Sanity is madness put to good use. – George Santayana
My apologies to James Carville. I plagiarized his tagline because the insurance industry has forgotten about sick people during our national healthcare debate.
I remember when nurses and insurance companies use to get along with each other. Back in the 1960s, these nurses even took time out of their busy schedules to pose for one of their ads. We took care of patients at the bedside, and the insurance companies paid the hospital bill. It was as simple as that, but then things started to change. It began with three little letters—HMO.
Insurance companies are spending a lot of time and money trying to scare people into opposing President Barack Obama’s ideas on health care reform. They are especially working hard to torpedo the public option plan. That plan would allow you to keep your own private health insurance policy or buy affordable health insurance through a public plan. Insurers are going all out to make you hate this idea by making claims that aren’t true. They are saying that the government is going to ration health care by dictating which doctor you can see, and by making you wait weeks to see a specialist. Ironic isn’t it? The insurance industry is already doing these things to patients everyday via their HMOs. We wouldn’t even be having this debate if they were playing fair in the first place.
Insurance companies make their money a couple of different ways. They rack in the bucks by not insuring people who are sick, a practice known as cherry picking, and by not paying out claims. They also make money by cutting out competition. This is the real reason why insurers are trying to muscle Uncle Sam out of the insurance business. Medicare administrative costs are equal to about 2 percent of what it pays out to providers. For private insurers the ratio over expenses to payments is typically over 15 percent. Why the big difference? Insurance companies have high overhead. Their CEOs take home mega-million dollar paychecks, they have to take care of their shareholders, and they have to pay for fancy ads that convince consumers that they will have health coverage when they really need it. They need those fancy ads. Insurance companies are always looking for ways to deny our claims, but I digress. Competition between private companies and a public plan would hit insurance companies right where it hurts—in their wallets. Fewer customers in private plans means less profits, and less profits, up to 20 to 30 percent by some estimates, means fewer martini lunches for those at the top of the corporate food chain. To make matters worse, those greedy folks who make money by NOT paying for care would have to lower their profit margin on the customers they do keep in order to compete with the government.
I’ll never forget the day that I learned about HMOs. I came into work and found red dots on the side of a few patient charts. My head nurse told me that the dots were put there to prompt doctors to discharge patients as soon as possible so that the hospital and the insurance company could make more money. That was twenty-five years ago and the system has been in freefall ever since. Year after year, nurses are voted as the most trusted profession in America in Gallup’s annual survey of professions for their honesty and ethical standards. We are patient advocates, and we never put anything above what’s best for our patients. That’s why I’m putting my seal of approval on President Obama’s public health insurance plan, and so are the American Nurses Association (ANA) and the SEIU. The insurance companies want your money. Nurses want to take care of their patients. We want all Americans to have affordable, high-quality healthcare.
Nicole
June 30th, 2009 at 11:58 pm
It’s so great to hear you speak so well in support of healthcare reform and against the insurance companies. I’ve been so shocked by how many nurses I know will say some of the most ridiculous things in opposition to the healthcare system getting an overhaul… especially when we see firsthand on a daily basis the negative effect insurance companies have on our ability to give patients the care they need and deserve. Alot of their reasons are just plain selfish, like they think it would effect their jobs negatively or their ability to get quality healthcare. I became a nurse to deliver healthcare to whomever needs it, I hate that we are not able to do this. I believe that healthcare is a universal right and not just for the privelaged. Thank you for writing such a great piece, I’m going to be sending the post to some nurses I know who need to gain some perspective.
Pat
July 1st, 2009 at 6:16 am
I think your point that HMOs are already rationing care is an excellent one. I’m not a nurse but I am a former HMO vice president…I couldn’t agree more with your well-written post. Thanks, MJ.
Healthcare Today
July 2nd, 2009 at 5:21 am
…
Here are a few of the real reasons why the health insurance industry doesn’t want you to support the public health care option….
The Curmudgeon
July 2nd, 2009 at 11:51 am
MJ — I want reform, too. As you may have picked up from my blog, I do legal work for insurance companies, sometimes, but other times I sue insurers, too. I’ve written about the practices of some private health carriers that specialize in individual policies. These are walking advertisements for nationalization of the health care industry: They only insure healthy people. If anyone has the temerity to present a claim, the insurer will go back to the application and discover/find/manufacture-out-of-whole-cloth an arguable pre-existing condition and sue to rescind.
But Medicare is a scandal, too. I was recently reminded of this when I represented a Medicare recipient in a personal injury case. Forget about how you can’t get the government to provide a lien amount until AFTER the case settles — which only holds up the payout to the client, sometimes for many months — when you examine the charges, you’ll find charges submitted by “providers” that the client never, ever saw. These aren’t usually big charges… $10 here… $25 there… but it adds up. And it’s pure fraud — and there’s no practical way to challenge it that I know of.
A friend of mine was just in Washington for some tests at Bethesda. He met another friend of ours at the hospital. This guy — retired Marine officer, current DOD employee — was in for an MRI. An MRI for which he had to wait three weeks.
“You’d think,” my Chicago-based, non-veteran friend told me, “that they’d be able to get a guy like that in sooner.”
But that’s government health care — and at its finest!
