The problem with Health Insurance/Health Care Industry (blood pressure, doctor, vs)

[Woland]

I see so many people that rag on health insurance and the costs associated with it. The issue is one of those circular problems that will continue until something interrupts the cycle. Here is how it goes:

1. Uninsured person goes to ER to seek care. Person waited until it was so bad that they had to go to the ER instead of seeking preventive care.

2. ER sees patient and isn't able to collect a dime from the person. Hospital writes off cost as uncompensated care and affects the bottom line.

3. Hospital will not eat the cost and needs to collect it elsewhere. Hospital renegotiates its contract with the insurance companies.

4. Higher costs are put to the insurance companies, but they aren't going to eat that cost either. Insurance companies are under pressure increase premiums, but are also under pressure to keep the premiums down. Insurance company raises premiums less and reduces benefits to keep the premium down.

5. People can't afford the increase or the reduced benefits still costs them too much out of pocket and have to go uninsured.

6. Return to #1.

A not so humble opinion from a health industry manager.

[Viralmd]

You're missing one important point: the uninsured don't see a doctor early in the course of an illness because they can't afford it!

[Woland]

The money part was not mentioned, but meant to be the reason for them to wait until things got so bad they had to go to the ER.

BTW, there are plenty of "Minute Clinic" type places that have reasonable rates. Minor illness exam

[bellalunatic]

Originally Posted by Woland

The money part was not mentioned, but meant to be the reason for them to wait until things got so bad they had to go to the ER.

BTW, there are plenty of "Minute Clinic" type places that have reasonable rates. Minor illness exam

I hear ya, but we don't have anything of that minute clinic sort around here...

have you seen this?

http://www.slideshare.net/danroam/he...re-napkins-all

[CosmicWizard]

Woland

I mostly agree with your cycle, except that I would add a step before your step 1 which you stated as:

1. Uninsured person goes to ER to seek care. Person waited until it was so bad that they had to go to the ER instead of seeking preventive care.

Prior to seeking preventative care, is for each of us to PRACTICE healthy living. In the so called health care reform debate, I rarely even hear that aspect mentioned.

[grannynancy]

And it is not just uninsured - my daughter and son in law have poor insurance coverage - he is a state employee [teacher] making a teachers' salary and, even though they opted for the highest level of coverage it is very expensive for them with deductables etc. So they go without care unless they give in when we offer help.

And yes, healhy living and personal accountabiity are a BIG part of it but even with that people can still get sick.

Many of your more expensive illnesses don't show up untily way down the line and by then.........it is late -- how hard would it be to get blood pressure medicine and statins in the hands of those that need them? Why can you buy garbage food with food stamps?

Personally, I think you should not be able to buy ANY processed food with them [or maybe some limited processed foods for making sandwiches for lunch]

And I hate to say it but most medicare dollars are spent towards the last few months of life. I don't know if these particular numbers are accurate but maybe we should rethink the amount of effort we spend in keeping the inevitable from happening at the very end.............

http://www.thirteen.org/bid/sb-howmuch.html

[Starlady01]

Me being on the new health care already let me help with this. I have been on it and off it. With the new health care overhaul people who make less then $800.00 a month now goes into a bracket of not having full medicaid and medicare has been cut from here to eternity. Thus the insurance want pay the hospitals or the doctors why because they are under contract and if the doctor accepts the insurance they have to take the person. Dus either the doctor gets less pay or the insurance is pocketing the whole amount I'm unsure of this. All I know is that the doctors will do what ever the insurance tell them to do no longer doing what is right for the patient. I would much rather have a doctor treat me under (medical) terms vs (insurance) terms. Doctors now adays now that they are accepting these insurances have guide lines set by the insurance companies which in the long run will cost a person their life or more medical down the line. Insurance companies don't want the weight of the problems. People makiing less then $800.oo a month are having their medicaid cut by being put on particial medicaid them saying that medicare will take over. Excuse me Medicare has been cut like I said. Who is taking the loss I really don't know either the doctor or the insurance pockets the money. God help us all

[Viralmd]

Believe me, it's not the doctor who gets much money. Physicians who accept insurance (thus not most plastic surgeons or those who do elective procedures) are 1) drowning in paperwork and 2) have to see unconscionable numbers of patients each day to make ends meet. No wonder the good, thorough doctors are leaving practice.

[Woland]

Originally Posted by Viralmd

Believe me, it's not the doctor who gets much money. Physicians who accept insurance (thus not most plastic surgeons or those who do elective procedures) are 1) drowning in paperwork and 2) have to see unconscionable numbers of patients each day to make ends meet. No wonder the good, thorough doctors are leaving practice.

Doctors aren't totally innocent in this whole mess. I have been in the health care industry for a while and have seen some of the tactics that docs use to increase revenues including having patients come in for follow up care that is not needed just so they can bill.

When a system pays for visits done, then what do think happens? More visits.

[CosmicWizard]

I've read that the old Chinese healers, doctors, and what nots, got paid to keep their patients healthy. When the patient got sick the doctor didn't get paid. A system like this ( a monthly retainer to the doctor to KEEP you healthy....no insurance company middlemen! ) would dramatically alter the way doctors treat their patients. Instead of arranging treatments to maximize income, doctors would have to find ways to keep the patients healhy.....or lose income. I bet we'd see a BIG shift toward the better in the way medicine is practiced. Now I'm sure that many holes could be found with this type of system, but I cannot imagine that it would be any worse than the current system.