Friday, August 21, 2009

There You Go Again, Sarah Palin

Sarah Palin, the health care expert, is continuing to share her wisdom. She writes on her Facebook page that the plan making its way through Congress will "inevitably" lead to health care rationing. Palin claims the president wants to enact a rationing system that would

"refuse to allocate medical resources to the elderly, the infirm, and the disabled who have less economic potential."

Lordy, lordy - what is this rationing business that Palin and others are using to scare people? Basically, it means fairly allocating portions of a scarce resource - usually according to some formula or rule. For example, rationing was used for many food items during World War II. Although no one liked it, few complained. It was recognized as necessary and for the most part was fair - and run by the government. Did they refuse rations to "the elderly, the infirm, and the disabled"? Of course not. Before rationing was instituted, only the wealthy could get the scarce commodities. Free market mentality!

We have rationing in health care right now! You think you can get whatever health care your doctor thinks you need? No chance in hell - unless you're extremely wealthy and pay out of your pocket. Right now, some insurance clerk without a medical degree decides if they'll pay or not - and they will nitpick you to death - literally. As a patient and former health care provider, I can tell you it is extremely difficult to convince one of these clerks (who frequently cannot even spell or pronounce the disorder) that a treatment is necessary.

Insurance companies are in business to make money - period. During the hard times, they just keep racking in the dough. If they're losing money, do they have to tighten their belts like the rest of us? Hell no, they just deny more claims. There is not a single health insurance company in the country losing money right now.

You hear opponents of health care reform talking about "tort reform" - which refers to lawsuits against doctors - and it does need to be addressed. However, there's one area you never hear mentioned - and it's far more important. Do you know if your child dies because a health insurance company denies coverage, you can't sue them? That's right. No matter how good your case, you have no recourse to the courts. You can complain to your State Insurance Commissioner - but let's face it - a cash strapped insurance commission can't begin to compete with a multibillion dollar insurance company. When's the last time you heard a state get anything from an insurance company? Probably never.

There are thousands of horror stories of health insurance companies denying care right now. And there's nothing you can do about it - except support reform that requires fairness.


JBodine said...

No insurance companies are denying care. The only thing they can do is enforce the provisions of the contract and not pay. It is up to the Provider of Health Services to deny care.
You say that the Insurance Companies are in business to make money. True. Why do you think the Doctors are in business?
What do you think Doctors will do if Obamacare does not pay them what they want. Yes, just like they do now, refuse to take medicare and medicaid patients. There you go, free market rationing do to the involvement of government. You want something, easy, pay for it. You have no right to my labor to pay for what you want.

Casey Ann said...

I'm sorry JBodine, but you are very wrong. You and your doctor decide you need treatment X and then submit it to the insurance coverage to determine if it's paid for. The "provisions of the contract" are so vague - intentionally so - that only the insurance company can interpret.

Believe me, I've been through this thousands of times.

JBodine said...

So, where am I wrong? No, you and you Doctor do not decide what treatment you need. The Doctor does, you decide if you want it.
The Doctor does not then submit it to the insurance company for approval. You decide on the service, you take it, your Doctor submits the bill to the insurance company for payment. The insurance company pays of doesn't pay according to the terms of your particular contract. Any amount unpaid is your responsibility.
If you do not understand the terms of the contract, simply contact the carrier or the carriers agent and get it all explained. They are happy to do so.
Seems you are not taking the responsibilty to know your coverage. That is on you, it is not being hidden or kept a mystery. You need to take the time and effort to spend alittle time with your carrier or your carriers agent. Then if you don't like the terms of your contract, get a new policy that has what you want.
Or are just wanting someone else to do the paying, that you feel it is owed to you for some reason.
You never did address any of the points I made in my first comment, you just took the time to tell me I'm wrong and closed by saying you know because you have been through
this a thousand times.
Sorry, but that does not mean you know anything. That is just your impression of the things you have gone through. Please, name that doctor who diagnoses you and then sends you away, awaiting notice from an insurance company before rendering the care he/she deems appropriate.
I know because I used to render the services of my profession and do the billing. Anything the insurance did not pay resulted in a bill being sent to the patient.

Casey Ann said...

JBodine, you're totally missing the point, which is the insurance companies determine which treatments will be covered - not you or your doctor. Of course, if you're wealthy and can afford to pay, then you're fine. But the vast majority of Americans cannot afford to pay - and thus cannot have the treatment. That is rationing by insurance companies - and only the wealthy are not affected.

