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View Diary: What you should know about health insurance industry lobbyists and their lies (276 comments)

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  •  Can someone elaborate on the difference (0+ / 0-)

    between health care vs. health insurance, particularly with respect to single payer. Right now, we do have universal health care in America -- it's embodied in the law that says that hospitals cannot turn away emergency cases. So, universal health care in America means that you can show up at your local emergency room and get seen. Pretty minimal. There's also the network of nonprofit community health clinics that don't turn away anybody.

    Wouldn't universal health care start with all of the medical services that you can get without paying anything, and build from there? More funds to county hospitals, community clinics, etc. Maybe print up a card and give it to every American along with a number so that you would at least have a continuous medical record.

    Aren't single payer and Medicare-for-all just more of the same: confusing health care with health insurance? Not that I don't agree with those also, but it seems to still buy into the same fundamentally wrong paradigm -- that without health insurance, you die.

    •  ER care is not healthcare (8+ / 0-)

      Right now, we do have universal health care in America -- it's embodied in the law that says that hospitals cannot turn away emergency cases.

      That is EMTALA and it was enacted to prevent hospitals from dumping ER patients and turning them away. That hardly qualifies for healthcare. Someone with an acute heart attack will probably get appropriate ER and hospital care, but the fact he/she got to that point is damage done and cannot be undone.
      ER fees are astronomical and while someone may get care, they are likely to get a bill that is 3-5x what insurance will pay. Look at any EOB and you will see.

      Not that I don't agree with those also, but it seems to still buy into the same fundamentally wrong paradigm -- that without health insurance, you die.

      that is not wrong, without health insurance you die. A slow death, but you die.

    •  It's much more complicated (8+ / 0-)

      Emergency rooms are required to get you emergency care.  In other words get you stabilized.  If you have cancer they are not going to give you 6 months of chemotherapy.  The community  clinic probably can't afford to give you that 6 months of chemotherapy, or is just set up to treat minor illnesses.  And not every region has a hospital that is for the poor and many of these are underfunded and short on staff.

      People ARE dying due to lack of insurance in this country.

      Without insurance there are many specialists that won't see you, many tests doctors are hesitant to run.  Our hospital here won't run any expensive test here without cash up front - even if you HAVE insurance. And we are the only hospital in the county.

      •  Wait (1+ / 0-)
        Recommended by:
        Alexandra Lynch

        People ARE dying due to lack of insurance in this country.

        My question is: is the problem that they don't have insurance, or that if you don't have insurance you don't get care?

        •  Even people WITH insurance are having problems (5+ / 0-)

          because often the insurance cost much and covers little.  This leaves them with limited funds when something does go wrong.  Then they will put off care, or not be able to afford the care they need.

          So in all honesty, I believe the answer is both. Though we probably have more people dying due to being uninsured at this point, we do also have people underinsured who are delaying care and paying the consequences.

          In our county as I pointed out, it doesn't matter whether you have money or not.  Unless you are in the ER and about to die, a test does not get run unless they have money up front. So you may have cancer, but no way to find out in time to get life saving intervention.

        •  If you don't have insurance, you can't afford (0+ / 0-)

          the fees to seek care.

          I have, for example, godawful pain once a month from my menstrual periods. I sweat, turn white, and get nauseated, and weep uncontrollably. I have to stay at home and lie naked on a bed because clothing on my body makes the pain worse. The only thing that works on it is high enough doses of narcotics that I spend the thirty-six hours of agony in a drugged stupor.

          Now, from the symptoms, a lot of people will say, "sounds like endometriosis". I don't know. It's $1200 for the ultrasound that will show up what the hell is going on in my pelvis. We make, net, about $2500 a month. If it is endometriosis, surgery to clean it out would be another several thousand dollars. That's not counting the loss, during that time, of my labor doing various things that keep our household costs down. We'd have to pay for the laundry to get done, food to be prepared that I can eat, etc.

          But, of course, it might not be. It might be uterine cancer. But we can't afford to chase down "might be's". We are poor. This is why people only find out they have cancer when they collapse or it causes other symptoms. We can't go check out the lesser ones.

