Sicko

[Bonez3]

I like the validity of suggesting someone should work 80 hrs a week- that's a tough time of life.

And, I believe I am being rationale, being it's what I see everyday. I guess we work on opposite sides of the fence. I'm sure you only see the paperwork where I see the actual product.

[SnyderShrugged]

I like the validity of suggesting someone should work 80 hrs a week- that's a tough time of life.

And, I believe I am being rationale, being it's what I see everyday. I guess we work on opposite sides of the fence. I'm sure you only see the paperwork where I see the actual product.

I don't know how much more logically and calm I could have said it when I stated I can pretty much raise daily examples.

I have seen hundreds of real life examples of individuals working up to the jobs they desired. Sometimes working extra hours and making other sacrifices are worth the comfort that comes from having good insurance. There isnt shame in changing jobs or working extra to gain that, why would you feel it's inappropriate at all?

and I live in the real world just like you except I am close to the front line of the insurance claim process. I see much more than you possibly could unless you were ether a physician or a claim adjudicator. I know from your misplaced vitriol that you arent. Whatever point you hope to make by making errant and unsubstantiated claims will be lost on me so really save yourself the time and focus it on one who hasnt already gone out of his way to respectfully correct your errors and non-facts.

again, good day

[Bonez3]

I have seen hundreds of real life examples of individuals working up to the jobs they desired. Sometimes working extra hours and making other sacrifices are worth the comfort that comes from having good insurance. There isnt shame in changing jobs or working extra to gain that, why would you feel it's inappropriate at all?

and I live in the real world just like you except I am close to the front line of the insurance claim process. I see much more than you possibly could unless you were ether a physician or a claim adjudicator. I know from your misplaced vitriol that you arent. Whatever point you hope to make by making errant and unsubstantiated claims will be lost on me so really save yourself the time and focus it on one who hasnt already gone out of his way to respectfully correct your errors and non-facts.

again, good day

You keep using those powers of interpretation- you're doing a phenomenal job on the state medical insurance in this country.

[SnyderShrugged]

You keep using those powers of interpretation- you're doing a phenomenal job on the state medical insurance in this country.

thats what happens when you speak from fact vs. assumption and conjecture.

[Bonez3]

thats what happens when you speak from fact vs. assumption and conjecture.

We'll just agree to disagree.

But, someday I feel one of us will see the others point of view much clearer- and I'm not holding my breathe.

Good day sir.

[SnyderShrugged]

We'll just agree to disagree.

But, someday I feel one of us will see the others point of view much clearer- and I'm not holding my breathe.

Good day sir.

It's not a simple disagree when you are dead wrong but ok

take care and good luck

(the offer still stands if you do need help with explaining some of the details on how the system normally works and even who to go to if something has gone wrong for you)

[The Sisko]

the Dr makes that call, not the insurance company (despite urban legend)

Nevermind the "urban legend" about the MD actually being the gatekeeper for the insurance company. Now since you seem to be in the industry, I don't need to explain capitation to you. However, for those on the board who aren't insurane types, capitation refers to the practice of the insurance companies paying MDs a flat rate per patient. In theory this means the MD is thus given the incentive to save as much money as possible while delivering quality care. However, in practice it means your MD is thinking about his own wallet along with, or in some cases instead of what's best for the patient when ordering meds, tests or other procedures. Now, please explain how this is NOT a conflict of interest?

Secondly, since you seem to think our healthcare system is so great, how do you explain the fact that Canada Does Better Job than United States Controlling Health Care Administrative Costs?

From the above:

U.S. administrative costs totaled at least $294.3 billion in 1999, $1,059 per capita, versus $9.4 billion, $307 per capita, in Canada.

Health administration accounted for 31 percent of U.S. health expenditures versus 16.7 percent in Canada.

Canada's national health insurance program had overhead of 1.3 percent.

Canada's private insurers had higher overhead (13.2 percent) than U.S. insurers (11.7 percent) did.

Overhead of U.S. insurers was higher than that of Medicare (3.6 percent) and Medicaid (6.8 percent).

Overall, public (Medicare and Medicaid) and private insurance overhead in the United States totaled $72 billion, 5.9 percent of total U.S. health spending, $259 per capita. Insurance overhead in Canada was 1.9 percent of health spending, $47 per capita.

Providers' administrative costs were far lower in Canada. Overall administrative costs totaled $89.9 billion, $324 per capita, in the United States, versus $3,258 million, $107 per capita, in Canada.

Between 1969 and 1999, administrative workers' share of the U.S. health labor force grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (These figures exclude insurance industry personnel.)

