Care Managers (or Why We Need Single-Payer Insurance)
Editors Note: I’ve been so in the weeds that I just got around to reading this excellent Liberalgeek post.
Related Item: Principal (Health Insurance) Financial Group reported Monday that third-quarter operating earnings increased 23 percent to $312.9 million. The Financial Group is the business unit that figures out how to invest the obscene profits that the Health Insurance unit rakes in.
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I was visiting a friend this weekend in Baltimore. He has a doctorate in Psychology and he was telling me about a job that he had for a short time when he first got out of school. The title of the job was “Care Manager.” His job, as he explained it was really to be a mis-manager of care. For every claim that comes in, try to find a way to deny it.
It reminds me of the job that the Father in The Incredibles had, denying claims from little old ladies. But this Care Manager position sits in judgment of questions such as:
- Is the person really suicidal and in need of emergency treatment?
- Is the person really a danger to themselves and others?
- Does the addict really need to be in an in-patient program or can they just live at home and go twice a week?
- Oh, and is there any way that we can claim that this isn’t covered by the insurance?
This is not a job that is designed to ensure proper and appropriate care. It is designed to maximize profits. And if a few sick people off themselves, well they wanted to do that anyway, right?
This is exactly the job that the private healthcare system encourages and almost requires.
Bill Maher has been on a bit of a jag about the past few weeks with the great schtick that the Republicans have going. They yell and bitch and moan about how ineffective, wasteful and destructive government is and then they go and prove their own point. The morons over at FSP are always making this point as a reason to avoid single-payer health insurance. I have news for you guys, the system is broken.
Either we are a nation of competent people that are way smarter than the French, or we are too dumb to build a system that works better than the French system. Which is it?
I am in favor of the free market in things that require free markets. But when it comes to health, defense, social security and a few other markets, it is inappropriate.
Tags: Health Care
There is no limit to the demand for a service that is free, but there are finite limits on the availability of the service.
Most people would rather avoid a trip to a doctor unless things seem really bad. There are a substantial number of folks who will run for care after experiencing what they believe to be a symptom.
In what areas do governments provide better goods or services than are available in the private sector?
Does anyone around here drive a Trabant?
#1 The government provides a better navy than the private one. See the “provide for a common defense”.
#2 The Constitution also stipulates “promote the general welfare”. This might fall under that.
As liberalgeek said, the government has being running stuff terribly… they way that the GOP does it.
So, Arthur, your assertion is that people will go to the doctor more if there is a single payer system? Why? Because it is such a wonderful experience? Right now people with real symptoms don’t go to the doctor until it is an emergency.
I have come to the very reluctant conclusion (<a href=”http://commonsensepoliticalthought.com/?p=2026″here and (<a href=”http://commonsensepoliticalthought.com/?p=2067″here) that we will have to go to a single payer universal health care system, but it’s still an enormously bad idea.
The socialized medicine countries have lousy systems, as noted in the second of the links, where there are “health tourists” leaving the United Kingdom, because health care is so bad there. In some provinces of Canada, the wait for an appointment exceeds half a year!
However, to maintain a private-pay system requires the market discipline of not providing health care for those who either fail to purchase health insurance or cannot pay for it privately; if someone lacked insurance or money, if refusing to sell him that for which he cannot pay means he must die in the street, then we must be willing to let him die in the street.
And we are not. Oh, there will always be the few horror stories, such as that of Diamonte Driver (who was eligible for Medicaid), but for the very greatest part, no one is denied health care. We have Medicare for the elderly, Medicaid for the poor, we have all sorts of programs, and, in the end, if someone shows up at the emergency room without either any program eligibility or any way at all to pay, we’ll still provide him with treatment, essentially free of charge.
It was the Frost case, the one dragged out by the Democrats over the SCHIP veto, which finally persuaded me. The Frosts could have paid for health insurance, but chose not to do so, something I consider just plain child neglect. And we’ll still provide the health care the Frosts’ children need.
Why did the Frost case persuade me? Because the Frosts were scumbags who worked the system, irresponsible people who could have done the right thing but chose not to, and have pushed their responsibilities off on the taxpayers. Well, if we had a tax-based single payer system, at least the malingerers like the Frosts would have to pay something.
Our health care system will probably be every bit as good as the UK’s or Canada’s in single payer, but we’ll get what we deserve.
Oh, and Mr Geek: the British National Health Service has plenty of people involved in trying to reduce health care costs by deliberately stretching out appointments and other tricks, figuring that some problems so stretched out will simply go away.
Arrgghhh! I fouled up my links! They should be this and this.
We already have crappy health care today. You just aren’t doing the math right: If you ask everyone to rate their health care from 0 to 5, most people who are covered will probably choose 3 or 4.
But the 47 million people who aren’t covered will choose ‘0’ (or maybe ‘1’ if they like taking their kids to the emergency room).