I do think government has a role to play in health care — but as a regulator, reining in the wretched excesses of, for example, the individual health insurers. How can a hospital charge one patient $10,000 a day because she is UNinsured and then charge an insured patient — for the same service — $2,000? How can (as my nursing student daughter was just grousing about) a bag of saline cost $40? Those $25 Advils aren’t just anecdotal. I think a lot of the obscene prices come from the fact that government pays them… or at least a fraction of them… setting the market. Having the government pay more for more people seems, to me, to be a recipe for higher costs, not lower — and, eventually, as happens in England and Canada, when the system can’t absorb any more… rationing.
I guess you’d say I’m just spouting the other party line — but I’m NOT in favor of the status quo either.
Bo
July 2nd, 2009 at 12:01 pm
If I even THINK about the topic of HMO’s and insurance companies I get so mad I can’t see straight. I was once a charge nurse on a neuro/psych ward. A cerebral palsy patient who had experienced a head injury the day before suddenly had a change of the level of consciousness—WARNING! So I called an ambulance, but the Director made me cancel it. He said (and I quote) “Don’t call that ambulance—or we might end up having to pay for it. Have somebody drive her in.”
That hospital was later sued royally (over other things) and is no longer in operation—so they got their just desserts.
LibraryGryffon
July 27th, 2009 at 10:21 am
I spent several years on Tricare (it’s still my secondary), and rather longer before that in Ireland in their NHS system. Which is why I worked hard to get a good job so I would have something NOT run by a gov’t. The Navy tried quite hard to kill my eldest child, and I still have occasional problems stemming from the post-appendectomy abscess in Galway (“Oh, but 10% to 20% of all appendectomies get post-op abscesses!”)
At least HR 3200 is currently not quite as bad as HR 676 – Medicare for all! No co-pays, ever! No for-profits of any kind anywhere in the health care system (we’ll buy them out forcibly)! The gov’t will decide in advance how much they will allow a geographical region to spend on care for the year! (Ask the UK how that’s doing – no money for cleaning and other basic supplies.) A rather Orwellian/Soviet-sounding “National Board of Universal Quality and Access”! What could go wrong?
Yes, the current system needs some fixing. But handing it over to gov’t bean counters to decide whether the only treatment that will cure me is “cost-effective” or if I’m far enough up the queue is not something I ever want to deal with again.
Am Ang Zhang
July 28th, 2009 at 10:30 am
Thank you for being part of the Tour de Grande Rounds.
The Cockroach Catcher
Cathy Lane RPh
August 21st, 2009 at 12:52 pm
“We wouldn’t even be having this debate if they were playing fair in the first place.”
I’ve not practiced long enough to evaluate differences from before HMOs, how they came about, and what goes on nowadays. The current state of affairs suggests somewhere along the way health professionals are encumbered in trying to look out for the best in health concerns for many citizens.
It is ridiculous that a pharmacist’s day immeasurably is caught up in phoning insurance companies to verify or ascertain coverage for patients’ prescription. If denied coverage, sometimes pharmacists have to arbitrate between patient and insurance for medically acceptable benefits.
It seems that the insurance businesses have access to most abuse the current system, with their role in obtaining unfair pricing deals between government and the private programs.
Insurance companies influence decisions affecting everyone in healthcare–not just those enrolled in a specific programs, and have undue influence in reimbursement rates and decisions for providers.
Sometimes, I’m convinced the reason there was a push for ‘all PharmD programs’ is so that pharmacists would be provided extra training in statistics, drug evaluation and information, as well as medical assessment, to be able to discuss and help make decisions on behalf of patients at the counter. However, insurance companies have tied pharmacists hands as well with inordinate time spent on dinky individual insurance program peccadillos e.g. this patient’s employee insurance covers this and that, or brand name this or that, whereas the next company only covers this or that. It’s like constantly juggling more and more objects. as we attempt to help patients, contact prescribers, and go-between insurance companies while adhering to our employer policies.
Technically, pharmacists should be playing a larger ‘expert’ role with attempts to mandate health care money spending, but drugs are not the largest component of health care.
With major and disproportionately outrageous roles, insurance agencies involved that have no provider role at all, seem to push the system to even further convolutions such as how drug manufacturers ‘voluntarily’ offer to discount their drugs to Medicare, a government program. Why did manufacturers get away with gouging us (tax-payers) with their price-fixing to begin with?
The current state of affairs got this way from a variety of systemic failures, I’m sure of that. When folks argue against reform, it appears they’re only looking at some ‘acceptable’ at the minute short-sighted quick-fix that they think might solve everything for minimal investments of time and cost.
In my lifetime I’ve seen physicians paid with reasonable fees in cash, to evolution of convoluted health insurance schemes. I’ve seen the time where I was able to pay pharmacy school from summer jobs plus a Pell Grant, to the current time in which students leave college thousands of dollars in debt
We, in health care subscribe to that ol’ Hippocratic Oath, which admonishes us to think first of what needs to be done for the best of our knowledge for our fellow human beings. Too many times, when a patient’s insurance policy gets in the way of the most efficacious and affordable (even in the long run), the decisions we’d been trained to make in medical treatment might actually not be what a patient might receive. Maybe, one of the more insidious facets to that statement is that it involves inadequate pre-natal care of some our most vulnerable, in which there themselves cannot provide input.
Paris
August 27th, 2009 at 11:58 am
Patients will continue to trust their nurses because of people like you. Thank you so much for lending your voice to this controversy. This is a highly educational post and I’m glad to be given insight into a nurse’s perspective on the history of the health insurance industry.