It’s not been a particularly good week for feeling warm and fuzzy about your health insurance carriers.
First, earlier this week, the LA Times did a story revealing that Blue Cross, “the state’s largest for-profit health insurer,” was trying to get California’s physicians to be on the lookout for conditions that the Blue Cross folks might use to cancel new patients’ medical coverage.
(The next day Blue Cross claimed that its intentions were horribly misunderstood and it was back-peddling on the strategy.)
Then yesterday, New York’s Attorney General, Andrew Cuomo, held a press conference at which he reported… “an industrywide scheme perpetuated by some of the nation’s largest health insurers to deceive and defraud consumers.”
How cheering!
Here’s more from the New York Times:
It is a common medical puzzler. The benefits statement arrives from the insurance company, saying that although the doctor has charged, say, $200 for that recent office visit, only $80 is covered — and the consumer is obliged to pick up the balance….
Mr. Cuomo announced a sweeping investigation into whether health insurance companies have systematically forced patients to pay more than they should when using doctors and hospitals outside their insurer’s networks.
According to the LA Times, the alleged scheme “could affect 70% of Americans with health insurance coverage.”
It seems that the nation’s largest health insurers —among them UnitedHealth Group, Health Net, Aetna and Cigna—have been cheating patients by rigging the rates companies pay physicians and forcing consumers to pay higher medical bills.
[SNIP]
At the heart of the case, [Cuomo] said, is Ingenix, a company that sells data the insurers use to decide how much they will reimburse patients for out-of-network visits to physicians.
Cuomo said that insurance companies typically use the data to lowball the amount they pay these out-of-network doctors and that most policies require consumers to make up the difference.
New York officials said 70% of people with health insurance are on plans that require them to pay a higher fee for the right to use physicians who are not under contract with their carrier. Such out-of-network arrangements often require the insurance company to pay 80% of “reasonable and customary” rates for physician services.
The investigation found that poor and distorted data from Ingenix allowed insurers to keep their reimbursements down by lowballing local market rates for various types of physician services, investigators said.
For example, the investigators said, insurers knew that most physicians charged $200 for a routine visit. But the insurers, using Ingenix data, claimed to their members that the typical rate was $77. Applying the 80% reimbursement rate, they covered only $62, leaving the patient to pay $132 out of pocket.
“Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is,” Cuomo said at a news conference. “But when insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need.”
Right. And this is exactly why health care is one of the biggest issues in this year’s presidential race.
PS: While you’re at it, have a listen to this Terry Gross interview on the three front-runners’ health care proposals (Dem and Repub). It’s informative and seems even-handed.
God knows we’ve got to do something.
We have to do something? Why does that mean a take-over of our health care by government rather than tweaking the private system that we already have? So, let’s just have the government take over all private enterprise? Oh, wait. That’s what the Democrats will do.
Well, I see more incompetence, waste, and dishonesty in government programs. Go back and read your own articles on King-Drew Hospital while I read current articles about Atlanta’s Grady.
There is nothing on the table – even single payer modeled after, say, France – that mandates “takeover of our health care by government.” Please educate yourself to the actual proposals. I would be more than happy to have the government “takeover the private health insurance industry” and institute a system comparable to the French because the insurance companies ADD NO VALUE TO THE SYSTEM. None! They suck money off the top, attempt to limit access to their product to those who are less likely to actually use it AND enforce a degree of rationing that Woody would be screaming about if Hillary Clinton were the person telling you to get your mother out of the hospital by sundown or it’s coming out of your own pocket. There is NO empirical argument for the present system of health insurance – only an ideological belief in the virtues of “markets” whether or not they are real. In the case of our current health care and insurance system, the “market” argument is bogus. And claiming that any Democratic plan – including Kucinich’ – that is predicated on the government taking over the health care system. It’s all about whether or not everyone is guaranteed insurance. Even Kucinich’s single payer plan – the most “left” and “eliminationist” so far as the insurance companies are conerned – is virtuall identical in concept to instituting a universal “school vouchers” program – which libertarians and conservatives – along with some liberals – argue for as a way of introducing competition into an obviously bureaucratic and often dysfunctional system – than setting up a state health care bureaucracy that in any sense replicates the existing public school system.
“And claiming that any Democratic plan – including Kucinich’ – that is predicated on the government taking over the health care system” should have read “And claiming that any Democratic plan – including Kucinich’ – is actually predicated on the government taking over the health care system is false – or at best so misleading and ill-informed as to constitute rhetorical malpractice.
Sorry about the rest of the mangled grammer and typos, but the points – though written in haste – stand.