When you crunch all the numbers, you get sub-par satisfaction, probably under ‘3.”
For a national system to beat the current system, all it has to do is deliver ‘3’ -level service for everybody.
“For a national system to beat the current system, all it has to do is deliver ‘3′ -level service for everybody.”
You are leaving quite a bit out of the equation aren’t you? First, is the assumption that the 47 million who aren’t covered, can’t be. As Dana correctly points out there are many who choose to spend their money on other things. Am I saying that there are not people who cannot afford or cannot obtain health insurance? Of course not, there are many in that case, but I think that number is MUCH under that 47 million mark. And of those who CANNOT get insurance, you are also making an assumption that they need or even want health care. There are many people with or without health insurance that couldn’t be dragged to doctor for anything.
As for your final assertion that all we have to do is deliver a three, you have greatly illustrated the problem that I am many sane people have with socialism. I’ll bet you wouldn’t be happy if the education system dumbed itself down so that everyone could pass. Would you be happy with that? Then why should we let our health care system (arguably the most advanced in the world), wither away to sub-standard care…just to make life fair. Even those without health insurance ultimately benefit from a top notch health system. Yes, they may unfortunately be getting their first exposure to it through the emergency room or free clinic, but they are still ultimately benefiting from the advances we make through our current system. Go to your threes and EVERYONE loses.
The guy doing the job of limiting healthcare delivery in the Geeks post will just have to work for the government under his plan.
If we had an actual free market for insurance, we could move to another company when confronted by this kind of stupidity and obstruction.
Try moving to another country when your single payer is playing the same game.
Anon wrote:
Well, I’d give mine at least a 4¾! 🙂
When I had an acute problem, I was seen immediately, and treated; when that required a radiological procedure (an upper and lower GI in my case), it was done that evening.
When I had a non acute problem (I needed to schedule a dental appointment), it took me a whole week to get an appointment — and that was because I couldn’t go in the very day that I called, when the dentist did have an opening.
But we pay completely unfair rates for our medical coverage, and it will only get worse. The Congress will continue to add, incrementally, more and more programs, which will increase our taxes. In the meantime, our private insurance keeps costing more and more because the hospitals must charge paying customers more to make up for the non-paying cases, and because the government does not pay enough (or quickly enough) for Medicare and Medicaid patients. Thus, those of us who do radical things like work and pay taxes and pay health insurance, get the shaft.
Dana, To some extent, I agree. I don’t know the ins and outs of the Frost case, but the way you described it is exactly how the right has cast this debate. “Why should I have to pay for health insurance if I am a healthy 25 year old non-smoker?” The answer is that if you do get sick, the rest of us are going to have to pay for your illness.
And while I do concede that there will always be people that will “manage” care, there won’t be someone looking over their shoulder demanding that they deny 10% of the claims or deny enough to justify their job.
I don’t have a problem with managing the care of a hypochondriac or people who game the system, but to use this position as a place to squeeze out a profit is quite a different beast.
When it comes to quality of care and how much you like your coverage, ask you doctor how much he/she spends to bill insurance companies. More than half of what we spend on medical costs goes to administrative overhead. The numbers are in the 10% range for VA and Medicare.
I have another post in the proverbial chamber to address some other reasons we should go with a single-payer universal coverage system. So there is more to come.
Dorian,
there you go with that pesky piece of paper aka the Constitution.
next you will tell me that women and blacks should be allowed to vote
moron,
listen these kids and people deserve this. it’s their fault their poor. Just look at the frost’s. So one family represents the 50 million. it’s that easy
duh, why can’t you just accept it man.
Now if we could just make abortions illegal we could get that number of uninsured up to at least 75 million or so by years end!
woohooo
fuck the poor! it’s their fault!
I will be on WDEL on Friday at 1 PM discussing Delacare 2008. Private universal insurance with choice and competition.
Wellness Security Productivity
Listen and offer your comments.
Our biggest health care driver is the rapacity of some trial lawyers, Edwards was such a hustler.
Doctors are seldom rich people and insurance companies are often non-profits that ‘pass through’ costs to the consumer. Guess who pays when lawyers can buy sports franchises and palaces?
The costs of court settlements is often the tip of the iceberg. When medical practices are done to provide ‘CYA’ rather than out of clinical necessity, there is simply more money spent. Again, guess who pays?
Edwards scam involved cerebral palsy, and the fallacious claim that a C-section would have assured a happy outcome. A lot of impressionable jurors fell for his theatrics (that included ‘channeling’ to a foetus). The defensive medicine involved an increase in the number of costly and statistically-dangerous C-sections being performed. There was no decrease in CP cases as a result of medicine being driven by a fear of litigation.
f–k the poor! it’s their fault! Donviti
Perhaps poverty involves more a lack of spirit than of cash.
