Both sides of the insurance debate
I really enjoy political discussions as long as everyone can keep an open mind, cool heads and it doesn't descend into name calling. I can easily be on many sides of this issue, especially since my vested interest is getting single, preferably multi-level lumbar disc replacements.
Sometimes I really get disgusted with how insurance companies tend to leave out common sense in their determination of what is and is not covered.
I had to have two crowns last year. Used up my $1,500.00. in dental coverage by September. As luck would have it, in November, I had a big pus pocket develop at the root of a molar that had a crown put in place 4 years ago. I had to have a root canal in that tooth ASAP. I got a new crown in February of this year as the old one couldn't be re-used. Insurance would not pay for a new crown because it had been less than 10 years for the original crown. It was not like I lost it or broke it. I needed a new one due to circumstances beyond my control.
A son has a mental disease. Insurance for mental illness is in the dark ages. $2,000.00 a year with a $10,000.00 lifetime cap. This is for a top of the line policy.
I'm currently in the back and forth with my insurance company before surgery. From the protagonist side of the fence, the insurance companies don't make an excess profit based on gross. Most are less than 10%. I did a Google search on BC in California since I've heard so much bad about them. See attached financial statement. Under penalty of law, they can't just plug in numbers. https://www.blueshieldca.com/bsc/aboutbsc/annual-report/index.jhtml
Insurance companies need to be able to cross state lines to encourage competition. In the present form, most every state has their pet mandatory issues that are required to be available free to everyone covered. In my state of NC, it is mammograms and colonoscopies. I’m not saying these are not necessary tests, but to leave this decision up to state laws is not what is needed for everyone without input from the patient and their doctor. For me, with a questionable lung lesion and a Bosnic II complex renal cyst, I need studies of these before I need a colonoscopy. We can’t trade what the insurance companies are required to pay for.
Tort reform should be in any health insurance overhaul. It is not the recovery for malpractice but punitive damages that need attention. Venue shopping, where plaintiff’s attorneys pick a place where juries are most likely to render a favorable verdict, should be limited in cases involving doctors, hospitals and insurance companies. Class action suits should have these same restrictions involving medical cases. There was a case in our paper on 9-3-09 involving a pharmaceutical company with a settlement of $2.3 billion dollars punitive damages. In my past, I spent almost a year working for another major pharmaceutical company. This very same practice was going on then as well and it was not the company named in the settlement. The six corporate “whistle-blowers” shared $102 million. The actual people responsible didn’t feel any “pain” or jail time. The stock holders who are general people like you and me are the ones who suffer in this type of suite.
Hospitals need to stop cost shifting. Our local major medical center, a non-profit that pays no property taxes or any taxes for that matter, has two twin turbine multi-million dollar helicopters, a helipad on the roof with crew quarters. The only use one helicopter, the other is a spare. There is no way they can charge what it actually costs to provide this service. Since the helicopter service started approx. 15 years ago, two have crashed and were total losses with the death of all on board. As an X paramedic, patients are not supposed to be transferred from one hospital to another with being stable. The time saved in 95+% of cases makes no difference. Another thing, these helicopters are not pressurized. They are restricted to low altitudes, sometimes 500 ft AGL or less. In cloudy mountains, like we have around here, it is a recipe for disaster.
The last job I had as a PA was in a walk-in clinic. My supervisor (business manager and not my supervising physician) would say “ching-ching” like an old cash register would make. This was the sign to run up the bill with any test that could logically be accounted for under workers-comp or when an insurance company would be paying for the bill. This is not an unusual practice. Another issue that I was constantly chastised for was giving people who were self pay and on limited budgets a full course of meds from the sample closet so they didn’t have to pay for their prescription. Around here, the Hispanic population almost always pays their on bill unless it is workers comp. If they had the time, they would go home, clean up and come to our clinic neat and fresh. The respect they show our medical clinic was appreciated.
A few months back, our adopted son who has psychophrenia was still driving at the time. We have since taken his license away as we can’t get insurance due to the number of wrecks he has had. Anyway, the officer who investigated this minor accident involving only him and a small shrub thought he was behaving funny. The officer did a breathalyzer which was clean. He then proceeds to call an ambulance at $675.00 to take him 4 miles to the local hospital. At the ER, in addition to the drug screen the law officer wanted, they did a head CT, urine for blood, complete physical and who knows for $5,700.00 bill plus the ambulance just so the police can get a drug screen. The ER doc, worried about lawsuits orders a complete neuro workup. I’m sure the fact he had his insurance card paved the way.
