I am reposting two great posts for your information and entertainment by Trisha Torrey from her great blog: Every Patients Advocate
Why Sicko is Only The Tip of The Iceberg
Some final points about the health insurance industry — a few steps beyond Michael Moore….
Private — even not-for-profit — health insurance companies exist in this country for only one reason — to make a profit and to line the pockets of their employees.
Hear me out…
They are businesses FIRST, many with investors to please, and as such, that is their requirement — to make money. No matter what the business is, no matter how they do it, their number one vision, mission, goal, is to make money for themselves and their investors. It’s no different than a pizza vendor or the power company or the state lottery. Making money is their only reason to exist.
What that means is that the amount of money coming IN, must at least exceed, and at best FAR exceed the amount of money going out. Even for the so-called not-for-profit health insurance organizations, they must bring in much more money than they spend, because their executives are making six figures — and sometimes more. It could be the organization is considered not-for-profit, but that doesn’t mean they have paychecks that are anything less than those of their colleagues across the industry.
The only way they make money is by charging their customers — we patients and our employers — more money.
They want us to believe that their costs are skyrocketing because the hospitals and doctors and pharmacists and other providers are charging them more — BUT — that is only partially true. In fact, they tell the providers what they will pay — not the other way around! Are we patients getting any sicker? As a group — no.
And don’t forget — on top of all that profit, they must continually pay out the expenses of lobbying state and federal legislators, not to mention donating to their campaigns…. and yes, that gets more expensive, too.
So think about it this way, taking a stab at the healthcare dollar you and your employer are giving the health insurers:
- a percentage is being paid for executive salaries, bonuses and perks
- a percentage is being paid for administrative costs
- a percentage is being paid for lobbyists and campaign contributions
- a percentage must be kept to make investors happy
- and then, whatever little is left over actually covers a PORTION of your health care.
Frustrating, isn’t it? What’s wrong with this picture?
Here’s another way of looking at it: in the health insurer’s perfect scenario, we pay in and pay in and pay in for as long as we stay healthy — then as soon as we get sick, they would just as soon we die.
Once we die, then they don’t have to pay out for our care!
Especially for those with chronic diseases, or something that needs newly developed treatments or surgeries – either we are uninsurable, or if they are already stuck with us, then we are denied care.
I suppose denying us service might be the only better scenario than letting us die. At least then they don’t feel like our blood is on their hands.
Is it any wonder they employ people (like the guy in Sicko) who do everything they can to uncover reasons not to pay out? Is it any wonder why they refuse to pay for “experimental” treatments?
This is not about the human thing to do. In fact, allowing these health insurance companies to make decisions about what care they will — or will not — allow to their insurance customers is simply providing them with a license to kill.
The more of us who die early, the more money they will make.
Does all this sound a bit extreme? Well, OK. Then tell me what I’ve missed?
Now do you understand why being a sharp patient is so important?
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Read two more posts about Sicko:
A Patient Advocate’s Reaction to Sicko
What Sicko Doesn’t Tell Us
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A Patient Advocate’s Reaction to Sicko
…. is that Michael Moore has only exposed the very tip of the dysfunctional American health care system’s iceberg.
As confessed in yesterday’s blog post, I’ve never been a fan of Michael Moore’s. I think his previous works have been inflammatory and one sided. Not that he doesn’t raise awareness of issues, and not that he doesn’t cause dialogue that is helpful, because he does. Rather, because he takes facts and bloats them, and his audience walks away believing partial truths.
But for Sicko? He is inflammatory, and if I worked for a health insurer, I’d want to hide. And if I were an executive for a health insurance company, especially the “medical director” of a health insurance company, I would be embarrassed beyond belief.
But as far as whether his presentation was balanced — well — his story was no more unbalanced than reality. The reality of what healthcare in the US has become is so lopsided, that it’s falling into the deep unknown.
If it’s any indication, I’ve never attended a movie that elicited applause, not just at the end, but in reaction to statements made during the movie, too. And whereas many had told me I would laugh, and on occasion, I did — but — I left with tears in my eyes.
