35% of Health Care Insurance cost are Pure BullCrap

[FreakinDJ]

20% of Hospital cost goes to cover "Un-reimbursed / Uninsured Medical Cost" and 15% increased operating cost (admin cost) to cover the legions of lawyers and plan administrators dedicated to denying your claim.

Let me see

12 x $866.00 /.35 = $3637.20 per year

Shit I'd love to get a Tax Cut that big but I'll gladly settle for the decreased Health Insurance cost

Let me see - I could pay down my credit card with that money

or it would go to 1/2 the cost of a New Roof for my home

or I could plan a nice vacation for me and my wife

or I could make a down payment on a New Harley

or I could blow it on stippers down at the Nudy Bar

The possibilities are endless

[sharesunited]

1. Those are actual costs which you simply object to the hospital attempting to pass through.

By the way, in the category of administrative costs, please remember to include medical malpractice insurance premiums.

It is a mistake not to address tort reform in any comprehensive reform of health care financing.

And most of the legions of pencil pushers I would be willing to defend as being dedicated to billing and collection, not denying care, because of the level of detail required to demonstrate legitimate delivery of covered services.

Hey, and what about cable TV delivered to hospital rooms? Have cable TV subscription fees EVER gone down? No, they only go up up up.

[warren pease]

2. Ummm... not exactly

First off, some things are simply too important to be left to the vagaries of the alleged "free market." It has absolutely no place in a real health care system, such as the ones found in all truly civilized countries, where health care is a right and not a privilege. Remember that tired old saw about "...life, liberty and the pursuit?"

Health care is what happens when patients and health care professionals – doctors, nurses, technicians, researchers, epidemiologists, pathology lab staff and so on -- collaborate to, in the best case, successfully diagnose, treat, alleviate and/or eliminate a patient's medical problem(s).

Insurance is the protection money you're compelled to pay the leg-breaking racketeers in the middle to enable this transaction. This isn't a health care system. It's just another corporate shake down. Premiums are protection money paid to legalized extortion syndicates, who then allow you to keep most of your stuff – house, car, pre-Columbian art, stamp collections, et al -- if something serious (i.e., expensive and maybe requiring hospitalization) happens to you.

Look up "medical loss ratio" and realize that the additional 20 percent to 35 percent overhead goes to:

Outrageous exec compensation; shareholder return; obsessive paper pushing; outside investments in such things as real estate and hedge funds; motivational junkets to the Bahamas for execs and their girlfriends; salaries and perks for armies of actuaries and claims "adjusters" (whose real job is to "adjust" your claim down to zero via technicalities or, if they can't find any, just make shit up); and so much more... none of which has anything whatsoever to do with performing the job their corporations are chartered for: paying medical claims to health care providers for their subscribers.

That's their only job, and they manage to fuck it up, refuse to do it and pervert it until it's unrecognizable.

So you get crazy situations like this one, sent to me a couple of years ago when I had asked people to send me their own horror stories. I was writing this article comparing Americans' experiences with the US medical extortion racket and contrasting them with the experiences of people seeking identical procedures and living in actual civilized countries. You can read the anecdotal results at the above linked article.

In order to get three simple blood tests performed this
week, I had to do the following yesterday:

1. Phone call to primary insurer to ensure coverage
2. Phone call to secondary out-of-state contractor to find approved lab
3. Phone call to doc's office to get procedure code--not known
4. Phone call to first (erroneously chosen) lab to get procedure codes
5. Phone call to secondary insurer to give procedure codes. Lab is
not approved even though the hospital it is attached to is approved
6. Phone call to approved labs to find out whether I need new
form--no answer at either facility
7. Series of six runaround voicemail messages at lab 1--after
reaching correct person, I get cut off
8. Series of four runaround voicemessages at lab 2--asked to be
called back and never am
9. Direct call to lab 2 to confirm procedure code--must have new form
from doc
10. Phone call to doc to get new forms--two voicemail messages
11. Phone call to lab 1--no new form required

All of this required two hours of my time. For one blood test. In all
I was transferred or left a voicemessage or had to listen to menu
options a total of 22 times. For one blood test.

And this is after the secondary insurer misinformed me that all the
facilities of an approved hospital are within the network. They are
not. Just because a lab is contained within a hospital, employs
hospital staff, and bills through the hospital does not mean that it
is part of that hospital.