I’ll reiterate that the U.S. government spends about the same per capita on health care as the French government, without achieving universal care and showing outcomes that are no better and, arguably, worse in notable areas. That doesn’t include the consumer budget for private insurance, which makes our per capita spending ridiculously high with nothing to show for all of the (rapidly increasing) expense. I’ve never seen anything convincing coming from conservatives on this except special pleading, attempts at end runs around empirical data and a belief – akin to an old communist’s – that they MUST be right because all of their ideological predilictions tell them so. Sanity is beginning to prevail among what is probably a majority of Americans who are moved by their own experience with the system by now and – like the Iraq war – the notion that the GOP has anything even remotely approaching credibilty on health care – much less a “solution” – is being roundly debunked in that arena of so many broken dreams – the real world.
Here’s a question for John McCain. As the Son and Grandson of Admirals who then went into the Navy via Annapolis and served honorably – including those years as a POW – and then retired and ran for public office, first as a Congressman and then as a Senator, WHEN has he ever had anything but a Govt. payed for health scheme. In fact, for most of that time he had a Govt. Health provider as well – rather like Britain’s NHS.
(And I assure you that the military doesn’t give you a choice of physician and there are waits for elective procedures. Didn’t bother me when I was in and it sure didn’t seem to trouble the three generations of the Mccain family that availed themselves of it.)
Screw France. Maybe if they spent more on their military and less on health care they wouldn’t always need the U.S. to protect them. Also, you presume that any system the U.S. would adopt would include the best of existing socialized medicine rather than the worst. Don’t be so sure.
If the Democrats cared more about U.S. citizens than their own power to conntrol them, then they would allow tax incentives for private coverage and would kill the malparctice lawyers.
I threw a theoretical at a client who has an IRS lien the other day. Suppose he went to the government emergency room and they accessed his master file. It would go something like this, “Oh, Mr. X. We see that you owe the government money. Now, we’ll take care of you, for now, but you will have to speak to the IRS liaison before you leave.”
Do you think that he would have second thoughts before he ever went or ever went back? The government will force the creation of “back-room” medical clinics for more than just illegal Mexicans.
So I guess when your client goes to SBA for a loan or to Ag for his adjustment check this doesn’t happen?. Or for that matter when those nice people from the Census Bureau come around.
Woody, the rest of the world spends far less and has better outcomes. Its documented a hundred ways from Sunday in a thousand different reports – the UN’s WHO, the OECD, Lancet, Harvard and Johns Hopkins Schools of Public Health, and so many more.
Our system doesn’t work. It kills people like Natalian Sarkissan, the 18 year old who thought , as her parents did, that she was covered by their CIGNA policy. But saw here recommended course of treatment – by docs at World-class UCLA Med Center – disapproved by bean counters there.
See Kevn Drumm today over at Politcal Animal. An article on the myths of Candian Health care. How docs there get by with one assistant and don’t need an office staff to argue with the insurance companies over reimbursement. How a doc here has a workweek of about 70 hour – 35 practicing medicine and 35 on the phone trying to get the insurers ro shell out.
Only someone who has never been sick or is making money over this this crappy system defends it. And NONE of our reps in DC would deign to live under it. No, its govt paid health care for them!
rlc, for every horror story on U.S. medical care, I can produce two for socialized medicine. Your sources are quite suspect, btw. I’ve never seen a study by the U.N. that didn’t call for more centralized government control. Rather than matching stories, use your common sense–government is inefficient, incompetent, and corrupt. I’ll take my chances with my choices rather than theirs.
I think this debate really iterates the larger conversation taking place: Democrats say there’s a terrible problem that needs to be fixed with increased government involvement, Republicans say that the Democratic solution is terrible and will lead to the distopia of socialized medicine. The reality is that our medical system has serious problems and while middle-class voters are risk-averse in terms of making major changes to the system, the conservative argument lacks direction and only measure success in it’s ability to keep the status quo. And long term, that isn’t gonna work.
Maybe if they spent more on their military and less on health care they wouldn’t always need the U.S. to protect them.
Allow me to slap you with the facts yet again:
Keep that knee jerking.
Randy, what an absolutely stupid reference to “disprove” what I said. France benefits from the U.S. presence all over the globe, including protecting their oil interests with no help from them. We’ve bailed their rear-ends out in two world wars. Get real.
Ahh, Woody. More name-calling and less truth. So typical.
For good or for bad, France has sent it’s troops to several places where US troops don’t go: The DRC and Chad, for example.
V-E Day was nearly 63 years ago. As I recall, it wasn’t just the USA, hence the term Allies.
As for spending, France is number three in the world, slightly behind the UK and well behind the US, but ahead of China, Russia and Brazil, three nations significantly larger than France.
One wonders if you actually have an original thought in your head or if you merely spit back recycled RNC, talk radio and Newsmax talking points.
Wow! Chad’s a real threat to the U.S. Thank you, France! Maybe they found one place where they won’t lose and be embarrassed.
