Is the participation of insurers in health care immoral?

[chapdrum]

That is the general question I'm posing.

[Ed Suspicious]

1. If they were simply administrators who made sure the books balanced,

then no. Add in profit motive and you have a great Satan.

[Baobab]

24. They have known the insurance system would not work since 1992

thats the last year a majority of working Americans (more than 50%) could afford adequate health insurance to prevent bankruptcy.

Now the percentage is tiny, its probably less than 15%. (the last figure I saw was more than 10 years ago and it was 14% then. And prices, especially drugs have soared since then, and health insurance has become MUCH more expensive.

But - we're stuck because of something horrible done in the Clinto era..

[ret5hd]

2. IMO, yes.

[Buzz cook]

3. Not in and of itself.

Several European nations use a health insurance network, Switzerland and Germany for two iirc. Those countries have health care we should be envious of.

The problem we have in America boils down an abysmal lack of regulation and oversight. Or you could just say the profit motive is more important than lives in America.

[Baobab]

25. but they had the regulation before they joined the WTO.

Canada has a single payer system because it was grandfathered in. We're trying to make new public services impossible.

[Peace Patriot]

4. YES!

[Vinca]

5. Yes, if they are "for profit" insurers.

The only way to make a profit is to gouge the premium payers by either raising rates or denying care.

[Hoyt]

8. Unfortunately, most people don't select not-for-profits and a number of cooperatives went belly up

last year. I was fine with Kaiser when I had it, but most people would howl.

[Baobab]

27. collecting money for years and then dumping them with huge bills when they get sick.

Thats a guaranteed winner.

Simply wasting half of every health care dollar helps a lot with making it seem much more unaffordable than it should be. But the #1 reason things are so bad is this:.

"For the purposes of this Agreement…

(b) 'services' includes any service in any sector except services supplied in the exercise of governmental authority;

(c) 'a service supplied in the exercise of governmental authority' means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers.

[MgtPA]

6. Clearly, yes.

Human ticks.

[nolabear]

7. As a mental health provider I have seen some things, let me tell you.

We get our diagnoses and treatment choices challenged all the time by evaluators who have never laid eyes on the patient. Countless unpaid hours are spent trying to carefully dot every i, cross every t and predict what the next claim will be that denies insurance for treatment and recommends a drug or some cheaper, far less effective treatment instead. If ever you think we make too much money, you can cut most of our pay by at least a third as we fight insurance companies on our patients' behalf.

[TeddyR]

9. I hate having to deal with my insurance company

And have had many a dispute over denied claims. At the same time, they do provide what is for us a valuable service. For example, our daughter needed surgery last year for migraines and the insurance company worked with us on making sure everything was covered.

With respect to denied coverage, there are providers who recommend unnecessary treatment or excessively expensive treatment when something less expensive might work. I think that is rare but it does happen. And of course there are individuals who seek treatment with out of network providers and coverage is denied for that reason. That was the primary concern with my daughter's migraine surgery -- making sure we could find an in-network facility.

[chapdrum]

16. I've a sibling subject to migraine;

if you're inclined, I'd be interested to learn of what the surgery entails.

Thanks.

cd

[TeddyR]

21. Sure

The surgery involves implanting an electrical stimulator -- basically a battery -- in the upper chest and running wires the under the scalp that receive electrical impulses that block the pain. Our daughter had suffered from migraines for about three years and received immediate relief following this surgery, and the relief lasted for about a year. However, the migraines recently returned so we are exploring how to correct.

[surrealAmerican]

20. That's a really good point.

You would have more time to spend on your patients if you didn't have to "work with" insurers.

[arcane1]

26. That's how they make their money, by denying payment.

How could an industry like that be anything but amoral?

[Dont call me Shirley]

10. uh, YES!

[Downwinder]

11. Is gambling immoral?

They are netting you are going to be well.

You are betting that you are going to get sick.

[chapdrum]

14. Betting that we'll get sick

is an easy one, or am I missing something?

[TheProgressive]

12. Yes, the health industry is completely wrong and immoral...

Health insurers are noting but money-changers who do not provide one iota of 'health care'.

That's immoral enough, but then add in the fact they do everything possible to not pay for
the health care you do receive.

The health insurance industry is a crime against humanity...

[Dragonfli]

13. Yes because they only exist to deny healthcare and actually provide none of it

Not a single health insurer employee so much as applies a band aid, they are a completely unnecessary middleman.