What else can you say about a community that lionizes thugs such as drug dealers and pimps? Will transfer payments and ‘self-esteem as an entitlement’ really make things better?
“What else can you say about a community that lionizes thugs such as drug dealers and pimps? Will transfer payments and ’self-esteem as an entitlement’ really make things better?”
And that would be DV’s A** being handed to him. Nice post Arthur.
Arthur, you are misleading. John Edwards and lawyers have almost nothing to do with it. 2% of healthcare costs are malpractice insurance. Excluding insurance company personnel, 31% of medical costs are for people that are completing paperwork.
Why are you trying to nip at the edges of the healthcare costs while ignoring the huge inefficiencies?
As for your denigration of urban culture, let’s not forget that suburban culture lionizes socialite-sluts and classless CEO’s (I’m looking at you Trump!).
A lot of impressionable jurors fell for his theatrics
Why do conservatives think malpractice juries are foolish and easily swayed to reach the wrong verdict… but death penalty juries get it right every time?
“Why do conservatives think malpractice juries are foolish and easily swayed to reach the wrong verdict… but death penalty juries get it right every time?”
Not true. OJ’s jury blew it.
Geek,
I have worked at the interface between industry and government for many years. I find the government generates more paperwork and pays more for it than private industry does. So if we spend 31% on paper now, I would estimate 41% within four years of having the government take over.
To try to generate profit from rejections is an accusation. To see a government worker generate rejections to make his STATS LOOK GOOD for promotion is something I have seen with my own eyes more times than I care to count.
Our biggest health care driver is the rapacity of some trial lawyers,
Bullshit GOP talking point alert!
Flunky GOPsters like Downs want to take the right of injured parties to get redress…right up until the day that a 2×4 falls off the rack at Home Depot and hits him in the head or someone misdiagnoses his hypertrophic pulmonary osteoarthropathy.
At that point, all of a sudden, lawyers aren’t so bad after all
Alan, I might believe that if the VA and Medicare weren’t so much more efficient than the insurance companies.
As for making stats look good; It all depends on what people are motivated to do. You are presuming that the system would reward employees for denying claims.
“Flunky GOPsters like Downs want to take the right of injured parties to get redress…right up until the day that a 2×4 falls off the rack at Home Depot and hits him in the head or someone misdiagnoses his hypertrophic pulmonary osteoarthropathy.”
Let me guess Andrew…are you a trial lawyer? Or better yet, someone you decided to live off of a settlement.
I work in the medical industry and it is malpractice insurance rates (driven by the obscene lawsuit awards) that are driving doctors out of the industry. Yes OUT of the industry! How many OB/GYNs have dropped the OB part because of the extreme rates? So much can go wrong during a delivery that is beyond their control, and yet juries, persuaded by lawyer hacks with NO MEDICAL TRAINING, manage to convince them that it could have been prevented, when often it cannot. So physicians making perfectly sound and CORRECT decisions are still getting their butts sued off because the plantiffs are not happy with the final result. This is understandable because juries feel for the person who has lost a loved one or is suffering. They want to see them get money whether or not the doctor is really at fault. With all the hateful crap spewed by the left about rich doctors and insurance companies, the juries don’t think it hurts the doctors. But it does. And as more and more give up the business or are sent into bankruptcy for doing NOTHING WRONG, it will hurt us all. But I don’t want to keep you any longer, I know you have to get after that ambulance that just drove by.
‘Alan, I might believe that if the VA and Medicare weren’t so much more efficient than the insurance companies.”
Where is the BS flag when I need it. Hello?!?! All I here about from the LEFT is how bad the VA is and how we are mistreating soldiers and vets. NOW, when it is convenient, you say it is good?
Medicare? Why do you think private rates are so high? Dr’s have to jump through so much crap to get (if they ever do) the payments from Medicare. How is that efficient? Go back to your la-la land. You are making yourself look like a fool
Too many good docs are getting out of the business. Too many OB-GYNs aren’t able to practice their love with women all across this country.
Chris, Are you kidding? Doctors have to hire people whose only job is to follow up with 20 different insurance companies with 20 different requirements. The private insurance companies are not propping up Medicare. The largest fool that comments here is you, hands down.
As for the VA, I have not been critical of the VA, just the conditions that the military have allowed to fester in various parts of the system. In many ways, the VA is one of the most efficient systems going.
And if you would like to really answer a question, what does malpractice insurance cost an OB/GYN? Does it cost more than the person or two assigned to processing the multiple insurance company’s complaints, referrals, billing issues, etc?
Artie and Chrissy,
What else can you say about a community that lionizes thugs such as drug dealers and pimps? Will transfer payments and ’self-esteem as an entitlement’ really make things better?
so you mean black people? I said poor people, you infer blacks.
you are two sad men and your colors truley show. The GOP should be happy to have you 2 bigots, you fit right in.
and that would be your ass handed to you ahole.
