HMO executive compensation

-jt · Jul 2, 2001

Why then is there suddenly this attitude of 'hands off we can't tell insurance companies how much profit margin they can have. >>

Because those organizations are paying millions to their lobbyists to make sure of it! And probably because the rich CEOs of HMOs are putting on the same green at the same club that the rich CEOs of hospitals are. I wonder how much the CEO of Oxford (my health plan) "gave" to election fund-raising, political parties, etc to get them to come up with that philosophy you mention.

MollyJ · Jul 2, 2001

Someone asked me earlier on if I thought all insurance should be medicaid/medicare. The real answer is I don't know. I think that the problems of health care supply and demand need to be dealt with. My old ethics professor said that Americans have an unlimited appetite for health care; that we can provide more health care than we can pay for; and that health care generally makes lives last longer but NEVER makes the expenses of maintaining that life less expensive.

I personally think that Americans need more fiscal responsibility for their health care. We all tend to spend differently ie more carefully--when the dollars we spend are our own. Therefore I think co-pays and deductibles are good. On the other hand, their are certain types of health care that we don't want to impair access to because they are so likely to impact the health of others. This is obvious with vaccination but can theoretically extend to any care to a wage earner in a family. In America, we have traditionally not wanted to even sketch in those lines.

This is an obvious rationing point, but I think willingness to spend on individuals needs to be SOMEWHAT connected to their ability to work and give back to society, whether as custodian or bank president. (and not tiered: whether custodian or bank president, the same indications would need to be met for CABG.) I would never NOT ADVOCATE for COMFORT CARE for a person of any age and that should be given expertly, but I think doing life extending procedures on people who no longer have an ability to give back to the society in which they live squanders our health care resource dollars. Of course, any FAMILY that is willing to pay for this procedure for their own family member should always be allowed to do so.

What is essential care? What is humane care? What care, when invested in, provides the most good to society at large? How many men and women have extended their working years (when they might have formerly become cardiac cripples) through the high tech, high expense intervention of CABG? My work with tech dependent families caused me to question whether we were using technology correctly many times. Not one of my families questioned whether or not their child should have been given the technology. But the decision exacted a high price on my families emotionally, in terms of family integrity, economically and psychologically. Lack of a government payment system would have simply hastened the inevitable--death. That sounds pretty callous, even to me, but I remind you of the inevitability of death in all of our lives and that fact is really what I am referring to here.

In Garrett's book, the cobwebs of what-if's are swept away when you read her long chapter on health care in Russia and you get a clearer picture of what true essential services are: vaccination, clean water, a populace educated in good self care (thank you, D. Orem) measures (healthy diet, good personal hygiene, exercise, tobacco avoidance, avoidance of addictions, stress reduction etc). While Americans weigh the pro's and con's of braces for the kids and breast reduction/augmentation, Russians fight cholera, MDR-TB and other antibiotic resistances and lack knowledge (even many of their professionals) about normal infant growth and development.

While I am for patient's rights (who isn't), I am disturbed by the right to sue HMO's. I actually don't think anyone should be suit proof, but there is NO WAY around that fact that opening HMO's to litigation will dilute their mission to thoughtfully ask whether or not a procedure should be paid for by the insuror. Unless you let SOMEONE (and we could argue that it should not be the insuror) ask this question, you might as well go back to fee for service which was notoriously bad at cost containment. Ultimately, I fear that Americans are so unable to address the question of, "What are the most essential health care services?" that they will not do it. It will be done eventually, helter-skelter out of necessity. Oregonians know that they tried it and it didn't taste good; it was not easy.

I am not eager to see a system in which the government is the only payor. I am hard pressed to believe that that will do little more than breed a new set of problems. I think all systems need to address the need for basic insurance for all, a shift to comfort care for the chronically ill that lack a capacity to "give back to society", a willingness to define essential care and care that, when it is done, benefits society at large and optional care. I think that R & D, in this environment, will not be as vast, but perhaps it will be aimed toward areas that are essential: vaccination, clean water, keeping working populations healthy, ethical comfort care, teaching populations about their role in self care.

regardless of the system, someone will be figuring an angle from which to exploit. That, alas, is human nature. Sorry it took me 7 paragraphs to tell you I don't know how I'd reshape the health care system

MollyJ · Jul 2, 2001

Feistynurse, I enjoyed reading your earlier reply, too. This obviously describes a "laid out" approach to government healthcare and I think it sounds workable, but has their been any effort within this plan to look at the question of what care to who and when? i still regard these as the essential questions.

natalie · Jul 3, 2001

Molly-Appreciate your thoughtful posting and grinned at the end. The whole system is so convoluted and I fear the answer will play itself out when this system has a total breakdown in the next decade. As a capitalist AND a nurse, I've had trouble even answering the question "Is healthcare a right or a privilege?"

