I didn’t much trust insurance companies back in 1999 when I wrote this piece for the Desert Leaf. I still don’t. I bet healthcare costs would go way down if some morning everyone in America simply cancelled their health insurance.

 

It’s a good idea to remember that your Health Maintenance Organization is just an insurance company. Don’t be fooled by the classy billboards that advertise that there is always a doctor in their house, or that you can get one ASAP.

Your HMO is a for-profit corporation with very highly paid executives and numberless stockholders, all of whom expect their wages and dividends to continue on a regular basis.

If you are of  medic-age, the government may be buying medical insurance for you from an HMO. The nut is $587 a month, or $7044 a year and for that the HMO agrees to take care of all your doctor and hospital fees, and some prescriptions, less a small co-pay.

On the face of it this seems like a good deal. We all understand insurance, because we have for years bought fire insurance, auto insurance, business insurance and so forth.

Unfortunately, health insurance is a very special case. You may drive your whole life long without ever having an accident, losing your house to fire, or being ripped by a dishonest business partner.

But everyone your HMO insures is going to get sick someday.

Therefore, if you’re an HMO it’s to your financial interest to see that the provision of health care is limited to people who are not as likely to need it; or to pay out as little for it as possible; or pray that we all die on the couch. Why?

The obvious answer is that the health these organizations are ultimately set up to maintain is their own financial health. They don’t have nearly as much interest in maintaining your physical well-being or the financial health of doctors and hospitals.

In the long run this can’t be good for medicine or the nation’s health.

A couple of months back I was knocked off my motorcycle by a momentarily distracted car driver and made a trip to the urgent care center of my hospital.

I got excellent care: Two x-rays of a battered ankle, happily not busted but severely sprained; road rash disinfected and bandaged; consultation with both a doctor and a nurse on how to speed my recovery.

On the way out I paid a seven dollar co-pay,  my HMO kicked in 23 dollars, but the hospital wrote off 129 dollars.

Am I happy to have paid seven dollars? Of course. Is the hospital happy to have written off 129 dollars? Hardly. And I wonder if, in the long run, this is a good thing for the hospital system. Hell, I don’t wonder at all. It’s not good.

I don’t believe that hospitals should be profit-making operations, but I do believe that they have to be well-enough paid for their services to provide for capital improvements, new equipment, and adequate staff.

Nor is the current situation good for people without insurance, or who are paying hefty deductibles. They end up paying…if they can pay at all…far more than would be fair in order to make up some of what’s lost by underpayment from my HMO.

We certainly need to maintain a system of health insurance, especially for our poor and our elderly, but we need to stop these insurance mega-corporations from what some of us view as meddling in our relations with our physicians.

Incidentally, I’m old enough to remember when the clerical staff at a doc’s practice didn’t out-number the medical staff. Boy, those are the dear dim days beyond recall. Maybe healthcare costs would go down if docs and hospitals didn’t have to hire an armory of insurance experts, clerks and accountants to do the paperwork and fight for their fees.

Let’s all be thankful that fire insurance companies don’t run fire departments the way HMOs seem to be making medical decisions and running medical services.

Your house is on fire. You dial 911 and hear:

“Fire Prevention Maintenance Organization”

“Quick, send the fire truck, my house is on fire”

“Just a moment, Sir, have you called your fire evaluation gate keeper to determine that yours is an eligible fire?”

“No I haven’t, for God’s sake send the fire truck!”

“Oh, Puleeze! We can’t spend money sending fire trucks out willy-nilly. Is yours a pre-existing fire?  Are you requesting a merely elective fire extinguishment service?”

“No of course not…hurry.”

“Certainly, Sir, We’ll send one out immediately. Would you care to make an appointment?

“What do you mean would I care to make an appointment? Of course not, my house is on fire. Do something now!”

“Well I’m sorry, sir, but  some of the fire departments  are no longer with us, because we didn’t pay them enough. We have an excellent department in Casa Grande, shall we send it?

“Yes, anything, please…koff koff.”

Pretty scary, huh? Can anything be done? Apparently not.

Good Grief.

 

 

This entry was posted on Monday, July 11th, 2011 at 8:35 pm and is filed under Health, Health Insurance, Life. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.