          If I present in an ER with the pain, they will give me a few narcotics and send me home. They will not treat the underlying condition. They don't have to.

    •  I'll try (11+ / 0-)

      Health care is what doctors,nurses, respiratory therapists, and other medically trained professionals provide to patients.  It encompasses everything from preventative care like routine check-ups to trauma care like resuscitating people who have been in a car accident.  It is the act of trying to help someone be healthy and whole.

      Health insurance is what a middle-man provides and is, essentially, gambling.  The health insurance company sells a customer an insurance policy and gambles that the customer won't need more money spent on their health care than the company is charging them for the policy.  The more frequently they gamble correctly the more profit they make.  Put another way, the less frequently they actually pay for health care the more profit they make.

      Customers buy the policies because they fear the risk of a catastrophic medical issue or the onset of some expensive chronic medical issue.  Even though they hope they won't need it they're willing to pay for it to have some protection against financial meltdown in the face of some unexpected medical issue.  

      No one needs health insurance to live.  At some point or another most people will need health care to live, or at least to have a good quality of life.

      To the extent that hospitals cannot turn away people who present with emergent issues patients are protected from instant death due to some trauma or sudden catastrophic medical event like a heart attack.  But make no mistake, if the issue is not life-threatening, once the fact that it is not going to immediately kill you has been established the hospital is under no obligation to treat you.  

      Also, once they have treated you, they can also bill you and put you into collections if you don't pay.  This is not universal health care - it is a stop-gap measure put into place because some hospitals were throwing dying people out on the lawn when they found out they didn't have insurance coverage.

      Currently, most health insurance plans seek to minimize their risk of having to pay for actual health care with all sorts of loopholes, pre-existing condition exceptions, and outright refusals to cover certain things like patients seeking emergent care for things that turn out to be non-life threatening.  That is, they take a gamble on their client's health and if the client becomes ill they don't want to make good on their bet.

      Universal coverage, which isn't by necessity a single-payer plan, is simply a committment on the part of the government to make sure that everyone gets the health care they need.  Single-payer plans do this by spreading the risk of catastrophic illness, major injury, expensive chronic illness, and other costly medical issues over a whole population all of whom are paying into the system.  

      It is different from health insurance companies in that the single payer plan isn't really gambling on the good health of the individuals in the pool.  If everyone is in the pool it is a foregone conclusion that some people are going to need the coverage although it isn't predictable in advance who those people are going to be. Single-payer plans take everyone unlike insurance companies who usually are only willing to gamble if they can cherry-pick the healthy people.

      It is also different in that the money being paid in by the population is meant to go to actually providing health care and administering the plan.  No money is being removed from the system in the form of profits to people who aren't providing actual care or administrative support for the system.

      "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

      by Edgewater on Sun Jan 25, 2009 at 01:25:36 PM PST

      [ Parent ]

      •  If everyone is going to be covered (0+ / 0-)

        then why have a "plan" that needs to be administered? Why do you have to have "coverage" if nobody doesn't?

        •  I may be misunderstanding your question (2+ / 0-)
          Recommended by:
          Kentucky DeanDemocrat, snakelass

          and if so let me know and I'll try again :)

          Q.  Why have a "plan that needs to be administered" if everyone is going to be covered?

          A. Well, first to get everyone covered we, as a nation, first need to establish that everyone is, indeed, going to be covered.  As part of that, we need to establish some way for doctors, hospitals, and other health-care providers to be paid.  This would be the plan part.  

          The administering part would be determining how much the plan is willing to pay for what kinds of service/drugs, how providers would prove they had actually provided care to someone and what that care was, and things of this nature.

          Q.  Why do you have to have "coverage" if nobody doesn't?

          A.  This would go to billing, at least in part.  There would have to be some means for a patient to provide their identity to the facility providing care so that then the facility could bill the plan for the charges provided to that patient.  This identity, this person, is the covered person that the plan then pays out for.

