Health care - administrative incompetence

[Rolfe]

A few years ago I was in Ireland and there was some huge news story about some woman who died from cancer after she didn't receive some service quickly enough or after she was denied a service (I can't remember which, and I can't remember if she was a patient who simply died SOONER than she would have without treatment, or if she could possibly have lived without treatment). It was in the paper, on the news, and there was even a rally in downtown Dublin, where I was at the time, with people protesting what had happened. I don't know how the case resolved, as I was only in the country briefly, but people really were looking for heads to roll on this.

I just remembered being so shocked. In Ireland, ONE patient being denied medically necessary services and dying was some huge scandal worthy of public and media outrage...to me, this is just something I deal with every single day in my ONE hospital, insurances denying medically necessary procedures to patients.

I really hope you guys appreciate how luck you have it.

I'm not sure everybody does. Familiarity breeds contempt. Bashing the NHS is almost a national sport. An extremely dangerous national sport in my opinion, especially with a right-wing government in power.

But when I read threads like this, and at the same time I'm showing up to get treatment for a frozen shoulder and a broken toe (both at the same time!), and I can show up at any hospital that happens to be handy and they all have access to my medical records and will inform my own doctor of their findings, and I can request that my own doctor phone me so I can ask her opinion on whether I need to be screened for osteoporisis (no, after going through a standard questionnaire) and then a screening kit arrives in the post quite out of the blue for bowel cancer, then I get a letter saying negative, you will be offered screening again in two years, and the doctor writes personally to my mother asking her to come in to discuss her blood results, gives her a full examination, takes more samples, then writes another personal letter saying results much improved, we won't put you to the trouble of going to see a specialist in that case (mother is 94, what was that about death panels again?)....

Pause for breath.

And then there are my relatives - diabetes care and hip replacements and knee replacements and glaucoma surgery and (in one case) removal of an oesophagus and cancer surgery and long-term allergy care and I could go on all night....

And all this in return for a very modest amount of tax, which is graded by ability to pay, and nobody is asked for a single penny when they actually get the treatment (apart from a small prescription tax which is being phased out and isn't paid by the people who use the service most anyway)....

OK, I am the most grateful thankful mortal on the face of the globe. All because I read the threads on the JREF forum, and realise what hell can really be like.

Rolfe.

 

[Agatha]

I really hope you guys appreciate how luck you have it.

I certainly do!

I have Crohn's disease, which is not much fun, and also rheumatoid arthritis and fibromyalgia; the RA has put me in a wheelchair. At the moment I can only manage part time work, so I'm not earning much and don't pay a lot of tax.

As you can imagine, I see my GP, IBD specialist nurse, consultants, physiotherapist, and occupational therapist on a regular basis, and every month I pick up a carrier bag full of drugs, all at no cost to me.

A few weeks ago I developed a new pain, I rang my GP surgery and arranged an appointment for my next day off work. The GP suspected gallstones and referred me to the local hospital for an ultrasound. I had a letter from the hospital two days later asking me to ring for an appointment, and I arranged this at my convenience (eight days later - I could have had it sooner but I was busy).

Despite Derbyshire being blanketed in unprecedented snow, the ultrasound took place with no waiting around - I was taken straight through as soon as I arrived in the department - the results were emailed to my GP who then phoned me to discuss them. I could have had the op to remove my gallbladder by now, but I asked that it be arranged to take place in the school holidays because of my childcare responsibilities.

Every time I read of more examples of the US's broken healthcare system I want to weep for you, because it doesn't have to be like that.

We pay less tax for a more efficient and more effective service. Even if the US didn't follow the NHS model, there are insurance backed systems which work much more effectively than the US.

 

[Kaylee]

Honestly, the evidence is so overwhelmingly in favor of Universal Health Care (provided by the government) that it is rather shocking how many people are against it.

I agree.

Anyone have any thoughts as to why Americans haven't been able to get UHC and Canadians and most (if not all) Europeans have? For anyone who says the American lobbying system is at fault -- than why are lobbyists so much more powerful in the US than in the other countries that have managed to implement UHC?

It is in the insurances FISCAL INTEREST to make things as complicated as possible. That is because the more things that get missed or filed incorrectly, the more claims they get to deny. The more claims they deny, the more money they keep in their pocket. The whole "competition" thing doesn't work for a couple reasons.