Ultimately, the only way I can answer it is to come from the viewpoint as a mother/daughter member of a society and how I want the society to function. One of the markers for the best we can pass on to future generations should be how we tend to our sick, our children and our elderly. (But I have no answers how to fix it all!) I only know we're doing a dismal job of it and one of the biggest reasons is the unabashed, free-for-all, market-driven healthcare system.

Here's an article that sums up all the problems, whether you agree on making the case for national insurance or not. When I scrolled down and glanced at all the headings, I was overwhelmed all with the problems that exist.

http://carbon.cudenver.edu/~kcorbett/facts.htm

fiestynurse · Jul 3, 2001

"There is enough for everyone's need, but not enough for everyone's greed" ---Mahatma Ghandi

In 1997, the US spent $4090 per capita on health care expenditures, nearly twice what Germany($2,339), Canada($2095), and France($2051) spent per capita, and well over the OECD mean of $1747 per capita. Yet the US is the only developed nation that has failed to offer universal care coverage.

Obviously, by looking at CEO compensations, we can see where much of the health care dollars are going. The only thing that stands between universal coverage and the present condition is corporate greed. Our present system is so morally and ethically wrong.

Mijourney · Jul 7, 2001

Originally posted by fiestynurse
"There is enough for everyone's need, but not enough for everyone's greed" ---Mahatma Ghandi

In 1997, the US spent $4090 per capita on health care expenditures, nearly twice what Germany($2,339), Canada($2095), and France($2051) spent per capita, and well over the OECD mean of $1747 per capita. Yet the US is the only developed nation that has failed to offer universal care coverage.

Obviously, by looking at CEO compensations, we can see where much of the health care dollars are going. The only thing that stands between universal coverage and the present condition is corporate greed. Our present system is so morally and ethically wrong.

Hi. In addition fiestynurse, we lag behind other developed nations in many of our morbidity and mortality stats although we have the ability to provide world class medicine. I agree with you that we need a reformation of our health delivery system. I agree with MollyJ that this issue has to do with moral and ethical concerns. I pointed this out in another post.

In my opinion, capitalism has gone awry in health and medical care. Giving or making available good quality health and medical care in my opinion is the right thing to do. What people choose to do with it should be their choice. WWJD. Even though I've touted it myself, I now feel that it's a little too simplistic to say that each individual has an obligation to do what's right for his/her health. I also feel that society as a whole has an obligation.

For instance, One of my patients had a unique respiratory condition that was as a direct result of an environmental pollutant. Do you think she asked to be a part of this? What about children who by no fault of their own are exposed to lead in their living space or school houses?

For a long while, people did not know the effects of the tobacco they used, the food they consumed, the spaces they lived in or used, the vaccinations they may or may not have been receiving. It has just been since the advent of managed care, 24 hour media, and the internet that more and more people are learning anything about food and drug safety.

In essence, health care practitioners have failed in our duties to truly inform our patients about their legitimate health and medical needs and especially encourage proactive participation. When everything was fee for service, it was not to our advantage to do this. Now that manage care has come in and practically done an overkill on the system, we're logically upset.

Huganurse · Jul 7, 2001

OUTRAGED!!!

Tim-GNP · Jul 7, 2001

You know what's really sad about this. The money they make and they assume no liability or anything for their poor decisions and greedy actions.

Yet, a nursing home administrator who might make $55,000/year if s(he) is lucky can be hauled into court if a wack-job family gets a wild hair up their rear-end because their mothers breakfast consisted of eggs when she prefers pancakes [failure of facility to identify care needs/routines, failure of facility to adequately assess/document and implement nutritional interventions aimed at preventing weight loss, failure of facility to adere to patient's rights of free choice]... and those are only off the top of my head, I 'm sure if I dig into the regs a little more I could find a hell of a lot more [haven't had the 2nd cup of coffee yet, though].