Commentary: How insurance firms drive debate, By East TN man.

[Guest thorn]

And you propose to fix human nature how? A solution is what? Or are we going to bitch and moan about "big government" and instead of letting the govenment bankrupt us we are going to let insurance companies bankrupt us instead. It is a fact that health costs are out of control and will continue to rise as the boomers live longer lives and suck more of the resource. Health Care is like anything else it is finite. Saying the system is so broken it cant be fixed is the same thing as Obama's solution. Both "solutions" are B.S.

Remember it was you who said:

"You are right people are broken. That IS the problem. I would suggest that having no program in place is as bad as having too many. It is just a different extreme."

I do not think the insurance or healthcare industries are too broken to fix and I never said anything to imply that. What is currently proposed does little to nothing to fix either. I'm still on the business end of insurance and healthcare where as on our Government I'm limited to some hope.

Edited August 19, 2009 by thorn

[tntnixon]

I find itsomewhat amusing and very scary how little people know about healthcare and how it's actually run. Part of the problem is the fact that since health insurance and Medicare/Medicaid started, people don't actually pay their bills other than the premiums. It's the old cliche "that which costs nothing has no value" and causes a huge abuse of the system by the patient, the provider and the insurance company and/or the government.

First lets examine how bills are paid. When you are admitted to the hospital you are assigned a DRG (Diagnosis Related Group) meaning that all your health problems are lumped together with other people with similar problems and a fee is set. If it costs the hospital more money to treat you than the fee (you have unexpected complications) that is a loss. If it costs less (the hospital is super-efficient in getting you better) then that is profit. I hear all these talks about $60.00 Tylenols and, being a member of the health care community, I laugh. I laugh because I know it's a lot of smoke and mirrors. It's a game that the hospitals and insurance companies and/or the government play, knowing that it will never be reimbersed.

If the hospitals sent a bill to the insurance company for exactly the actual cost of services, the insurance company would try to pay them less. So we all play this little game where we send crazy bills knowing that ultimately we're going to be paid based on the DRG. If you look at the EOB(Explanation of Benefits) your insurance company sends you, you'll see it as "plan savings".

I also hear about peoples' insurance company kicking them out of the hospital. This is also false. The insurance, once again, pays based on a DRG, not on hospital days. Therefore, if you're kicked out of the hospital, it's for two reasons. Either you're better than you think you are but still want someone to be your hired help in the hospital(this actually happens a lot) or you are dealing with a hospital and/or physician who is trying to improve their own bottom line(this also happens, but not in any hospital that I have ever worked for). This last scenario is never believed by patients because they don't want to admit that they have made bad choices in health care providers. Therfore, the insurance company gets blamed because it's a faceless entity.

Let's call this lesson one in medical reimbursement.

[tntnixon]

Now lets move on to lesson two. We'll call this one basic math.

$1,300,000,000,000 (that's the cost of this bill, $1.3 trillion dollars for those who are overwhelmed by the zeroes).

300,000,000(that the number of men, women, and children who live in the USA).

32% of all tax returns have zero or negative tax liabilty.

That leaves 204,000,000 people picking up the bill.

That leaves $6372.00 for the burden of every man, woman and child in a tax-paying family or roughly $25,000 for a family of four.

30,000,000 (the number of unisured in America, for whatever reason).

Divide the total cost of the bill by the number of uninsured and you get a cost of 43,333.33 for every man, woman, and child that is uninsured or $173,333.33 for a family of four.

Now I'm gonna give the libs the benefit of the doubt (although I dobt it quite a lot) and assume that they're telling us the truth with regards to being able to keep your current benefits package. The average family of four would be paying for all their own health care (premiums and payments to providers) and still be "on the hook" for $25,000 for someone else's benefits. Is that acceptable?

And, I'm sorry, but you can buy a family plan all f'ing day for less than $173,000 regardless of your "pre-existing conditions". The cost is absolutely absurd.

[Smith]

Now lets move on to lesson two. We'll call this one basic math.

$1,300,000,000,000 (that's the cost of this bill, $1.3 trillion dollars for those who are overwhelmed by the zeroes).

300,000,000(that the number of men, women, and children who live in the USA).

32% of all tax returns have zero or negative tax liabilty.

That leaves 204,000,000 people picking up the bill.

That leaves $6372.00 for the burden of every man, woman and child in a tax-paying family or roughly $25,000 for a family of four.

30,000,000 (the number of unisured in America, for whatever reason).

Divide the total cost of the bill by the number of uninsured and you get a cost of 43,333.33 for every man, woman, and child that is uninsured or $173,333.33 for a family of four.

Now I'm gonna give the libs the benefit of the doubt (although I dobt it quite a lot) and assume that they're telling us the truth with regards to being able to keep your current benefits package. The average family of four would be paying for all their own health care (premiums and payments to providers) and still be "on the hook" for $25,000 for someone else's benefits. Is that acceptable?

And, I'm sorry, but you can buy a family plan all f'ing day for less than $173,000 regardless of your "pre-existing conditions". The cost is absolutely absurd.

shhhh, they will report you!

[tntnixon]

Lesson number 3: "Personal Responsibilty"

Another factor that figure into the health debate, as well as all facets of our society, is the lact of personal responsibilty and it's impact on cost. In health care circles we call it "non-compliance".

