posted on July 5, 2001 11:30:29 AM new
What about having some standards in place that define different health care packages? Insurance companies could still offer anything that they wanted to, but they would have to offer each of those packages at the least. That way, consumers could really shop the best plans on an apples-to-apples basis. Also, the insurance companies having to make a quote on each type of package would have some REAL competition -- not just charge as much as they think that they can get away with. Wouldn't that be the "Free Hand of Capitalism" at its best?
I think that if this system were put into place, potential employers would simply either purchase a standard package of benefits for their employees or to create such a package for self-insurers. That way, no one would get cheated.
I wanted to say that when I first got out of the military, I went to work for Radio Shack. They used Aetna. For the several times my wife and I had to use the medical plan, Aetna always turned down our claims. I was too ignorant and naive in those days to know how to handle it; such as resubmitting it with another doctor's opinion, going through the state Insurance Enforcer (I forget the title), ort simply to sue them for Breach of Contract. The real point being, I shouldn't have had to fight at all, that Aetna should have paid those claims that we were covered for. I eventually pulled out of the medical program because I couldn't see paying for something that we were not receiving.
posted on July 5, 2001 11:35:52 AM new
LindaK, you are missing the point regarding the controversy of the PBOR and employer lawsuits. Again, it has to do with ERISA. Specifically, this Act, along with IRS tax code changes, ENCOURAGED employers to offer health benfits IN RETURN for TAX INCENTIVES. At the time, it made sense financially for coporate business to underwrite the cost of health insurance for employees in return for those financial incentives. But unless ERISA is rewritten (as it applies to coporate funded health insurance)it is a catch-22 loophole as it applies to any Patient's Bill Of Rights allowing for lawsuits in which HMO's are held accountable for any damages beyond actual cost of medical treatment. AND, it's been shown that all the dire predictions of increased costs from your corporate slanted urls have not come true in at least TWO of the state that have passed their own PBOR, Texas and California.
posted on July 5, 2001 11:47:56 AM new
I am not a lawyer or an insurance professional or anyone of any significant position in life (other than I breath), so I just make noise... I do have an opinion, but that's not unique in anyway. I also quite clearly state (usually in bold) that I am expressing my opinion so as to not have anyone think I know anything about anything!
I really don't know the best way to handle this, but I do know allowing someone to sue for any reason and not putting a cap on punitive damages (at least) and not recognizing each of us is ultimately responsible for our choices and our choices need to be factored into the equation, is not going to result in better health care at a lower (or even affordable) cost.
I just hope whatever they come up with, will be uniform and fair to everyone. What are the chances of that happening??????
posted on July 5, 2001 12:16:51 PM new
Hi KatyD - (I come in peace ) I don't think I'm missing the point. I understand what you're saying. I understand that part of what they're trying to change. I understand wanting the ability to sue HMOs for proper care.
What I'm saying is that I, and my corporate slanting urls believe this bills wording is too vague. It is not specific and is worded so that any employer is at risk of being sued just because they offer insurance. Unless they turn the whole ins. coverage project over to another company to administer. That, of course, with large additional costs.
Just one law suit against most small employers could put them out of business....or cause them to not carry insurance.
It (this bill) doesn't speak to specific times when an employer is or is not capable of being held liable. It's wording leaves it totally open to different interpretation. That's what all those urls agree on, at least.
This woman (me) from Arkansas (who's not a Republican) has a wonderful insurance program that would pay to replace my defective pace-maker. My husband's employer doesn't have to be open to being sued just because they offered us an insurance program. It should be between me and the hsp. doctor, etc, IMO. And as far as HMOs go, when signing up for those programs those people are aware that part of what reduces their premium cost is the fact that they agree to arbitration, rather than being able to sue.
I'd just hate to see employers cancel their workers insurance just to avoid this one vague clause. I'd also hate to see it raise the cost of their insurance to the point they couldn't afford it any more. That's all.
posted on July 5, 2001 02:00:38 PM new
Hi LindaK, I come in peace too! Nevertheless, you are STILL missing the point. The wording of the bill is very specific contrary to what your "corporate slanting urls" say. Your husband's employer doesn't HAVE to worry about being sued UNLESS his employer is directly involved in the medical/administrative decisions regarding his medical care. "Self-insuring", administering and/or underwriting such benefits WOULD make your husband's employer a "party" to any healthcare actions, and in that case, his employer COULD be held liable for any egregrious action (or inaction) regarding healthcare. And rightfully so.
