Health Insurance

[one...two...tree 2,762]

No system is going to be perfect, but looking at the overall quality, Canadian's have better health care for a lot less than what we pay per person. I think we need to have private insurance as an option within a universal coverage plan.

[w¡n9Nµ7 §£@¥€r 123]

I think we need to have private insurance as an option within a universal coverage plan.

Do you agree that the public option should be set up so as to not have a built-in systemic advantage over private options?

[I AM NOT THAT GUY 5,715]

or just maybe, it's a recruitment and retention tool. with national health care, how's the military gonna meet quotas to remain a viable military force?

Once we get all that change happening, and we are singing kumbaya with the Taliban and Al Qeda, folks will rush to join the military again, and wear those kewl blew helmuts!

[w¡n9Nµ7 §£@¥€r 123]

Survey Reveals that Doctors Feel Pressured by Health Insurers to Alter the Way They Treat Patients

LAKE SUCCESS (9/2/2008) – The Medical Society of the State of New York just released survey results, which indicate that health insurer rules often force New York State physicians to alter the way they treat patients – and not necessarily for the benefit of patients. Instead, the rules appear to have been developed to increase insurer profits at the expense of the best health practices and patients’ health.

...

Ninety percent (90%) of the physicians surveyed said that they have had to change the way they treat patients based on restrictions from an insurance company, and 92% said that insurance company incentives and disincentives regarding treatment protocols “may not be in the best interest of the patients.”

Physicians’ most common complaint was that health insurers required them to change prescription medications; 93% of the physicians voiced this complaint. Over three-fourths (78%) said that an insurance carrier has restricted their ability to refer patients to the physicians they believed would best treat their patients’ needs.

A majority (87%) of physicians said that they sometimes feel that they are pressured to prescribe a course of treatment based on cost rather than on what may be best for the patient. Over half (62%) of the physicians surveyed, however, are either somewhat concerned or very concerned (37% and 25% respectively) that they may be cut out of an insurance network if they do not follow the policies requested by insurance companies.

Physicians overwhelmingly (95%) agreed that “Decisions on what medications are right for a patient should be made by the patient’s own doctor and not by the health plan or the insurance carrier.” As a result, 91% of the doctors surveyed said that there should be enforceable legislation to regulate the restrictions that insurance carriers put on physicians in regard to treatment modalities they prescribe for patients.

[I AM NOT THAT GUY 5,715]

I don't know where this fits into the discussion, but the CDC, the FDA, and the DEA have increasing roles in dictating what treatment plans the physiciams must follow. A few years ago, the CDC decided doctors were over medicating, and warned against prophylactic courses of treatment. The DEA and FDA have set strict guidelines and are auditting doctors prescribing pain killers. Washington is already telling your doctor what treatment you get. It's not just the insurance companies any more.

[SunTiger 0]

Two suggestions:

1) Your ins. co. should have an appeal process--ask about it and appeal with documentation from your doc who recommended it

2) Contact the hospital/office where your wife had it done and explain that your ins. co. won't cover it and ask if they have any discounts for those w/o insurance coverage.

Edited May 10, 2009 by SunTiger

[Ban Hammer 13,619]

or just maybe, it's a recruitment and retention tool. with national health care, how's the military gonna meet quotas to remain a viable military force?

A few years of service to the nation, either military or civilian, should be mandatory anyway. And maybe, just maybe, the military wouldn't have trouble recruiting if there wasn't the fact-based perception out there that our civilian leaders send them into war based on lies and deception.

you're sounding like a republican

[sjquin 0]

U.S. health care system SUCKS!!! It's this thing called HMO (Health Maintenance Organization) It's a lucrative business. Only the HMO companies(ie. Kaiser, HeatlthNet, Aetna, Humana, and so on..profits on the expense of the people..

Here in the US if you don't have insurance you're screwed....if you do you have pay for expensive monthly insurance premiums(only a few company fully pays for their employees premiums because it's getting very expensive, especially todays economy) fu%K the HMO....Their main objective is to make money, they don't care about the welfare of the people, It's a wicked organization.....read more about it and research for yourself....

Kaiser is the largest not-for-profit HMO in the country.

That's what they want you to think, it's still HMO system

[We're practically speechless, so we'll just ask one question: How can a non-profit double its net income -- with zero membership growth -- and still call itself a non-profit?]

From San Francisco Business Times:

Kaiser Permanente’s 9-months’ profit more than doubles to $2.5 billion

by Chris Rauber

Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and their subsidiaries announced gigantic jumps in net income, operating income and investment income for the third quarter ending September and the year’s first three quarters, including startling increases sure to raise questions about the organization’s non-profit status.

Operating income more than doubled from $868 million in the first three quarters of 2006 to $1.8 billion this year, and first nine-months’ net income soared from $1.1 billion to $2.5 billion, officials said Nov. 7.

Net income in the third quarter, meanwhile, jumped 56.8 percent, from $417 million last year to $654 million for the quarter that ended Sept. 30.

In other major developments, officials at the Oakland-based health-care giant said Wednesday:

* Third-quarter operating income jumped 26.5 percent from last year’s $355 million to $449 million.

* Operating revenue for the quarter was $9.4 billion, up 8 percent from $8.7 billion a year earlier.

* Operating revenue for the first nine months jumped 9.3 percent, from $25.8 billion to $28.2 billion.

Kaiser also posted $205 million in non-operating third-quarter income, resulting in a quarterly net income of $654 million, up nearly 57 percent from $417 million in 2006’s third quarter. Kaiser attributed that explosive growth to a strong performance in finanical markets.

* Capital spending totaled $641 million for the third quarter, compared to $631 million a year earlier, while year-to-date capital spending for the nine months ended September 30 was $1.8 billion, compared with $1.9 billion during 2006’s same nine-month period.

Membership remained “relatively flat” at 8.7 million members. Officials at the Oakland-based health-care giant said “ongoing efforts to address health-care delivery costs and administrative efficiencies” contributed to the strong financial results for the quarter.

[I AM NOT THAT GUY 5,715]

U.S. health care system SUCKS!!! It's this thing called HMO (Health Maintenance Organization) It's a lucrative business. Only the HMO companies(ie. Kaiser, HeatlthNet, Aetna, Humana, and so on..profits on the expense of the people..

Here in the US if you don't have insurance you're screwed....if you do you have pay for expensive monthly insurance premiums(only a few company fully pays for their employees premiums because it's getting very expensive, especially todays economy) fu%K the HMO....Their main objective is to make money, they don't care about the welfare of the people, It's a wicked organization.....read more about it and research for yourself....

Kaiser is the largest not-for-profit HMO in the country.

That's what they want you to think, it's still HMO system

[We're practically speechless, so we'll just ask one question: How can a non-profit double its net income -- with zero membership growth -- and still call itself a non-profit?]

From San Francisco Business Times:

Kaiser Permanente’s 9-months’ profit more than doubles to $2.5 billion

by Chris Rauber

Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and their subsidiaries announced gigantic jumps in net income, operating income and investment income for the third quarter ending September and the year’s first three quarters, including startling increases sure to raise questions about the organization’s non-profit status.

Operating income more than doubled from $868 million in the first three quarters of 2006 to $1.8 billion this year, and first nine-months’ net income soared from $1.1 billion to $2.5 billion, officials said Nov. 7.

Net income in the third quarter, meanwhile, jumped 56.8 percent, from $417 million last year to $654 million for the quarter that ended Sept. 30.

In other major developments, officials at the Oakland-based health-care giant said Wednesday:

* Third-quarter operating income jumped 26.5 percent from last year’s $355 million to $449 million.

* Operating revenue for the quarter was $9.4 billion, up 8 percent from $8.7 billion a year earlier.

* Operating revenue for the first nine months jumped 9.3 percent, from $25.8 billion to $28.2 billion.

Kaiser also posted $205 million in non-operating third-quarter income, resulting in a quarterly net income of $654 million, up nearly 57 percent from $417 million in 2006’s third quarter. Kaiser attributed that explosive growth to a strong performance in finanical markets.

* Capital spending totaled $641 million for the third quarter, compared to $631 million a year earlier, while year-to-date capital spending for the nine months ended September 30 was $1.8 billion, compared with $1.9 billion during 2006’s same nine-month period.

Membership remained “relatively flat” at 8.7 million members. Officials at the Oakland-based health-care giant said “ongoing efforts to address health-care delivery costs and administrative efficiencies” contributed to the strong financial results for the quarter.

What good does it do to post earnings from 18 months ago, when everybody was showing record earnings? Do you think someone is "skimming off the top"? If so, show your cites amd build your case.

Edited May 10, 2009 by Mister_Bill

[one...two...tree 2,762]

I think we need to have private insurance as an option within a universal coverage plan.

Do you agree that the public option should be set up so as to not have a built-in systemic advantage over private options?

No. If for-profit insurance companies can compete with not-for-profit ones right now, I don't see why it would be any different.

[one...two...tree 2,762]

Survey Reveals that Doctors Feel Pressured by Health Insurers to Alter the Way They Treat Patients

LAKE SUCCESS (9/2/2008) – The Medical Society of the State of New York just released survey results, which indicate that health insurer rules often force New York State physicians to alter the way they treat patients – and not necessarily for the benefit of patients. Instead, the rules appear to have been developed to increase insurer profits at the expense of the best health practices and patients' health.

...

Ninety percent (90%) of the physicians surveyed said that they have had to change the way they treat patients based on restrictions from an insurance company, and 92% said that insurance company incentives and disincentives regarding treatment protocols "may not be in the best interest of the patients."

Physicians' most common complaint was that health insurers required them to change prescription medications; 93% of the physicians voiced this complaint. Over three-fourths (78%) said that an insurance carrier has restricted their ability to refer patients to the physicians they believed would best treat their patients' needs.

A majority (87%) of physicians said that they sometimes feel that they are pressured to prescribe a course of treatment based on cost rather than on what may be best for the patient. Over half (62%) of the physicians surveyed, however, are either somewhat concerned or very concerned (37% and 25% respectively) that they may be cut out of an insurance network if they do not follow the policies requested by insurance companies.

Physicians overwhelmingly (95%) agreed that "Decisions on what medications are right for a patient should be made by the patient's own doctor and not by the health plan or the insurance carrier." As a result, 91% of the doctors surveyed said that there should be enforceable legislation to regulate the restrictions that insurance carriers put on physicians in regard to treatment modalities they prescribe for patients.

Thanks for posting this. It shows that whatever problems can be found with public insurance, can also be found with private.

Here's an idea. Have public insurance be overseen by an outside party, one that is independent but contracted by the government, which would rule in cases where the doctor is prescribing care to a patient that the insurance doesn't believe is necessary. This panel should have some doctors on it and their final decision should trump all other decisions. Also, any health plan should have the provision that no one shall be denied services in a life threatening situation.

[I AM NOT THAT GUY 5,715]

Survey Reveals that Doctors Feel Pressured by Health Insurers to Alter the Way They Treat Patients

LAKE SUCCESS (9/2/2008) – The Medical Society of the State of New York just released survey results, which indicate that health insurer rules often force New York State physicians to alter the way they treat patients – and not necessarily for the benefit of patients. Instead, the rules appear to have been developed to increase insurer profits at the expense of the best health practices and patients' health.

...

Ninety percent (90%) of the physicians surveyed said that they have had to change the way they treat patients based on restrictions from an insurance company, and 92% said that insurance company incentives and disincentives regarding treatment protocols "may not be in the best interest of the patients."

Physicians' most common complaint was that health insurers required them to change prescription medications; 93% of the physicians voiced this complaint. Over three-fourths (78%) said that an insurance carrier has restricted their ability to refer patients to the physicians they believed would best treat their patients' needs.

A majority (87%) of physicians said that they sometimes feel that they are pressured to prescribe a course of treatment based on cost rather than on what may be best for the patient. Over half (62%) of the physicians surveyed, however, are either somewhat concerned or very concerned (37% and 25% respectively) that they may be cut out of an insurance network if they do not follow the policies requested by insurance companies.

Physicians overwhelmingly (95%) agreed that "Decisions on what medications are right for a patient should be made by the patient's own doctor and not by the health plan or the insurance carrier." As a result, 91% of the doctors surveyed said that there should be enforceable legislation to regulate the restrictions that insurance carriers put on physicians in regard to treatment modalities they prescribe for patients.