“What else can you say about a community that lionizes thugs such as drug dealers and pimps? Will transfer payments and ’self-esteem as an entitlement’ really make things better?
so you mean black people? I said poor people, you infer blacks. ”
Funny. Last time I checked it wasn’t just the black community that was propping up drug dealers and pimps. Claiming racism where it isn’t again, DV. What do you guys call that “projection”.
Besides even had we meant black people, the fact that you assumed we meant black people as a whole tells us loads about your thoughts on the subject. I know the segment of black people that support that destructive culture (meaning drug dealers and pimps, not African-Amercian Culture) is a minority percentage of the black community.
As for you assertion that I assume poor people are black, you are off your mark there too. I am well aware, that while a larger percentage of the black community is poor compared to the percentage of the white community that is poor, that whites still make up the majority of the poor. So shove your phony baloney “holier-than-thou” liberal crap back down the toilet where it belongs.
Geek:
I expect all incentives will be in place to spend the maximum amount of money until it runs out. Then limitations on service will kick in and your description of the job of “gatekeeper” will fit the government employee to a T.
Oh, I forgot, the Federal spigot will never run dry.
Besides even had we meant black people, the fact that you assumed we meant black people as a whole tells us loads about your thoughts on the subject. I know the segment of black people that support that destructive culture (meaning drug dealers and pimps, not African-Amercian Culture) is a minority percentage of the black community.
translation:
besides we all know that blacks are poor and are a self hating race that will never succeed as long as they keep being black.
you are so pathetic Chris. Like I said please stick with the GOP they love your kind.
Let me be very clear about this. Steroids ought to be banned from baseball.
“translation:
besides we all know that blacks are poor and are a self hating race that will never succeed as long as they keep being black.”
While I don’t doubt that is your belief it is certainly not mine. If that is what you took from my post, you are not only crazy you are just plain dumb. Why don’t you try a little education and then get back to me.
You righties have no leg to stand on here. The issue with the VA and Medicare is the amount spent on administration. It’s the usual for government health care, single digits. It’s over 30 for private industry, because they also spend a great deal on advertising, other marketing, and of course trying to deny claims. If you think that’s not involved, I can only hope you suffer some malady that involves “experimental” care, since you apparently won’t believe anything you don’t see with your own eyes.
Malpractice insurance rates for OBs in Pennsylvania are now over $100,000 a year. If an OB delivers 200 babies a year, that means $500 per delivery additional cost just for the malpractice insurance. It doesn’t buy one bit more health care, it doesn’t make the doctor better or the patients healthier; it simply provides a reservoir of money for scumbags like John Edwards to siphon off in jackpot justice cases.
Dana, Perhaps it reflects the dangers involved in the delivery of babies. We are talking about all sorts of potential issues that affect the rest of the patients life. What value does any insurance bring? Airlines have to have huge amounts of insurance, as do trucks, and demolition experts. But they pay those rates, because it is reflective of the risk involved.
If the insurance for the delivery of that baby costs $500, then you pay it and move on. But to put the blame on the victims in malpractice suits and the lawyers that they choose is a bit convenient.
Here’s another fun fact, the insurance industry is raking in huge profits, so it isn’t all sucked up by lawyers.
Oh, and here is a telling report about the “explosion” of medical malpractice cases in PA. Please read it before you comment again.
It looks like many of us are ready for a single payer system. There’s no reason not to do so, unless you approve of non-medical personnel profiting off the ills of others.
And to all the defeatists out there that say a single-system can’t work or will cause more problems than we currently have – all I have to say is that you are yellowist of cowards, and to have such a lack of faith in our governance is evidence that the people you vote for are a detriment to all of us. You know – the whole “Government is the problem” crowd.
I’ve said this before and I’ll do so again:
Just prior and during WWII, we mobilized a mostly agrarian society to switch over to manufacturing, and then subsequently out-produce all of our allies and the axis combined, along with defeating the enemy (in less time Bush took to fuck up Iraq – BTW), but YOU say we can’t even create a proper universal health care system for all Americans. Your defeatist attitude is disturbing, and certainly un-American. That or you’re a greedy SOB – IMO.
Malpractice insurance costs are only part of the problem. Many of our hospitals self-insure if they have the reserves to do so.
The cost driver is more one of defensive medicine, tests or treatments that are not necessarily good clinical practice but done for the sake of ‘CYA’.
So would single-payer increase those costs, Arthur? I suspect that they would likely remain unchanged. In fact, they may go down slightly if care decisions can be passed back to docs. Many times, patients have to undergo less expensive treatments and tests due to the insurance company’s attempt to find the lowest cost, effective treatment. I have a friend that has gone through 3 different medications for a sleep disorder, because the insurance company doesn’t want to pay for the one the doctor recommended in the first place.