Michael Moore's Latest Target: Your HMO

[BDBohnzie]

That's thing catch-22 about Michael Moore. You don't want to like the man, but you end up respecting what he does to open your eyes to the world without the rose-colored glasses. I can't stand Moore, but because of his controversy, you tend to see things a little bit differently.

[Southpaw]

I can't stand Michael Moore because he twists facts and flat out lies to make his point, but I would love to see him to take a shot at the healthcare system because for whatever reason, he ruffles the feathers of the decision makes.

I have a friend who has to take Rhemicade for a condition. Rhemicade is an intravenous drug that he gets every eight weeks and basically allows him to live his life normally(lift weights, rock climb, etc). Without it, he'd be in extreme pain and his joints would lock up. The cost of this wonder drug is $20,000 per treatment, for 32oz of liquid that is very easy to synthesize and mass produce. Fortunately, he has very good insurance that covers it, but what about people with poor or no health insurance? I'd be willing to bet that if you don't have health insurance, you can't afford 60k-120k per year to be able to live like everyone else.

[Schneed10]

Ugh. I'd love to go toe to toe with this douchebag in a healthcare debate.

First I gotta say that the American healthcare system is pretty busted up. But you can't blame the HMOs or the drug companies for that as Moore does in his film. The HMOs don't pull mad profits from their business. It's a low-margin business.

I can see an argument against pharmaceutical companies to some extent, because they pull in massive profits. But you can't get all up in arms about one particular drug costing an insane amount of money. People like to say oh well that drug only costs $10 to make and they're charging $100 for it. Well that's because they spent $80 researching other possible drugs and vaccines that were deemed either ineffective or unsafe by the FDA. Pharmeceutical R&D is a huge expense and has to be factored into the equation for the drugs that do actually make it to the market.

[Southpaw]

Originally Posted by Schneed10

I can see an argument against pharmaceutical companies to some extent, because they pull in massive profits. But you can't get all up in arms about one particular drug costing an insane amount of money. People like to say oh well that drug only costs $10 to make and they're charging $100 for it. Well that's because they spent $80 researching other possible drugs and vaccines that were deemed either ineffective or unsafe by the FDA. Pharmeceutical R&D is a huge expense and has to be factored into the equation for the drugs that do actually make it to the market.

For the record, the vast majority of drugs are insanely marked up. I understand that the research and development side is expensive, but look at cancer treatments, which have been basically the same for 20+ years. My father has been on aggressive chemo and radiation for several months now. He was getting one of each treatment almost weekly for a while, and racking up around $10,000 in bills per week. It's friggin ridiculous that people are being charged insane amounts of money for drugs that are easily mass produced and haven't changed dramatically for over two decades.

[Schneed10]

Originally Posted by Southpaw

For the record, the vast majority of drugs are insanely marked up. I understand that the research and development side is expensive, but look at cancer treatments, which have been basically the same for 20+ years. My father has been on aggressive chemo and radiation for several months now. He was getting one of each treatment almost weekly for a while, and racking up around $10,000 in bills per week. It's friggin ridiculous that people are being charged insane amounts of money for drugs that are easily mass produced and haven't changed dramatically for over two decades.

OK here's the lowdown on cancer drugs. Essentially, the federal government is retarded, and incapable of catching unscrupulous practices by the pharmaceutical industry.

You're right, there are cheap cancer drugs like Vincosar, Troposar, and Neosar. They're mass produced and aren't all that expensive. But pharmaceutical companies know that Medicare patients are the most frequent recipient of cancer treatments. And the pharmaceutical companies know that Medicare administrators aren't always on the ball. So, knowing that Medicare will reimburse the pharmaceutical companies at 80% of AWP (the average wholesale price), the pharmaceutical companies jacked up the AWP of cheaply manufactured generic cancer drugs. They'll charge $700 for a 2 mL dose of Vincosar, knowing that Medicare will reimburse them 80% of it ($540 per dose).

So Medicare pays this high price because they're not on the ball, and as Medicare continues to pay that price, it only lends validity to the high price in the marketplace. So... if you don't have Medicare? You better have solid insurance that has an agreement in place with the Pharmaceutical companies to pay a reasonable price for the drug (Aetna at 30% of AWP, etc.). If you don't have insurance? You're on the hook for all $700 per dose. Blame the pharmacuetical company for being unscrupulous with the pricing, blame the federal government and Medicare administration for being too inept to catch the problem, and blame yourself for not getting a job that has good insurance coverage. Plenty of blame to go around.

One of the true horrific examples of our bullshit system.

Does your father have insurance coverage? Is it commercial coverage or is he on Medicare?

[Southpaw]

Originally Posted by Schneed10

Does your father have insurance coverage? Is it commercial coverage or is he on Medicare?

I believe he has commercial coverage through his employer, but I know he was basically fighting his insurance company to get them to cover some of the costs. And thanks for the info. I always assumed that federal government was involved, but your example makes them sound completely inept(shocker...) instead of being in on the scam.

[dmek25]

Originally Posted by Schneed10

Ugh. I'd love to go toe to toe with this douchebag in a healthcare debate.

First I gotta say that the American healthcare system is pretty busted up. But you can't blame the HMOs or the drug companies for that as Moore does in his film. The HMOs don't pull mad profits from their business. It's a low-margin business.