<snip>

The other thing is that most people get their insurance through their work, they don't get to just chose it themselves because privately bought insurance plans simply aren't affordable for most people. And your employer, more often than not, isn't looking for the plan with the best services, but the most affordable. So again, the whole "competition" thing doesn't really work the way it does when you have an individual trying to decide which car to buy.

I've read that companies started offering health benefits in the US to get around the wage freeze during WWII. This appears to have backfired for most Americans.

I suspect that health insurance companies would be more responsive if they sold their product directly to the consumer and not through employers. Consumers, esp. ones on COBRA, have very little influence with health insurance companies.

I've often wondered if Congress had magically passed a bill requiring health insurance companies to only be allowed to sell directly to the consumer and not indirectly through employers, professional organizations or other 3rd parties, phased in over a few years, what the effect would have been. I think we would have ended up with a system that was still inferior to the better implementations of UHC in Europe and Canada, but better than what we have now.

To address the OP more directly, the market forces would be freer and therefore more likely to address administrative incompetence and intentional foul-ups designed to prevent consumers from getting the health benefits that they paid for.

What do you all think?

 

[Kestrel]

I don't think he does it on purpose. I think he genuinely believes what he says about the cases he highlights in Sicko. He's a movie maker, not a healthcare expert. Maybe having an advisor who could have selected the cases a bit more rigorously would have helped.

But I don't know it would have made much difference. His underlying point was sound, and well made. Those who viscerally oppose him weren't doing so on the basis of a couple of his cases being over-dramatised, but because they deeply loathe any suggestion that their taxes should pay for something someone else might benefit from. Even though that's exactly what happens at the moment.

If you want totally serious documentaries, join the rather small audience that watches Frontline on PBS.

Michael Moore's movies are aimed at a broader audience but still informative and popular with audiences. This happens at times for subjects like cute penguins, but popularity is rare for documentaries about serious subjects.

When it was first released, there was a well funded propaganda campaign against the movie Sicko. As a result, none of my conservative friends have watched the movie. They all believe that health care is in places like the UK is horrible and fear government involvement here will create nothing but paperwork. They don't understand that the private US health care system spends one out of every three dollars on paper shuffling. A huge administrative overheard compared to countries with "socialized" health care systems.

The good part is that several of the abusive insurance company practices documented in Sicko are specifically prohibited by the new Obamacare^WP law. It's a step in the right direction.

 

[Rolfe]

I've watched two absolutely excellent Frontline documentaries about this. There was one about different methods of delivering universal healthcare and how they arose, historically. It almost made me want to emigrate to Sri Lanka!

Another interesting one was a John Stossel propaganda film against universal healthcare, which sparked a very long thread here a couple of years ago. It was interesting because if you actually looked at his examples, it was the people with US insurance who were completely screwed, by the system. He'd picked up some isolated examples of universal healthcare gone wrong, where people had fallen through the cracks for some reason, but these were telling because they were people who were actually entitled to care they hadn't got for some reason - and they had redress. The US people simply had no entitlement to care under their system, and there was bugger-all they could do about it.

He was pushing for a particular insurance system to be more widely adopted which seemed absolute madness to me. All about people stepping up and taking responsibility for themselves and that sort of right-wing rhetoric. As if anybody on a minimum wage job can possibly take responsibility for a quadruple bypass!

From each according to his means, to each according to his need, works extremely well when it comes to healthcare delivery.

Rolfe.

 

[Rolfe]

They don't understand that the private US health care system spends one out of every three dollars on paper shuffling.

Is that all?

Rolfe.

 

[Beerina]

I once tried to have a discussion about Sicko here. I started a thread specifically to discuss the film, without any ad hominem attacks on Michael Moore. No chance. Absolutely swamped with people insulting the man, pointing out that he's fat, you name it. Constant complaints that the dramatic presentation was "emotional", and that he shouldn't have used any music - even though I've seen right-wing propaganda from Republicans telling blatant lies about the NHS, with sobbing, emotional music too. Nobody prepared to discuss the actual points raised.

From what I remember some of the points were over-stated. The man with the kidney cancer was going to die, sadly, and the treatments his wife was pushing for under the insurance were absolute straw-clutching - he'd had all the standard treatments. I couldn't say the NHS would have taken a different view. I was not, however, persuaded that the Cuba sequence was faked as so many posters insisted. It was set up, of course it was, but that didn't appear to be a "foreigners-only" healthcare tourism establishment which was treating the Americans, and to someone used to universal healthcare and having seen some more unbiassed documentaries about Cuba, it didn't strike me as at all impossible that what they were given was the best the Cubans' own system could offer.

