Dirty Tricks of the Private Healthcare Industry

[volatile]

"High-ranking insurance PR flack defects, explains dirty tricks"
http://www.pbs.org/moyers/journal/07102009/watch2.html (via BoingBoing)

If you have a few moments, take some time to watch this interview with Wendell Potter, former VP of health insurance firm Cigna. No longer able to tolerate the fundamentally broken system, he defected: his insider perspective on the mendacity, ideology and political shenanigans behind the industry opposition to health-care reform.

It's damning.

Thoughts? Comments?

 

[Skeptic Ginger]

First, how about clarifying your title. Perhaps you can get a mod to edit it for you. It isn't the health care industry, it's the third party payer system or health care INSURANCE industry. As a health care provider, it is insulting to treat the two as one.

 

[volatile]

First, how about clarifying your title. Perhaps you can get a mod to edit it for you. It isn't the health care industry, it's the third party payer system or health care INSURANCE industry. As a health care provider, it is insulting to treat the two as one.

I see your objection - but my error, as it were, comes from the fact that where I'm from, health-care provision isn't an industry at all. The only "industrialised" bit is the private sector - the insurers.

 

[BartiDdu]

Quite funny methinks that it was a quote by Dante reminding him he'd go to hell unless he took a stand that was his motive to becoming a turncoat! Maybe not funny really. I find it quite sad that people in the 21st century still come to ethical conclusions based on the reward/punishment idea.

Secondly, although it's only a clip of Moore's film, in his typical way he paints a very rosy picture of healthcare in the UK. The NHS is the biggest employer in Europe. The increasing complexity of healthcare and inevitable choices of what is a good way to spend a limited amount of healthcare money and on whom has to be made by someone. Is a publicly owned body the best way to do it? No doubt many people get a good service here in the UK but there are some issues spiralling out of control, not least the bill to the taxpayer!

Thirdly, Potter describes the current US system as 'very much a free market healthcare system'. It is no where near a free market system! Tax penalties for individuals opting to choose their own insurers over their employers, the imposition of state-limited choices and all the regulation that makes better competition, better service and lower prices impossible.

And finally we have all that lobbying and corruption with the current monopolies and cartels doing all they can to keep the status quo. I really don't have any answers for you US folk but overall, we in the UK are as married as we can get to the concept of 'free' healthcare. No popular politician would dare question the principle of 'free' health care so we can all sit back and watch the NHS as it implodes! What you have now is obviously not right but why don't you see how it goes here for a few years before copying a deeply flawed system on a much bigger scale with masses of dollars you don't actually have!

BDd

 

[Skeptic Ginger]

I see your objection - but my error, as it were, comes from the fact that where I'm from, health-care provision isn't an industry at all. The only "industrialised" bit is the private sector - the insurers.

If you believe that you are very poorly informed as to what is meant by, health care industry.

 

[Skeptic Ginger]

From Wiki:

The health care industry or health profession treats patients who are injured, sick, disabled, or infirm. The delivery of modern health care depends on an expanding interdisciplinary team of trained professionals.[1][2]

For purposes of finance and management, the healthcare industry is typically divided into several groups and sectors. The Global Industry Classification Standard and the Industry Classification Benchmark divide the industry into two main groups: (1) health care equipment & services and (2) pharmaceuticals, biotechnology & related life sciences. Health care equipment and services comprise companies that provide medical equipment, medical supplies, and health care, such as hospitals, home health care providers, and nursing homes. The second industry group comprises sectors companies that produce biotechnology, pharmaceuticals, and miscellaneous scientific services.[3]

And under Health care in Wiki:

Healthcare Industry

The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team.[4][5]

The Healthcare industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals. According to market classifications of industry such as the Global Industry Classification Standard and the Industry Classification Benchmark the healthcare industry includes health care equipment & services and pharmaceuticals, biotechnology & life sciences. The particular sectors associated with these groups are: biotechnology, diagnostic substances, drug delivery, drug manufacturers, hospitals, medical equipment and instruments, diagnostic laboratories, nursing homes, providers of health care plans and home health care.[6]

According to government classifications of Industry, which are mostly based on the United Nations system, the International Standard Industrial Classification, health care generally consists of Hospital activities, Medical and dental practice activities, and other human health activities. The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. This involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratiories, pathology clinics, ambulance, nursing home, or other para-medical practitioners in the field of optometry, hydrotherapy, medical massage, occupational therapy, speech therapy, chiropody, homeopathy, chiropractice, acupuncture, etc. 7

From a business dictionary:

health care industry
Definition

Comprises of providers of diagnostic, preventive, remedial, and therapeutic services such as doctors, nurses, hospitals and other private, public, and voluntary organizations. It also includes medical equipment and pharmaceutical manufacturers and health insurance firms.

 

[volatile]

If you believe that you are very poorly informed as to what is meant by, health care industry.