I learned a few things, which I will present to you, although I have not yet confirmed them to be absolutely true. The scary part is, even if they are only half true, then they are still worth noting.
For example: one woman who used to be a health insurance sales person spoke of a 37 page document of “pre-existing conditions” which would automatically cause denial of coverage to an applicant.
Another woman described how executives in health insurance companies get paid: the higher the rate of denial of coverage (not just in policies, but in pre-approvals for treatment), the higher the bonus.
“Payment of any claim,” she explained, “is defined as a medical loss.”
One gentleman explained his former job as a health record spy — in effect, if someone made a claim the insurance company didn’t want to pay, it was up to him to comb through the previous medical records of the patient and use anything at all — ANYTHING — to create a case for denying a claim. Of course, the insured has no recourse. None. (By the way — this is a perfect reason for making sure your medical records are always correct.)
I’ve often wondered if there was a watershed moment in American history that caused the previously considered “good” system of healthcare to go awry.
Moore explains it as a Nixonian decision. In 1971, then president Richard Nixon and his buddy Edgar Kaiser (of Kaiser Permanente fame) created a new approach to healthcare where denial of service became a profit center.
And then there is Moore’s statement that there are 4 times as many health insurance lobbyists in Washington as there are congress members. Can you guess who is paying for those lobbyists?
The last example of what I learned (although there is really quite a big more) is that Moore visits Canada, Great Britain, France and even Cuba, and claims that in those countries, where healthcare is a given, paid for by taxes, then provided at no additional cost to its citizens, people live 3 or 4 years longer than Americans on average.
Even the Journal of the American Medical Association cited those statistics. In England, doctors earn more by keeping their patients healthy, too. Amazing.
So here are a few comments from your friendly patient advocate — now that I’ve had a few hours to think it over:
1. While Moore did a good job pointing out the foibles of our system as they relate to how medical care is paid for, he didn’t even attempt to talk about medical errors, misdiagnosis, drug-related problems, etc (although he mentions pharma as being almost as evil as insurance.)
2. As long as Washington politicians are bought and paid for by health insurance, nothing will change. As long as health insurance companies continue rewarding their top echelons with huge paychecks and bonuses, nothing will change.
3. I whole heartedly agree with some of his statements as they regard the services we are all entitled to because we are citizens of America and our communities: police, firefighters, public education, inexpensive postal services, parks, libraries.
Why isn’t healthcare on that list? Well — for seniors who use Medicare, it is. And what about the other 47 million of us?
For the first 50+ years of my life, I never would have believed I could even think this thought, much less type it…. and based on the research I have done, all of it prior to seeing Sicko today….. I do believe American needs to move to universal healthcare.
Don’t forget — you’re hearing this from a woman who has owned businesses, and believed in private enterprise and profit all her life….. but LIFE is the keyword here…. and because health insurance and big pharma have become so greedy, because that greed is costing lives, because the need of the masses to access better care is more important than the need of individuals to control…. yes…. I believe we need to create a healthcare model similar to our public education model.
Do I think it will be perfect? Heavens no.
But if it parallels public education, then many MANY more will benefit, and for those who still believe private care is important — well — we have private schools, too, right?
Of all the statements that made me really think, and there were many, this is the one I will leave you with:
“You can judge a society by how it treats its worst…. and its best.”
Society, our politicians, and our American way of medical care is failing us. It’s time we patient stood up and made the noise necessary to invoke the change that’s needed.
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Read what others have said about Sicko:
R J Eskow in the Huffington Post
And to learn more about how those running for president have reacted: The LA Times
…. and see follow up blog posts from Every Patient’s Advocate,
What Sicko Doesn’t Tell Us and Why Sicko is Only the Tip of the Iceberg
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Want more tools for sharp patients? Sign up for Every Patient’s Advocate once-a-week or so email tips Or link here to empower yourself at EveryPatientsAdvocate.com |
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Filed under: Free Speech, Health, Politics, Scandals, Secret, Solutions
