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| No. 10 | 
Jun 07, 2009, 05:47 PM
 Re: What do health insurance corporations do? Originally Posted by wowza  While I agree that in theory this could be a great good for the citizens of the united states, in practice it goes against many of the core ideals that this country was founded upon:
1) It creates a good for one class at the servitude of another. Providing health care for one group is not more just than taxing another to get it.
an example: If I needed a car, would you feel it was right to be forced to pay for my car? The "need" for a car is discretionary , wheras the need for healthcare , is usually obligated by a health condition that requires treament , (whatever the cause )
2) Giving the central gov't the power to supply the money for everyone's health care is a stone's throw away from full control. It will give the gov't the impetus to control how health care is delivered and later to whom(this is being done at present by the Insurance corporations , whose decisions are motivated by their need to creat profit for their shareholders, while the single payer would have no direct influence upon the course of treatment your physician orders . Never before in US history has the gov't been given such power over the life and death of ordinary citizens. This is a disconcerting possibility that we are facing.Having lived in a country with UHC , I never felt the same level of influence upon healthcare decision then as I do now under a private insurance system , whose decisions are driven by the bottom line .
Perhaps when it is first created there will be none of these dooms day problems I worry about but allowing your rights to be slowly chipped away will surely lead us there.
Whilst I am not against a system which enables providers to generate enough profit to finance healthcare provision , what I am against , is the existence of a middleman ( the Insurance Corporations )inserting themselves between the consumer and provider , making a vast profit , professing themselves to be indispensible , but fighting against a system that at least shows a reasonable promise of providing healthcare to all at a reasonable cost .
 | | Advertisement Sponsored Links | | | | No. 11 |
Jun 07, 2009, 06:15 PM
Updated
Aug 22, 2009 at 07:02 AM by sirI
Re: What do health insurance corporations do? Originally Posted by CRNA2007 Those who cry the loudest for the government entitlements are the ones who will fund it the least. I would love for nurses on here advocating government funded healthcare to have a $1000/ month taken right out of their checks to pay for it. They would be screaming bloody murder but when it is someone else footing the bill it is a moral obligation.
Whilst ( I guess you don't pay $1000 / month for your health insurance ) your position appears to be I'm alright jack and I don't give a ******** about the uninsured ( or those already paying $1000/ month ) , as long as they don't effect my income .
You appear to feel health insurance is a benefit to be earned either directly from your employer , or paid for directly by the individual from their income . I feel it would be a benifit for all of us if health problems could be adressed early by our PCP , reducing the number of people waiting until their health conditions demand expensive attention at an ER , followed by admission to hospital , which could have been avoided by seeking healthcare earlier .
I have never had to pay anywhere near $1000 / month , for healthcare , even when heaven forbid , I was covered by a UHC system BTW there was much less intrusion into healthcare decisions , there than here with my private insurer .I never once had to seek preapproval for a treatment . When I changed jobs I didn't have to worry that a propective new employer may decide against employing me , because by taking me on their insurance premiums would be jacked up , also there was no break or change in coverage from one employer to another .
No funding system for healthcare is perfect , but at least a single payer system spreads the costs over a larger pool of payers ( all tax payers ) and covers a larger pool of participants ( the whole population of the US)
| | No. 13 |
Jun 24, 2009, 12:33 PM
Re: What do health insurance corporations do?
I have family members who work for a small health insurance company, which I would argue is relatively un-evil. From what I can tell, a lot of employee hours, in this company anyway are spent...
- Building and maintaining a network of providers statewide in order to have a sizable base of providers for clients and to comply with federal regulations for 3rd party Medicare payers. This involves a lot of visits to remote counties, talking to PCP's and specialists and convincing them to sign up and remain affiliated with the plan, and then filling out a lot of paperwork to submit to the gov't to demonstrate this work and to appeal unobtainable requirements (for instance, in a county with zero cardiologists, there is no way they can contract with the minimum number of cardiologists per capita in that county)
- On a similar note, negotiating with hospitals and providers for fees. The bigger companies often have more bargaining power with hospitals, so those companies may get better prices for some services.
- Keeping up sales. This company in particular only sells to groups via employers and to medicare enrollees. So, they have a sales staff that maintains good relationships with companies to maintain and grow their customer base, and another sales staff to find new medicare enrollees
- Health promotions and cost reduction campaigns... so they have a staff of actuaries and nurses and physicians and other types of professionals figuring out how to maximize efficiency of care. Are there docs who are prescribing new and expensive drugs when older cheaper ones would just as well or even be safer? Are there things employers could do to promote employee wellness so their medical costs will be lower? Of new technologies on the market this year, which should the company cover? Are there hospitals they contract with who have lots of nosocomial infections? Do members need better access to health information and their medical records online? They look at these questions and try and come up with solutions.
- Customer service... pretty obvious. A lot of people sitting at the phone or at a computer helping frustruated people figure out how to fill out and submit their paperwork, and figure out what's covered and what's not.
- Legal stuff... they have lawyers figuring out the extremely complex and rediculous rules for health insurance companies in general and for medicare providers specifically to make sure they've filled out all their paper work and are following every rule to the letter. If you want to go to law school and get experience with these types of regulations, you could be very well paid to do this extremely frustruating job. Other legal stuff involves defending the company against lawsuits placed by frustruated clients (although this happens very rarely at this company... I think the big ones have pretty big staffs for this job). Also, occasionally placing lawsuits against other companies, hospitals, or government agencies acting in illegally in bad faith.
- Claims processing. When health care providers spend time filling out paperwork to submit to companies, someone on the other end is approving it, rejecting it, and filing it away. This would also involve considering appeals etc.