Wow! Chad’s a real threat to the U.S. Thank you, France! Maybe they found one place where they won’t lose and be embarrassed.
Chad borders Darfur. Still couldn’t address the facts. So typical of your buffoonery.
Chad’s rebels may also be getting aid from Sudan. There are some allegations that they may have ties to radical Islamists.
BTW, France foiled a plot to bomb the US Embassy shortly after 9/11, breaking up a major Al Qaeda-linked cell in the process.
New poll out from the Kaiser Health Foundation. If you define “Socialized Medicine” as a system where both the financing of medical care and its staffinf (i.e. state run hospitals with govt paid doctors and other health professionals) how do you feel about adopting such a system:
Approve – 45%
disapprove 39%
In other words, with the GOP and the Insurance lobby and their “Useful Idiots” like Woody spouting nonsense about a system that NO ONE HERE is advocating (what we’re advocating is govt vouchers to pay for private care – like that Woodster?) the public is basically split with a slightly larger cohort saying yes.
I think our system is so broke and so many people have horror stories that they’re will to try anything.
Another triumph of the market!
The market hasn’t spoken. There has been an extensive ad campaign to convince people to accept something that they have not seen. Maybe passing around this article from a country with socialized medicine would cause them to reverse their views.
http://www.telegraph.co.uk/news/main.jhtml;jsessionid=051FGMFR2EG1RQFIQMFSFFOAVCBQ0IV0?xml=/news/2008/01/27/nhs127.xml
“Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives. Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.
“About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt. Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.”
Really, if you guys want the govenment to be your nanny, adopt these crazy plans in California and we’ll see how great they work before we adopt them. Make it a state issue, not a federal issue.
Woody should get together with the Reading Comprehension specialist. The point of the poll, as I thought I made it clear, is a proposal WHICH NO HERE IS ADVOCATING now draws equal support in polling. What we’re talking about, of course, is a system in which the financing is done thru a Govt (not-for-profit) Health plan which reimburses the health care providers who are PRIVATE. Like Medicare. Like Medicaid, like S-CHIPS. All wildly popular. Of course if you like “Socialized Medicine” there is that option. And you’ll find it in the VA which, according to Harvard and the BEW ENGLAND JOURNAL OF MEDICINE, is offering high quality care at a cost lower thatn Medicare. Problem there was the GOP’s unwillingness to fund it so that a wait list of 600,000 vets exists to use the facilities. Then there is the Military Medicine system which isd as socialised as can be and which, as I noted above, was John McCain’s principal source for care as a kid, at School and in the Navy – and it was good enough for dad and grandad as well and all their depenedents. Did the “Torygraph” look at that?
Everything rlc said…
I very much doubt that McCain has a medical plan with no choice of doctors and a wait for elective surgeries — those are hardly what Obama and Hillary are referring to when they talk about offering everyone the Congressional Health Plan.
Woody is right about the downsides of single-payer in other countries. However most everyone does better in working to offer treatments as an alternative to major surgeries that are common here because they’re highly reimbursed, and the only way the doctor can make any money off you. (The fact that hysterectomies are so common here, when less invasive procedures are available, is a disgrace — but it’s a very highly paid procedure and easy to perform, bread and butter to an OB/GYN office.)
It’s true that healthcare here is too insurer driven, and people are afraid to reveal pre-existing conditions to their doctors, not just because of this Blue Cross scandal. A family of 4, healthy with two kids, can pay almost $15K/year for an HMO, and yet when you go to the doctor, some uneducated asst. comes out, treats you like something to process through the system taking your stats, then the doctor comes in and thinks “Just $20 reimbursement for seeing this patient, so let me see what reimbursable tests I can run…” Their negotiated rates are often that low, whereas an out of pocket patient might pay $200 a visit.
So the doctor and patient both suffer, and the insurer benefits. Their CEO’s are overly compensated, their overhead and staff numbers are way too high, and they have luxurious offices while many doctors even in Beverly Hills are struggling to pay their rents and malpractice bills.
But neither Obama or Hillary offer anything specific enough in terms of “fixes” to convince me they can deliver. (Yes, I have pored through their policy papers and speeches.) They’d have to start by taking on the big insurance companies and stripping them of much of their stranglehold on the medical industry — good luck. They both talk about persuading doctors to help them in this: how?
By the way, in France, Canada and other single-payer societies, doctors don’t expect to be paid exhorbitant salaries or be treated like G-ds. They treat patients as equals and try to treat them without regard for financial incentives per procedure: so if any electeds can knock the doctors and insurers down to size, and make the system patient-centered, great.
On the negative side, they don’t have the quality assurance and risk management models we do, don’t even know the cost per procedure because they just offer services until the money runs out, then start to ration or close down facilities (many in Canada have closed, as tax revenues are down — kind of like our county facilities are faced with now), and they do indeed as Woody quotes about the UK, deny anyone over 65 from many procedures like organ and corneal transplants. (Penalizing the obese, smokers and alcoholics who’ve ruined their livers by choice makes sense since they’re subsidized by those who make healthy choices, but it seems uncivilized to just let them die.