          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

          by Edgewater on Sun Jan 25, 2009 at 02:03:58 PM PST

          [ Parent ]

          •  Yes, you do misunderstand me I think (0+ / 0-)

            My original point questions the link between universal health insurance and universal health care. I tried to point out that there already exists a system whereby people who lack insurance nevertheless receive health care. Admittedly, said system in the United States is horrific. That is not the case in other countries. People get the care they need paid for by the government, without the necessity of having health insurance. So, my suggestion would be that another way to approach universal health care other than universal health insurance would be to greatly improve the quality and quantity of health care that one can receive for free paid for by the government (or nonprofit organizations, as the case may be).

            I got several comments in response talking about the inadequacy of ER treatment and the fact that in the United States, if you don't have health insurance, you're basically fucked.

            •  Ok - I'll try again (3+ / 0-)

              In your initial post you raised the provision of the The Emergency Medical Treatment and Active Labor Act and said about this provision that:

              Right now, we do have universal health care in America -- it's embodied in the law that says that hospitals cannot turn away emergency cases. So, universal health care in America means that you can show up at your local emergency room and get seen.

              The thing is that EMTALA is not universal health care as emergent care makes up only a small part of the health care needs of a given individual or population.

              To understand a little more about EMTALA you can look here

              If you look in the FAQ there you will see that the statute says:

              Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition".
              If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.
              If the patient does not have an "emergency medical condition", the statute imposes no further obligation on the hospital.

              This statute really cannot be considered in the same category as universal health care in the sense that most people mean it when they discuss universal health care.

              In reading through this latest question you pose I am beginning to see where you are headed with this:

              That is not the case in other countries. People get the care they need paid for by the government, without the necessity of having health insurance. So, my suggestion would be that another way to approach universal health care other than universal health insurance would be to greatly improve the quality and quantity of health care that one can receive for free paid for by the government

              In other countries where people get the care they need and it is paid for by the government there is a national health care plan that allows this. Those people receive health care that is paid for out of everyone's taxes.  Typically these types of plans are among the type of plan known as single-payer plans.

              I pointed out the difference between single payer plans and health insurance in my post to you above but to save you the time of scrolling up I'll point them out again here.

              Health insurance is designed to make profit and so it tends to exclude people who, for whatever reason, are assumed to be at high risk of actually needing health care.  Money paid in is removed as profit.

              Single-payer plans are designed to provide health care to a population of people and so everyone is covered.  Money paid into the system is used to maintain the system and provide health care.

              There are a couple ways to run a single payer plan.  One, which I don't prefer, is to call it national insurance and charge everyone for it as if it were just like a private plan with the profit motive removed.

              Another, which I do prefer, sounds more like what your're talking about.  This way allows everyone to receive medical care which is billed to the government.  The government pays for the health care out of a fund that is ultimately paid for by taxes.  No person would ever receive a health care bill or a bill for national health insurance.  People would pay more taxes but the burden of paying for health care would be equitably distributed based on income.

              This second method would still have administration costs because the government would still need to negotiate drug/procedure/provider visit costs with providers as well as make sure care was provided everytime a bill was received.  But I think the costs would be less.  The headache for patients would certainly be less.

              Is that answer closer to what you were asking?

              "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

              by Edgewater on Sun Jan 25, 2009 at 05:40:02 PM PST

              [ Parent ]

              •  Yes, option number two is what I'm talking about (0+ / 0-)

                My point, however, is that we may be retarding our progress towards it by allowing the discussion to be so focused on universal health "coverage" or "insurance" to the exclusion of the actual real experience that people have of the "universal" health care that does exist. I fully agree that what we have in the way of universal health care in no way meets the definition of "Universal Health Care," but it is how people without health insurance access medical care and I don't see why it should be completely ignored in the discussion.

                In essence, I see two sides to the universal health care discussion. The one side focuses on finding a way for everyone to have health insurance, the other side involves improving the quality of care available for those who don't have insurance. All of the focus has been on the former for the past fifteen-plus years, but it is only the latter has actually provided medical services to those who can't afford it. Can we expect another fifteen of the same?  

