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There are ten case studies in the article cited below of how for profit HMO's are driven to make poor medical decisions. I have mentioned only two. This is an old, but still functional report on profit and it's negative impact on the health of people. Go to the link to read of the other cases.
When the for-profit sector took over the HMO reform there were no guidelines set for the maximum profit and minimum care, leaving a for-profit corporation to determine the guidelines on its own. Since the only true mandate of for-profit corporation is to make profit for their shareholders, it is not surprising that the commercial medicine in U.S. has reached a level where patients' health became a function of a bottom line.
(1) A 65-year-old Tennessee woman suffering from a painful gastric condition resulting from a bleeding peptic ulcer went to see her physician, Her doctor prescribed the drug Prilosec, but the patientts managed care company wouldn't pay for it since it wasn't on the approved company formulary. The patient was given an alternative drug without the knowledge of her doctor.When he found out, the doctor complained to the HMO, saying that without Prilosec he would have to operate on the patient's stomach, The HMO wouldn't budge. For five months the patient found herself in the middle of a battle between her doctor, who gave her free office samples of Prilosec whenever he could, and her HMO, which switched her to its approved drug just as often. At the end of the five months the woman's ulcer had become so bad it required surgery, Doctors removed 35 percent of her stomach. Furthermore, the woman suffered a stroke in recovery and is now partially paralyzed along her left side, (K eating, 1997).
(2) When a couple's daughter was born three months premature, an eye exam indicated she had the early stages of retinopathy, a condition that is usually correctable, Doctors assured the parents that there was no cause for alarm, and a follow-up test was scheduled, The parents' HMO demanded that they again see a primary care doctor before the test could be approved. That led to an eight-week delay, which resulted in the little girl becoming permanently blind, (Findlay, 1997).
These are just a sample of the host of malefactions committed by the HMO in the wake of increasing the profits of medical care. Clearly, given this type of failure rate, and the severity of the failure itself, the situation mandates defensive measures to combat the evils of for-profit health care.
Here’s how it works. AARP isn’t your every-day citizens’ advocacy group. The AARP is also one of the largest private health insurers in America. In 2011, the AARP generated $458 million in royalty fees from so-called “Medigap” plans, nearly twice the $266 million the lobby receives in membership dues.
Adding catastrophic coverage to Medicare, while restraining the ability of Medigap plans to waste money, is a key to Medicare reform, one that has been a big part of bipartisan plans in the past. According to the Kaiser Family Foundation, the Medigap reforms that AARP blocked would have saved the average senior as much as $415 in premiums per year.
But the AARP aggressively, and successfully, lobbied to keep Medigap reforms out of Obamacare, because AARP receives a 4.95 percent royalty on every dollar that seniors spend on its Medigap plans. Reform, DeMint estimates, would have cost AARP $1.8 billion over ten years.
The U.S. spends twice as much as other industrialized nations on health care, $8,936 per capita. Yet our system performs poorly in comparison and still leaves 50 million without health coverage and millions more inadequately covered.
This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.
And I know something about this company. I worked for one of its hospitals for six years, and parted ways after discovering and reporting to senior management how its middle managment staff was knowingly violating the agreement between HCA and the Federal Government for a PREVIOUS infraction that had cost HCA hundreds of millions of dollars in fines. Senior management at the hospital did nothing about it, but they sure gave me the parting package I requested (and I was an administrative flunkie).
Reuters, August 12, 2012
HCA, in an unusual move, issued a detailed rebuttal defending itself ahead of the publication of a New York Times article that said a complaint by a nurse at an HCA hospital in Florida led to an internal investigation that uncovered evidence of unnecessary heart procedures being performed at some of the company's hospitals.
The Times reported on Monday that HCA found cardiologists at some of its hospitals, mainly in Florida, were unable to justify many of the procedures they performed between 2002 and 2010. In some cases, the doctors made misleading statements in medical records, the paper said, citing internal company reports.
At that level we the people (those who actually work for a living) don't need insurance at all.
Maybe a small homeowner type backup for special events.
Only the hospitals need it (to protect them from the occasional bankruptcy).
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Originally Posted by Captain_Fingers
That would only work if basic care becomes affordable, which it is not as we speak.
At the level that most of us experience medical services... it is affordable.
More expensive than it needs to be... but still within "affordable".
The point being made is that most of us are mostly healthy and don't have much need for much care.
So if all we had was one incident a year and if it cost $500... that $10 a week is affordable.
