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RE: [IP] HMOs, & etc.

Roxanne [mailto:email @ redacted] wrote:

> I have been through the proverbial 'wringer' with a former 
> HMO plan that I
> had through work.  I ended up with a $4,000 hospital bill 
> from when I went
> into DKA (the first and hopefully last time!)  They paid 
> every claim until
> the hospitalization, then decided that they 'didn't realize 
> that the insulin
> that I had been purchasing was being used to treat diabetes.' 
>  There is no
> other disease that it is used to treat! I just got that 
> hospital bill paid
> off last year...5 years after being hospitalized!


Let me begin by stating that I'm no fan of *any* insurance company.  

Having said that, I'll point out that not all HMOs, just like all other
companies, are not alike.  By and large I am very pleased with my coverage
through Kaiser Permanente Georgia.  It seems that some HMOs, like Kaiser,
have figured out how to do managed care well.  When it's done poorly, it can
be a disaster.  But when we see other incompetents, that can be a disaster
as well.

Managed care is coming.  Is has to.  The cost of healthcare has gotten so
out of hand that it's become untenable.  Most of that is due to several
factors, and most stemming from the insurance industry (whether and HMO or

First is the cost of paperwork.  It often takes specially trained people
just to fill out the forms!  Dr. Everett Koop has data that indicate that a
universal one page claim form for all insurance claims would reduce
healthcare costs by 10%.

Second is the demand for high end services, often when not needed.  A
surprising number of people use emergency rooms for non-emergent treatment,
and many people use the ER in place of having a regular primary care

Third, and perhaps most important, is the cost of malpractice.  Insurance
companies find it less costly to settle malpractice claims than to fight
them.  This is mostly because juries are biased toward claimants and against
"rich" doctors.  As a result, malpractice insurance claims go higher and
higher, in some cases as high as $50,000 per year for some specialties.
Virtually all attempts to regulate this, either through legislation or by
executive order, have met with incredible resistance from trail attorneys
(whether or not associated with insurance companies).  Since lawyers, as a
group, are one of the biggest contributors to political campaigns (all the
soft money we've been hearing about), it's not too likely that Congress is
going to go against them.

There are a couple of possible solutions to this last.  I suggest that
enacting a law that anyone who files a malpractice suit (and/or the
attorneys who recommended filing) *and loses* be required to pay court costs
and defendant's legal fees, and possibly other penalties.  That would go a
long way toward ending spurious suits, particularly from ambulance chasers.

I also suggest (warning: political activism content!) supporting the McCain
Feingold Bill will tremendously reduce the influence of insurance companies,
trial lawyers, etc.  You can see the full text (in pdf format) by clicking
on http://www.commoncause.org/issue_agenda/mcfncn012401.pdf.  

Finally (and if you're still reading, thanks for your perseverance!),
recognizing that managed care is the way things will be is an important
step.  Rather than complaining, it is better to participate and make sure it
is/will be as equitable as possible for everyone.  It will never be perfect,
but then nothing ever is.  If it's done right, it can be fair.

Jim Handsfield
email @ redacted 

The opinions expressed are mine and may not represent those of my wife who
runs our house and makes more important decisions than I do.
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