I work for a health insurance company. . .

. . .and I don't much like being called a murderer.

This is my first diary, but don't worry about being gentle. I can take it.

I read mehamo's diary offering a physician's take on the healthcare industy and I think I can offer some perspective on healthcare and health insurance that is lacking here.
I currently work for an HMO, one of those much-villified organizations. This company, however, was founded by a physician who was frustrated with how many insurance companies are run and decided to start one himself believing he could outcompete on quality.
While I have some bias, we do perform better than most as far as taking care of our enrolled members, but the looking over the shoulders of doctors and demanding authorizations is a necessary part of the business.

I read mehamo's diary offering a physician's take on the healthcare industy and I think I can offer some perspective on healthcare and health insurance that is lacking here.
I currently work for an HMO, one of those much-villified organizations. This company, however, was founded by a physician who was frustrated with how many insurance companies are run and decided to start one himself believing he could outcompete on quality.

While I have some bias, we do perform better than most as far as taking care of our enrolled members, but the looking over the shoulders of doctors and demanding authorizations is a necessary part of the business.
Health Insurance is business that runs on VERY slim margins. Not being an accountant I cannot articulate to you exactly how slim, but I can tell you through what I've gleaned from conversations with the COO that we have to save every little cent to run a profit.

The fact is, there are a lot of greedy doctors out there who will run tests that are totally unnecessary just for the sake of billing the insurance company. This leaves us with the choice of either raising premiums (and thereby put insurance out of the reach of even more people) or looking over the doctors to make sure their utilization of medical services are not excessive.

Yes, it is a system set up with what economists call "perverse incentives" but I will submit that the blame does not rest solely on the shoulders of the insurance companies, but the "fee-for-service" model of medical care itself. It forces even well intentioned and well run insurance companies to have to play the asshole.

Medical professionals have highly specific, highly specialized knowledge that is outside the scope of most people expertise. You can't just let them have free-reign or they will swindle you.

I do not know much about cars, but I know I get exceedingly suspicious when the mechanic tells me he has to charge me $50 to replace a busted thingamabobber. And yet this is how we run out healthcare system. I have seen doctors who had the gall to unnecessarily put their patients under the knife. Knowing the kinds of complications that can arise from thoracic surgery, they nonetheless willfully submitted their patient to it. (When complications did arise they were arrested. Thankfully the patient is okay.)
George Bernard Shaw said it best, and 100 years ago at that.

"That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity."

It is true that we need another system of compensating medical professionals for their care, because the way we do it simply isn't working.  But the blame for it being broken does not rest on any one party's shoulders and we ought to keep that in mind. I am suspicious of single-payer plans for just this reason. It doesn't address the fundamental perverse incentive on the part of the physicians. But I'll go more in detail about that later.