                •  Agree that health insurance isn't the way (0+ / 0-)

                  that's why in my first post to you I said "no one needs health insurance to live.  At some point or another most people will need health care to live, or at least to have a good quality of life."

                  I agree you that the best choice for achieving universal health care in America is one which discards the idea of health insurance altogether.  I disagree with this point you seem to be making though:

                  Aren't single payer and Medicare-for-all just more of the same: confusing health care with health insurance?

                  The answer to this question is no - and this is what I was trying to communicate to you albeit somewhat incoherently since clearly you didn't understand this is what I was saying ;)

                  Here is a good explanation of single-payer plans from Wiki:

                  "Single-payer health care is the payment of doctors, hospitals, and other health care providers from a single fund and is one of the systems used with universal health care. The administrator of the fund is usually the government."

                  "An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company."

                  Link

                  A single-payer plan does not necessitate a national health insurance plan.  All it assumes is a single payer.  How that payment is arranged may differ from plan to plan.  And when I use the word plan I don't mean health insurance plan - I mean health care plan.

                  I would disagree that the two sides of the debate on health care are focused on finding a way for everyone to have health insurance and improving quality of care for those who don't have it.  

                  If you look in this thread you'll see many instances where people who have insurance are saying they cannot afford the insurance they have and that even though they have insurance they still don't have access to care.  I think people here, at least, are very clear that what they want is good access to good health care for everyone.  Insurance isn't, by necessity, a part of the equation.  This is a third side to the debate.  

                  What the diarist has pointed out is a fourth side to the debate. This fourth side is the insurance companies who are fighting any change to the current system at all. I agree with the diarist that they are trying to find a niche in any national plan which is why in the middle of this thread I debated so vehemently against the idea that insurance companies provide health care and against the idea that providing access to health care is equivalent to providing health care.

                  Many here already agree that the insurance model doesn't work well, involves too much paperwork, and places too many administrators between a patient and their doctor.

                  I don't think the answer is to suggest as you did

                  If everyone is going to be covered then why have a "plan" that needs to be administered

                  The big problem we have right now is that our national solutions are provided only for the very poor, the elderly, and military veterans.  There is no national plan that takes care of everyone.

                  I think the debate needs to be focused to:

                  1. Eliminating private insurance companies as a legitimate source for channeling access to health care.
                  1. Establishing a governement plan that covers everyone.
                  1. Creating a system of payment based on taxation not the formation of a patchwork of health insurance policies that can be purchased from the government.

                  I don't think we're going to focus that debate by claiming EMTALA is a form of national health coverage or by suggesting that we don't need a plan that requires administration.  We need to be clear that what we want is open access to health care for everyone that is paid for through taxes.

                  Incidentally, the most clear form of single-payer coverage we have right now that is not in the form of health insurance is the Veteran's Administration, not Medicare or EMTALA.

                  "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

                  by Edgewater on Mon Jan 26, 2009 at 04:06:13 AM PST

                  [ Parent ]

                  •  Thanks (0+ / 0-)

                    I really appreciate the extended discussion. I think we're pretty much in agreement. I completely agree with your goal:

                    We need to be clear that what we want is open access to health care for everyone that is paid for through taxes.

                    But I still don't see that you've addressed my question of why not focus on the health care that is available to everyone that is paid for by taxes instead of the insurance that is not. Your VA example is another good one that I hadn't thought of. That's exactly the kind of thing I'm talking about that doesn't get discussed in all of the focus on expanding insurance coverage.

                    •  I have addressed your question regarding EMTALA (0+ / 0-)

                      if this is what you're referring to when you discuss "health care that is available to everyone that is paid for by taxes."  Perhaps this quote from Wiki will summarize EMTALA in this regard more clearly and show that this is not "free" care that is paid for by federal taxes:

                      The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[4] Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented".[5] More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care.[6] There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.

