Monday, July 20, 2009

Health Care Is A Lot Of Different Systemes Glued Together

In America, heath care is a business. You need to keep this in mind. Hospitals and doctors and insurers have to make money to stay in business. With insurers trying to control costs often times they tie the doctors hands when it comes to deciding what treatments and medications patients can get.

Have you ever heard this scenario? The doctor prescribed a medication or service, only to have the insurance company decide over and above what your doctor determines is medically best. It happens all the time.

To be fair, insurance companies are a business and they need to make a profit. So they are trying to rid excessive use of services and expensive medications when lesser expensive ones will, in their opinion do the job. But there is not always an absolute and it’s the patient who suffers.

If you think this will be any better with government run health care. It will only be worse when it’s the government deciding your course of treatment and what is cost effective.

Mike McAllister, president and CEO of Humana told an audience at a recent 2009 Wharton health care business conference, “We don’t actually have a health care system. We have a lot of different systems that are glued together.”

Folks, we have (HMO’s, PPO’s POS’s, Indemnity, Limited benefit plans, ceilings on various categories of care, limitless out of pocket costs and more.

We have the wrong objectives. The incentives are wrong for everyone, the providers, the payers and the patients.

Consumers need to be involved in health care as they are in all other aspects of the marketplace, McCallister, told the audience. With regards to health care “you can’t get the price and quality information” to make smart health care shopping decisions.
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Medical providers are to blame too. Excessive use of services is one of the main elements at the heart of the health care crisis. For example doctors and hospitals making money off of CT, MRI or Pet scans that aren’t always necessary. And then the patient, if they lay down long enough someone will scan them.

Did you know that the number of hospital and doctor visits is up 20% in the past 5 years on a per capita basis? Why?

Want to know why health insurance policies are area factored?

Why does Wyoming have a rate of back surgeries of 9.63% per 1,000 people while the sate of Illinois is only 3.39% surgeries per 1,000 people? Especially when the rate of back problems isn’t that different in the two states.

And why are health insurance policies so filled with loopholes, limits and exclusions?

Disclosure statements about gaps in coverage are weak. It’s difficult for consumers to figure out what a policy covers and doesn’t cover. Why does one health insurance policy have a limit on organ transplant procedures of $250,000 when another covers the same procedure to $1 million?

Decent insurance is supposed to protect you in the event of a catastrophic illness.

Health care is not going to be an easy fix. It didn’t break overnight. It’s not going to be fixed overnight. Keep in mind. Like in the game of dominoes, when one domino falls it affects all the others.

I’d like to see policies streamlined with fewer choices. Get rid of all these loopholes and make policies easier to read. The federal governments role should be in regulating all polices rather than the individual states, so we can have one standard definition of what constitutes health insurance.

Create portability and open up state lines to create more competition. You are able to cross state lines for everything else you buy. Why not health insurance?

Let’s get health care back into the hands of the consumer and the medical providers. When we know what we are paying for we are more likely to be savvy shoppers.

When it comes to health care I urge you to educate yourself so you know what you want and why you want it. Don’t let yourself be led blindly.

The good thing is people are talking about this and thinking about this.

This is my opinion. I’d like to hear yours.

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