Not what I "believe", just that the term applies to a very narrow set of the total healthcare sector where I come from. If I was talking to anyone in Britain about "the private healthcare industry", they'd know I was talking about BUPA and the like. "Private healthcare" means, at least in my country, "healthcare provided to patients outside the NHS". We talk about "going private"; BUPA style themselves "a private healthcare and healh insurance company", and they run both the insurance side and the hospitals, which are inextricable.

The thread title is accurate as far as I'm concerned - Mr. Potter is talking about the private healthcare industry; i.e. the [insurance] industry that provides private (not public) healthcare.

 

[volatile]

This is a difference in perspective on what "private healthcare" means, not just "healthcare" or even "healthcare industry".

Of course the latter includes drug companies and even sanitary-wipe manufacturers, but these are not what I (nor my compatriots) would understand by the term "private healthcare", which applies exclusively to the provision of primary healthcare (and the associated insurance schemes) to patients outside the government-funded system.

 

[Rolfe]

And finally we have all that lobbying and corruption with the current monopolies and cartels doing all they can to keep the status quo. I really don't have any answers for you US folk but overall, we in the UK are as married as we can get to the concept of 'free' healthcare. No popular politician would dare question the principle of 'free' health care so we can all sit back and watch the NHS as it implodes! What you have now is obviously not right but why don't you see how it goes here for a few years before copying a deeply flawed system on a much bigger scale with masses of dollars you don't actually have!

I don't think anyone is suggesting that the only alternative for the USA is to copy the NHS exactly. There are many different ways of delivering healthcare throughout the developed world, and mostly they seem to work. Given where the USA is starting from, something like the Swiss or German systems would probably be a better road to go down.

I don't think, either, that in Britain we can do nothing apart from either revert to a private system or "sit back and watch the NHS as it implodes". I don't think the NHS is as close to implosion as all that, and I think there are a great deal that can be done without compromising the principle of healthcare "free at the point of need". However, that's not what this thread is about. This is about the protectionist beghaviour of the US health insurance companies. If you want to start a thread about the problems in the NHS, do so, but that's a different subject.

In this context, I strongly suggest watching the documentary linked from this page - Sick Around the World. It's a look at about six different systems in operation in different countries, how well they work, and how satisfied the citizens are with each one. The main problem noted is insufficient funding, when countries are spending only 6% to 7% of GDP on comprehensive healthcare for their citizens. Since the USA currently spends about 16% of GDP on healthcare, then that shouldn't be a problem faced by that country.

Rolfe.

 

[ponderingturtle]

I don't think anyone is suggesting that the only alternative for the USA is to copy the NHS exactly. There are many different ways of delivering healthcare throughout the developed world, and mostly they seem to work. Given where the USA is starting from, something like the Swiss or German systems would probably be a better road to go down.

But those are harder to rally against. And remember the most important thing is that insurance companies make lots of money.

 

[Ivor the Engineer]

First, how about clarifying your title. Perhaps you can get a mod to edit it for you. It isn't the health care industry, it's the third party payer system or health care INSURANCE industry. As a health care provider, it is insulting to treat the two as one.

It's both. The interests of both health care providers and insurance companies are divergent from those of health care consumers in the US.

The solution is obvious but completely and utterly unpalatable to many Americans because they would have to admit they are wrong, both ethically and rationally.

 

[Rolfe]

But those are harder to rally against. And remember the most important thing is that insurance companies make lots of money.

Well, that's exactly the point. US insurance companies using only about 78% of income to pay for healthcare for their customers compared to about 95% in other countries. And direct stock market incentives (in the US) to make that figure even lower.

The insurance companies are dead set against any change to the system which might put a crimp in this gravy train. Therefore they lobby against change, even though it's highly probable that change would be of great benefit to a sizeable proportion of the population. As part of their lobbying they disseminate "black propaganda" against the concept of universal healthcare in any form. These propaganda messages are picked up and used by right-wing politicians and commentators to represent to the voters that universal healthcare would not be of benefit to them, or to the population as a whole.

It appears, however, that the reasoning behind these arguments is not genuine concern for the health of the population or for efficient healthcare delivery, but a desire to protect insurance company profits and share prices.

I think this is the point. If you want to argue in favour of protecting insurance companies' profits and share prices, then do so. But don't dress it up as genuine concern for efficient healthcare delivery.

Rolfe.

 

[Beerina]

He just regurgitates the usual. I find "worrying about competition from the government" an odd statement.

How many private companies can force you to help pay for their product even though you use the competitor's? And I don't mean a "Microsoft tax", I mean real threats to use real men with real guns to put you behind real bars if you don't pay.


Having said that, I don't put it above some corporations to use the "rent seeking" of laws to try to guide business their way. You have an arrogant child misusing power, the government, threatening to require health care. Better they be forced to buy from you, or you and everyone be forced to buy from them? Pick one of your two children to die. Have a nice choice.