Most Americans do not read their insurance policies and wouldn't understand them if they did. Those of us who have read and understand them know they are purposefully vague to allow the insurance company a great deal of leeway.

People pay for insurance to cover them for health treatment. They expect to pay deductibles and copays, but they expect the insurance companies to pay for any legitimate treatment. Then they are shocked to discover that insurance companies go out of their way to avoid paying - especially for very costly treatment.

You said, if someone doesn't like their insurance contract, they can get another. That is totally ridiculous, since the vast majority of Americans get their insurance through their employer and have no choice whatsoever.

I can't believe you are defending these unconscionable practices. You'd probably defend Bernie Madoff.

JBodine said...

Casey Ann, You were doing well until the end, the madoff thing was uncalled for.
Now as to the content of you comment. No, the insurance company does not determine what it will cover, the contract does, they do not violate the contract, you just fail to understand what is says. It is your responsibility to do so.
True, your Doctor does not determine what is in the contract, but you do. If your employer is covering you, and you don't like your coverage, talk to you employer. If you don't like what the employer tells you, change employers, or start your own business and employ yourself and buy the insurance you want. Don't blame the insurance company for not covering something that you did not ask to be covered.
Do you buy a car and suddenly find out you have to buy the gas also.
As you state, most do not read their insurance contract and just assume all is covered, and then blame the insurance company when it is discovered some things are not covered. That is an individuals problem, Insurance companies will happily sell you what ever coverage you want. Just remember insurance is a payment plan for future costs, plus administrative costs and profit.

You may discover that I don't believe in can't. I have been selfemployed most of my life, had no health insurance until Novenber, 2007 after I was diagnosed with cancer. Yes, I got coverage with a pre-existing condition. No problem. I pay 427/mo. And considering what cancer can cost, I'm not complaining at all. I had lot's of choices for coverage and I picked one with a 2000 dollar deductable and 3000 out of pocket maximum. Needless to say I hit those thresholds in 2008. It was my choice, pay or die. This time for my wife's sake I payed. But she knows I will die before I leave her penniless. Yea, I know it is always nice to have things paid for by someone else, but that is not Liberty, that is tyranny. Take charge of your life, or someone else will.

Casey Ann said...

Jbodine, you still don't understand insurance contracts. Let me give you a real life example: The contract says it will pay for 10 mental health visits per year. The seriously ill patient begins seeing an approved provider who develops a treatment plan using only 10 visits. The provider submits the bill, and the insurance company says this patient only needs two visits, and the doctor vehemently disagrees and calls the insurance company with no result. The patient kills herself.

You may not have experienced anything like that, but I know of thousands of cases like that - although not all as tragic. Believe me, this is happening.

Your advice is to change employers if you don't like your insurance. Get real! That is so proposterous. We have the highest unemployment since the Depression, and you're going to run out and get a new job? And you're going to run into the same problem in the new job. Go in business for yourself? Not everyone has the skills - not to mention the money - to do that. Plus the most expensive insurance is that purchased by individuals.

When I buy car insurance, I expect it to cover me if I'm in a wreck - and it does. And I got to choose my own car insurance.

You had no health insurance until Nov 2007. That's pretty irresponsible. What if you have an emergency? You're taken to the emergency room and the taxpayers pay for your care. Or you go bankrupt and harm your family. How was your cancer treatment paid for? How did you get insurance with a preexisting cancer? Do you have connections? No one else can. Don't talk about being self sufficient when you don't even have health insurance and expect people to take care of you. How hypocritical.

If you didn't have health insurance until a little over a year ago, then you have no experience with it and have no business criticizing those who do know what they're talking about.

Having your insurance company pay for a covered service is not having things paid for by someone else. I pay the premium for years when I don't need it. Is the insurance company having something paid for by someone else? No, and neither am I, when I make a claim. We entered into a contract for services. If I don't pay my premium, they cancel my policy. But if they don't pay my claim, I'm SOL. I can't even take them to court.

mintjulep said...

Really good rebuttal, Casey!

Actually, your example reminds me of the case of Andrea Yates..whose coverage was depleted..tragedy happened..and a Texas jury stated they didn't even "believe" mental illness exists.

Bodine...I imagine only in a dream world does someone have a great choice of health insurance providers, after announcing their recent diagnosis of cancer.

Mine eyes glaze over when someone says 'tyranny' anyway.