Michael Moore's Latest Target: Your HMO

first off, what exactly is the cost of running an insurance company? it only takes a handful of non trained professionals to deny a claim. managed health care was thought up by a group of insurance companies to control costs, and make sure the profit margin is at its greatest. there should be no way an insurance company can deny someone coverage on a claim that is needed. but it happens all the time. when these companies start dictating to the medical profession what they can do, and what they can charge, thats the problem. i am for national healthcare. it cant possibly be any worse then it is now, and it will be cheaper

Your knowledge of the industry is severely lacking, Dmek. Everything FRPLG said in response to you is true.

Directing your bitterness at the HMOs is misplaced anger. They are not the problem.

all i know is that my brother in law went years never going to the doctor, never using any of his insurance " benefits". now, he gets very sick, to the point he undergoes a heart transplant. my sister and their family and now thousands in the hole, money owed to doctors because of squabbling over what gets paid, and what they owe. i might not have my facts in order, but i can still see whats right and whats wrong

all i know is that my brother in law went years never going to the doctor, never using any of his insurance " benefits". now, he gets very sick, to the point he undergoes a heart transplant. my sister and their family and now thousands in the hole, money owed to doctors because of squabbling over what gets paid, and what they owe. i might not have my facts in order, but i can still see whats right and whats wrong

This is where things get personal, and I'm absolutely not going to take it there, only to say that a good portion of the problem stems from people not understanding the coverage provided by their healthcare plans. Many HMOs won't cover the most expensive procedures, and that's spelled out in their plan literature.

I certainly get that it feels "wrong." But the blame lies with the healthcare system in general, not with the HMO. The HMO is simply trying to operate within the flawed system. If the HMO paid the claim for the heart transplant procedure, they'd either have to charge a higher premium (one resembling a PPO's premium, which defeats the whole purpose of your bro having the HMO in the first place) or they'd go out of business.

It feels "wrong" because the fundamental belief at work here is that healthcare is a "right" as opposed to a "privelege." But the HMO isn't trying to deny someone their "right." They're simply trying to pay the bills. And no, their profit margins are not very high, just take a look at the trend in their stock prices.

Subject matter aside that guy makes me sick. He's a jerk.
My Humble opinion.

You may now continue OnTopic.

peace


couldnt agree more

all i know is that my brother in law went years never going to the doctor, never using any of his insurance " benefits". now, he gets very sick, to the point he undergoes a heart transplant. my sister and their family and now thousands in the hole, money owed to doctors because of squabbling over what gets paid, and what they owe. i might not have my facts in order, but i can still see whats right and whats wrong

I can sympathize with this situation. My family has faced similar circumsatnces. But I feel what you are saying is basically this, and please correct me if I am wrong:

That because your brother was insured for years and rarely if ever used medical services,he had 'banked' services, or he deserved to have coverage since he had not used the insurance. Hein lies the problem. Insurance is not a fungible product. You don't bank it and you can't trade it for something. In this case simply being insured IS THE SERVICE. Whether you use the benefits of the service is irrelevant. He got exactly what he was supposed to get through the years. A big well funded company sitting there willing and able to pay for his policy defined covered benefits. The company being there is the service. Apparently his policy did not cover a needed heart transplant, which sucks beyond belief. That is the problem. Not that the insurance did not pay for the heart transplant but that the heart transplant is so damned expensive that the insurance company simply CANNOT cover heart transplants and provide affordable insurance. See the problem isn't with the insurance companies. Sure they have issues just like any multinational billion dollar industry but their problems are small and rather insignificant to this discussion. The problem is that healthcare is so damned expensive. That is not insurance industry's fault.

Now I'd love to discuss why healthcare is so expensive. I suspect we'd jive pretyy well on that. Or at least we'd be in agreement on some things.

Published on Tuesday, May 15, 2007 by Agence France Presse
US Health System Ranks Last Compared to Other Countries: Studies
WASHINGTON - The US health care system ranks last among other major rich countries for quality, access and efficiency, according to two studies released Tuesday by a health care think tank.

The studies by the Commonwealth Fund found that the United States, which has the most expensive health system in the world, underperforms consistently relative to other countries and differs most notably in the fact that Americans have no universal health insurance coverage.