                      Link

                      If you read that quote you see that what EMTALA really does is force hospitals to provide emergent care, charge the patient for that care, and then write off the debt if the patient cannot pay.  This has resulted in a net decrease in the availability of emergency care which was an unanticipated outcome of EMTALA.  

                      EMTALA is not a model for national health care - it is a model for an unfunded mandate that has had serious detrimental effects on the health care system.

                      If instead we focus on the VA as a source of care that is available to everyone that is paid for by taxes then we run into a couple of problems IMO:

                      1. The VA system, fairly or not, has been badmouthed to the point where many people think of it as a bad thing rather than a good thing.
                      1. The VA system itself is a "perk" given for military service that often puts individuals in harm's way and so, philosophically speaking, is not quite the same as providing free care to a larger class of individuals many of whom are not risking their life for their country.  In this sense, the VA can be seen as a reward for being willing to make the ultimate sacrifice for one's country and doesn't serve well as a model for providing care to our weakest, least able citizens.

                      I think the best focus is similar to what ncyeve is doing in this diary.  This focus is on how private profit-driven insurance is decimating our health care system, leaving millions without coverage, costing the system enormous amounts of money for ever-increasing paperwork, and taking money paid into the system as profit while providing no care.

                      This focus needs to be expanded to address how insurance plans themselves cause needless paperwork, headaches for patients, and extra cost.

                      This would be a good start.  

                      "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

                      by Edgewater on Mon Jan 26, 2009 at 04:30:38 PM PST

                      [ Parent ]

      •  Very good point but... (3+ / 0-)

        If an insurer has a large population, the risk becomes fairly predictable and the issue becomes more of management than of gambling. that is why many large employers (50K-80K employees) have their own system usually administered by another organization. The problem with for profit insurance is that their aim is profit and not healthcare.

        •  True (2+ / 0-)
          Recommended by:
          alizard, Alexandra Lynch

          to some degree about covering a large population.  In such a case the risk can be minimized in a few ways both of which current insurers use.  The first is you can cherry-pick the healthy paitents and refuse to cover sicker ones.  You can also cover people with chronic illness with the exception of anything having to do with their chronic illness.  You can introduce co-pays which discourage people from going to the doctor.  And etc.

          The heart of the problem is as you say, insurance companies aim for profit not provision of health care.

          Their goal is fundamentally opposed to providing the commodity that people think they're buying when they get an insurance policy - access to health care.

          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

          by Edgewater on Sun Jan 25, 2009 at 05:52:46 PM PST

          [ Parent ]

    •  The ER provides only certain kinds of care (8+ / 0-)

      The ER's mission is to keep you from dying today. They do not have an obligation to keep you from dying next week, nor do they have an obligation to restore you to optimal operating condition. For example, if your hand is injured, they are obligated to stabilize you, but they are not obligated to offer you specialist care to retain your fine motor skills. If you make your living as an artist, this could end your career.

      They also cannot help you with longer term or chronic conditions. They can probably diagnose you with cancer, but you cannot receive cancer treatment - not surgery and not chemo or radiation - through the ER. They can treat you for a diabetic emergency, but they cannot provide you with a daily supply of insulin or glucose monitoring to keep you from having that $100k emergency. They can treat you for a heart attack, but they cannot give you bypass surgery or statin drugs.

      The situation for medical care for those who cannot pay is spotty and highly variable from region to region. An additional factor is that people who work may not be able to spend 4-5 hours waiting to be seen during regular working hours, whether at a clinic or at a traditional doctor's office.

      Currently, those clinics and hospitals are victims of a shell game of payment. For example, recently a court ruled that counties do not have to pay for ER care of uninsured people brought in by law enforcement (who are under arrest but have not yet been booked). Our county has been paying, correctly realizing that if they do not, that our hospital may not be financially viable. But now the courts say they don't have to. The hospital will have those costs anyway. So who will pay? The state? all the other patients? We can argue until the cows come home, but in the end we'll waste a lot of time and paper ... and the taxpayers and the citizens are able to pay will pick up the bill anyway.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Jan 25, 2009 at 01:45:33 PM PST

      [ Parent ]

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