Sunday, March 28, 2010

Race and Health Care Reform

Rather than weight in on the health care bill with a hearty eye-roll at the Tea Party movement, I point to Frank Rich's New York Times Op-Ed. He suggests that the conservative outrage over the bill stems from underlying racism.

I can't help but think he's right. If congressman Emanuel Cleaver were white, I don't think that protester would have spit on him.


Heather PJ said...

I haven't read what he has to say, but I will maybe one day when I have the time. My thoughts in general on the healthcare bills are this:

1) I do think that healthcare should be more affordable. I think its not affordable because of insurance companies making it hard on doctors to get paid and because of malpractice lawsuits.

2) The insurance companies decide how much doctors get paid. Every year they come out with a fee schedule. Blue Cross Blue Shield as consistently cut some of the procedures over the past years, or not raised the price they are willing to pay. That means that if a doctor accepts payment from BCBS they have to agree to accept that amount and not charge the patient the difference. This means that if the doctor wants to charge $48 for an adjustment and $25 for ultra sound therapy he won't receive that if he accepts BCBS. Because, BCBS already decided that they were only going to pay $36.57 for an adjustment and $12 for therapy. This also means that at our office we pay an employee $12 an hour, and her main job is ultra sound. She can do 2 patients an hour, but sometimes only sees 4-7 patients a day. This means that we either, can't afford to pay her a decent wage, or have to work harder in other areas so we have extra money to pay her so patients get treatment, because we can't pay her based on what she is bringing in. The fee schedule for insurance companies and with medicare has gone done since I started working in my area of healthcare. Some of the fee schedule prices are the same as they were 20 years ago. So doctors have to see more patients to keep up with the rising costs of doing business and living because they aren't going to be paid more, even if they raise their prices (unless they raise those prices for cash customers). This means more patients and less time to spend to give that care that is needed.

4) Which leads me to this: Cash customers should get the discount in healthcare. Why would a doctor make a cash customer pay $75 for an adjustment when BCBS is only going to pay $36.57? They have to write off that amount for BCBS, why not do it for the cash customer? I know as a healthcare provider, that's what I try and do.

5) I have spent many many many hours of my life on the phone with insurance companies in a doctors office. I have realized that a lot of people have no clue what insurance is about, what they're deductible is, what it means to be in network or out of network, and what they're percentages owed are verses a copay. I think there needs to be a lot of education there and how insurance and the system works, and people need to be more responsible with wanting to learn how it works. People just toss me their cards and say, "I pay $20." They are shocked that their insurance might not pay for chiropractic or acupuncture. Or it will only pay 12 visits or $250, whichever comes first. Or it won't pay anything until a pre-certification is received.

Heather PJ said...

6) Insurance companies try to stick it to doctors. They make up "networks." If you are in the network they give the patients a "in-network deductible" when they see you. This is usually substantially lower than the "out-of-network" deductible the patient when they see out of network doctors. For example, the in-network deductible is $100 they out of network could be $500, but I saw one today that was $2000. This means that your insurance will never pay the out-of-network chiropractor or family doctor that you love, because that doctor doesn't want to be in the insurance company's pocket.

So, let's say you see the doctor. The charge is $75. The in network doctor charges you the $20 copay.
The out of network doctor charges you $36.57 because that's what BCBS allows and you have to meet your out of network deductible of $250. After you have met that though, you insurance company will pay him 80%, so then you are only responsible for: $7.13 each visit.

This whole concept is crazy to me.

7) I don't think that anyone should force you to pay for healthcare. If that's what this new bill is about, I'm not about that. I think its your choice whether you want to purchase something or not. I never go to the doctor. Why should I pay $125 a month for healthcare? Why should I be fined if I don't have it? Are they going to pick up the bill if something were to happen to me? My friend had cancer, her insurance wouldn't pay for anything and kicked her off (Thank you BCBS for Federal employees) because she wasn't a student anymore (because she had to quit college for a term because of her cancer). The government did nothing to help her. She tried to find a job, no one would hire her. Now, if they made it where insurance companies couldn't get rid of you that would be great. But I don't think there's an economic incentive for the government for me to have health insurance or so why force me to have it besides that you think it's smart for me to get it?

8) I am about free basic health services though. IF they want to give it free to everyone. We must all receive the same free healthcare benefits, without regard to what our salary is.

However, I have seen the ugly side of this, and I don't really like the idea of a big business of the government telling you what you can and can't have in your healthcare plan and who you can and can't see. Will they pay for preventative healthcare? vitamins? acupuncture? If they are going to pay for treatments are they going to tax those items that make us sick? Who decides what makes you sick? A Harvard doctor said on the news that coke could be a good choice for a snack, and I know that's wrong. It's hard. Your healthcare should all be your choice, and anytime you involve all these organizations it stops being your choice from what I have discovered.

9) My current solution to the issue, wouldn't be mandated health insurance, but more insurance company reform, like what happened with the credit card companies. We need reform within the insurance business and not forcing everyone to be apart of that industry in my opinion. Heath Coops and different plans out there are working for people to not work with insurance companies. We can figure out a different solution if we focus on reforming the wicked twisted ways of the insurance companies.