how is this better than single payer, or even different

[barbtries]

other than the profit aspect?

my son has an apparent pinched nerve in his back which is causing him constant pain. the doctor recommends an MRI. i'm scared shitless of how much this will cost me since my Aetna "gold" HMO has already resulted in surprise charges following my colonoscopy and IVP procedures (even though in the latter case, i was very careful to explain to the Dr's office that i needed to know my bottom line before anything was done).

so i called Aetna this morning to get the bad news ahead of time. if it's too much money we'll do cortisone shots first, or acupuncture. but given the amount of pain he is in, how long he's been symptomatic, and his tender age (he's only 17), i would like for his doctor to be able to see what's happening in his back. as would his doctor.

so aetna tells me that authorization must come from their "third party Administrator" MedSolutions. Apparently what must happen is my doctor's office calls these MedSolution people who request and review the "clinicals" and then render their decision on whether an MRI is indicated. According to my dr's office it's 50/50 whether they'll approve it. i am then told that if it is approved it will cost only my copay of $30.00. I record the Call ID so that when they hit me up for more than $30 later they can hear for themselves this rep of their company telling me repeatedly that i will only have to pay $30 as long as the doctor's office contacts the proper "third party Administrator" and procures authorization through them.

i want to know: how does this rigmarole constitute making a decision "between the patient and his doctor"?! it's BULLSHIT! private insurance companies, ever mindful of the business they are in (read: it is NOT patient care, it IS profits for the shareholders), have created a bureaucratic nightmare for hapless consumers to try to pick their way through even a minor illness or injury. i dread ever having to maneuver this maze in the event of a major life threatening illness.

the government could not possibly do worse than this, probably would do much much better, and without a doubt when the profit aspect is removed from the equation, more people will be covered for less money.

SINGLE PAYER Health Care for Everyone. NOW.

[Laelth]

1. Hear, hear! n/t

:dem:

-Laelth

[tjwash]

2. A huge part of the bill is getting rid of the surprise charges and pre-existing conditions denials.

It is mostly un-talked about in the news, and the biggest reason that the insurance companies are busing in thugs to break up the town halls; they stand to lose billions a year in coverage denials, that they are free to do right now. It contains key insurance reforms that prevent insurance companies from denying care or coverage based on pre-existing conditions, dropping you because you get "too sick" and imposing annual and lifetime limits on coverage.

Doctors and patients will be empowered to make treatment decisions - the way it should be - rather than the profit-driven private insurers who don't give a shit about your health.

[sinkingfeeling]

3. Sorry for your 'normal' insurance problem. I'm totally surprised Aetna would even do a MRI for just

the co-pay from you. My insurance company requires $1000 out of pocket.

I do not think there is any way to go directly from insurance company run to single payer health care. I think the USA might get there over a period of time if we could get a good public option passed. As employers began to see the advantage of getting out from under providing insurance, pressure would grow for single payer. The insurance industry isn't going to let itself be put out-of-business and that's why they're lobbying like crazy. Also, in today's economic environment, I wouldn't want to see all those insurance employees without jobs.

[barbtries]

5. i'd heard about that from others

hence my fear. i made her say it about three times then asked for her last name or rep ID and she provided the call ID. I think i've done everything i can to make sure there are no surprises this time and am still skeptical.

i will say this: they authorized it and my dr's admin only had to spend 20 minutes on the phone for it. wow. he goes in tomorrow.

[RaleighNCDUer]

8. The Brits did it. The Canadians did it.

Why can't we?

Are Americans that much less competent?

[sinkingfeeling]

9. No they didn't. Neither Canada nor England ever had a private insurance based care program. Their

current programs both began in the 1940's. As was true in the USA, at that time, most people paid for their own health care. Insurance via employers and private companies began to gain steam after WWII here. Universal plans went into place elsewhere.

[endarkenment]

14. Canada 1966. Try again. nt.

[sinkingfeeling]

20. The 1966 the Medical Care Act was passed extending the universal care to all

providences. And yes, 65% of Canadians today carry supplemental insurance from private companies.

During the Great Depression calls for a public health system were widespread. Doctors who had long feared such an idea reconsidered hoping a government system could provide some stability as the depression had badly affected the medical community. However, governments had little money to enact the idea. In 1935, the United Farmers of Alberta passed a bill creating a provincial insurance program, but they lost office later that year and the Social Credit Party scrapped the plan due to the financial situation in the province. It was not until 1946 that the first Canadian province introduced near universal health coverage. In 1957, the federal government passed the Hospital Insurance and Diagnostic Services Act to fund 50% of the cost of such programs for any provincial government that adopted them.

http://en.wikipedia.org/wiki/Health_care_in_Canada

How does that compare to the USA from the Great Depression onward?


You might want to read this article which explains how our 'health insurance' really isn't insurance but employer-subsidized health care. http://www.truthout.org/080709A

[RaleighNCDUer]

16. Ah, when people pay their own insurance is IS a 'private insurance

based care program'. What ELSE could it be?

Do you imagine that there was no such thing as 'health insurance' before 1940?

