Friday, August 07, 2009

On the current national quarrel

Whoops. She's right — lewlew, that is, when she remarked on the last paragraph in yesterday's musing about the current health-care quarrel.

If the insurance companies, over the past several decades, only had shown some inclination toward helping people meet their health-care expenses as opposed to building shrines for themselves and their employees, perhaps the power-grabbers would not have sensed an opportunity.

Aren't you supposed to grab your audience with the lead in the first paragraph? =)

In a nutshell, this is the largest shell game shilling the consumer in need of medical care. You hit the issue spot on in that one lovely sentence. I wish solving our need for medical care without nannyship and red tape were as eloquent. Harrumph!

I have long been of the opinion that the goal of an insurance company is first to keep your premium in its possession for the longest possible time. I have watched mighty edifices constructed along highways, gleaming architectural tributes to the insurance industry. I have taken tours and seen the expansive fitness centers and tasted the delicious food in the cafeterias where the insurance company minions went when they were not in their cubicles — or, in the case of the executives, when they were not in the well-furnished offices that were larger than the modest offices where I and a dozen other people toiled.

And I knew these luxuries were provided with money that should have been used to more fully reimburse the expenses of customers who were told the policies they purchased only covered a certain percentage of the cost, leaving them with bills for thousands of dollars.

The current quarrel regards whether this status quo is acceptable, or whether the process should be placed in the hands of a non-productive class of greedy souls who seize the income of the producers by guile and force, then redistribute it for a variety of bribes and acts of violence, saving a significant chunk for themselves.

The insurance industry has generally failed its customers while executives bask in personal and collective luxuries, opening the door for the fear-mongers to grab a piece of the action.

At the root of the problem is that we have become to believe in a system where I make a token investment in my own personal health but someone else — either a private company or Big Brother — should pay the bulk of the cost, leaving me free to purchase video-game systems and iPhones and other pretty toys.

It seems ensuring my healthy survival should be a higher personal priority — especially when the third party I hire insists on making judgment calls (as it has the right under the golden rule — "he who has the gold makes the rules") regarding how my doctor and I wish to spend the money it is providing for my medical bills. In a perfect world, the doctor tells me a reasonable price to cover his/her costs and an appropriate profit, and I hand over the cash or arrange installments.

Instead the medical payment system is as convoluted as any Internal Revenue Service process, and the simplest medical procedure comes with multiple bills and fiscal surprises. However, to reinvent the system to give more power to the creators of the IRS seems foolhardy to the maximum.

I don't have the answer. Well, no, I think I do: Give me the responsibility for the cost of all of my routine care, and I'll buy some of that insurance for catastrophic medical needs. Eliminate the middlemen and -women and the lawyers and the politicians from the process, and perhaps the doctors won't have to charge me as much as they do now.

Some people, economically wiser than I was in my youth and early middle age, already fund their health care like that. It works so well for them that the politicians are crafting a bill that would take that choice away, penalizing those who choose not to purchase a basic insurance policy and prohibiting the purchase of individual policies.

The lack of squealing from the insurance lords tells me that they'll still receive an adequate piece of the pie to keep the comfortable edifices they built with our premiums. And the politicians will keep their limousines and private planes and expensive suits; perhaps they'll even exempt themselves from the monstrous system they're creating for the masses.

People are raising their voices and objecting because it's clear they're watching a shell game. Almost everyone agrees medical decisions should be made by patients and their doctors. Neither the status quo nor the proposed solutions addresses this basic agreement.

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Anonymous lewlew said...

I saw on the morning news more information about the continuing upheavals at local town meetings, where the fedgov toadies are trying to sell health care reform. It ain't going so well.

It's interesting how the shell game has not only kept the insurance folks fat and happy. It's also lulled many doctors into this non-thinking apex of test now, ask questions later. As a medical care consumer, you need to ask questions now, before undergoing expensive, possibly unnecessary testing.

Please don't think I'm anti-medical tests, because I'm not. A very expensive test I went through in the recent past hopefully saved me from a painful, expensive future. No, I'm speaking of minor ailments that so many doctors treat as full blown testing emergencies, because they fear malpractice suits or have grown lackadaisical in their practice. For so long the selling point of test now was "your insurance will cover it." Not so, any more. It's more expensive to remain fat and happy, to shine the chrome and stock the cafeterias.

There is even a term for the current trend of shrinking insurance benefits: underinsured.

Imagine going to your doctor and then wanting a second opinion. You pick both doctors, you work with those you are comfortable with and whose prices you find to be reasonable. You are in charge, as the consumer. You could compare best practices, prices and decide which medical facility you'd like to take your business to in an emergency. Poor quality hospitals and quacks would go out of business because people would vote with their wallet and their feet.

12:22 PM  
Anonymous Hal O'Boyle said...

All solid observations regarding insurance companies, but you miss the root of the problem.

Before the government became the largest single buyer of medical care in the country in 1964 with the introduction of Medicare, few people had medical insurance or needed it. The government's creation of a privileged class of fully insured medical care consumers introduced the distortions in the market that snowballed into the cost nightmare we have today. Without that large class of people for whom medical care is essentially 'free' we would never have arrived in the insurance hell we occupy today.

Insurance is not the answer, it's the problem. Third party payers distort market feedback. Universal insurance creates unlimited demand. Every country that has it rations care through delay in providing it.

The real solution is for the government to exit the medical insurance business altogether. Unfortunately, that solution is so far outside the confines of the orchestrated 'debate' that it will never even be considered.

9:19 AM  

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