The essential points the film is making seem to me to be entirely valid. His portrayal of the NHS was entirely truthful. We really do trust it to deliver for all of us, and overwhelmingly, it delivers. The only answer the naysayers had was to post links to some newspaper stories (mostly very old!) about people who had not got what they were entitled to. The point that we are actually entitled to treatment, and for this we pay less in tax than you guys pay to support publicly-funded healthcare in the US that you yourself can't access, seems completely lost on everyone.

Except the ones who say that having no-quibble no-worry no-cost access to healthcare makes us morally degenerate. Well, I'd rather be morally degenerate in that case. I like being the sort of moral degenerate whose taxes pay for their neighbours' healthcare so I don't have to see anyone go bankrupt.

Rolfe.

Rolfe, neither you, nor Cuba, nor Europe, nor the US for that matter, can give out free health care unless somebody invents it first. Insofar as socialized medicine (as with warlords or anarchy or dictatorships) contributes to a generally business-unfriendly environment, scientific development rates suffer.

And the scientific rate of development of treatments and cures outweighs over the decades, like compounding interest, everything else. I'd rather have costly 2010 care than "free" 1990 care. Or 2000 for that matter. Much less 1970.

How many decades behind is the world because, say, Europe has a much more unfriendly environment than the US? How much faster will development go as China gets into the act?

 

[Rolfe]

You're like Groundhog Day, you know that? No matter how often and in how many ways that rubbish you spout about scientific advances is shredded, you just pop right up again with the same delusional nonsense.

The US is wasting about 8% of GDP on gadzillions of clerks, plush HQ buildings, private jets and gold-plated cutlery, not investing it in medical research.

And you know perfectly well how the NHS is funded, and so do we, and we're absolutely fine about it. Particularly as we're paying a bit less for it per skull than you're paying for the "socialised" healthcare you can't access. So you have to pay all over again. And we've already sent you plenty of links to medical research going on in Britain, made better by the comprehensive patient access the NHS can provide.

So by one way of looking at it, we're getting it for nothing compared you your situation. And I wouldn't trade places on a bet.

Rolfe.

 

[Beerina]

Beerina, I typically really enjoy your posts. Sometimes I agree with you, a lot of times I don't, but even when I don't, I tend think you make good arguments, and I can understand your point of view even if I don't necessarily agree with it.

However, I always cringe when you chime in on health care issues because you really have no idea what you're talking about.

Thank you for the detailed post. I notice a number of things you mention border on outright fraud (denying appeals until time expires, inconsistent approvals for the same treatments for the same conditions, etc.) but that's a separate issue.


So, here are the market forces, if I see that correctly: Most people have insurance provided by the company. The company wants "reasonable" insurance at as cheap a cost as possible.

Presumably, they find it. Meanwhile, the insurance companies earn, let's say for the sake of argument, a fixed fraction of all their income. In the long run, this is a general push upward in overall costs since they can charge more. 5% of ten million is more than 5% of eight million.

But...things don't work that way. There's no knowledgeable entrepreneur who can recognize some of the things you (and others) have said and cut costs and thus offer an equivalent or better product (w.r.t. treatments) for equal or lower costs?

This is what I find hard to believe. That ratcheting-upward of costs would somehow win over the streamlining forces of competition.


According to Kaiser, program administration is 7%.

 

[Rolfe]

< cough >

What Schrödinger's Cat is talking about is not "administration" in that sense. Kaiser may say it's spending only 7% on administration (I don't think Kaiser has a particular reputation for gold-plated cutlery, to be fair), but that doesn't include the vast burden of administration imposed on the providers by the bloated system. All the clerks and other paper-pushers needed to process the insurance company's paperwork.

And the debt-collectors and people like Schrödinger's Cat himself, people who try to help the patients come up with the money, people who try to get denied claims approved....

Beerina, you're like a little boy looking at a model aeroplane made of lead and saying, "but it ought to fly!!!"

Rolfe.

 

[stokes234]

I'd also like to see statistics on how much goes on advertising and PR in the american system. I imagine they contribute to a fair chunk of the extra money that the american healthcare system costs over its european equivalents.

