Wednesday, July 25, 2007

Take an Aspirin and Call a CEO

Welcome to George W. Bush's world of privatized, corporatized medicine.

A world where the premier protector of the health of our citizens, the Surgeon General, is muzzled and constrained by the administration's political agenda.

A world where insurers, not physicians, rule on the type and level of care.... or even if one receives care.

The question posed today in the Washington Post.... "Who Killed U.S. Medicine?" .... reveals how increasingly under Bush's corporate-favoring agenda our physicians are under siege, both professionally and financially.

It's medicine for profit not care.

"Doctor's work is dictated by the policies of insurers and governments, and independent physicians have been replaced by salaried doctors who are accountable to the hospitals or insurers that employ them."

And, government oversight entities, like state insurance commissions who used to work to protect the insured.... today work to enforce insurers ever-constricting coverage guidelines as their budgets are slashed and their mandates weakened for political expediency.

A headline in today's Des Moines Register reports such an outrage.... "Iowan vs. insurance company: Another lost fight for payment." It tells the all-too-frequent story of an insurance company.... this time it's Transamerica Life Insurance and their long-term-care policy.... refusing to pay on a technicality.

In this case, the policyholder Alzheimer's patient was being looked after in the locked memory-care unit of an assisted-living facility and receiving specialized care. Transamerica said it wasn't a "nursing home" and refused payment. The Iowa Insurance Division upheld the insurance company on this matter of semantics.

Shameful. It wasn't that long ago that the mere mention of the insurance commissioner brought such loop-hole-abusing insurers into line. No more.

But, the single-payer system so widely lauded by many politicians isn't the answer either. Under this type of government-run system, the physicians incentive is stifled by imposed salaries, and the inevitable result is a lowered standard of care.

"German physicians unhappy with their salaries and work hours under this kind of a system had no recourse against their monopolistic bosses but to go on strike last year." Not a healthy situation for doctors nor those under their care.

The AMA, who should be the entity battling for the physicians, has recently too often engaged in "trivial warfare" while physicians are "increasingly forced to becomes salaried employees.... and constrained by recipes for the practice of medicine that are cooked up by government and insurance company bureaucrats."

The answer to this sorry state of affairs.... our political leaders must have the courage to legislatively step on the neck of insurers and hospitals, and put teeth into enforcement so physicians can practice their profession.

Government oversight agencies must once again be directed to protect the public, and the AMA must refocus their efforts to advocate reversal of the corporatization of our physicians and medical care.

Perhaps then, we can stop our health-care system's slide toward imminent collapse.


Scott A Olson, CLTC said...

Many of the long term care policies that were sold in the 80's and 90's were nursing home only policies. These policies did not pay benefits for care at home, nor did they cover assisted living facilities or memory-impaired facilities.

The nursing home only policies would only pay benefits for care received in a nursing home. Generally, a "nursing home only policy" was about half the cost of an "integrated" or "comprehensive" policy. Most of the policies purchased over the past 15 years are "Integrated" policies.

Based upon the last paragraph of the article, which ends rather abruptly, Transamerica will pay benefits for the nursing home where Mrs. Zieser is now residing.

Although it's not stated in the article, we can conclude that the Zieser's bought a "nursing home only" insurance policy.

Long term care insurance is a very important purchase. Most long term care insurers offer lots of choices when you purchase a policy. It's important to choose the benefits that are right for you.

Scott A. Olson, CLTC

Truth Hunter said...

Scott A. Olson, Thanks for your thoughtful comment. With your certification and career in long term care insurance, I can certainly understand your interest in this subject, but not in defending the insurance carriers point of view.

The subjects in the Des Moines Register article who were denied payment obviously did know know, or understand, that the policy they paid into for many years would deny them coverage based on semantics... if indeed they did have a "nursing home" only policy.

It appears insurance companies use this "nursing home" wording as a "loophole" instead of working with their policyholders to advise them of their policy's shortcomings.

Perhaps the answer is for state legislatures to pass a law giving the terminology "nursing home" a more comprehensive meaning to include "locked" and nursing units in assisted-living facilities.

Denying Alzheimer patients benefits seems particularly henious, especially since so many "nursing homes" are not equipped to care for them properly.

Legislatures should also insist on a new and very simple form to be signed by the policholder to the effect that they are aware their policy's coverage is limited in nature, especially if it is "nursing home" only coverage.

Those two corrective actions would go a long way toward providing the coverage the policyholders most likely intended.

Truth Hunter said...

Obviously meant.. "did not know" in second paragraph.

elgringocolombiano said...

TH, check my post about the debate & Biden's poor money mgt skills. Am I correct here? I need a wiser perspective to verify my theory

Truth Hunter said...

Decisions about buying long-term care insurance, or not to buy, can be difficult.

A professional friend did some searching and found a resource that is loaded with cautions when buying insurance: "Avoiding Fraud When Buying Long-Term Care Insurance: A Guide For Consumers and Their Families"

Hope this is helpful.

Truth Hunter said...

elgringocolombiano....Let me say up front, that I think Joe Biden is a sterling fellow even though his bank account may not be.... I'll try to give you my reasons for this opinion.

On a recent trip to Des Moines he admitted he had not thought as much about how (money) to secure the presidency as what he wanted to accomplish as president. Refreshing. He vows to fix that.

Insofar as salaries are concerned, there are several reasons why he hasn’t amassed the usual fortune in his 35 years in the Senate.

First of all, salaries haven't always been $165,200. When he joined the Senate in 1972, the salary for a Senator was $42,500 and remained so until 1975 when it went up to $57,500. Although it increased over the years, it didn’t reach the $100,000 mark until 1991 and then increased gradually to the current $165,200.

In addition to his salary, he teaches constitutional law at Widener University School of Law as an adjunct professor, probably not much money to be made there. His wife is a teacher.

What you may not know about him, because he doesn’t use it like the Edwards and Gore, for example, is his personal history.

Right after he was elected in 1972, his family was in a car accident, his wife and infant daughter were killed, and his two young sons very seriously injured. In fact, he was sworn into office at their bedside. He wanted to resign but was implored not to, so he commuted the nearly two hours daily between D.C. and Wilmington to be with his sons.

An experience like that is life-changing, a getting-priorities-in-order experience. I think if it ever did, making money no longer motivated him.

He also had a brush with death, two brain aneurysms that hospitalized him for over half a year. This was right after he dropped out of his last bid for president.

He has been in the forefront, the champion actually, of legislation for battered women, and more than once has chaired the Senate Committee on Foreign Relations and served on the Judiciary Committee.

I truly do think he is one of the best, and for the best of reasons. If he isn't a good money manager, I would trust him to find the very best person for that job.

Although I don't agree with his take on everything, I do think he is exceptionally qualified to be president, and especially to unravel the mess that Bush has made of Iraq and many other things.

I hope you give Biden another look. I could be wrong, but I think he's heads and shoulders above the pack.

I would be interested to hear your further thoughts on this.