This phenomena is responsible for a huge amount of our health care costs. Let me give you an example: Every patient I get for an outpatient sedation procedure is told to have a sober, able bodied person to accompany them to be their ride home and to get instructions post-procedure. Somehow, people seem to think that this is meant for everyone but them. So here's an example of what happens: the ride drops them off and goes shopping, they go to the bar and get drunk during their loved one's procedure, the "driver" is in worse physical health than the patient and has an expectation that we'll provide care for them as well (for free, of course), or the patient decides that there is nobody in their life that they can trust enough to get their instructions or drive them home.

Countless hours and money is spent just to accomodate the "idiot factor", which is rampant in America.

Then there's the patient and/or family that believes by being rude and nasty to their health care providers that they'll get better care. The truth is that rudeness and quality care are usually inversely proportional because the provider just avoids them like the plague.

The truth is health care has some major flaws. However, instead of trying to point fingers at others, we need to all look in the mirror whether we're a patient, a provider, a government agent , an insurance representative, a malpractice lawyer or from some nameless advocacy group.We all have some piece of this we can call our own.

What we don't want to do is "throw out the baby with the bath water". We have the most caring, technologically advanced health care system in the world. We are the envy of all others. Why do we want to destroy all that is right?

People want to point to statistics and use them to decry our system by saying that mortality and morbidity rates are higher here than in other countries. That is simply because, in America, whether we like it or not, we are free to make bad choices for ourselves. Unfortunately, that is all too often. But that is what makes America great. Because a lot of good choices are also made. Choices that have helped make us the envy of the world.

There is nothing great or unusual about the soil or natural resources in these United States as opposed tothe rest of the world. The United States is great because great men and women made unusual choices and had great ideas. We have done things different than other countries and had great outcomes. If we try to do things like everyone else, we are likely also to have the same outcomes they have had.

[Guest mn32768]

Just making health insurance affordable is not going to solve the basic problem of supply and demand. There's a shortage of doctors in the U.S that's estimated to grow to 124,000 by the year 2025. The government has made it impossible for bring in doctors from abroad, too. The so-called "tort reform" alone is not going to solve the shortage.

If everyone all of a sudden gets free healthcare, who's going to provide it?

[Guest grimel]

Some people are a victim of circumstances and some people are able to better themselves under the same circumstances. It is funny how that happens. Luck, divine intervention call it what you want to but it is not ONLY hard work although that goes far.

It's called choosing to not pity oneself and dealing with life. Decide you are a victim and life will suck.

[Guest theoldguy]

Anyone who has ever served in the military will know what a government run health care system would look like. Military Dependants will take their kids (3 or 4) to the emergency room because 1 of them has a runny nose. they will sit there for hours just do they can get cough drops and maybe some Tylenol for free instead of going to wally world and paying $4.00 for it If you have ever went to the VA for medical treatments you would find out that you might have to wait 4-16 weeks for an appointment to get anything checked out whether it be a lump in you chest or something else..but you also can go to sick call and sit there for up to 6 hours and might or might not be seen..If you are seen then they will make you an appointment with your primary doctor and then again it could be 2-4 or 6 weeks before you get seen..Is it better than nothing? Yes, but that is what you get when you deal with them military or the VA..When the government gets involved, the price increases x10 and the availability and or the quality decreases x10. I for one think that we should roll back the government control back to about 1930..that goes for the federal/state/local governments.

[Guest canynracer]

It was tongue in cheek. Two ridiculous statements.... anyway....

There are many that do not have the opportunities you do or had. All I am suggesting is that you give it a little more thought than a slogan that might look good on a T-shirt.

Oh pahhhhleeeeze!!!! victim of circumstance...sorry man, that is a total copout, people CHOOSE to stay in situations, they also CHOOSE the easy way, or the hard way out of them...

dont give me this "They dont have a choice"....freaking STARBUCKS offers FULL benefits for slinging coffee!!! McDonalds, there is A LOT of companies that will offer it.....even if you are ONLY working to pay for that insurance, it doesnt matter, you can still get it...

I have zero sympathy for those that can do and DONT....I have all the sympathy in the world for those that TRULEY cant!

Edited August 24, 2009 by canynracer

[E4 No More]

Oh pahhhhleeeeze!!!! victim of circumstance...sorry man, that is a total copout, people CHOOSE to stay in situations, they also CHOOSE the easy way, or the hard way out of them...

dont give me this "They dont have a choice"....freaking STARBUCKS offers FULL benefits for slinging coffee!!! McDonalds, there is A LOT of companies that will offer it.....even if you are ONLY working to pay for that insurance, it doesnt matter, you can still get it...

I have zero sympathy for those that can do and DONT....I have all the sympathy in the world for those that TRULEY cant!

Incorrect, sir. My 30 year old son-in-law cannot get health insurance to this day because he survived lymphoma as an adolecent. Thanks to our idiot governor, he was kicked-off TennCare during their cut-backs.

[tntnixon]

Incorrect, sir. My 30 year old son-in-law cannot get health insurance to this day because he survived lymphoma as an adolecent. Thanks to our idiot governor, he was kicked-off TennCare during their cut-backs.

This probably true now. However, if he had gotten a job, within six months of losing his coverage, that offered insurance they would have had to cover him and the pre-existing clause would have been waived. This was the whole purpose of HIPAA. HIPAA stand for the "Health Insurance Portability and Accountability Act of 1996". Everybody knows it for it's privacy clause. However, that was not it's original intent or the meat of it. The actual intent was exactly the scenario that your son-in-law was facing. The law provides for a waiver of all pre-existing conditions if the party affected was covered at any point during the last six months.

Unfortunately, very few people actually take advantage of this until it is too late.