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Apr 16, 2009

Well, since this just happened to me I thought I would write about it. This effects ever family who has health insurance, including Medicare and Medicaid, or a joint effort when you become disabled and have SSI Medicaid.

Now, most insurances are under the HMO titans these days. Part of the reason why was in the early eighties it was thought that coordinated, cost capped and regulated private insurance would drive costs below the inflation rate. Hospitals and private clinics freaked out and selected what they thought would grantee the best rate of return for a sick child. It has nothing to do with helping people, it has everything to do with upper managements pockets.

Currently, off the top of my head (maybe wrong), but health care costs have been trending double if not up to triple, in some years back since before the early eighties and after HMO's and PPO's became fully vested in American society.

Now flash forward twenty years to today. What is interesting is it has become almost a feudal system, were each private health care clinic or doctor or hospital can select from a wide assortment of insurances they would like to take. Notice, I said like. This is because health insurance has become such a profitable business that everyone is involved.

Gone are the days when there were only a couple in a region. Of course, this is not the case with the small proprietor or the individual working for a MNC right down to the lower fortune 500. We, use regular unleaded insurance for our bodies, not the ultra 102 and only get one or two choices. Usually one or two mega offerings from our employer with a choice between high deductible, which give little until you get hit by a bus in Manhattan or a low deductible, where your premiums per month are sky high.

So what private practices have is many and we have one. Mr. employee has his trusted pocket ID card that has all his life existence information on, including his favorite food and color, that in theory, should allow him to get health care. After all, he or she is paying 500 to 1000 dollars a month on premiums. Not deterred but happy, he goes to a local doctor and the doctor says sorry we don't take that insurance but we take many others. He becomes the disgruntled family guy. I must at he has every right to be....

Like that fictitious person, I did the same thing and got the same results. Notice how fiction all to often becomes fact, or facts are better than fiction.

However, armed with information I asked the simple question as to just why they don't take my insurance. Now I know the answer very well. It was a step by me for them to speak the truth out loud instead of hiding it. I have gotten into a habit of flushing out well concealed truth lately.

Of course the answer was, "We are a private practice so we select from different plans (because its like a buffet line. Why be decent and go for some pizza when you can head over to the corner table for crab legs and roast beef?)."

So then I asked, "Is it because they don't pay well?"

Answer, "Maybe."

Morgans response, "Well, I know she gets 175 an hour and my insurance will not pay such an exorbitant price for 45 minutes (that is more than many doctors get on salary, not to mention overworked interns)." then pointedly, "Is it because you can get more from other insurances?"

Answer, "Maybe, I really don't know."

In thought: Actually you do....

Now this was not front desk, but in the back office with whom I was talking too.

Morgan: "Listen, I know you are creaming the top of insurances. I know what goes on, I am in health care.

Answer, "Might be."

Morgan's response, "Well, I am an Admin in health care I know what goes on. Listen, cancel both my appointments. It's too bad that you are doing that. I will get a clinic where they are more realistic on such prices."

(175 dollars for 45 minutes and for a non-physician with a masters degree. I got one and I make much less. Hmmm, maybe I should get another masters in something more popular.)

Naw, I would rather advocate for us and grow the non-profit!
At least I can sleep sound at night.


It cost us all from those with poor health insurance or excellent insurance because it splits the insurance pool so that those who are in excellent health (and or rich) can get what they need and those (not so rich) to afford the Kings and House of Lords health insurance get shuffled to the bottom. The insurance pool becomes stratified. When everyone is in a large plan with more open enrollment and features, health risk is spread out, which means on average if one person gets catastrophic sick we all pay just a little for her to get healthy again. But if those who are already in good health (and rich) isolate themselves, they won't have to put in, like we all do, for everyones health. They in essence go for the crab legs, eat them all and leave us with the pizza. When we finish the pizza they don't need to give us any crab legs, so we go home hungry.

We get less coverage but still pay more than we have to because we are shifted to a lower tier of the health plan universe, risk is greater because the health pool is less healthy, less able to pay for the premiums, less likely to be able to afford the co-pays and deductibles and so on.

If you take good care of your health like me, but still can't afford the House of Lords Health plan, then when you do need a doctor, your out of luck because those LLC clinics are run by managers that own the place, not the doctors that do the day to day helping of people and getting them better. So they cream and we then dream. Dream of a day when money is not the worship of those stuck in there own castles in the sky.

For all the information and more you can stand on these types of subjects check out the The Henry J. Kaiser Family Foundation here at this link:

http://www.kff.org/

I have been doing a lot for research with there articles. They put out excelled work for us Americans to use.

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Posted: Apr 16, 2009 6:26am

 

 
 
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Morgan La Femina
, 1
Middletown, NY, USA
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