Bear in mind that this isn't an apples to apples comparison. The Canadians are actually covering everyone (i.e. universal coverage) while we leave ~50 million people out in the cold with no coverage.

Furthermore, we've got the most expensive system in the world but the quality of care we receive sucks. And for those of you that believe that WHO's ranking us 37th had to do with politics, check out where we rank with regard to average life expectancy.

Finally, for those of you squawking about how great Kaiser Permanente is, I personally know of two people who died as a direct result of exactly the kind of incidents that was spoken of earlier, i.e. undiagnosed cancer. Of course that's anecdotal. However if you scroll down to the very bottom of the RWJ report I linked to earlier you'll find the following tidbit that would seem to support my low opinion of them.

From 1997 to 2000, higher administrative costs at HMOs were consistently associated with lower quality. Of 65 quality measures studied, 53 showed a significant correlation and nine showed a non-significant correlation between higher administrative costs and lower quality. Quality measures included immunization, mammography and diabetic eye exams.

Sorry SS but you're just not going to convince me that the system isn't broken. I've seen it from the inside for far too many years....long enough to know I can't be a part of this farce any longer. However, the thing that really scares me is that I can change careers, but one day sooner or later I or someone I love may need to rely on the healtcare system for our very lives.

[SnyderShrugged]

Nevermind the "urban legend" about the MD actually being the gatekeeper for the insurance company. Now since you seem to be in the industry, I don't need to explain capitation to you. However, for those on the board who aren't insurane types, capitation refers to the practice of the insurance companies paying MDs a flat rate per patient. In theory this means the MD is thus given the incentive to save as much money as possible while delivering quality care. However, in practice it means your MD is thinking about his own wallet along with, or in some cases instead of what's best for the patient when ordering meds, tests or other procedures. Now, please explain how this is NOT a conflict of interest?

Secondly, since you seem to think our healthcare system is so great, how do you explain the fact that Canada Does Better Job than United States Controlling Health Care Administrative Costs?

From the above:

Bear in mind that this isn't an apples to apples comparison. The Canadians are actually covering everyone (i.e. universal coverage) while we leave ~50 million people out in the cold with no coverage.

Furthermore, we've got the most expensive system in the world but the quality of care we receive sucks. And for those of you that believe that WHO's ranking us 37th had to do with politics, check out where we rank with regard to average life expectancy.

Finally, for those of you squawking about how great Kaiser Permanente is, I personally know of two people who died as a direct result of exactly the kind of incidents that was spoken of earlier, i.e. undiagnosed cancer. Of course that's anecdotal. However if you scroll down to the very bottom of the RWJ report I linked to earlier you'll find the following tidbit that would seem to support my low opinion of them.

Sorry SS but you're just not going to convince me that the system isn't broken. I've seen it from the inside for far too many years....long enough to know I can't be a part of this farce any longer. However, the thing that really scares me is that I can change careers, but one day sooner or later I or someone I love may need to rely on the healtcare system for our very lives.

If you read my posts, you will clearly see where I totally accept and admit that there are errors that occur. My main points were only geared towards stating that it's silly to think that the insurance compnaies are maliciously withholding claim payments and delaying procedures. I also maintain that the processes where the federal government had gotten involved (Medicair and Medicaid) that THEY are the root causes of the vast majority of claim errors and delays.

I can tell you first hand that the current system is Fubar in many respects, again, if you read my posts you will find that I mentioned my job is identifying and fixing where those defects occur in our processes.

Since you seem to have a good grasp of the way things generally work, then you must also be aware that an insured will only get coverage that is gauranteed by their contract. These contracts alnost always come with a written "Performance Gaurantee" that the ins. co must meet to continue the provider/insurer relationship. Insurance companies maintain a 98% financial accuracy standard as a rule. This benchmark is what is used for most Health insurance quality awards as the minimum performance.

This information is the best I can give that I am certain is accurate. I also know the company that I work for also maintains stringent minimum standards and that loses millions of dollars annually by an environment of "Err on the side of caution".

I have no idea why anyone would want the government any more involved in health care than it already has. It's a lock to mess things up for you worse than even the crappiest private company could offer.

[The Sisko]

I'm not one of the folks who says that insurance company execs are sitting around in a boardroom somewhere saying "Deny granny's claim to save us an extra couple of bucks." However, one way or the other the insurers are doing everything they can to take in as much as they can in premiums and cut as much in the way of costs as possible.

I'm not an expert but I suspect that what they're doing is writing the contracts with as many loopholes as possible to stack the deck in their own favor such that they unload as much risk as possible. That way, they can legally say "Hey, we're not obligated to cover that" and it still passes the standard for complying with their contractual obligations. However, if this is what's going on, it may pass the legal test but not the sniff test. However, that's purely conjecture on my part.

