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> | > | > | > | > | > | "David Moffitt" stompingweasels.org> wrote
> in
> | > | > message
> | > | > | > | > | > | >
> | > | > | > | > | > | > Walk into any emergency room tonight and see who
> is
> | > | > sitting
> | > | > | > there
> | > | > | > | > | > waiting
> | > | > | > | > | > | > to
> | > | > | > | > | > | > be seen. Who do you think is picking up the tab
> for
> | > the
> | > | > | > healthcare
> | > | > | > | > of
> | > | > | > | > | > all
> | > | > | > | > | > | > of
> | > | > | > | > | > | > the illegals you sitting there? You are. They are
> well
> | > | > aware
> | > | > | > that
> | > | > | > | > they
> | > | > | > | > | > | > will
> | > | > | > | > | > | > get their healthcare free. (to them)
> | > | > | > | > | > | >
> | > | > | > | > | > |
> | > | > | > | > | > | And you know what?
> | > | > | > | > | >
> | > | > | > | > | > I worked in healthcare. And you know what about it
> beyong
> | > | > | > kneejerking?
> | > | > | > | > | >
> | > | > | > | > |
> | > | > | > | > | Too many years covering health issues as a reporter and
> way
> | > too
> | > | > many
> | > | > | > | > years
> | > | > | > | > | working in and around the health insurance industry.
> | > | > | > | >
> | > | > | > | > I sold insurance before going to college and getting an
> honest
> | > | > | > vocation.
> | > | > | > | >
> | > | > | > |
> | > | > | > | Yet, these are the people who are currently in charge of
> health
> | > | > care,
> | > | > | > and
> | > | > | > | apparently the people many would like to see remain in
> charge
> of
> | > | > health
> | > | > | > | care.
> | > | > | > |
> | > | > | > | Curious, that.
> | > | > | >
> | > | > | > I don't like it either. You want to just change the
> controller.
> | > | > | >
> | > | > |
> | > | > | And you apparenty don't.
> | > | >
> | > | > Not to federal government control. They cannot run the VA Hospital
> | > system
> | > | > much less all of healthcare.
> | > | >
> | > |
> | > | Then, who? What you have now is effectively the same thing, and it
> just
> | > | might be easier (stress might) to effect pressure on lawmakers with
> some
> | > | semblance of federal control. Number one, the insurance companies
> are
> | > still
> | > | gonna be mostly in control, but as we've all seen they're now
> totally
> in
> | > | control and effecting every single bugaboo the opponents of any kind
> of
> | > | national insurance plan, system or whatever you want to call it,
> | > virtually
> | > | without oversight from anybody.
> | >
> | > There is a tremendous amount of federal oversight now. The federal
> | > government controls when and where you can open a hospital and how
> many
> | > beds
> | > it can contain.
> | >
> |
> | Yet, they've done diddly squat to force carriers to live up to the
> policies
> | they sell. Matter of fact, they've relaxed regulation to the point that
> even
> | many business leaders are starting to call for some semblance of
> regulation
> | again.
> |
> | > |
> | > | Ya really think the free market has any impact there? Not with the
> | > insurance
> | > | giants holding their fingers in both ears and crying, "We can't hear
> | > | youuuuuu!"
> | > |
> | > | They've effectively convinced even the providers that the whole
> problem
> | > is
> | > | all those sick people just overusing the resource.
> | > |
> | > | Take your pick... it's gonna either be increased federal regulation
> or
> | > still
> | > | more control by an industry that has shown clearly that it cares
> | > absolutely
> | > | nothing about its policy holders.
> | >
> | > There is no easy answer but having the federal government in total
> control
> | > is not the answer.
> | >
> |
> | I've never said it was. What I have specifically said is that the
> current
> | system is broken, and I don't see any evidence that any leg of the
> current
> | system is listening to much of anybody. Mostly, they're all just
> lobbying
> to
> | protect their own particular turf.
>
> SOP for everone.
>
Sure, but not everyone has the lobby resources of the hospitals, insurance
carriers, pharmaceuticals and the AMA.
> |
> | > |
> | > | Hell, the pharmaceuticals (hardly known for their altruism) and
> Wal-Mart
> | > | (along with a few other pharmacies) are doing far more to help
> control
> | > | medical costs than the insurance carriers, hospitals and doctors,
> and
> | > | they're NOT doing it by just yelling, "Deny! Deny! Deny!"
> | > |
> | > | What you have is a system that is broken, and it's not likely to
> ever
> be
> | > | fixed by allowing it to police itself.
> | > |
> | > | What level of public (as in government if you prefer) is required, I
> | > have
> | > no
> | > | idea, but continuing to allow the fox to guard the henhouse is
> nothing
> | > more
> | > | than and admission that Richard Nixon was right when he said how
> much
> he
> | > | loved managed care plans which increased profit by giving less care.
> | >
> | > Managed healthcare has saved the consumer a lot of money. Would you
> like
> | > an
> | > example?
> | >
> |
> | Oh, I can give you hundreds of examples of how it's saved insurance
> | carriers, perhaps, billions. Here's one. In a work-related injury, even
> a
> | pre-existing condition is compensable IF it exacerbates that
> pre-existing
> | condition. Yet, carriers are getting away with calling those instances
> | age-related and simply denying the claim. Under current Tennessee law,
> | that's about the end of the line.
