Medical Insurance Is Only A Discount Plan And Not Insurance Plan
(There is supposed to be a difference. Please see the Federal Trade
Commission consumer alert for their warning and advice by clicking this
link: FTC Consumer Alert)
I have been saying this for years now. The list of medical insurance woes is a very long interweaving laundry list with historical nuances and beyond a short blog post. It is the story of multiple books since its complex and compound details simply cannot be confined to just a few. Bearing this in mind, however, lets just take a quick jaunt through some salient and some recent developments that have come to the battlefront and stirred considerable political debate. Lets pull back the curtain and let me give you a bit of the benefit of my 21 years of industry exposure from a Podiatrists perspective, from an admittedly anecdotal view, and via the application of simple deductive analysis, i.e. common sense.
Medical insurance is quickly becoming a discount plan and not real insurance in the sense that we have all grown accustomed too. A recent article in the AP news wire service
quotes a recent study that forecasts deductibles, co-payments, and
out of pocket expenses will rise again next year. That means you the
patient pay more of the share of the cost and the insurance company
pays less. However your insurance bill will not go down. I don’t know
how the insurance companies continue to get away with increasing the
cost on both sides of the balance sheet while reducing what they pay
doctors and hospitals to the point where many hospitals, emergency
rooms, and doctors are going out of business. In the face of this the
insurance companies have reported record profits until this year! ("WellPoint Boosts Premiums to Bolster Profits") It seems that bleeding your clients dry in the face of decreasing job market, increased energy costs, and increasingly undertreated epidemic chronic diseases is not a good strategy. You just don’t kill the cow if you want to get any milk.
While some relief of suspect health insurance company reimbursement practices is finally coming to California from Sacramento lawmakers it is certainly too little and certainly too late for many.
Legislature’s major healthcare accomplishments involved several
high-profile, though relatively uncommon, practices that afflict
consumers and patients. Lawmakers agreed to stop insurers from retroactively canceling policies of sick customers…"
"Legislators also voted to require insurers to spend at least 85% of the premiums
they collect on medical care rather than overhead and profits. If
signed by Schwarzenegger, that measure could turn out to be the
nation’s most stringent, although there are doubts that it will lead to
lower premiums. In addition, lawmakers decided that insurers must pay
for maternity care, orthodontics cleft palate treatment and the purchase of medical equipment such as wheelchairs."
changes appear to this observer as hardly earth shattering. If anything
they are common sense changes that should have been enacted long ago.
Good God I think that my health insurance should spend more than a mere
85% of what they get to take care of the sick. If anything why is there
a limit at all. Ah yes, of course profit. And the almighty profit is
worth more that the health of your mother, or sister, or daughter. Sure
that makes sense. (cyniscism and snarkiness borrowed from Republic
National Convention) Pay for a wheelchair! I’ll bet you thought that
was a given. Surprise, its not! (Limp or crawl home if you can’t afford
one or beat up that week retard down the street and take his
All of the measures await action by the governor, who has until Sept. 30 to sign or veto bills from this session.
is not unusual for a patient to visit my office, have a bill sent to
their insurance company for the $65 office visit, the insurance pays
me, the doctor, $9.00, and the patient is liable for the remaining $45,
with an $11 negotiated discount for seeing a participating provider in
your insurance plan. It is also common for a patient to present to my
office and pay a $35 or $45 co-payment at the time of visit and after
sending the bill to the insurance company for $65 they, the insurance
company, pay $ 1-10 (Or even less. I have seen checks in the amounts of
0.40 cents. Don’t believe me? Ask your doctor. E-mail Dr Sanjay Gupta if you please. Click here for Dr. Gupta’s Blog)
This means you pay $45 they pay $5 or $10 dollars for a visit to the
doctor that costs $65. All this, while you send them $500 to $800 a
month for what they call health insurance. That’s not insurance my friends that’s a medical discount card.
The average income of a family practice doctor is around $180,000 a year. No joke. Although that seems like a decent wage in comparison to other jobs, the years of study and the average student loan debt of over $150, 000 (mine
was closer to $200,000 and the average Podiatrist income in Los Angeles is placed at some at around $ 150,000) incurred by doctors it may not be so
attractive. I have met sales reps making the same amount and never had
to endure the long years of study and student loan debt. Article after
article has been written about and by doctors sharing their discontent
but more importantly students are being deterred from studying medicine, especially family care, as
a result of these dissincentives. Why should they toil taking difficult
pre-med courses in college, struggle through difficult medical school
programs, suffer long hours in residency and internships, and incur
great debt only to struggle to make ends meet and under the pressure of
mountains of debt for years? It is much shorter and easier for the
these intelletuals in our society to pursue some other mor profitable
venture. The result doctor shortages while an increase in patients due to the aging baby boomer population will create medical care crisis already being felt in parts of Canada and discussed with respect to Medicare costs.
health care is now largely delivered via a government-subsidized
private health insurance industry operating parallel to and within
Medicare. A recent nationwide poll of physicians published in the
Annals of Internal Medicine utilizing the AMA physician database
demonstrated that 60 percent of doctors support a single-payer national
health plan based on the most efficient and effective Medicare system.
national health plan currently before Congress (HR 676) would provide
medical care and low-cost prescription drugs to all Americans –
including the 47 million uninsured and 50 million underinsured citizens
– while maintaining the private-practice quality of physicians,
hospitals, clinics and therapists.
The lower overhead costs of
the most efficient Medicare insurance plan, which already treats more
than 40 million people, would provide substantial cost savings to all
Americans and businesses while maintaining quality private physician
practices and hospitals. A majority of physicians in this country can’t
be wrong in their support of a single-payer national health insurance
plan such as HR 676. – HOWARD A. GREEN, M.D."
Watch actual persons tell their story of medical insurance woes in person in an AARP TV Ad Campaign which hits the nail on the head by clicking on this link. Unless you are a human with a reptile nervous center you will be moved by these true stories (requires flash palyer)
(Blue and underlined words indicate a link to a source article or video, double click to view these. Quotes are in italics.)