Any laws that “make” all insurance companies pay for a test or study; it drives up premiums for everyone. With government, it is taxes going up. There just simply is not enough money to pay for everything everyone wants with the type of health care available today. Even the countries like Canada and Britain limit availability. People have a better chance of surviving cancer in the USA than in either of these countries.
Another consideration is who decides who gets what kind of care. Do prisoners who have to have a deputy accompany them to see a specialist or sit in a chair outside their door at the states expense get the same level of care? Who pays for it? What about illegal immigrants? I have had a duel career. Recently, due to back pain and narcotics, I removed myself from any work as a PA and continued as a general contractor. The following is an example of the way it works in my area with our immigrant, predominately Hispanic, population of skilled and semi-skilled workers: I contract with a nationally known company to furnish and install vinyl siding on my new construction. They sub-contract the labor portion and send out a crew of 5 to 7 people. This crew is owned and managed by a legal alien who runs seven crews with a mix of mostly illegal’s that may or may not be replaced by other workers the next day at my job site. The nationally known company sends the owner of the siding company an IRS form 1099. That way they do not have to withhold taxes and Social Security. The legal alien boss sends each of his workers a 1099 so he doesn’t have to deduct taxes or Social Security. I asked one of the workers who could speak English one day about paying taxes. If the Postal Service or his employer hands him one, he throws his 1099 away. He said he didn’t pay taxes and was only mildly worried about getting caught. He could always come back with a different name.
The honest guys can’t compete with this type of practice. That is why in recent years there are so few legals and those born here available to hire. The illegal’s, even if they are paid less, take home more money, driving their competition out of business. When our area first started getting an influx of illegals, I would send them away if they were illegal. Immediately afterwards, stuff started getting pilfered, copper wire was stolen right out of the walls. Soon there was no other labor available. In the mean time, when I got a building permit at the county office, I saw babies who were born here and US citizens and their mom’s at the Department of social services. If an illegal alien has a baby here, the whole family can get legalized and qualify for programs. We have an adopted son from a very poor orphanage in a Middle Eastern country. He had never been in a car or seen a flushing toilet until we adopted him at age four. There were many children and adults in this former communistic country who were trying to get here legally. I fear the beginning of the end if left up to politicians.
Californians should be familiar with this problem. See the attached from the
1. 40% of all workers in L.A. County (L..A. County has 10.2 million people) are working for cash and not paying taxes.
This is because they are predominantly illegal immigrants working without a green card.
2. 95% of warrants for murder in Los Angeles are for illegal aliens.
3. 75% of people on the most wanted list in Los Angeles are illegal aliens.
4. Over 2/3 of all births in Los Angeles County are to illegal alien Mexicans on Medi-Cal, whose births were paid for by taxpayers.
5. Nearly 35% of all inmates in California detention centers are Mexican nationals here illegally
6. Over 300,000 illegal aliens in Los Angeles County are living in garages.
7. The FBI reports half of all gang members in Los Angeles are most likely illegal aliens from south of the border.
8. Nearly 60% of all occupants of HUD properties are illegal.
9. 21 radio stations in L.A. Are Spanish speaking.
10. In L.A. County 5.1 million people speak English, 3.9 million speak Spanish.
(There are 10.2 million people in L.A. County.)
(All 10 of the above are from the Los Angeles Times)
Less than 2% of illegal aliens are picking our crops, but 29% are on welfare.
Over 70% of the United States' annual population growth (and over 90% of California, Florida, and New York results from immigration. 29% of inmates in federal prisons are illegal aliens.
Those of you who live in California may know more about this than I as I’m east coast. The relationship to medical care is our government cannot afford to give the level of care to everyone as they do for that available on medicare with prescription coverage, especially those that break the law to come here.
Suffered thru every non-surgical cure known without relief.
Pain management '06 to April '10,
Had minimally invasive PLIF with internal fixation on 12/28/09 for isthmic spondylolisthesis of L5-S1 (TDR contra-indicated) DDD at L3-4 & L4-5, All L-Spine doing well. Episodes of no pain at all. After being relatively pain free for 4 months, C-Spine gave up. MRI due 11-1
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