The difference is, when we had wage controls in place because of the war, the incentive used by corporations to hire was the providing of health insurance payments, which circumvented the wage controls. Corporations paying for insurance on behalf of the workers is STILL private insurance. That became the norm in this country while after the war the Brits and Canadians went with the government providing coverage - because it was cheaper and more effective. They went straight from private insurance to single payer.

So should we.

[sinkingfeeling]

21. Disability health insurance has been around since 1911. In the 20's and 30's, we got insurance to

pay medical expenses. Very few people bought this type of insurance. My dad, who worked for Chevrolet for 40+ years did not get employer paid health insurance until 1954.
The point is that we, in the USA, became accustomed to having employers' pay for insurance while other countries did not. Like Canada, they began in 1947 when one providence provided universal coverage and they migrated to universal coverage over the next 20 years.

I just said, I don 't think we'll be able to go directly from an employer-subsidized health care plan to universal, single payer, in a snap. We need to start with a good to great public option and migrate over time.


http://en.wikipedia.org/wiki/Health_insurance
Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations.<5> The predecessors of today's Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s and on during World War II.<6><7>

[endarkenment]

13. any way to go directly from insurance company run to single payer health care.

extend medicare to everyone. It would take a few months. There is no real obstacle to this, only political intransigence and corruption.

[truedelphi]

22. I disagree with you because

It is not such a black and white situation.

We could totally have a bill written that would knock the Executives out of the food chain. i don't know if you caught the DU discussion of this 96 hours ago. The threads focused on One Insurance Executive who receives billions as a bonus. I'd read about him earlier - his yearly salary is equal to the paychecks of all 3,300 employees at one Rhode Island hospital (Which his HMO administrates.)

We need to get rid of these people at the top. No one person is worth that much money. And these executive salaries and bonuses are probably responsible for about 20% of the cost of our health care in our country. Then if TPTB want to continue keeping the insurers in the loop, okay.

If we knock the insurance providers TOTALLY out of the loop, we would see a savings of 40%.

But right now, with these massive bonuses being paid, the rest of us have absolutely horrid care from our insurance "providers" - if we manage to be insured. Back when I was insured, Kaiser stalled my treatments, after initially not even telling me my condition had a treatment. (I found out what needed to be done by visiting the internets.)

[Oregone]

4. In a single payer system

You sons doctor would see him and call a facility to schedule an MRI. You son would walk out of the office (and not to the billing station). The doctor's secretaries would bill the visit at set rates to the system. Your son would walk into the diagnostic facility, get an MRI, and walk straight out. The facility will bill the system at set rates. The doctor will review the MRI and choose the most effective method(s) of treatment or refer him to a specialist. The doctor would consult with your son, then bill the appointment/analysis. All following treatment would be handled in the same way.

In other words, no one would ever have to call to get approval for billing, procedures, diagnostics, treatment, etc. All facilities would be guaranteed to be paid, and they can pursue any route they feel is best to perform their duties.

[Cleita]

6. I had an MRI and an MRA on my head three years ago on account of

dizzy spells I was having. I'm on Medicare with a medigap supplement. I was never charged for anything additionally out of pocket for either procedure other than my monthly premium. There were no delays, nor approvals first from any third party. Medicare for all is what is needed in this country. Sure there will have to be some updating in fee schedules and the gaps will have to be plugged, but I think it's very doable and estimates are that costs can be lowered by half of what they are today just by taking the for profit insurance companies out of the health care equation.

Now, I have been preaching about single payer for years, but unless Americans en masse rise up and demand it, our politicians are going to ignore the obvious in favor of protecting the corporate health care industry who throw so much money in campaign funds to them.

[barbtries]

7. i know you're right

i am so skeptical. they authorized the procedure after my dr's admin spent 20 minutes on the phone with them. in other words, just like that! and instead of feeling relieved and thinking maybe they're not so bad, i'm thinking this is just to further their cause of keeping the status quo. they're trying to cut back on horror stories until they've defeated single payer once again. hmph. i don't know that but that is certainly how cynical i feel.

[Shagbark Hickory]

10. Why'ncha book a flight to Jamaica or Mex. while the fares are still affordable and get the work done

without the hassle or high cost. If it becomes clear your HMO isn't going to pay for it.

[barbtries]

11. affordable as the fares may be,

add in the time off work and the cost becomes prohibitive. they approved it. we'll see if it actually gets done for the $30 copay i was told it would cost me.

[Shagbark Hickory]

17. Well my fingers are crossed for you & your kid. Best wishes. nt

[barbtries]

19. thank you

[truedelphi]

23. Fingers crossed for you here as well. n/t

[endarkenment]

12. Devices like MedSolution keeps insurance companies profitable

and they stay profitable in part by denying as much service, especially expensive services like MRIs, as they can get away with. A government run insurance system would be non-profit, it could have budget issues, but would not be under a mandate to maximize profits. While a government system could be worse than what we have now, such a system would have to work very hard to do so. In every modern industrial country I know of that has universal health care, their costs are lower and their outcomes are better than ours. Non profit public health care systems work more efficiently than for profit systems, and deliver superior results.

[Romulox]

15. The current proposal is to lock you into this relationship with Aetna, under penalty of law...

They might not be able to drop you for actually (gasp) making an insurance claim, but they'll still be able to refuse to pay for treatments they deem "unnecessary". :shrug:

[Stinky The Clown]

18. BRAVA!