I can see an argument against pharmaceutical companies to some extent, because they pull in massive profits. But you can't get all up in arms about one particular drug costing an insane amount of money. People like to say oh well that drug only costs $10 to make and they're charging $100 for it. Well that's because they spent $80 researching other possible drugs and vaccines that were deemed either ineffective or unsafe by the FDA. Pharmeceutical R&D is a huge expense and has to be factored into the equation for the drugs that do actually make it to the market.

ALL insurance companies have big time profit margins. should i start by posting links to the salaries of the ceos? insurance is almost bordering the pyramid schemes, where they want your money, but you play hell getting yours if something happens. if your looking for pity for the mega money insurance giants, your looking the wrong way. and this lies the problem. why should the same procedure have 3 different costs, for 3 different people/ its how they balloon their profits. no one in that business goes hungry. and the lobbyists in Washington are some of the richest, most powerful in the world.

[FRPLG]

Originally Posted by dmek25

ALL insurance companies have big time profit margins. should i start by posting links to the salaries of the ceos? insurance is almost bordering the pyramid schemes, where they want your money, but you play hell getting yours if something happens. if your looking for pity for the mega money insurance giants, your looking the wrong way. and this lies the problem. why should the same procedure have 3 different costs, for 3 different people/ its how they balloon their profits. no one in that business goes hungry. and the lobbyists in Washington are some of the richest, most powerful in the world.

Actually you are wrong. Insurance companies do not make what most people would consider "big time profits" relative to other comparable industries. Compare their profits to pharms and it isn't even close. And CEO salaries are not indicative of huge profits. They are more closely aligned with revenue than with net profits. The cost of doing business as an insurance company is astronomical. What do you think the "managed healthcare" concept was born out of? The need to increase profits to a viable point due to the skyrocketing cost of healthcare. Go ahead and posts the CEOs salaries, they mean nothing.

[dmek25]

Originally Posted by FRPLG

Actually you are wrong. Insurance companies do not make what most people would consider "big time profits" relative to other comparable industries. Compare their profits to pharms and it isn't even close. And CEO salaries are not indicative of huge profits. They are more closely aligned with revenue than with net profits. The cost of doing business as an insurance company is astronomical. What do you think the "managed healthcare" concept was born out of? The need to increase profits to a viable point due to the skyrocketing cost of healthcare. Go ahead and posts the CEOs salaries, they mean nothing.

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

[FRPLG]

Originally Posted by dmek25

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

Insurance companies pay out BILLIONS of dollars a year in claims. THAT is the cost of doing business.

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.

Umm yeah pretty much. They are public companies with share holders. That is why the company exists. Healthcare was becoming more expensive therefore hurting the bottom line. So insuarnce companies figured out how to still offer their services while also making the profits that they are supposed to make. You don't like it? Then go find another insurance company who isn't doing that. Can't find one? That ought to be a clue about what is going on here. If the profits were so "massive" then there would be companies running to get into the market to get a piece of the pie. That would in turn cause prices to drop. That isn't happening. I wonder why? Because insurance companies don't make "massive" profuts in the way that you mean. It is simple economics.

there should be no way an insurance company can deny someone coverage on a claim that is needed.

Actually there should be. If their policy doesn't cover it. A lot of people bemoan the insuarnce companies for not paying out claims that they should pay out when in fact they are simply not paying out a claim that they shouldn't pay out. Very few insurance plans cover everything.

[Schneed10]

Originally Posted by dmek25

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.

[firstdown]

Originally Posted by dmek25

ALL insurance companies have big time profit margins. should i start by posting links to the salaries of the ceos? insurance is almost bordering the pyramid schemes, where they want your money, but you play hell getting yours if something happens. if your looking for pity for the mega money insurance giants, your looking the wrong way. and this lies the problem. why should the same procedure have 3 different costs, for 3 different people/ its how they balloon their profits. no one in that business goes hungry. and the lobbyists in Washington are some of the richest, most powerful in the world.

We all would probably admitt that CEO's pay is excessive in most industries and not just insurance. Why not post the profitts of the insurance co which would tell the true story. The Chinees have purchased some of the best Co's in Americia and there's a reason that they do not buy Ins. Co.

[Schneed10]

PS I work in hospital financial administration.

[MTK]

I'll give you quality... but I think most would agree that doesn't outweigh the negatives.

[Schneed10]

Originally Posted by Mattyk72

I'll give you quality... but I think most would agree that doesn't outweigh the negatives.

It sounds like you're comparing our healthcare system to those of European nations where healthcare is nationalized.

I'd take the American system any day of the week. There are more positives than just quality...

- Choice. Overseas, you are often designated to a certain facility or healthcare provider. If you don't like them, tough, you're stuck. Here, even if you have a crappy HMO, you still get to choose from a network of providers. If you have a PPO, you can see anyone.

- Fire and rescue services (including the 911 system) here are 1000% better than in Europe.

- Wait times at hospital ERs are way shorter here.

- There is a much greater specialization of surgical services here. In Europe, if you need to have a tumor removed from your spine, you often end up having a general surgeon do it. In the US, you have a spine specialist do it. Explains why survival rates are so much higher here for like procedures.

All this is not to say that we don't have major problems because we do. No matter what, it's total bullshit that someone without insurance pays 10 times what someone with insurance is charged. But I'd take quality over cost any day of the week; especially if it's my wife, daughter, mother or other family member getting taken care of.