As Christopher Murray, M.D., Ph.D., Director of WHO's Global Programme on Evidence for Health Policy said recently regarding a new version of the 2000 study that only ranked the top 50 countries (the US was 37th again):

"The position of the United States is one of the major surprises of the new rating system. Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries." Swell. Sounds like the very apex of applied modern medical science.

[sharesunited]

3. For-profit health insurance deserves to be excoriated.

But you wouldn't use the pejorative "protection money" to condemn a share-the-risk model, would you?

Collecting premiums from a large group to cover the expenses of the few who need care at any given moment?

Squeeze out the perks and junkets. Squeeze out the shareholder dividends. Squeeze out the lottery ticket malpractice awards.

The pure protection achievable through the law of large numbers isn't inherently unwholesome, is it?

And a public option with continuous open enrollment is a realistic way to get us there.

[Hannah Bell]

4. no, but the overhead to insurance cos is outrageous, as the poster said.

[warren pease]

7. Yes in fact I would call it what it is: protection money

>But you wouldn't use the pejorative "protection money" to condemn a share-the-risk model, would you?

Actually, I would. Having lived through the 1989 Bay Area quake and watched the difference in how FEMA (back before FEMA was the blanket agency for a nascent national security state) and private insurers treated quake victims, I'd have taken FEMA in a heartbeat.

FEMA operated on the assumption that quake victims were telling the truth, and then investigated to determine the extent of the damage and what it would cost to restore normality.

Private insurers' claimants were assumed to be lying unless they could prove otherwise. Avoidance of liability was legendary (and any payouts correspondingly minuscule or nil) and reminiscent of how medical insurers dispatch their armies of investigators to find those magical pre-existing conditions -- like denying coverage for essential procedures because a subscriber forgot to list a broken toe that occurred 40 years previously. Details upon request.


>Collecting premiums from a large group to cover the expenses of the few who need care at any given moment?

See below re law of big numbers.


>Squeeze out the perks and junkets. Squeeze out the shareholder dividends. Squeeze out the lottery ticket malpractice awards.

No argument there.


The pure protection achievable through the law of large numbers isn't inherently unwholesome, is it?

That's the whole point behind single-payer: spread the risk over the largest possible number which, in this case is the entire population of the US.


And a public option with continuous open enrollment is a realistic way to get us there.

The public option is a way to placate the citizenry while making sure the industry stays in the game. Single-payer works everywhere it's been tried, lowers costs dramatically and is about as far from socialized medicine as the asteroid belt is from earth.

It's real simple. Single payer means:

* One nation, one payer

* Everybody in, nobody out

* No exclusions for pre-existing conditions

* No doctor bills

* No hospital bills

* No deductibles

* No co-pays

* No in network

* No out of network

* No corporate profits

* No more medical bankruptcies

We need look no further than Medicare for a domestic single-payer that works. It would work far better if our wingnuts in congress would properly fund it, but even though it's intentionally hobbled by the old "death by budget" game, it's intrinsically more egalitarian.

The rich will always have better everything. Else why bother being rich? This is simply an effort to tilt the playing field back toward class/caste equilibrium. To the extent it works the way Canadians say it does in the article cited in my previous post, single-payer seems the way to go.

Of course, if we've decided to abandon any pretense of a government of, by and for the people, as well as promoting "life, liberty and the pursuit of happiness," then by all means keep the the existing menagerie, since triaging on bank balances rather than medical necessity is what it does best.


sf

[FreakinDJ]

5. What percentage of Malpractice is due to Denied Coverage

This personally happened to me

I had an injury in my spine and the Doctor refused to treat it. Kept giving me muscle relaxers and sending me back to work. I finally had to hire an attorney to force the doctor to treat the injury and by the time the injury was finally treated it was 200% worse then when I originally sought treatment.

BTW: the administrative Cost I am refering to are any and all cost above what medicade charges (1.5%) Insurance Co. have administrative cost of +16% which pays for Lawyers and Plan Administrators - who which by the way are the ones to decide which claims they deny to increase their profits

[sharesunited]

6. Yes hospital administrative costs are what I was trying to defend. Insurance companies not at all.

And you are so right that proper diagnosis and care are the stitch in time which saves nine.