bizguy wrote: Joanimaroni wrote:Climb back up.....
The health maintenance we now have ia a direct result of Hillarycare. HMO is a system that dictates to the patients, physicians, and hospitals what they medically can and can not do. If you do not follow the insurance recommendations and guidelines they will not pay for services rendered, they can and do drop physicians from their network, and will drop hospitals if they do not comply. Insurance companies retain physicians, on their payroll, to dispute and deny medically recommended treatments. There ia also a clause....if the insurance physicians is wrong...they can not be held accountable.
I'm up...I have a different take. HMO's have been around since way before Hillarycare. The Health Maintenance Organization Act was signed in the early 1970's. However, when I used the term health maintenance contracts I was not referring to an HMO type plan. I'm talking about how the industry has changed from true insurance to plans that pay benefits for simple things like a runny nose or a cough. My point is that your health insurance plan should not pay for these things...just as your car insurance policy doesn't pay for oil changes.
Insurance /HMO's dictate to physicians, ancillary services, and hospitals the amount they will pay for services rendered. In order to be a provider.....health care facilities and physicians must agree to the charges set by the insurance company. They have to have prior approval for tests, procedures, and admissions. Due to the large number of patients insured.....hospitals and physicians either agree or lose a huge patient data base.
HMO's don't dictate prices, they negotiate prices in an effort to reduce costs. That's just prudent business practice. He who pays makes the rules.
The problem with healthcare is and has been insurance. We need to surgically remove the hand of the insurance company from our collective balls.When we need them we ask the insurance company to pay out significantly more in claims than we pay in premiums. Then we get mad because the contract that we agreed to has terms and conditions. To continue with the anatomy analogy...I think we need to ween ourselves off the teat of the insurance company by going back to true insurance coverage for relatively rare but expensive events. Going to see a doctor because you have a cold or flu should not be an event that involves the insurance company. That should be a transaction between you and the doctor and paid for at the time of service. That would greatly reduce the operating expenses of the doctor and in turn reduce the cost of the office visit. If I have the flu or cut my hand and need a few stitches I can go to a clinic in Gulf Breeze and pay $50 to be seen. For those that can't afford it, there are free clinics operated by charitable organizations that will provide free medical and dental care. Interfaith ministries operates a free clinic in the Gulf Breeze area that treats about 4000 patients a year and doesn't charge them anything.
HMO's have actually been around since the early 1900's.
Hillary tried to put everyone in an HMO..... HMO enrollment increased from the 80's, around 9 million enrolled to 36 million in the mid 90's. It was an effort to eradicate the independent practice of medicine and replace it with their system --- managed competition, centered around gatekeepers and HMO..... in which they had (and have) a vested financial interest. This vested interest, where freedom of choice and competition are suppressed and forced physicians to lose their autonomy and patients their freedom to choose. The HMO replaced basic medical and major medical coverage. It was a plan that was suppose to make the insured healthier by providing wellness programs and insuring preventative health care....
Employers, in the 90's faced with increased costs of providing insurance to all employees, chose HMO's.
Managed care networks are functioning like a cartel under monopolistic government protection, similar to what was envisioned in Clinton's ill-fated Health Security Act of 1993.
The theory of an HMO was appealing but it was also a conflict of interest. We allowed a for-profit company to be in charge of our health. It was the biggest conflict of interest ever....many times we prosecute "conflict of interest" cases all the time....but this was welcomed by employers with open arms. How can we assume that insurance companies will have the same interest as the patient in need of medical care?
Back to dictating care....insurance companies still have us by the balls. They do dictate what we can and can not have done. Yes, they negotiate prices but they also approve or reject services deemed necessary, by refusing to pay. Hospital costs have skyrocketed for many reasons...one of those being the low pay negotiations set forth by the HMO's.
I preferred the basic medical and major medical coverage. Insurance covered emergencies and hospital admissions. Doctors and patients decided medical care.
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