Thanks for posting this. It shows that whatever problems can be found with public insurance, can also be found with private.

Here's an idea. Have public insurance be overseen by an outside party, one that is independent but contracted by the government, which would rule in cases where the doctor is prescribing care to a patient that the insurance doesn't believe is necessary. This panel should have some doctors on it and their final decision should trump all other decisions. Also, any health plan should have the provision that no one shall be denied services in a life threatening situation.

I think that is in effect now. I know everytime I contact Kaiser, the first message I get is, "If this is a medical emergency, hang up, and call 9-1-1 now...."

[one...two...tree 2,762]

Survey Reveals that Doctors Feel Pressured by Health Insurers to Alter the Way They Treat Patients

LAKE SUCCESS (9/2/2008) – The Medical Society of the State of New York just released survey results, which indicate that health insurer rules often force New York State physicians to alter the way they treat patients – and not necessarily for the benefit of patients. Instead, the rules appear to have been developed to increase insurer profits at the expense of the best health practices and patients' health.

...

Ninety percent (90%) of the physicians surveyed said that they have had to change the way they treat patients based on restrictions from an insurance company, and 92% said that insurance company incentives and disincentives regarding treatment protocols "may not be in the best interest of the patients."

Physicians' most common complaint was that health insurers required them to change prescription medications; 93% of the physicians voiced this complaint. Over three-fourths (78%) said that an insurance carrier has restricted their ability to refer patients to the physicians they believed would best treat their patients' needs.

A majority (87%) of physicians said that they sometimes feel that they are pressured to prescribe a course of treatment based on cost rather than on what may be best for the patient. Over half (62%) of the physicians surveyed, however, are either somewhat concerned or very concerned (37% and 25% respectively) that they may be cut out of an insurance network if they do not follow the policies requested by insurance companies.

Physicians overwhelmingly (95%) agreed that "Decisions on what medications are right for a patient should be made by the patient's own doctor and not by the health plan or the insurance carrier." As a result, 91% of the doctors surveyed said that there should be enforceable legislation to regulate the restrictions that insurance carriers put on physicians in regard to treatment modalities they prescribe for patients.

Thanks for posting this. It shows that whatever problems can be found with public insurance, can also be found with private.

Here's an idea. Have public insurance be overseen by an outside party, one that is independent but contracted by the government, which would rule in cases where the doctor is prescribing care to a patient that the insurance doesn't believe is necessary. This panel should have some doctors on it and their final decision should trump all other decisions. Also, any health plan should have the provision that no one shall be denied services in a life threatening situation.

I think that is in effect now. I know everytime I contact Kaiser, the first message I get is, "If this is a medical emergency, hang up, and call 9-1-1 now...."

Well, in the case that AJ posted earlier - where a woman was diagnosed with cancer. IMO, it's important that health care providers remain private, and that both public and private insurance can coexist.

Edited May 10, 2009 by Col. 'Bat' Guano

[scandal 951]

But there are plenty of stories to the contrary.

Not all insurance is the same. Aetna HMO is very well regarded by medical professionals. United Healthcare is seen as very interfering and as a bad business partner.

I understand that.

I am far from an expert on health care policy. It is really on the back of my mind.

I would guess it all boils down to people not being good consumers and picking bad plans or not updating their plan as they get older and are at higher risk for medical complications.

People's insurance is usually tied to their employer. The employer decides what policy to use, which is usually to the benefit of the bottom line of the company and not the employee. This isn't a matter of not being good consumers, picking bad plans or not updating their plans. The employee is not in charge of this decision.

Very good point.

Many employer plans do have some degree of choice. Mine (with BCBS) does have a cafeteria plan to let me choose based on my needs.

Many plans will let you select between an HMO or PPO option. And between different rates of copays/premiums.

Employers and insurance companies have recognized that employees have different needs. Different family and medical situations. Some want the flexibility of a PPO, some prefer the managed care of an HMO.

I'm not defending the American system. It's broken and gives very poor return for the money spent. It definitely needs a radical overhaul. Having 40+ million uninsured, and millions more underinsured or in danger of losing their insurance is unconscionable.

[Big Papa Zone 93]

I'm sure you'll let us know how that goes the first time you give it a go.

You know it, baby!