Your Health On Politics

Forget about the current push to defund Medicare and the on-going tirade over the new but heavily watered-down federal healthcare plan, which benefits some but still leaves a lot to be desired. If you think those are the only battles being waged over medical care, you’ve been living in a cave.  Healthcare in the United States is among the most politicized systems ever established. It’s politics on steroids.  It is about money, power, and greed; rarely, and sadly, is it ever about what it should be about: the well-being of patients and daily life-and-death battles waged by real people and their usually well-intended caregivers.

Each of the following will likely be a blog in the months to come, but, for now, simply consider the multitude of ways in which politics — not government — is affecting the way our medical care is focused and dispensed.

**On Obesity: We say we’d like to address the obesity epidemic in this country.  Certainly, First Lady Michelle Obama is doing her share with her “Let’s Move” campaign for children.  But are state and local governments — as well as businesses and insurance sectors — backing her?  Until obesity is recognized as a disease, like diabetes or mental disorders, its treatment will not be covered by insurance companies, meaning that only the well off will be able to afford treatment. Until the federal food-subsidy program is overhauled so that the healthiest foods — fruits, vegetables, and lean proteins — are more moderately priced than say, a starch-laiden extra-value meal — then obesity will continue to rule.  Until schools and corporations get serious about physical education and fitness as well as food services then youth and adults will continue to struggle with weight problems and productivity will suffer.

**On Health Insurance: Fewer doctors, psychologists, and other providers are accepting insurance, which, once again, means that quality healthcare is a privilege of the elite. We can’t necessarily blame the providers; they have to make a living.  We can blame the insurance industry, which makes it nearly impossible for doctors and psychologists to receive reimbursements that match the quality of their services.  But Republicans in Congress don’t want to overhaul the system.  Citizens, the GOP says, should be responsible for their own healthcare needs. What they really believe is that, were they to vote to make insurers behave ethically, were they to create an efficient and fair system, then they and their colleagues would lose millions in campaign funding and perks piled on by crooked insurance companies, who, frankly, don’t give a lick about your health or mine.

**On Women’s Health — Several states are lobbying to cut funds for women’s health clinics; others have already done so.  Such officials are balancing their budgets on the backs of poor and lower-middle-class women in need of health services. Then there’s the lack of more acceptable screening tools for breast cancer.  (We now have mammography that produces higher quality images while also producing more radiation. Swell.) And women’s heart disease awareness continues to lag.  I’ve interviewed women who’ve said they were having heart-attack symptoms when they were turned away from emergency rooms, simply because they “didn’t look like” a heart-attack victim, i.e. an overweight middle-aged man. These women’s lives were saved only because of their own insistence that something was wrong. Reality check: Many, many women with heart disease don’t look like they have heart disease and don’t manifest it in the same way as men.  If the system treated men and women equally, this would have been a non-issue years ago.

**On Doctors and Drug Companies: Too many doctors in clinical practice are accepting money from drug companies.  This is a clear conflict of interest, especially when it is not declared to patients and then those same patients are prescribed a medication that their doctor’s employer manufacturers.  In such cases, the drug companies are directing your healthcare, not the doctor.

These are some obvious examples but they only scratch the surface.

Stay tuned!

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Comments

  1. You mention that doctors have to make a living, but do you realize there’s nothing that governs how much of a living they can make? Most people have no idea how much their doctors charge for a service beyond what their co-pay is because someone else is paying the bill. If someone say gets the flu, they want to go to their favorite doctor. They don’t know nor care if their doctor charges three times as much for a visit as an equally-qualified doctor in the next building, and they don’t have to care because they aren’t paying. In 2004, BCBSF set up a program where they would capture how much each doctor charged for a given service, so members who went to doctors who charged less could get their premiums reduced. As soon as the doctors got wind of the plan, they threatened to cancel their contracts with BCBSF en masse. The last thing they wanted was their patients finding out they can shop around for a better deal. It’s amazing that people who will drive five miles out of their way to save five cents on a gallon of gas, or get a BOGO deal at a grocery store, will go into their favorite doctor’s office without any thought as to whether they are getting a good deal for their fellow plan members or letting them get ripped off.
    +1

  2. Bruce Reynolds says:

    By the way, in regards to providers accepting money from drug companies, you are spot on. Doctors receive kick-backs and other gratuities for prescribing various brand-name drugs. What most people fail to realize is that in most cases, new drugs are no better than older drugs. Most people who are prescibed these drugs will ask their doctor if a generic form is available, and the answer is always “no” because the drug’s patent hasn’t expired yet.

