Private vs Public via Moyers

July 11, 2009 at 2:20 PM (Uncategorized) (, , , , )

A shout out to uninsured and underinsured Americans via Bill Moyers last night.

Mr. Moyers asked his main guest a series of questions taking care to make clear this is no “disgruntled former employee, but a guy who was well compensated, well liked and often got bonuses and promotions.   His guest, Wendell Potter,  former Director of Corporate Communications from Cigna, a privately owned health insurance company, evidently  got shocked into reality by seeing a healthcare rescue mission near his hometown helping long, long lines of unisured patients in tents and stables.

The gentleman proceeded to tell it like we wish it wasn’t.    Burying heathcare horror stories. (In one case literally burying a patient two hours after a long delayed transplant was finally approved.  )

Lobbyists threatening centrist/Democratic politicians with a promise of no financial support if they dared to say in public  that Michael Moore’s film Sicko:

A: Was a documentary.

B: Had some actual facts in it.

This former Cigna employee went on to detail the characteristics of a private plan as outlined below:

In Private Plan…

Rationing = Yes = Economic

Does a bureacrat have a role in determining allowance of individual procedures, in other words, come between you and your doc?

*Yes*  a non doctor medical review employee can handle both first denials and appeals, with minimal supervision by a doctor.

Will a CEO threaten your access to care?  *Yes.* A CEO has to look at something called the medical loss ratio, in short, “How much cost avoidance can you get away with so that you only average about 80 % of each premium dollar going to pay claims.

Can a company retroactively rescind coverage at the slightest wiff of irregularity in  a patient’s chart?  Yes, and they’re going to keep doing it.

Public:

Do they have medical reviewers too that can “stand between you and your doctor?” Sure, just like the private plans.   But there’s no need to pressure this bureaucrat to deny  not on basis of ‘coverage,’ but simply so that a balance sheet looks better to Wall Street.  Also much less need for costs associated with ‘marketing.’

Do they have Rationing?  Yes, but unlike the private plans, it isn’t based on how big your bank account is.  I don’t like rationing/waiting lists based on ‘outcomes’ or some law of diminishing returns on an individual’s quality of life, but I’d rather fight a mechanism like that than, “You can’t pay and it’s not covered. Bye.”  Will a public plan dissapear because of poor ‘medical loss ratios?’ I can’t concieve of that happening.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: