Monday, February 18, 2008

Health Care: You Bet Your Life

In offering solutions for medical insurance, politicians of all stripes keep reassuring voters about their right to be treated by "the doctor of your choice" rather than some faceless bureaucrat in a white coat under socialized medicine.

There are problems with this argument. Most Americans are now covered by HMOs, which present them with lists of "in-network" physicians either on their payroll or who have agreed to pre-set fees and, in many cases, face pressure to make life-and-death decisions on what's best for the insurers' bottom line.

In California, this divided loyalty recently came into focus with Blue Cross' attempt to enlist doctors in reporting patients who fail to disclose previously existing conditions.

"We're outraged, "the President of the California Medical Association responded, "that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality."

The Blue Cross backed off, but the sanctity of the doctor-patient relationship is definitely showing symptoms of stress. New York Attorney General Andrew Cuomo is suing UnitedHealth for operating "a defective and manipulated database that most major health insurance companies rely upon to set reimbursement rates for out-of-network medical expenses.”

Translation: If you see "the doctor of your choice," your insurer will stiff you on how much of his or her bill they will pay.

That aside, there is the question of how Americans pick their physicians when they can. From all evidence, most do so more casually and with less information than they gather before buying a car or trying a new restaurant.

There is no Zagat guide to medical services, and consulting the "best doctors" lists of regional magazines only leads to the discovery that most are not taking new patients. Too often, the decision is based on the casual advice of a friend or neighbor.

The US Department of Health & Human Services has a few rudimentary suggestions for getting information, but for the most part, finding the right doctor is no more fact-based than finding the right mate. You have to trust your instincts and hope for the best. No politician can help with that.


Chief said...

I really want a single-payer system for health-care implemented nation wide by the next president. It will, or can be made to, work.

1. Medicare, the Veteran's Administration and Tricare (retired military) are all gov't administered, single payer systems.

2. Germany, Great Britian, Japan, Canada and France all have single payer health care for their citizens. We can take the beat of each and avoid known pitfalls.

Anonymous said...

The 800 Pound Gorilla in the Health Insurance Industry

A simple solution to end this health insurance abuse is have the states regulate the health insurance industry just like a public utility is regulated. This will rein in the obscene profits made by the insurance industry taking advantage of the vulnerability of sick Americans.

How does one deal with an eight hundred pound Gorilla that misbehaves and denies coverage for your medical bills?

Patsy Bates found out when a California court awarded her 9 million dollars for damages.

Her insurance carrier, Health Net cancelled coverage just when she needed breast cancer treatment.

Her lawyer, William Shernoff, not only read the book, he wrote the book: "Fight Back and Win: How to Get HMOs and Health Insurance to Pay Up".

Bravo for LA City Attorney Delgadillo and New York City Attorney General Andrew Cuomo for going after the health insurance industry for fraudulent practices such as cancellation for pre-existing conditions and underpayment for out-of-network doctor bills.

To read more:
Making Your Health Insurance Company Pay Up by Jeffrey Dach MD

Jeffrey Dach MD

my web site