    People don’t need the government to fix this problem. Just go to WalMart, Target, or any drug retailer with a generic drug plan, and get a copy of their generic drug program list, and take that to your doctor. When your doctor prescribes a brand name drug, ask “is there a drug on this list that will work just as well as that drug you’re talking about?” 99% of the time, the answer will be “yes”, and you just went from paying $30 or more for a month’s supply (as well as costing your fellow plan members $60 or more), to paying $4 or less.

  3. Bruce Reynolds says:

    Having worked as a business analyst for Blue Cross Blue Shield of Florida (BSBSF) for four years, I would like to point out a few points where you and many others are a bit misinformed. First, people need to understand there are two types of insurance: covered risk and shared risk. Covered risk is where an insurer agrees to accept a premium and in return will cover damages, and is what most people have to protect their homes, cars, life, and other valuables. The foundation of covered risk is there is a low likelihood anything will happen. Shared risk insurance, which health plans are, is the opposite of covered risk in that there is an expectation something will happen. People will get sick, need medicines, trips to the doctors, etc., so there isn’t much hope for an insurer to make a profit. As a result, insurers pool premiums together and and use them to pay off claims. In effect, the healthy pay for the sick, but the risk is shared amongst everyone. So when you hear stories of health insurers refusing to cover claims so they can increase profits, this is simply not true. As honest brokers of member money, they are responsible for managing claims to make sure the pooled money doesn’t run out or is wasted.

    In the current healthcare debate, Dems say the current system is broken, and what we need is not-for-profit, member-owned, co-ops to provide insurance, and the GOP says the current system just needs to be improved, and not-for-profit, member-owned, co-ops would be a disaster. What both sides don’t know is that most health insurers realized years ago that profits were a thing of the past because provider costs were driving premium costs beyond what members would pay, so they became… member-owned, not-for-profit co-ops! Most BCBS affiliates are not-for-profit co-ops, as well as other major insurers. So what the Dems are claiming is broken is exactly what they say will fix the problem, and what the GOP is saying would be a disaster is what they are actually defending! Both sides are arguing out of total ignorance! BTW, when you hear about insurers making huge profits, you’re hearing about insurers like Humana and Kaiser-Permanente who aren’t just insurers but also operate their own hospitals, which is where their profits come from.

    Shared risk insurers take in premiums, retain a percentage of those premiums to cover the costs of supporting the plan, and the rest of the money goes out to providers. In most cases, the retained amount is about 17% of every dollar (BCBSF runs at about 17.5%). So using BCBSF as an example, for every dollar they take in, 17.5 cents stays at BCBSF and 82.5 cents gets paid out to doctors, hospitals, etc. Again, this 17.5 cents isn’t profit (i.e., revenues left after the bills have been paid), this is to cover their operating expenses.

    You mention that doctors have to make a living, but do you realize there’s nothing that governs how much of a living they can make? Most people have no idea how much their doctors charge for a service beyond what their co-pay is because someone else is paying the bill. If someone say gets the flu, they want to go to their favorite doctor. They don’t know nor care if their doctor charges three times as much for a visit as an equally-qualified doctor in the next building, and they don’t have to care because they aren’t paying. In 2004, BCBSF set up a program where they would capture how much each doctor charged for a given service, so members who went to doctors who charged less could get their premiums reduced. As soon as the doctors got wind of the plan, they threatened to cancel their contracts with BCBSF en masse. The last thing they wanted was their patients finding out they can shop around for a better deal. It’s amazing that people who will drive five miles out of their way to save five cents on a gallon of gas, or get a BOGO deal at a grocery store, will go into their favorite doctor’s office without any thought as to whether they are getting a good deal for their fellow plan members or letting them get ripped off.

    So bottom line, even if you take insurers completely out of the picture, the most you’ll be able to reduce costs is about 18%. Worse, you still have to pay someone to administrate the collection of premiums and paying of claims, and when the government does this (Medicaid/Medicare), the cost runs about 24%. So doing away with insurers and having the government handle health insurance will automatically result in a 6% increase in costs before the first bill gets paid! The cost of health insurance premiums is far and away set by how much money the providers are charging for their services (the 87% mentioned previously). If those charges go up, your premiums go up. If they go down, so do your premiums. The insurer just keeps using about 16-18%. Until someone works up the political courage to get provider charges under control, and until people start shopping for their healthcare the same way they shop for everything else, costs are just going to keep skyrocketing whether insurers or the government manages the insurance.