The fundamental problems of health care in American start when you enter a doctors office

 

The obvious absurdity of what we are doing with health care in America is most evident in the statements of the supporters of the current legislation.  Simply put, they miss the boat and focus not on the problems, but on the symptoms.  A good example of that is the position of the AMA (an organization as bogus as the AARP in terms of representing its supposed constituency).  Consider this excerpt from a letter to the editor of the Wall Street Journal by the President of the American Medical Association. 

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HEY, IT’S MY JOB TO PROTECT OUR FEES…THE INSURANCE COMPANIES PAY TOO LITTLE

Our current health system is fragmented, and it’s not working for far too many patients and the physicians who dedicate their lives to patient care. Reform of our health system is needed, and the Senate bill includes key benefits that will increase choice and access while eliminating insurance company tactics like denying coverage for pre-existing conditions. 

What we fail to understand is that the fundamental problems of health care in American start when you enter a doctors office, not when you file a claim.  Forty- eight years of managing health benefits and of hearing claim appeals from employees tells me very clearly that people don’t get it, they want it all, they do not want to pay for anything, they think every test and procedure ordered by a doctor is warranted, and they never ask why something cost so much, but they always ask why the health benefits did not pay more.   That is what is wrong with health care in America.

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2 comments

  1. By federal law all employer plans have formal and detailed appeal procedures that cover the immediate emergency and the longer term appeal and the process is detailed in employee benefit booklets (which by the way most people simply ignore). In addition, most large employers have benefit centers that employees can call to inquire about such things.

    I am not sure of your last comment, but I think it reflects another flaw in our attitudes about health INSURANCE. That is it is not insurance at all. It pays for many things that are not insurable risks and should be paid for by individuals.

    Does getting full value from your auto insurance mean you have little or no out of pocket cost or that it covers routine oil changes or even major repairs? Why is it any different for health insurance?

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  2. Have you considered the idea that many people will not appeal their benefits decisions? You undoubtedly heard from all the people who don’t want to pay for anything. What about the people who don’t complain or don’t even realize that there is someone to complain to? I’ve never heard that there was such an option, and I’ve worked at Fortune 100 companies for years.

    Further, is it possible that people think that they are getting health insurance in lieu of higher wages and thus want full value for their money?

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