 

[blutoski]

Rolfe, neither you, nor Cuba, nor Europe, nor the US for that matter, can give out free health care unless somebody invents it first. Insofar as socialized medicine (as with warlords or anarchy or dictatorships) contributes to a generally business-unfriendly environment, scientific development rates suffer.

I think you'd have to demonstrate that that is true for medical advancements. My impression is that you are confusing medical research with medical provision.

And the scientific rate of development of treatments and cures outweighs over the decades, like compounding interest, everything else. I'd rather have costly 2010 care than "free" 1990 care. Or 2000 for that matter. Much less 1970.

How many decades behind is the world because, say, Europe has a much more unfriendly environment than the US? How much faster will development go as China gets into the act?

My take is that this statement is a non sequitur.

In the US, most 'breakthroughs' were done with public money in university hospitals. Likewise here in Canada and Europe. That's just the way it is and has nothing to do with the eventual deployment of these technologies, which is the task of the HMOs under discussion in this thread.

Bottom line is that the provision of healthcare through private HMOs vs public funding probably is immaterial to the development of new technologies.

As far as I can figure, the only innovations HMOs 'create' is new marketing approaches. I can't even say that they develop exciting new billing and accounting systems, because they probably do the economical thing and license established systems.

 

[MatildaGage]

Market pressures should come from the consumers who buy policies from the insurers...when the insurers are making needlessly complex/lengthy processes just to hold onto the consumers' money longer.

 

[Emet]

I'd also like to see statistics on how much goes on advertising and PR in the american system. I imagine they contribute to a fair chunk of the extra money that the american healthcare system costs over its european equivalents.

Here are some reported numbers for dollars spent lobbying for 2009:

Health insurers spent big bucks on lobbying over the past year


By Kevin Bogardus - 01/24/10 02:26 PM ET
America’s largest insurance companies spent millions more on lobbying last year as lawmakers debated healthcare reform, lobbying disclosure records show.
(...)
Humana, based in Louisville, Ky., showed the biggest increase in its lobbying spending among the insurers. The company spent roughly $3.2 million on lobbying in 2009, almost 80 percent more than the $1.8 million it spent in 2008.
(...)
The largest spender among the insurance companies though was Wellpoint. Headquartered in Indianapolis, Ind., the company spent about $4.7 million in 2009 on lobbying, 21 percent more than its K Street expenditures in 2008.
(...)
Another big spender was UnitedHealth Group. The insurer spent roughly $4.5 million last year on lobbyists, 7 percent more than their lobbying spending in 2008.
(...)
But the individual companies’ spending on lobbyists does not match their industry association, AHIP. The trade group spent about $8.9 million on lobbyists in 2009, according to disclosure forms. That is almost 20 percent more than what the business association spent on lobbying in 2008.
(...)
... Blue Cross Blue Shield Association — a national federation of independent insurers — which paid lobbyists about $8.9 million last year, compared to $7.5 million in 2008.

http://thehill.com/business-a-lobby...big-bucks-on-lobbying-in-2009?page=1#comments

 

[ZirconBlue]

I've seen claims for tens of thousands of dollars get denied because we didn't have an authorization for needle and tubing that costs $80.

Great post, SC, but $80 for a needle and tubing? Is it gold-plated.

We once did a little "mental exercise" where we thought, "What if we became a cash only clinic?" If we didn't have to deal with all the BS that comes with accepting insurance/govt. programs, we could reduce our staff significantly and get by with charging each patient we see about $40 per visit, along with greatly reduced costs for the tests we perform in-house. Unfortunately, I think it would be difficult to find enough people willing to pay for their healthcare out of their own pockets.

My office visit copay is $40, so that would work just fine for me.

While I believe that people will avoid needed medical treatment if it's too expensive, I have difficulty believing that a lot of people will go for unneeded medical treatment if it's cheap.

I don't think he does it on purpose. I think he genuinely believes what he says about the cases he highlights in Sicko. He's a movie maker, not a healthcare expert. Maybe having an advisor who could have selected the cases a bit more rigorously would have helped.

I haven't seen Sicko, but Moore lost my trust with his dishonest editing in previous films. He makes good points, but I feel like I have to do research to verify everything he says. If I'm going to do the research anyway, I might as well just skip the film.

Anyone have any thoughts as to why Americans haven't been able to get UHC and Canadians and most (if not all) Europeans have? For anyone who says the American lobbying system is at fault -- than why are lobbyists so much more powerful in the US than in the other countries that have managed to implement UHC?