At least, that's what it seems like to me. I'm sure I'm missing lots of other stuff, and maybe slightly mischaracterizing something, but for this most part this is the work I hear about from my family.
| | No. 15 |
Aug 24, 2009, 03:14 PM
Re: What do health insurance corporations do?
Well, I just saw this topic today, and thought the responses very interesting. They reflect the opinions with which the proponents and opposers of reform of health care, have dug down, with little possibility of those opposing revision, changing their view.
The health care bill has been pummeled, and lost some of the main advantages its proponents wanted for so long. If it loses the public program for healthcare, all the concerns about uninsured and underinsured persons will be lost, and the insurance industry's fat cats will continue to be paid exorbitant amounts + bonuses for bilking the country of billions of dollars!
This will be known as the era of exploitation of anyone who is not in the realm of the highest paid members of its society, since representatives in government have not won the support needed to save most of humanity here, from the clutches of big business.
| | No. 16 |
Aug 24, 2009, 10:33 PM
Re: What do health insurance corporations do?
I also really wonder how much this whole "customer service" BS is wholly detrimental to patient care. Nobody really says in a lawsuit "oh, your nurse was so busy attending to the rude loud annoying family who brought their infant children along and bothered the nurse for cokes and snacks so while she was doing that your family member was going south" They just blame the nurse as if she was filing her nails for the whole time the family member was going south.
If hospitals quit acting like businesses, you'd see a lot of the BS out the window. Does your local fire station or police station have a marble fountain in the lobby? Doubt it, but when you call 911 you get three services, only one of which is not paid through local taxes. Why?
| | No. 17 |
Aug 25, 2009, 01:43 PM
Re: What do health insurance corporations do? Originally Posted by StNeotser I also really wonder how much this whole "customer service" BS is wholly detrimental to patient care. Nobody really says in a lawsuit "oh, your nurse was so busy attending to the rude loud annoying family who brought their infant children along and bothered the nurse for cokes and snacks so while she was doing that your family member was going south" They just blame the nurse as if she was filing her nails for the whole time the family member was going south.
If hospitals quit acting like businesses, you'd see a lot of the BS out the window. Does your local fire station or police station have a marble fountain in the lobby? Doubt it, but when you call 911 you get three services, only one of which is not paid through local taxes. Why?
My local police department and fire station don't have to spend money trying to convince me to call them when I've been mugged or my house is on fire instead of calling one of the three (or seven, or twelve) other police departments or fire stations in town ... If the hospitals weren't competing with each other like they're chain restaurants trying to lure customers in, if we as a society just made sure that there was a sensible system in place that ensured that everyone could get the care they needed in a reasonably prompt and efficient manner, that would probably reduce a great deal of the money spent on healthcare now just by itself.
I don't see why more people don't think of healthcare the same way they do other public services -- we all pay taxes, and we all have roads, police service, fire-fighting services, public primary and secondary education, etc., available when we need it. Healthcare is also an essential service in order for society to function -- why isn't it handled the same way? (We all pay taxes to make sure we can all get the services we need when we need them. It seems to be working for every other industrialized nation on the planet ...)
| | No. 18 |
Aug 25, 2009, 01:54 PM
 Re: What do health insurance corporations do? Originally Posted by wowza While I agree that in theory this could be a great good for the citizens of the united states, in practice it goes against many of the core ideals that this country was founded upon:
1) It creates a good for one class at the servitude of another. Providing health care for one group is not more just than taxing another to get it.
an example: If I needed a car, would you feel it was right to be forced to pay for my car?
2) Giving the central gov't the power to supply the money for everyone's health care is a stone's throw away from full control. It will give the gov't the impetus to control how health care is delivered and later to whom. Never before in US history has the gov't been given such power over the life and death of ordinary citizens. This is a disconcerting possibility that we are facing.
Perhaps when it is first created there will be none of these dooms day problems I worry about but allowing your rights to be slowly chipped away will surely lead us there.
Providing public transportation, roads, clean water, parks, libraries, schools, police and fire protection is not a "stone's throw away from full control." How can you reason that health care services are any different? Cars? C'mon. At some point we'll all need access to healthcare. Reform isn't rocket science and it's not too complex to understand. What's so complex about ordinary equality and the government's role to protect and defend it? If our right to healthcare isn't assured, it's folly to think that any of our other cherished rights are guaranteed.
"Power over life and death?" Let's remove that power from the hands of insurance company bean counters. Once in awhile, an industry insider gets conscience and blows the whistle on an inhumane practice. Wendell Potter is the health insurance industry’s worst nightmare. He’s a whistle-blower. Potter, the former chief spokesperson for insurance giant CIGNA, recently testified before Congress, “I saw how they confuse their customers and dump the sick—all so they can satisfy their Wall Street investors.” And before him, it was Dr. Linda Peeno, testifying before Congress, and featured in the documentary, SiCKO.
One thing's for certain, we shouldn't be throwing any more "cash for clunkers" money at the health insurance industry. Their products are defective in terms of providing access to affordable medically necessary care, controlling costs, and preventing financial ruin for people who suffer from illness or injury. Faux "reform" proposals that would amount to a financial windfall for these insurers are tax credits, medical savings plans, and other subsidies that are next to meaningless to people without jobs or money. What good is an income tax credit if you don't have an income? And why, for that matter, is universal insurance presented as such a bright shining promise, when, more and more, people who do have insurance continually have to jump through hoops to get the coverage they pay for? Most of us that still have insurance through our employers are only an illness or injury or job loss away from losing it. It makes more sense for those premiums that we pay to go into a single universal publicly accountable risk pool so we don't lose those precious healthcare dollars into the pocket of a wealthy investor. Let's make sure they're available to pay for actual care.
The most effective weapon against the pharmaceutical industry and health insurance companies would of course be a single-payer system, which would give the government clout in negotiating prices with the drug companies, and render the insurance providers obsolete.  |
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