And as far as HMOs go, when signing up for those programs those people are aware that part of what reduces their premium cost is the fact that they agree to arbitration, rather than being able to sue.
Now tell me, what choice is the average American worker offered? If they DON'T agree to biased arbitration, they LOSE the ability to have insured healthcare. So isn't that a "let them eat cake attitude?" In other words, you're saying "Tough Luck! Look how lucky American peon workers are to have their health insurance partially paid for by their employers". Nevermind, that those EMPLOYERS aren't doing it out of the "goodness of their hearts" but because, under ERISA, they save money and get tax relief. It is financially beneficial to corporations to subsidize the cost of their employee health plans.That said, if they are going to be involved in the administration and underwriting of said healthplans, than they need to also be RESPONSIBLE for their actions. The truth is, if they are doing right by the American worker in the first place, they have nothing to fear, do they?
LindaK, I realize you claim not to be Republican, and it's certainly possible that you are not registered as one, but your sympathies and political opinion are most closely allied with the Republican policy platform. Therefore your chronic enthusiastic support of Republican propaganda spin is not surprising, but you sure are "Republican" for someone who's "not a Republican".
posted on July 5, 2001 02:41:01 PM new
Linda K- Any problems or law suits should be between you and your Dr. and hospital. However, with the advent of HMO's and cost cutting tactics by insurers and employers who exercise control over care choices, it is no longer between you and the Dr and the hospital.
Dr.s in many regions are considering starting unions to thwart the HMOs from telling them how to practice medicine.
While your insurance is going to cover your new pacemaker, did you know your doctor probably had to call your insurance provider and review your case with them before the insurer would cover the procedure ?
You came out OK this time, but what happens when the insurer doesn't approve a procedure that your doctor recommends or demands that the insurance will only cover an alternative procedure that your doctor doesn't feel will be as effective for you ?
If everything seems to be going right for you, you probably do not want change-- but don't complain when others turn a deaf ear to you when things arn't going right for you and you want change.
For those of us that haven't experienced HMO or insurance problems, we have to expand our thinking to realize that what has happened to others very well may happen to us in the future. When we allow corps or govts to prey upon the weak or minorities, you either have to side with the weak or hope that you'll never be one of the weak. I find that siding with the weak is not only the smart thing to do, but also the right thing to do. The wheel of fortune just keeps spinning around-- you never know who'll be next.
posted on July 5, 2001 03:26:56 PM new
KatyD - We just see this issue differently.
On my political leanings, I vote the issue and the candidate, not the party. I do agree I seem to more often agree with the Republican way of thinking, but not always. I am a conservative though. I will admit to that.
In regards to the HMO and So isn't that a "let them eat cake attitude?" In other words, you're saying "Tough Luck!
No, I don't see it that way. I wish everyone could afford to have insurance, but I'm not for socialized medicine.
I think we earn (work for) what we acquire. Just like in houses, we don't all live in the same size house, drive the same type car, have the same amount of spending money. Therefore, we can't all afford the same type of medical coverage.
posted on July 5, 2001 03:40:06 PM new
Medical negligence is when a health care professional or the hospital makes a mistake that causes injury and/or death.
sulyn1950, you may dislike civil suits, but when a person is rendered incapable of working, or simply performing activities of daily living due to medical negligence, they should be able to seek restitution in court.
I had the following incidents happen to me during one hospitalization
1. Air embolus
2. Central line fluids hooked up incorrectly.
3. Missed 3 dosages of necessary meds due to charting errors.
BTW, I do have one group of doctors to thank. If it had not been for them, I would be dead. I'll go to my docs, since diet and exercise cannot change an anatomic circulatory anamoly.
edited to add a phrase
[ edited by snowyegret on Jul 5, 2001 03:43 PM ]
posted on July 5, 2001 03:46:58 PM new
thank you Helen.