In my case I'll spend far more for dental care per year than I've ever spent on doctors.
Quote:
You don't want to have to spend $ 500 to get checked out for a cold
and then pay another $500 for 5 days of antibiotics.
Sure don't. The last time I did need a doctor I paid $85 at a "Doc in a Box" to be checked
out and then $10 for the antibiotics. That's affordable.
The last time I needed to see a doctor before this was sometime in 2008.
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We definitely need the 100% actuarial base, but we're nowhere near having that now.
If you're over 65 you have it, and if your income is below a certain level you have it.
The people in the middle have nothing, and this is the reason people lose their homes when they get seriously ill.
Exactly correct. People who have homes have incomes (that can be budgeted) to cover *most*
of the care they'll need until they get to the really expensive stuff.
Once that line is crossed... shift them into medicare. Even at 45.
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The positioning of the line will no doubt draw intense opinions, as well it should.
I may not agree with the 30-yard line, but I completely agree that it must be discussed.
That is one very good reason to get rid of employer-based health insurance. There are others too, like being able to compete in the global market, the reduction of the compulsion to stay with an employer solely for insurance, the increase in the number of small businesses because owners don't have to worry about health insurance either for themselves or for their hires.
At the level that most of us experience medical services... it is affordable.
More expensive than it needs to be... but still within "affordable".
The point being made is that most of us are mostly healthy and don't have much need for much care.
So if all we had was one incident a year and if it cost $500... that $10 a week is affordable. In my case I'll spend far more for dental care per year than I've ever spent on doctors.
Sure don't. The last time I did need a doctor I paid $85 at a "Doc in a Box" to be checked
out and then $10 for the antibiotics. That's affordable.
The last time I needed to see a doctor before this was sometime in 2008.
Exactly correct. People who have homes have incomes (that can be budgeted) to cover *most*
of the care they'll need until they get to the really expensive stuff.
Once that line is crossed... shift them into medicare. Even at 45.
Which many doctors agree that dental, especially gum disease, is the root and source of many health problems. But look at the astronomical costs of dental work. Talk about a major prevention issue that I hear little discussion about.
If the English system is so good and the American system is so bad, why do we hear so many stories about friends & families in the UK raising funds to send patients for treatment in the US?
Why don't they just get the work done (at no charge!) in the UK?
Why don't we hear about people in the US trying to raise money to send people for treatment in the UK?
I had a medical rep at my house this afternoon extolling the features, advantages and benefits of an innovative (and expensive ) medical device. He was preaching to the converted because two separate specialists have recommended that I consider getting such a device during the past few weeks. My insurance company have agreed to pay 80% of the cost, which will leave me with a significant bill.
If I was in the UK, my co-pay would be zero because NHS treatment is free at the point of service. Unfortunately, if I was in the UK, I wouldn't get one because there isn't enough money to provide everything for everybody and my case would not have sufficiently high priority.
If the English system is so good and the American system is so bad, why do we hear so many stories about friends & families in the UK raising funds to send patients for treatment in the US?
Why don't they just get the work done (at no charge!) in the UK?
Why don't we hear about people in the US trying to raise money to send people for treatment in the UK?
I had a medical rep at my house this afternoon extolling the features, advantages and benefits of an innovative (and expensive ) medical device. He was preaching to the converted because two separate specialists have recommended that I consider getting such a device during the past few weeks. My insurance company have agreed to pay 80% of the cost, which will leave me with a significant bill.
If I was in the UK, my co-pay would be zero because NHS treatment is free at the point of service. Unfortunately, if I was in the UK, I wouldn't get one because there isn't enough money to provide everything for everybody and my case would not have sufficiently high priority.
Incredibly unfair view of the NHS. No, Brits are not coming to the US in droves for the vastly superior healthcare here, which is what you implied. As for Americans going to the UK for treatment, that technically isn't legal. Aside from emergency care, you cannot just go to the UK for treatment.
I used the NHS for 24 years of my life and had no problem with it. It has its faults like everywhere else, but it generally works and the tide of public opinion in the UK is overwhelmingly in support of it. Reform is of course needed in places, but it still delivers and at a much lower cost to the end user than the US system.
Healthcare in the US is great and state of the art, IF you can afford it.
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Here's how for profit SCREWED UP Obamacare
) medical device. He was preaching to the converted because two separate specialists have recommended that I consider getting such a device during the past few weeks. My insurance company have agreed to pay 80% of the cost, which will leave me with a significant bill.
