Since I am awake and thinking nonstop about this it must be time to write it out.
Let’s look at car INSURANCE. Most states (all?) have insurance commissioners who regulate the insurance companies in that state. We have deductibles and there are limits and regulations for those insurance companies. Most states REQUIRE that we have our cars insured and if not, there are provisions in our policies that “provide” for uninsured motorists. Yes...we all pay for that! That’s insurance. We pay into the insurance and they pay for damages. Of course there are exceptions and times that things aren’t fair but USUALLY we get what we pay for.
Let’s look at MANAGED CARE (MANAGED COST). There are NO regulations on Managed care companies because they are NOT insurance. they are MANAGE COST companies. The only regulations (there are none) fall under the auspices of the U.S. Department of Commerce. which is, of course, BUSINESS. So, in fact, there are no regulations for the managed care/cost industry. And it is just that...INDUSTRY. NOT HEALTH CARE. These companies are not in the HEALTH or GOOD MEDICINE business...they are in the MAKE MONEY business. And there is nothing wrong with making money but not if it is at the expense of peoples’ health and, indeed, LIVES.
Years ago, we had insurance companies who did provide insurance for health care...real insurance. It was usually a 80/20 set up...we pay 20% and they pay 80% and doctors got paid too. Yes...doctors were paid and they did make money which everyone complained about...but don’t car mechanics and car businesses get paid for their work? hmmmmm...YES!!! and they still get paid a lot!!!
So...then there were HMOs. I think that was the beginning of managed care/cost. Kaiser would be best known one that lasted and is still around. We pay the premium and we are FORCED/obligated? to go to their doctors and hospitals. Yes, they do own hospitals as well as big office buildings and their executives are paid well...very well. Their providers (doctors/nurses, etc.) are paid but probably not too well...at least not as well as they should be paid. HMOs are not regulated by anyone...as far as I know.
Then came the managed care/cost companies...BIG business. We can find some of the CEOs of these companies on the Fortune 500 list...of the highest paid executives and richest people! And guess who put them there? You and me (those of us who do have health “insurance”) and the poor folks who can’t afford “health insurance” and the little children who are without any coverage. So, in case this isn’t clear yet...HEALTH CARE (YOUR HEALTH) IS BIG BUSINESS. And BIG politics. Because it is big business, it is BIG POLITICS. Big business BACKS big politics. That’s just how it is. It isn’t personal...it’s politics! Tell THAT to a mother with a sick child...
And by the way...the doctors, for the most part, are no longer rich. In fact, with the cost of malpractice insurance what it is many doctors are not practicing medicine any more. They can’t afford it! Sometimes, even if a procedure is approved, after it is done managed care/cost will decide not to pay. EVEN WITH PROOF of authorization, they simply decide not to pay. There is no recourse because there are no regulatory agencies watching over them. ENTER the litigating LAWYERS!!! EXPENSIVE!!!
It is also true that some doctors started their own managed care/cost companies. I don’t know how that has worked out but I think it was about trying to reign in the money that was going out to all the managed/care/cost companies so they could have a piece of the pie. Who can blame them? They could actually have the money they earn! And they could do procedures for people when necessary...business wouldn’t be controlling good medicine.
What do we do about it? Change the political system...HAHAHA!!
Seriously though...write letters/get angry/speak out/make phone calls/VOTE/ and LET YOUR current representatives know you are on to them and that you plan to change the way you think and vote! They probably won’t care about one vote but if enough people got behind it they will listen. Or be voted out of office. AND...oh yes...let’s not forget that the company YOU WORK FOR is responsible for choosing the “MANAGED CARE/COST” plan you are paying for (supporting?). YES...that’s right! the EMPLOYERS choose for their employees. The EMPLOYERS have the power to help change the system. Let them know that you know how it works. If people think we are stupid or that we simply don’t know how it works...let them know you DO KNOW and then ask how to fix it. We do need to fix it!
We are not powerless! We have choices! The thing is...if we didn’t have stop signs and traffic lights, people in their cars would be totally out of control. Regulation (a seemingly dirty word, these days) is necessary. It’s nice to think that we can all manage without any rules and regulations but that hasn’t been the case and still isn’t.