Linda, you're right. I just don't see it the same way you do. In fact I find your views repellent and classist. It's one thing to be able to afford a fancier car or a bigger house in a nicer neighborhood. But with this statement, I think we earn (work for) what we acquire. Just like in houses, we don't all live in the same size house, drive the same type car, have the same amount of spending money. Therefore, we can't all afford the same type of medical coverage.you are saying it's okay that some working poor DON'T HAVE any medical coverage, intimating that they "didn't work hard enough for it". The type of statement you made regarding health coverage for all Americans is a mind-set I would expect in a third world country, certainly not the United States. And yes, that statement illustrates perfectly a "Let them eat cake" attitude. You have yours, eh Linda? Who cares about anybody else, right? By your own reasoning, the (lazy) "poor" deserve substandard medical care because they don't work as hard a the "rich". What a crock.
KatyD
(punctuation)
[ edited by KatyD on Jul 5, 2001 03:48 PM ]
posted on July 5, 2001 03:47:57 PM new
reamond - I appreciate and agree with much of what you said in your post. I've stated if a person doesn't get proper care, they should be able to sue, but IMO, with a cap.
I don't feel HMO administrators should have the control over the medical decisions that they do. Etc, etc. etc. I worked at one, I know what goes on. And I'm aware just how much the doctors, nurses and support staff feel the patients aren't getting proper care. That's not my point. I just don't agree they should be able to sue their employer. Change the way HMOs operate....I have no problem with that. Just don't hold the employer liable just because they offer an HMO.
I hope you're aware that KatyD and I are just joking about my pace-maker. I don't have one. But, if I needed one, my doctor doesn't have to call anyone for approval. I, personally, am required to call the hospital for pre-admission, not to get approval, but to avoid having to pay 1/2 of the bill if we didn't. They can't refuse the surgery. They just require we do the pre-admission thing. Now, for any reason, should they refuse to pay for this surgery then I'd sue, but I still think there should be limits to that, and I certainly wouldn't think to sue my husbands employer because the insurance company denied my surgery.
Reality is we all buy (or not) what insurance we can afford. If our employer doesn't offer insurance that we want we either accept it or not. Are you saying that if, to save costs, your employer changes your insurance policy to another cheaper one, or charges you more to maintain your current charges, they don't have the right to do that?
posted on July 5, 2001 04:08:54 PM new
WOW!! KatyD - Can't we be tolerant of differing opinions? Why all the anger? Did this come because I said I don't believe in socialized medicine?
you are saying.... NO!! I didn't say those things. Those are your words, not mine.
Do you know that one in five children in the Unites States lives in poverty...the highest number in the industrialized world. Great Britain is next highest. Do you believe that these children should go without medical care?
posted on July 5, 2001 04:47:54 PM new
Helen - My statements of being for caps on medical lawsuits and employers not being sued just because they offer medical insurance to their employees, has nothing to do with your question.
I'm aware that my beliefs are very much in the minority here. That doesn't change them. Nor would I expect to change your way of thinking, just because I don't usually agree with it.
posted on July 5, 2001 04:53:07 PM new
First of all, Linda, you seem to think that employers have NO say in health policies as written. That is erroneous. Many of the large coporations "self-insure" (as someone else pointed out). They pay a managed health care company(or multiple ones)to underwrite the benefits and administer the plan. In other words, the Employer PAYS for health claims and is DIRECTLY involved in specifying the benefits of the plan and when and when THEY WON'T apply to the insured. So yes, no matter what "spin" the Republicans put on it, very often Employers ARE involved in making health care decisions of their employees. To hear Republicans tell it, this Bill will threaten every Mom & Pop business with employee lawsuits, and that is a lie. The bill is NOT written where your average Mom & Pop local employer who PURCHASES a health plan for employees can be sued.
Reality is we all buy (or not) what insurance we can afford. If our employer doesn't offer insurance that we want we either accept it or not. Are you saying that if, to save costs, your employer changes your insurance policy to another cheaper one, or charges you more to maintain your current charges, they don't have the right to do that?
