many different things to many different people. what do you mean by it?

[Maribelle]

9. Yes, your doctor cannot be overruled. Yes, everything is covered.

It could be free for the young and old and needy. It could be for a small cost for workers.

[welshTerrier2]

11. OK ... sooooooo ...

the insurance committee would no longer be relevant under universal health care. nothing is "negotiated" because whatever a licensed physician prescribes would be covered. is that correct?

[Maribelle]

12. That's right.

We could throw all the bums out!

[welshTerrier2]

14. all righty then ... and what about private insurers?

if we have to pay not only for the actual costs of medical care but also enough for insurance companies to make a profit, even bloated profits, it seems like with universal coverage we're trying to spend the same amount on health care but cover more people. one, that won't work. and two, if we do that, there's just less care and coverage for those currently covered. we're spreading the same dollars around to more people. you can't get blood from a stone.

the only way to make it work is to not spend as much of our health care dollars to pay for insurance industry profits. the amount saved on profits then could go to provide universal coverage. that's more or less how I understand single payer.

does that sound right to you?

[Maribelle]

16. With universal coverage ...

countries such as England and France do not have any "health insurance" industries.

And I totally agree with you when you say "you can't get blood from a stone".

We truly need to go through a metamorphous in this country.

I am not trying to cry poor mouth at all, but my husband and I pay slightly over $14,000.00 a year for 80% coverage. It’s obscene.

[slipslidingaway]

8. K&R for more answers. Kucinich wants the decision to be based

on current medical practices and not trying to make a profit for shareholders.

[Maribelle]

10. This would be extremely hard to implement.

I would bet there are tens of thousands of different plans that would have to be regulated by some government agency.

What we need is one plan for all.

[welshTerrier2]

13. right ...

that sounds like the definition of single payer ... my understanding is that single payer would establish a board of medical professionals who would determine what is covered and to what extent. they would be paid by something other than a for profit company and would would have no motive beyond sound medical practice in issuing policies and making medical determinations.

it seems to me the whole point is that if anyone making the medical decision has a vested interest in maximizing their company's profits, we are no longer focused on medical care. that's the system we have now and it stinks.

[slipslidingaway]

15. Yes, if the bottom line of a corporation plays a part in medical

decisions we lose more than just a person :(