Secondly, even if the guys in the boardroom aren't explicitly planning to deny certain coverages, I would imagine they're setting policies that all but require mid-level managers to increase the denial rate for claims. In other words, they set cost/profit targets and quietly look the other way with regard to how the numbers are met. That way, they can deny all knowlege of any such activity. Plausible deniability...see, everybody wins! Yay!

I've never been a huge fan of govt. care. However, after having reviewed the data as part of my graduate work, I came to the conclusion that a single payer system is probably the best solution. Unfortunately, the way things work in this country, we'll reach a major crisis stage, the voters will demand a solution and our politicians will screw it up royally. It's just the American way.

My solution to all of this? The allegedly horrible and unthinkable, i.e. rationing. Now before you all go getting your panties in a bunch, contrary to popular belief, rationing is already practiced here. It just goes on qietly and surreptitiously without you realizing it.

I'm a firm believer that the solution lies not in trying to cover everything for everybody. Rather, we should have an open debate/discussion of what will and won't be covered and set about providing that level of care in as high a quality manner as possible...for everyone.

[Siven]

Moore's a dickbag. he jumps in peoples cars to question them, and he gets kicked out, and he says crap like

"Well, obviously he doesn't want to talk, so he must be hiding something.

[ZoEd]

:applause:

Your right about Moore and how he creates a negative opinion on imporant issues because of his stupid tactics and bias agenda.

However, I don't have a problem with him making a documovie about this b/c i think its important that people be informed about this issue. People need to be better informed about the status of health care. And although you may not need to hear it from him, someone out there can benefit from becoming informed. Moore has always been able to generate audiences.

Health care is defintely "borked" as you say, but its not completely broken. Defintely needs fixing.

Problem is Moore will never make a movie to truly inform anyone of anything. Moore makes movies to push his agenda and beliefs. He's so biased it's sickening. Every time I see the fat **** I cringe. The way he makes films he could do a documentary on Charles Manson as a televangelist and make people who didn't know any better believe it. The guy has 0 credibility.

[SnyderShrugged]

I'm not one of the folks who says that insurance company execs are sitting around in a boardroom somewhere saying "Deny granny's claim to save us an extra couple of bucks." However, one way or the other the insurers are doing everything they can to take in as much as they can in premiums and cut as much in the way of costs as possible.

I'm not an expert but I suspect that what they're doing is writing the contracts with as many loopholes as possible to stack the deck in their own favor such that they unload as much risk as possible. That way, they can legally say "Hey, we're not obligated to cover that" and it still passes the standard for complying with their contractual obligations. However, if this is what's going on, it may pass the legal test but not the sniff test. However, that's purely conjecture on my part.

Secondly, even if the guys in the boardroom aren't explicitly planning to deny certain coverages, I would imagine they're setting policies that all but require mid-level managers to increase the denial rate for claims. In other words, they set cost/profit targets and quietly look the other way with regard to how the numbers are met. That way, they can deny all knowlege of any such activity. Plausible deniability...see, everybody wins! Yay!

I've never been a huge fan of govt. care. However, after having reviewed the data as part of my graduate work, I came to the conclusion that a single payer system is probably the best solution. Unfortunately, the way things work in this country, we'll reach a major crisis stage, the voters will demand a solution and our politicians will screw it up royally. It's just the American way.

My solution to all of this? The allegedly horrible and unthinkable, i.e. rationing. Now before you all go getting your panties in a bunch, contrary to popular belief, rationing is already practiced here. It just goes on qietly and surreptitiously without you realizing it.

I'm a firm believer that the solution lies not in trying to cover everything for everybody. Rather, we should have an open debate/discussion of what will and won't be covered and set about providing that level of care in as high a quality manner as possible...for everyone.

You totally misunderstand the contracting process. Please note that it's almost 100% the EMPLOYERS who negotiate out certain services in order to reduce their cost in premiums.

The Insurance companies don't have any vested interest in contracting for less because they lose money in the long run.

The open debate that you are seeking happens at every contract negotiation with an emplotyer group for their insurance. It's the HR departments of Employers that need to get the voice of their employees to determine what they want. There is always a trade off between coverage, premiums, and employer contribution. It's the mix that is negotiated and the insurance company simply writes the contract thet is agreed upon.You can't reasonably blame them for giving exactly what was asked for, can you?

Thats it, simple ignorance of the general public on how health insurance works has made it an easy industry for the media and candidates for office to create emotional talking points around.