The reality is that Employers get direct tax incentives and other benefits under ERISA to offer health insurance. Along with these incentives the Act states that these health plans CANNOT be sued for MORE THAN THE COST OF TREATMENT. When are you going to understand that Republicans want BIG Business to have all the perks but none of the pain that goes along with the responsibility of those so-called perks. Employers, by their act of receiving federal incentives to offer health insurance under ERISA ALSO will have the responsibility for making sure that the health plans they administer and subscribe to deliver to their employees the expected benefits. How difficult is that to understand? The reason Republicans DON'T want to rewrite the ERISA loophole is because it will open up their Big Business HMO's and other health care to higher monetary damages. How hard is this scenario to understand???
Your little girl is diagnosed with a particularly aggressive leukemia. Your HMO refuses to pay for a certain type of bone marrow transplant because they deem it not "provably effective" in this type of cancer treatment. You appeal and desperately try to raise the money for the procedure privately, but in the meantime (in the lengthy appeal process) your little girl dies. Finally, arbitration (two years after your little girl is dead) decides in your favor...yes there is plenty of medical evidence that the disputed treatment may have saved your daughter's life. The HMO SHOULD have paid for the treatment. So you sue the HMO. But, because of ERISA, you must go to Federal Court with your claims. Oh lucky day!! The judge says you are right! And orders the HMO to pay you what it would have cost them to perform the treatment, oh say $50,000. BUT...it cost you nearly $40,000 in legal fees, court, and travel fees. Guess what? You're out of luck. Do you think that $50,000. sends a message to the HMO to stop denying medical treatments? Nope. So, LindaK. What kind of CAP do you put on life? Does it depend upon whose life it is? Whether it was someone who "worked" for what they had?
KatyD
(ubb)
[ edited by KatyD on Jul 5, 2001 04:56 PM ]
posted on July 5, 2001 05:46:27 PM new
KatyD - I appreciate you trying to make things clearer for me, honestly. I'm just trying to say we're beating a dead horse here, as I just see things differently.
you seem to think that employers have NO say in health policies as written No, I don't think that. I know there are some that self-insure.
In other words, the Employer PAYS for health claims and is DIRECTLY involved in specifying the benefits of the plan and when and when THEY WON'T apply to the insured I understand that, and feel they have a right to say what they will and will not pay for (cover). All are required to disclose what procedures are and aren't covered under their policies. If everyone would read their policies, you will see what things aren't covered under your current medical insurance.
no matter what "spin" the Republicans put on it, very often Employers ARE involved in making health care decisions of their employees Spins....funny how each side accuses the other of spinning the issue. Glad we can agree on the employers are involved in making these decisions. Thus, the employers concern.
To hear Republicans tell it, this Bill will threaten every Mom & Pop business with employee lawsuits, and that is a lie I disagree. It's a matter of interpretation. The business, etc. on the urls I gave, feel the wording needs to be more specific.
reality is that Employers get direct tax incentives and other benefits under ERISA to offer health insurance. Along with these incentives the Act states that these health plans CANNOT be sued for MORE THAN THE COST OF TREATMENT I understand that. It's my belief that the government did this to encourage more employers to carry medical ins. for their employees. As an incentive they offered business a deal.
posted on July 5, 2001 06:08:14 PM newWhen are you going to understand that Republicans want BIG Business to have all the perks but none of the pain that goes along with the responsibility of those so-called perks See, this is another area that I see differently than you. I don't see that government did this so that big business would have perks. As I said, I see that it was done to provide more of the un-insured an opportunity to have medical insurance.
On my ill girl....boy, you give heart-breaking examples. Insurance policies state if they didn't pay for an experimental procedures, or one found not to be effective. You appeal and desperately try to raise the money for the procedure privately, but in the meantime (in the lengthy appeal process) your little girl dies.
See, this is an area I feel can be changed (rewritten). Specific (short - emergency) time limits can be set, in these special cases, so that the scenario you presented doesn't happen.
KatyD - While I know you, and many others here, don't understand my opinions (and that's okay). My concern is that the way in which this bill is written will cause more people to either lose their coverage or pay a much higher premium so that these lawsuits can be paid for. It's a lawyers free-for-all. They're the only one's who are going to benefit from this, IMO.
I do have an opinion, but that's not unique in anyway. I also quite clearly state (usually in bold) that I am expressing my opinion so as to not have anyone think I know anything about anything! 