The Democrats want no one to be excluded regardless of their condition, and that’s the humane thing to do, but that will raise rates overall despite added taxes. And what will adding millions of illegals to the pool do to the private hospitals like Cedars, UCLA and St. John’s, or will this just mean more federal oversight for county hospitals and continuing the two-tier system? Even liberals wouldn’t stand for waiting in clinic-like lines at these hospitals.
I’m all for radically reforming the system, starting with stripping insurers of their stranglehold on the system and the money they suck away from patient care, and getting doctors to “see” patients as people and not reimbursement figures dancing in their heads. This is the one thing Obama says that I’d like to see (not holding my breath): that he wants doctors to see themselves as providing a social good and not just what they can get out of the system…any bets?
A different topic, that Celeste may post as a thread anyway:
What do people think about the shooter at the Oxnard Middle School being tried as an adult, for premeditated murder with special circumstances of possessing a firearm and a hate crime?
Of course what he did was heinous, but it seems the school and the victim’s parents were not doing their jobs as adults, given what had obviously become a very awkward situation. The victim, King, would go to school wearing heels, dresses and full makeup (according to the Daily News and other reports), and many kids were “freaked out” be him. What were the boy’s parents thinking, letting him go to school like that? (They left another school last year for similar bullying.)
Why didn’t the school administration sit down all the kids to discuss how to treat kids who are “different?” Was there a school psychologist who could have talked to them, and King? To talk to King’s parents, to see if they knew what was happening? (There’s a boy like that in our school, who went on a beach school outing wearing a tutu, but he just got raised eyebrows and was ignored. Big schools seem to be brutally conformist, though.)
Or, was bullying so widespread — there are supposedly tensions there between newly arrived Mexican gangs and some other groups — that the administration has just thrown up its hands?
There are two issues here: what the school could have done, and how the shooter should be treated by the justice system.
WBC, you read my mind!
rlc, if you open up that door to government control of health care, it will get pushed open wider and you’ll never stem the rush of more promises by politicians for more give-aways and more control until the health care package that Democrats pretend to want becomes the one that they really want.
” the health care package that Democrats pretend to want becomes the one that they really want.”
In the case of Obama, at least, who’s expressed a preference for single payer, but doesn’t believe it’s politically feasible given the existing system, that would be a very, very good thing.
Just saw this…
AMERICA IS SPLIT ON UNIVERSAL HEALTHCARE
Neil Boortz is your source? What? Rush was busy having his cleaning lady score some Oxycontin?
Shades of Jonah Goldberg ! When they’ve gotta switch from decrying “socialism” to screaming “fascism” in order to attack universal health insurance, the game has obviously been lost. I guess they’ve come to the conclusion that it was the folks on the left and liberal margiins who relied on accusations of “fascism” in attempting to make their critiques of the Bush adminstration stick who ultimately soiled the GOP brand in the public mind. If I had been one of those who cheered on each successive BushCo debacle as it unfolded, I guess I’d also like to think that it was periodic ventures into semi-hysteria by elements of the opposition that ultimately turned the tide of public opinion against “my side.” Mimicing the least convincing and most trivial memes of Bush’s “tormentors” apparently gives Boortz confidence that his even more spurious spew and dubious drivel can help rescue the right in coming months. Keep it coming…
There’s an article in today’s L A Daily News about the threatened closure of L A County’s 11 public health clinics, which have offered free routine care to the uninsured, mostly black and Hispanic minorities, and kept even more of our over- burdened ER and trauma centers from closing. This is because of the state stiffing the county by some $200 million for health care this year. (Since many of this patient population are illegals, and they’re a state and federal “problem” first and foremost, this is very unfair to L A County and City.)
BUT the curious thing is that Supervisor Antonovich claims the slack can be picked up by private providers who contract with the County — they treat patients for less than $100/ visit, vs. more than twice that by the County? Why is that? The fact that unions are the main objectors gives a clue, but honestly, I’m generally just trying to evaluate the healthcare crisis (which it is) in financial and practical terms, leaving polarizing politics out of it. I wish we had more bilateral, apolitical analyses and proposals. Like with financing mass transit or any huge social expenditure, the solution seems to be some public/private partnership, not either/or.
Orange County does not run any public hospitals but administers a program called “Indigent Medical Services” which provides care on a sliding scale (if your monthly earnings are less than $600 its completely free). IMS patients can visit any ER at any OC hospital for care. Not as good as having a private doctor but no ten hour waits either.
BTW since the County Govt. is picking up the tab I guess we god fearing republicans down here are into “Socializrd Medicine” errrr!