<p>I’m the Director of Employee Benefits for a Fortune 500 company. I’ve also served on several professional organizations that study consumers’ attitudes toward health care and the health care system. I’ve been in the employee benefit field for over 25 years.</p>
<p>IMO, neither the insurance companies nor the pharmaceuticals nor the doctors nor the hospitals nor the big companies who employ us and who actually pay for our benefits are the bad guys. The problem is that they’re all (reasonably) trying to make a buck. (Yes, even Marcus Welby has to eat.)</p>
<p>And yes, we are generally unhealthy as can be. Poor health definitely means we’ll spend more on medical care than if we were healthy.</p>
<p>But the problem is the disjointed system we have. </p>
<p>My company is a for-profit company. When our medical costs increase, it directly hurts our bottom line. This is a major problem for the U.S. auto industry – GM, Ford, Chrysler. Not only are those companies paying for active employees’ and their family’s health care, they’re paying for thousands of retirees’ health care too. So companies cut back on coverage and shift costs to employees. They look like bad guys to their employees and, sometimes, to the entire universe (think Wal-Mart). </p>
<p>BTW, health care costs are one major major reason we’re losing ground to overseas companies. </p>
<p>Then, because my company can’t afford the continuing increase in health care costs, we tell our insurance company to figure something out or we’ll go to another insurer. So our insurance company negotiates greater discounts with the doctors and hospitals.</p>
<p>The doctors and hospitals are p*ssed. Sometimes they drop out of the insurance company’s network because they don’t want to or can’t afford lower reimbursements. Other times, the docs have to increase their patient load to keep up the same level of income. This makes the insurance companies look like bad guys.</p>
<p>To make sure my insurance company is paying out only on claims it should be paying, my company hires a cnother company to conduct a claims audit every few years. We’;re assured that the insurance company is only paying the claims they should be paying, that they’re not paying twice, that there’s no fraud, etc.</p>
<p>The insurance company also hires a lot of medical clinicians to make sure that the criteria under which they pay a claim is based on scientific fact. For example, bariatric surgery will only be covered if the patient meets very specific criteria. The public views this as sometimes unreasonably denying care or coverage.</p>
<p>I was once berated by a female employee with breast cancer whose doctor wanted to do an autologous bone marrow transfer. (That is, her own marrow treated and re-introduced into her body.) At the time, it was an experiemental treatment; it had not been proven to be safe or effective. First, the employee suggested to me that we were denying coverage for this treatment because she was a woman and breast cancer is a woman’s disease. Then, when the treatment was still denied, she e-mailed about 50 colleagues at work to tell them how mean and rotten we were.</p>
<p>We finally paid for the treatment out of a separate budget.</p>
<p>The woman died about a year later.</p>
<p>About three years later, autologous bone marrow transplants were shown to be ineffective.</p>
<p>Then there’s all the wasted time and money to determine whether Insurance Company A or Insurance Company B should pay for something . . . .</p>
<p>Our system stinks. It’s horrible. Rube Goldberg couldn’t have thought of anything more complicated.</p>
<p>We need a single-payer system not so the government can decide what’s covered, but simply so that determination of what’s covered is consistent, so that there’s only one payer to worry about, so that they monkey is off the backs of US for-profit companies.</p>
<p>BTW, of all dollars spent on health care in America today, about 50% is already paid for by the government – through the military, through Medicare (for > age 65s), and through Medicaid (for poor people). There is also the massive Federal Employees Health Care Plan, which is paid for by our taxes.</p>
<p>But the problem with all this is, politics and special interests. I think we will eventually have a national healthcare system, but I think it will take several more decades until we’re there.</p>
<p>Whoosh. Sorry for the long post.</p>