Oh, and I understand the satisfaction ratings in religion are higher than in atheist households. Therefore we should force everyone to join a religion for their own good. Objectors just don't wanna have to obey the law*. But the only real choice is whether you are to be forced to attend a private church, or whether the government will make one and force all the others out of business.






* Actual argument used by a female on the Bill Moyers show.

 

[Rolfe]

Non sequitur, much?



















Incoherent non sequitur, really.

Rolfe.

 

[Rolfe]

I don't imagine there's any logic or reason that can get past Beerina on this one. Maybe he has shares in health insurance companies.

However, taking the argument on a little for the more open-minded around here, is it really all fine and dandy for US insurance companies to spend only 78% of the money they receive on providing healthcare, when experience in other countries shows that a spend of 95% is possible? Is it desirable that all the financial incentives in the industry are all to provide the least amount of benefit for the greatest price? Is it acceptable that insurance companies deliberately trawl for technicalities that will allow them to refuse to pay out on a policy once the customer has developed an expensive illness - and that the patient then has no recourse to fund their treatment?

Just saying, well, I don't like the look of any of the alternatives, isn't much of an answer. Especially not when the alternatives that can be observed in operation cost substantially less and deliver at least as good results if not better.

Rolfe.

 

[Ivor the Engineer]

<snip>

Just saying, well, I don't like the look of any of the alternatives, isn't much of an answer. Especially not when the alternatives that can be observed in operation cost substantially less and deliver at least as good results if not better.
Rolfe.

The experience Americans have of Medicare and Medicaid in the US appears to paint a different picture. Those with private insurance get to see better physicians and receive better treatment than those enrolled in the state programmes.

As a group physicians are just as much to blame as the private insurance industry for the escalating costs and poor value for money the US public receives for the amount it spends on health care.

When you strip away the pretension, the objective of the US health care industry is to make the maximum amount of money out of people's misery.

 

[volatile]

The experience Americans have of Medicare and Medicaid in the US appears to paint a different picture. Those with private insurance get to see better physicians and receive better treatment than those enrolled in the state programmes.

As a group physicians are just as much to blame as the private insurance industry for the escalating costs and poor value for money the US public receives for the amount it spends on health care.

When you strip away the pretension, the objective of the US health care industry is to make the maximum amount of money out of people's misery.

According to the interview in the OP, satisfaction rates are higher amongst Medicare patients than private ones. I don't have the stats to hand (does anyone), but if true that shows the "private care is better care" to be just another industry-peddled deception.

 

[volatile]

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1304203

 

[Ivor the Engineer]

http://www.ncbi.nlm.nih.gov/pubmed/9682513

BACKGROUND: This article describes a survey of new clients entering care with nine practicing classical homeopaths in the Los Angeles metropolitan area between January 1994 and July 1995.

METHODS: Participants completed a self-administered questionnaire before undergoing diagnosis by the homeopath. Follow-up interviews were conducted by phone 1 month after diagnosis and face to face 4 months after diagnosis, along with a self-administered questionnaire before the final interview. A total of 104 participants entered the study; 77 completed all data collection.

RESULTS: Clients sought homeopathic care for a wide array of largely chronic conditions. Respiratory, gastrointestinal, and female reproductive problems were the most common primary complaints. Most clients were highly educated, but had limited knowledge about homeopathy before entering treatment. Approximately 80% reported earlier, unsuccessful attempts to get relief from mainstream care. Four months after treatment, general measures of health status showed improvement, and only 29% of participants reported no improvement for the primary complaint leading to treatment. Satisfaction with homeopathic treatment was high regardless of outcome. Three outcome measures of perceived change--overall health status, primary condition for which treatment was sought, and outlook on life--were predicted by different combinations of study variables.

CONCLUSIONS: Homeopathy does not divert people from seeking mainstream care. The use of alternative modes of care such as homeopathy can be understood as attractive and satisfying to educated individuals with chronic problems.

http://www.medicalnewstoday.com/articles/85917.php

If the care received by vulnerable older people concurrently enrolled in Medicare and Medicaid was evaluated on a grading scale, it would squeak by with a barely passing mark, a new UCLA study has found.

Using quality-of-care measurements developed by the Assessing Care of Vulnerable Elders (ACOVE) project, researchers found that vulnerable elderly patients received only 65 percent of the tests and other diagnostic evaluations and treatments recommended for a variety of illnesses and conditions, including diabetes and heart disease. The study findings appear in the October issue of the peer-reviewed journal Medical Care.

...

They found that in too many instances, elderly patients were not given the full range of treatments and services for their conditions. For example, only 42 percent of patients with diabetes were tested to gauge their blood sugar control or received an eye examination during the one-year study period. Likewise, many patients who were newly diagnosed with heart failure did not receive recommended diagnostic evaluations or medications known to be effective.

...

 

[volatile]

Fair point.

I don't doubt that private hospitals are swankier than public ones.