The three interested parties in our health care system--insured, provider, payer. Insureds are the patients, the largest but most disorganized group. Second are health care providers, medical personnel, technicians, pharmaceutical companies. Third are payers--insurance policies.
The critical issue is for patients, the insureds to fully organize and present the number one issue for themselves. While getting quality care is not perceived as big a problem as paying for care, the issue is getting quality health care. Ask anyone who's been ill and that person will talk about the process of getting diagnosed, getting treated, and hopefully being monitored or not for many years to come. The focus must be on the access to affordable and quality care. Everybody already knows this but by shifting the national conversation to insurance, we are playing in someone else's ball park and we've given up our home field advantage.
Last night I saw a warm and fuzzy commercial about how the AMA is committed to having people insured as if insurance was the equivalent of health care. The AMA has priorities too, keeping a paying patient base. How does being uninsured become the business of an organization that is merely promoting health care. Wouldn't the commercial encourage people to visit their doctors, whether or not they have insurance if the AMA promo was merely about patient health? Of course. But we love a warm fuzzy marketing technique whether it's the gruff House with his heart of gold, or the goofy providers of fabulous care on Scrubs or the very human but completely committed individuals on ER, we love the idea of Daddy Doctor. Get real for your own sake.
Insurers are our easy target, they don't where the white lab coat and have fifteen people in the front office who handle money issues. They don't touch our bodies and reassure us that they will make them well. They are the business end and consumers have no problem with raising issues with insurance companies about payment. With all the anger directed towards insurance companies, why haven't there been reforms? Ah that's the question. Partially because of our shift to get any coverage as long as it's cheaper. We started the flea market bargaining for cheaper premiums and we wrongfully assumed that basic coverages would not be impacted. Before we woke up we were covered for a dietitian but not a transplant.
We are three distinct entities, patient, doctor, insurer and while we all care about the bottom line, it is only patients who can advocate that access to affordable quality health care is number one.
The enemy of my enemy is my friend is not a recipe for success for current or future patients. While our issues may overlap, our goals do not. The issues are familiar: Cost of health care, paying for health care, insurance company avoidance of paying blah blah. We're wrong, our focus has shifted from health care to health insurance. Doctors are in business, they want to be paid. Insurance companies are in business, they want to show a profit. Us? We want to know that we will have access to and be able to afford quality health care if we get sick.
There are overlap issues. We even have stuff in common with those hate insurers. It is a dysfunctional triangle family of patient, provider, insurer. Why is the AMA concerned with everyone being insured? Is it because they care about patients? A little. Is it because they care about being paid for their services? A little more. Why do insurance companies want patients to be insured? Is it so they can pay for your health needs? Not really. Is it to collect premium dollars? Uh, yes. Why do patients care about health insurance? Is it to be sure doctors will be paid? Only indirectly, only so that they will treat us. Is it so that insurance companies will pay the costs for those providers? Uh yes.
MYTHS
The AMA battles Usual and Customary Charges Just Like Me
Many physicians do battle usual and customary charges just like us. If you look at the AMA litigation cites the AMA has major issues with reimbursement rates but why? Remember the priorities in our triangle. Insurance companies adhere to low usual and customary charges because that reduces their costs--no brainer. But if you look at the AMA litigation cases, the issue with low reimbursement rates for the AMA is that the rest of their fees they need to get from patients and you know what, patients can't always pay. As a matter of fact, while the right to charge fair market value was upheld by courts, the courts also protected insurers right to establish lower usual and customary charges. The difference between what physicians decide is the fair market value for their services and what insurers decide is usual and customary is known as Patient Responsibility.
The Politicians will fight for universal health care or at least health care reform, they know there's a problem
Okay, wake up call, politicians do not have difficulty in paying for health care, they are wealthy.
Politicians are fighting for their signature issues. Addressing the number of uninsured is as cheap a tactic as George Bush's phony southern accent and rolled up sleeves at community meetings and as phony as Ted Kennedy's support of the ancient patients' bill of rights--you know what, it's balogna. Health care reform depends on a stronger group fighting on behalf of a weaker group. How fast did some laws get passed after 9/11? The supprime mess? It's not that laws can't be passed immediately stating there is a national health insurance plan in place now. All physicians will see patients and will get reimbursement based on current calculations of reasonable and customary charges as determined by government figures used for Medicare and Medicaid. Any physician who charges more than this amount, accepts gratuities, or pads his billing will immediately have his medical license revoked. Appeals can be submitted in writing to......
Hospitals will fail, doctors will stop practicing medicine, insurance companies will fold, it will be the end of days if we try to reform health care
Hospital failures are basically public hospitals right now because they treat the uninsured masses. Government dollars do not cover their expenses because people with insurance choose the private conglomerate hospitals that advertise newest equipment, best staff, etc. If all hospitals are public this issue disappears.
http://www.medicalnewstoday.com/articles/27348.php is a cite to an article and study that is available for your viewing that shows that the US spends more on health care per capita than most other countries but does not get its money's worth. We are 42 in life expectancy. How's that working out for us? We are spending the money we're just spending it badly.
Years ago there was a magazine cover that talked about the new poor and talked about single Moms. If you really think that physicians will make the cover of an updated version of this headline if we have national health insurance, think again and really do more than think do the research.
I've got insurance coverage that I pay for so who cares?
Really? You might want to read your insurance coverage and its changes over the past year. New exclusions, new copays, new requirements.....
