Wednesday, February 18, 2009

Ranting at The Health Care Blog

I just put together a rant over at The Health Care Blog. Just got going and couldn't stop myself. That's supposed to be a bunch of health care professionals but they got their panties all in a wad over the politics of the stimulus bill, of all things. This is what I left in the comment thread:

Boy is this unsettling. I just started tracking The Healthcare Blog and thought I was really into a great source of professional information. Instead, one mention of the stimulus bill and all I see is a bunch of medical professionals carping and fighting among themselves in a catfight no better than a comment thread at Kos' or Malkin's places.

As a layperson looking to health care professionals for advice I am neither impressed nor encouraged.

I'm not without bias. My attitude about insurance companies was poisoned many years ago when I discovered that their business was tracking actuarial tables and peddling a product calculated to do a lot more than insure me against liability, property loss, injury, whatever... Over and above the actual costs of insuring a risk group, they must also pay an administrative cost which includes not only keeping a database but rewarding outstanding sales people, brokers and executives more handsomely than other competing insurance companies, they are also expected to generate enough income over and above that to insure that shareholders receive dividends. Oh, did I mention the lawyers? Don't get me started.

But as I said, I'm biased.

So when now I come to the stage in life when my wife and I are trying to make sense of a bewildering array of supplemental insurance plans to go along with our Medicare benefits, I find that the insurance industry has now grown to the point that a variety of Medicare Advantage plans is kidnapping beneficiaries from the system to be enrolled in yet another measurable risk group in yet another form of managed care.

Here's the odd part: unlike the old medigap policies these so-called "advantage" plans have lower premiums. Huh? Yes, and depending on what county you live in, the premium might be ZERO! What's that all about?

Heck if I know. All I can figure is that they are being paid by Medicare so much that they are awash in money. Either that, or they are able to "manage" the care of their population so well that is costs less for some reason. The devil in me wonders if that reason might be rationing what they offer their clients. Or kickbacks from drug companies. They must be doing well because with all this economic crisis I'm not hearing anything about health care insurance companies having any problems.

Something is very, very wrong with this picture, folks.

I sincerely hope it's worked out in a gentlemanly manner, but I'm not seeing much of that the closer I look. All this carping about record-keeping makes me want to puke. Hell, if they want to deny coverage to someone the insurance companies seem to have no problem uncovering the most obscure piece of trivia from someone's medical history. I bet everyone reading this knows anecdotal evidence of what I just said, but I doubt anyone would admit to it on the record.

Credit card companies, banks, and retailers have data galore about all of us. I can go on line and for about thirty-five dollars can find out more about someone than they know about themselves, including their mother's maiden name and the names of their pets.

Every time I fill up my tank using a credit card I wonder why, after all these years, the card company hasn't lost track of a single digit of a transaction. But NO, buddy. They always appear on my monthly bill. I went to Staples a few weeks ago and used my credit card to make copies on their copier which was equipped with a credit card terminal. I had a line item on my Mastercard bill the next month for seventeen cents!

Come on, ya'll. Get real. i know medical records are a different creature. I know if you have an STD you don't want your spouse to find out, or if there is reason to believe you might be dead in two years you don't want the life insurance company to find out... especially after you're dead, because if you knew that and failed to reveal it that might be fraud. Well I don't really give a crap about all that. All I want is better health care at more reasonable rates.

One more thing before I end this rant. As a food service manager I employed several thousand people over the last thirty or so years. I found our long ago that ordinary people from other countries often return to their home countries for medical care because they get it so economically that they can afford to make a round trip, see their friends and family while they are there, and still come out better than if they had done it in America.

Likewise, one of my post-retirement jobs was in a hospital where I learned the term "medical tourism." When I heard it I thought it meant rich foreigners, probably loaded with petro-dollars, coming to America for medical care. Wrong! I'm sure readers of this thread, being in the profession, already know that medical tourism means Americans going elsewhere, notably India or Thailand, to get expensive procedures done at rates so low that they can include the costs of travel and lodging and still come out ahead.

Does any of you even care about what was once called a good bedside manner? Or the privacy concerns of HIPAA that so obsessed the workplace where I spent five years? This comment thread is a very public place to be airing your dirty laundry. And as a consumer (Remember me? Does my opinion really mean anything?) I am very unimpressed.

If there is one take away from all this it would be the following:

►Providers deliver health care. They are the professionals and that is their mission.

►Administrators and insurance companies do not deliver health care. Their mission is to manage it based on costs.

There is a symbiotic, incestuous relationship between health care and insurance companies that serves shareholders, executives and other non-medical professional quite well. The system operates at the expense of quality health care to a population badly in need of it and health care professionals who deserve better compensation and resources than they are being allowed, in order to do a better job of what they do well. I heard one politician state it well who said "We have the best health care system in the world and the worst possible way of paying for it."

I figured out what the problem is. It isn't the stimulus bill. It isn't the economy. It isn't even the election of Barack Obama.
The problem is that the era of worshiping the free market and believing that the market would self-regulate has come to an end. Even through the Clinton years the prevailing attitude was... (and to come extent I swallowed it along with everyonen else... after all in our deepest hearts we are all to dome degree libertarians) left along the marketplace will eventually work out a remedy for all problems. Less intervention means more innovation and creativity.


Lured into complacency by this tempting faith, even the regulators in place fell asleep at the switch. Reagan said "government IS the problem" and it sounded so good everyone wanted to believe it. Even the loyal opposition (Democrats in those days) let them get away with it. And it didn't work.

First there was a "shadow banking" system.
Then there was a storm of credit. So much credit that China could jump into the marketplace.
Then there were hedge funds.
Then they came up with the idea of collateralized debt obligations.
Then there were credit default swaps.
And Bernie Maddoff was running a ponzi scheme.
Glass-Stegal was done away with and everybody and his brother got into the banking business.
I think by now everyone knows what happened next, when DEBTS got sold as ASSETS. (Try to make sense of that one!)
So here we are...

What has this to do with health care?

This is not about health care.

This is about drinking the wrong Kool Aid.
We all did it. And it got to be an addiction.
We now have a collective case of substance abuse and are having a hard time with detox.
That's what the comment thread over at the Health Care Blog is all about.

The sooner we get over it, the sooner we can move on with our lives.

Sorry, Mr. Reagan. This time government is the solution, not the problem.

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