“The United States stands out as the only nation in these studies that does not ensure access to health care through universal coverage and promotion of a ‘medical home’ for patients,” said Commonwealth Fund president Karen Davis.

“Our failure to ensure health insurance for all and encourage stable, long-term ties between physicians and patients shows in our poor performance on measures of quality, access, efficiency, equity, and health outcomes.”

In “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care”, the study focused on interviews with physicians and patients in Australia, Britain, Canada, Germany, New Zealand and the United States who were asked to speak about their experiences and views on their health systems.

The US ranked last in most areas, including access to health care, patient safety, timeliness of care, efficiency and equity. Americans were also last in terms of whether they had a regular physician.

“The US spends twice what the average industrialized country spends on health care but we’re clearly not getting value for the money,” Davis told AFP.

She also noted that 45 million Americans, or 15 percent of the US population, have no health insurance, which contributes to the country’s medical woes.

The United States is also far behind in adopting modern health information technology, which translates into spiralling costs and poor care.

“We pride ourselves on being advanced on so many areas of technology but it’s not the case on health information technology,” Davis said. “Other countries have just moved ahead.”

Britain got the top score in overall ranking among the countries in the study, followed by Germany. New Zealand and Australia tied for third followed by Canada and the United States.

The second study delves into why health costs in the United States are so much higher than in eight other countries of the Organization for Economic Cooperation and Development: Australia, Britain, Canada, France, Germany, Japan, the Netherlands and New Zealand.

The study, “Multinational Comparisons of Health Systems Data,” found that even though the US spends the most on publicly and privately financed health insurance, its citizens had the most potential years of life lost due to circulatory and respiratory diseases as well as diabetes.

“This study blows a lot of myths about the US health system,” Davis said. “We spend three times what the average country spends on a day of hospital care and we also spend twice what the average country spends on prescription medication.”

Health care is likely to be a prominent issue in the 2008 US presidential elections with various candidates already promising to tackle rising costs and the burden placed on big business to provide health insurance.

Copyright © 2007 Agence France Presse.

It seems to me that the larger issue is that we as Americans - who have the most expensive health care system in the history of the world - get less value for our dollar then other countries.

Regarding Moore, I don't understand why he is held to different standards of objectivity then any other mainstream media polemicist. It's not like he is trying to be Peter Jennings. Of course he selectively uses evidence to make his case. So do lots of people. If you wish to disagree with these arguments, do that, don't just say that you hate him and accuse him of being corrupt.

Regarding the above France Presse story, I am amazed that Britain ranks first. Anyone who watches Prime Minister's questions knows that complaints about the National Health are incessant. They have ridiculously long waits for common procedures and I suspect that the outcome of this study was fore-ordained. Think tanks and the like have agendas and their "studies" should be taken with a grain of salt.

its not that i think he banked anything. it just seems like when you and your family are NOT in need of any care, everything is fine with the insurance company. but once you need them, they run and hide. New Orleans is a perfect example of this. and to say they cant pay for a procedure like a heart transplant is just plain crazy. if they cant, who can? now my sister and their family are probably going to be financially burdened for maybe the rest of their lives

Regarding Moore, I don't understand why he is held to different standards of objectivity then any other mainstream media polemicist. It's not like he is trying to be Peter Jennings. Of course he selectively uses evidence to make his case. So do lots of people. If you wish to disagree with these arguments, do that, don't just say that you hate him and accuse him of being corrupt.

The problem with Moore is that he started out by presenting his arguments as authoratative "documentaries" - not "fact based", but "factual" documentaries.

Sure everybody now knows that he is simply a demagogue in the vein of Sharpton, who has an agenda (including his own aggrandizement) and who resorts to half truths, omissions and hyperbole. Originally, however, Moore presented himself, and allowed himself to be presented, as honestly portraying the facts of the subjects of his "documentaries". Go look up the Fahrenheit 911 thread - As I recall their were several defenders of Moore's "truth".

Sorry, Moore played the "I honestly portraying the facts" card and has since been called on it. He is in the same class as Sharpton, Limbaugh and others of that ilk and deserves to be reviled by any one who values honesty in approaching and solving the problems that confront us as a society.

As for being corrupt, I am not so much accusing him of being corrupt as dishonest in both his method and in his motives.