I wonder if lobbyists wield more power in our adversarial 2-Party system than they do in parliamentary systems?

 

[Drachasor]

My office visit copay is $40, so that would work just fine for me.

...

While I believe that people will avoid needed medical treatment if it's too expensive, I have difficulty believing that a lot of people will go for unneeded medical treatment if it's cheap.

I find it curious that some people seem to think what appears to be a proposal for a legally mandated office cost makes much sense. How is that going to pay for any tests? How is that going to adjust for inflation? Historically, clumsy attempts to dictate how things like this should work on the market don't do a good job. It's a classic example of a bad economic policy, and far more crazy than just going with a government run program to provide coverage for everyone.

 

[ZirconBlue]

I find it curious that some people seem to think what appears to be a proposal for a legally mandated office cost makes much sense. How is that going to pay for any tests? How is that going to adjust for inflation? Historically, clumsy attempts to dictate how things like this should work on the market don't do a good job. It's a classic example of a bad economic policy, and far more crazy than just going with a government run program to provide coverage for everyone.

Was that the proposal? I thought I was responding to a proposal for a particular medical practice to go "cash-only" to reduce administrative costs.

 

[blutoski]

I'd also like to see statistics on how much goes on advertising and PR in the american system. I imagine they contribute to a fair chunk of the extra money that the american healthcare system costs over its european equivalents.

CMAJ had an [editorial with citations] and in 2002 a peer-reviewed research [article] showing profit motive significantly deducts from quality of care in healthcare, rather than enhancing it.

Canada and the US had identical systems until the end of a transition over 1969-1972, and in the time since then, the US has fallen drastically behind in outcomes and is now more than double the cost. This value gap has grown especially fast since 2000.

IIRC, HMOs' costs outside actual care delivery - eg: accounting, marketing/advertising, lobbying, lawsuits, claim screening, collections - has inflated to about 30% of costs, compared to between 1 and 2% in Canada, depending on province.

The efficiency of US healthcare delivery is considered to be less than half of Canada's, even though Medicare is almost as efficient. This means that outside of Medicare (which has a 2% overhead) - so that means HMOs and private hospitals - is less than half as efficient. Maybe about 35% as efficient, based on my back-of-the-envelope estimate.

 

[Kaylee]

Anyone have any thoughts as to why Americans haven't been able to get UHC and Canadians and most (if not all) Europeans have? For anyone who says the American lobbying system is at fault -- than why are lobbyists so much more powerful in the US than in the other countries that have managed to implement UHC?

I wonder if lobbyists wield more power in our adversarial 2-Party system than they do in parliamentary systems?

That's a very interesting question. When time permits, I'll probably post that question in General Politics.

Here are some reported numbers for dollars spent lobbying for 2009:




http://thehill.com/business-a-lobby...big-bucks-on-lobbying-in-2009?page=1#comments

Wow. And to add insult to injury, we, the consumers, are paying for it. The lobbying costs are funded by the health insurance premiums.

CMAJ had an [editorial with citations] and in 2002 a peer-reviewed research [article] showing profit motive significantly deducts from quality of care in healthcare, rather than enhancing it.

Canada and the US had identical systems until the end of a transition over 1969-1972, and in the time since then, the US has fallen drastically behind in outcomes and is now more than double the cost. This value gap has grown especially fast since 2000.

IIRC, HMOs' costs outside actual care delivery - eg: accounting, marketing/advertising, lobbying, lawsuits, claim screening, collections - has inflated to about 30% of costs, compared to between 1 and 2% in Canada, depending on province.

The efficiency of US healthcare delivery is considered to be less than half of Canada's, even though Medicare is almost as efficient. This means that outside of Medicare (which has a 2% overhead) - so that means HMOs and private hospitals - is less than half as efficient. Maybe about 35% as efficient, based on my back-of-the-envelope estimate.

Very illuminating -- thanks for posting. More evidence that Congress ended up passing the worse health insurance program possible. American consumers will be required to pay for-profit companies who will continue to be free to spend money on advertising, lobbying, and way-overpriced executives -- and who most likely will continue to make most of their products only available through 3rd parties and therefore continue to be immune to what individual consumers want.

 

[sgtbaker]

I just have a few questions about socialized medicine. Do you have medical group-type offices or individual practices? Is there any out of pocket costs, at all, when you go to a doctor? Is the price of prescription drugs controlled or do you pay similar prices to the US on medicine?