Now, I can say with passion, that most folks don t realise that the Health Insurance Lobby is in major bed with the "single Payer" support crowd. Many Health Ins execs desire winnning the contracts that government will award for administering the programs involved. The so-called "single Payer" system will be very little different from what we currently have except it will most likely generate even more waste than is already present. This I can say with confidence.

Let me give an example without putting myself in HiPPA or HR troubles.

There is a federally sponsored low income program that my company works with (It's one of the big ones that you all have heard of, but I've got to be careful what I say here).

We are required to simply pay a certain level of coverage per individual based on their income levels and life status overall. Their records are on file as to what level we pay. Upon our payment to the physician for services rendered, we then submit for re-imbursement to the Fed. Simple right?

Well, we literall get turned down for re-imbursement 65% of the time! Thats upwards of $50M annually that my company pays and then eats.

Thier rational is that what we paid doesnt match what they have on their records as the level of coverage.

The capper, The federal program managers provide 5 reports a month that all give conflicting information of coverage and they literally will not provide the specific criteria that we are supposed to match. They say "Figure it out".

Our execs understand this waste but rationalize it due to the fact that the other claims that do get covered bring so much in ROI that the benefit far outweighs the cost. This benefit to the ins co. would go away under the single payer system, but few are willing to see that far into the future.

It's an interesting dilemma.

[NattyLight]

In my humble opinion, it's the United States government that is responsible for the physical welfare of their constiuents; from drug laws to seatbelt laws. These laws are put in place to protect our countrymen. If heathcare isn't the core building block for physical welfare I don't know what is.

The government should ensure everyone has healthcare.

[edgun88]

I dont like Moore at all.

[SnyderShrugged]

In my humble opinion, it's the United States government that is responsible for the physical welfare of their constiuents; from drug laws to seatbelt laws. These laws are put in place to protect our countrymen. If heathcare isn't the core building block for physical welfare I don't know what is.

The government should ensure everyone has healthcare.

such a shame that socialism is becoming so widely accepted in our nation who has fought so hard to adhere to the intent of it's constutution.

[The Sisko]

SS I fully understand that it's the one who pays the premiums (i.e. the employer in most cases) who determines the level of coverage. However, my point is that there's always different ways to interpret language in a contract. Besides, what does the employer care if the insurance co. inserts language to protect itself from "excessive" claims? That's not their problem because to the employer, employees are just as expendible as the insured are to the insurer. Besides, you guys get to hide behind the ERISA laws anyway. And of course, you never commented on my contention about the pressure coming from middle management. That could never be a source of denying legitimate claims right?

As for your comments about a single payer system, you're correct that if things are implemented the way W did with the Medicare drug plan, overhead will probably go up and things may actually get worse. That's because he buckled to pressure from the insurance/drug lobby and allowed insurance middlemen to get in the mix. However, in a true single payer system , the govt. is the only payer thus cutting out the excessive overhead ( click here to see where some of that excessive overhead goes) from the insurance companies. No matter how you slice it, Canada's and other single payer systems do a better job of covering more people than ours does and the health outcomes data reflect it. Don't believe me? These guys do.

As for your employer, just like many physicians that chose not to accept Medicare/Medicaid patients anymore, if they weren't making money they'd discontinue those product lines...and quick. Of that I'm quite sure and I'd be willing to bet you'd agree.

[Corcaigh]

I don't know what kind of coverage you can get for $160 per month. The average cost of healthcare premiums for a family of four is now about $1000 a month.

US healthcare is horribly broken. US spends 16% of its GDP on healthcare and 50million are not covered. Countires like Switzerland, Germany and France spend a fraction of the US and hae full coverage with equal or better coverage.

[Cooked Crack]

The movie is available for download on the internets. 2 Weeks till it opens and I can sit down here and watch it. Quality is pretty decent.

[Cooked Crack]

The film was alright if you have 2 hours to kill. As a person who doesn't trust insurance companies I liked the first part of the movie. He talked about the way health care providers would try any way to save money. From the initial denying applications for man reasons.(like people being too thin/fat) Then if you got the coverage they will deny your claims to save a buck. Alot of sob stories here. Even had one guy who's daughter was going deaf but the insurance company was only going to cover to get hearing in one ear recovered. They eventually covered both ears only after he wrote them saying he was going to put them in a Michael Moore film. If you get past all that they will have people who will dig up your application and have a full investigation to see if they can still get their money back.

Second part was all about pimping universal health care. Showing how it's done in other countries. I think there was too much focus on this. He went to Canada, UK, France, and eventually Cuba. Of course he doesn't talk about their downfalls. Some more sob stories but now with 9/11 volunteer rescue workers who are sick from helping out.

I'm also sure people will love that he referred to Hillary "Hilldog" Clinton as sexy.