UPMC's greed and complete disservice to our community. Non-profit status? I think not! (cost, budget)

[gg]

Originally Posted by lprmesia

Think of it like a car accident. Insurance company A will only authorize repairs at body shops that it owns, and Insurance company B will only authorize repairs at a body shops that it owns. Sure you can take it to any body shop you want and pay for it and they'll accept you, but the insurance company is the one footing the bulk of the bill.

Yes, lets look at it like a car repair. Makes perfect sense. Tell that to your friend that just lost his/her oncologist. due to greed. Whatever!

[eschaton]

Originally Posted by lprmesia

It sounds like you should be mad at the insurance companies, not the hospitals. Any hospital or doctor's office will treat you and provide services - but your insurance company will only pay the XX% of the bill if you go to their places. The hospitals/doctor's offices are non-profit - the insurance companies (Highmark and UPMC's Health Plan) are not.

The main problem with healthcare in the U.S. is very high prices (when compared to other countries) that providers and pharmaceutical companies charge. Health insurers do a lot of evil things, but it's mostly in response to those high prices in order to keep their own premiums lower. Hence they restrict networks (to try and cut out the highest cost doctors and hospitals), attempt to deny valid claims for very high-cost care, etc. There is some overhead at insurance companies, but it's not dramatic. And the level of profit even the for-profit insurers (which doesn't include Highmark) typically have margins of around 5% - less than a third what pharmaceutical companies have.

Any attempt to fix our healthcare system thus has to go beyond just tinkering around with insurance and get to the route of the problem - hospitals, doctors, and pharmaceutical companies charge way, way too much for their services. There's basically two ways around this. One is single-payer and its different variants. The other is what countries like France and Germany have done, which keeps private insurance in place but puts effective price controls on cost escalation for medical care.

[gg]

Originally Posted by eschaton

The main problem with healthcare in the U.S. is very high prices (when compared to other countries) that providers and pharmaceutical companies charge. Health insurers do a lot of evil things, but it's mostly in response to those high prices in order to keep their own premiums lower. Hence they restrict networks (to try and cut out the highest cost doctors and hospitals), attempt to deny valid claims for very high-cost care, etc. There is some overhead at insurance companies, but it's not dramatic. And the level of profit even the for-profit insurers (which doesn't include Highmark) typically have margins of around 5% - less than a third what pharmaceutical companies have.

Any attempt to fix our healthcare system thus has to go beyond just tinkering around with insurance and get to the route of the problem - hospitals, doctors, and pharmaceutical companies charge way, way too much for their services. There's basically two ways around this. One is single-payer and its different variants. The other is what countries like France and Germany have done, which keeps private insurance in place but puts effective price controls on cost escalation for medical care.

As you know I am anti-big government, BUT when it comes to the healthcare in our country, it is time they step in and get control of this mess. I think people should be able to get their pills from other countries. Free market! People are actually traveling outside the US for operations as well. This country is ridiculous when it comes to healthcare!

Our government is failing us, but we don't seem to care. The longer our government waits on taking some control of these rising costs the worse it will become. Best to put limits on things now before it even gets higher and higher.

[Enough_Already]

Originally Posted by Goinback2011

The obvious answer is - buy UPMC insurance. Or CIGNA - where you have a choice of UPMC and AHN doctors and facilities.

Most people don't have a choice they have to take what their employer offers or pay the full cost themselves. What UPMC and Highmark are doing is not in the best interest of the people of this area. That by itself disqualifies both of them from non-profit status.

[Enough_Already]

Originally Posted by lprmesia

It sounds like you should be mad at the insurance companies, not the hospitals. Any hospital or doctor's office will treat you and provide services - but your insurance company will only pay the XX% of the bill if you go to their places. The hospitals/doctor's offices are non-profit - the insurance companies (Highmark and UPMC's Health Plan) are not.

Don't forget that Highmark owns Allegheny Health Network. Highmark wants you to use their services instead of going to UPMC. You can still go to UPMC, or Excella, or any other place for service and pay out of pocket - but Highmark won't pay for you to go to UPMC just as UPMC won't pay for you to go to Highmark/AHN facilities. It goes both ways. It's all PR.

We need a history lesson. For most of their history, Highmark sold insurance and UPMC provided healthcare. Highmark was accepted by nearly every provider in the area. Then UPMC go into the heath insurance business but only allowed people with that insurance to see UPMC and independent providers. Only then did Highmark get into the business of providing healthcare and they put in the same restriction as UPMC. Both are wrong but it is UPMC what started us down this path to the detriment of the people of this area.

Our politicians should have done something to protect the people but...

[Enough_Already]

Originally Posted by erieguy

Bingo.

Not an answer at all. For people who get health insurance at work most of the time that is not an option. Every time a provider changes affiliation, a company changes health insurance, or a person changes jobs, they lose access to providers. This well result in negative health outcomes including premature deaths.

[Goinback2011]

CIGNA covers both UPMC and AHN doctors and facilities. Spend a few seconds researching plans offered by your "national company".

[erieguy]

Originally Posted by Enough_Already

Not an answer at all. For people who get health insurance at work most of the time that is not an option. Every time a provider changes affiliation, a company changes health insurance, or a person changes jobs, they lose access to providers. This well result in negative health outcomes including premature deaths.

It is an answer. Nobody is forced to take the health insurance the company they work for provides. Anyone is free to pay for the health care provider they choose.

[eschaton]

Originally Posted by erieguy

It is an answer. Nobody is forced to take the health insurance the company they work for provides. Anyone is free to pay for the health care provider they choose.

Most employers will not if your forgo healthcare give you a salary increase equal to what their total premium contribution would be. Even if they did, said wages would be subject to taxes. Thus you'll always come out worse off if you decline employer-provided health insurance and go out to buy coverage of your own individually.

[erieguy]

Originally Posted by eschaton

Most employers will not if your forgo healthcare give you a salary increase equal to what their total salary contribution would be. Even if they did, said wages would be subject to taxes. Thus you'll always come out worse off if you decline employer-provided health insurance and go out to buy coverage of your own individually.

Obviously, and I never said anything to the contrary. The fact is that anyone is free to pay for the healthcare provider they choose.