They actualy profit off of misery every time they stand between the patient and the care needed from a doctor. Sometimes they even kill people by doing so.

They are nothing more than vampires that feed off our illness and misery.

[WyLoochka]

15. Health insurance companies add no value

They drain value being that they are basically unnecessary duplicative billing offices. As such, they add a staggering amount of inefficiency when one considers it would be much more cost effective to simply use the billing office we already have for folks 65+ - Medicare - and just open it to all of us, cradle to grave.

Medicare operates at around 3-4% admin cost. Before the ACA, private insurance operated at 30-40% admin cost. The ACA required private insurers to improve their efficiencies so as to operate at 20% admin cost.

It was a step in the right direction but that padding of 16-17% to prop up unnecessary, value siphoning, private, for profit corporations is still a huge waste of money that could be better used to pay the actual health care providers.

[Yo_Mama]

22. Medicare billing is handled by private cos, often owned by insurers. There is no Medicare billing

office. They bid for the service contract by area.

Some of them are pretty bad, too. Private companies take the claims and process or deny them, then they forward the net to CMS and CMS issues the check. They also set policies and so forth.

Here's a pretty current list of the MACs (Medicare Administrative Contractor).

So, take Highmark, which became Novitas Solutions, which is owned by DSO, which is wholly owned by a Blue Cross Blue Shield.
http://www.govhealthit.com/press-release/novitas-solutions-starts-medicare-jh-contract-work-jobs-coming-soon

You have to follow the legal spaghetti, but in the end these are insurance cos.

[WyLoochka]

29. That sucks

I stand corrected.

Perhaps you can explain the difference in the admin costs? Thx.

[Jim Beard]

31. Damn I hated hearing from a right wing nurse that Blue Cross administers Medicare in Texas

[pnwmom]

17. Non-profit health insurers are doing a service and are not immoral.

They should all be non-profit.

[DirkGently]

18. Health insurance is just a systemically bad idea, really.

As someone else here noted, someone probably has to connect patients with health care providers. The huge problem comes when that administration is done as a for-profit business that must, by the very nature of the thing, somehow extract billions of dollars from the process.

Sure, they could make things "profitable" by encouraging efficiency, but that only goes so far, and nothing is ever far enough when it comes to corporate profits.

So the profit ultimately comes by reducing care to patients, and compensation to providers. The whole framework of reimbursement for discrete services is not a health care model, but rather a way to pin down costs in rigid ways that can then be chiseled away, inevitably again by reducing care and provider payments.

None of the touted benefits of free enterprise apply in a system like this. There is no real competition, because people can't really "shop" for health insurance; even under the ACA, they mostly take what their employer gives them, period. And there are so few insurance providers to begin with that they can easily prevent any kind of superior way of doing business from emerging.

It's not even really "insurance." Insurance is a pooled distribution of risk, like the risk of car accidents or fire. Health care problems happen to everyone -- more so to some people, like the elderly -- but ultimately health problems aren't a "risk;" they're an inevitable cost of staying alive for literally everyone.

What we've got is a forced brokerage system, where a multi-billion-dollar industry dictates how health care works on both the patient and the provider sides to ensure it gets richer every year. Their "customers" will never walk away, because (haha) they can't.

No one has to twist their mustache for evil to happen. All it requires is the ungoverned application of normal human greed and short-sightedness, and the unwillingness of enough people to do something about it.

[Jim Beard]

32. I wonder how a cooperative would work?

Starting during the Populist and Progressive Eras, Farmers started marketing their grains and cotton through area co-ops. Each farmer was paid market but at the end of the year, any profits were returned to the producers. I don't know how the ratio is figured. I still get divided checks from my Depression Era Telephone and now internet provider and my electric provider. ( The electric provider spent money on a power plant and didn't pay for several years.

There would have to be a larger real insurance company to cover losses.

May not work because profit isn't the motive but losing less is.

[Doctor_J]

19. Absolutely. At least the participation of profiteers.

[TeddyR]

23. So what does everyone propose as an alternative

To insurance companies providing health insurance? I'm far from an expert on health insurance, but I think our system often -- certainly not always -- works well. I have no idea how England's system compares to ours, but here's a story about the failures that occur in England's system -- http://www.liverpoolecho.co.uk/news/liverpool-news/20-month-old-birkenhead-tot-11065383

[BillZBubb]

28. It has become so, yes.

[Rex]

30. Well yes, but they are not alone.

A lot of foxes 'guard' the hen house.