>
> Not really. I sued--- won--- and now retired. They said my knee problem
> was
> a pre-existing condition that was exacerbated. There was one problem with
> their position---- They were the insurer with the first injury to my knee
> also.
>
How long ago. Not at all likely to happen in Tennessee today. Today, their
being the insurer in your first knee injury will likely be considered
grounds to deny on a pre-existing condition.
Look, I went through this, though I fought teeth and nail. In a recent wreck
(I was a passenger) that was work-related, I banged a knee on the dashboard.
My boss made me go to a doc-in-the-box to get checked out. Well, I knew what
was going to happen. And, it did. The entire exam consisted of forty five
minutes of filling out paperwork and killing time, and precisely thirteen
seconds of the "doctor" squeezing my knee and telling me I was fine and
dandy.
He even admitted to watching me from behind a one-way mirror, and further
admitted he watched ALL his workers' comp patients in that fashion.
Further, I decided later when the knee started hurting seriously to at least
get my orthopedist to check it out a little further. Two calls to the
carrier to secure a referral, and to this date, three years later, I have
not yet heard from them.
I even informed my boss of that little fact, and neither my supervisor nor
our branch manager could have cared less.
> And it's not much of a line to begin with.
> | You, the injured worker, have essentially no say in what kind of health
> | care, if any, you get after being hurt. Those decisions are entirely up
> to
> | your employer and their insurance carrier.
>
> Not really. Lawyers love cases like that. they even advertise it on TV.
>
Yes. I've seen the commercials. I've also read recent Tennessee law, and the
amounts they can hope to collect are miniscule compared to what they were
even three or four years ago.
Trust me on this... you have no choice today if you're injured on the job.
The doctors are presented to you in a panel of usually three, and those are
the ONLY doctors your workers' comp carrier will even consider paying for.
The one good thing is you can opt out of the system and actually get better
care and better payment going through your private insurance.
> |
> | In one case here, a guy was treated with nothing but physical therapy
> for
> a
> | torn rotator cuff, only to be told after that year that HE had waited
> too
> | long and there was nothing they could do for him. He was released from
> care
> | and his employer immediately fired him..
>
> Yep! I'm collecting from an employer right now for that very thing. When I
> was 22 I got 4 ribs broken welding on some of those Apts you see on Due
> West
> that back up to I65. The doctor returned me to work for light duty and my
> employer laid me off. After contacting my lawyer I collected my pay for 6
> months until my ribs were completely healed. Lawyers love cases like that.
> they even advertise it on TV.
>
When you were 22. The case I cited occured less than five years ago, and
it's what current Tennessee law (and most other states for that matter)
allow.
The days of a workers' comp injury resulting in a lifelong gravy train are
over, even in completely legitimate cases. I could cite you fifteen or
twenty cases where a person is totally disabled and the carrier is still
coming back, looking for ways to pay for less and less care.
> |
> | Yes, I'm quite aware of what "managed care" has come to mean all too
> often.
>
> Managed care also prevent hospitals from running un-necessary tests. In
> the
> 80's a person over the age of 50 going into the hospital got a full blood
> profile, an upper GI study, gallbladder and a barium enema. When I worked
> in
> the hospital in the early 80's we has an elderly man come in who had fell
> on
> some ice outside his home. He substained a partial fracture of his right
> elbow and was to be kept overnight for observation. He got out of the
> hospital 3 weeks later without his gallbladder. He never had a problem
> with
> it but his scan showed he had stones. I've got a whole stack of examples I
> saw over the years. Are you aware that the government healthcare system
> called Medicare is managed care?
>
Yes, I'm well aware of that as well. It's another one of those promises to
veterans that has never been kept. Actually, there's a very good military
retiree program called CHAMPUS, but the day you become eligible for
Medicare, you get kicked off.
And, of course, managed care can be most beneficial, especially in avoiding
unnecessary tests. Unfortunately, it's also become most beneficial in
helping carriers avoid paying for completely necessary tests, and to deny
coverage because you're simply "too old" to waste the resource on.
>
>
> |
> | > |
> | > | And the folks who continue to oppose national health care because
> they
> | > fear
> | > | not being able to choose the doctor they want really need to read
> their
> | > | policies. It's entirely possible right now that this will happen to
> you,
> | > | even with a doctor you've spent years doing business with.
> | > |
> | > | Frankly, I'd be satisfied with legislation that simply requires
> | > insurance
> | > | carriers to live by the words in their policies. I'd even allow them
> to
> | > | continue to write those policies in the impossibly convoluted
> legalese
> | > they
> | > | have employed for years. There are lawyers who can read that crap
> and
> | > will
> | > | gladly oppose them in court that already know how to beat them at
> their
> | > own
> | > | game.
> | > |
> | > | Of course, much of our governmental effort these past several years
> has
> | > been
> | > | to pass legislation limiting your ability to fight your carrier,
> even
> | > when
> | > | it can be proven beyond even a shadow of doubt, never mind the legal
> | > terms,
> | > | "preponderance of the evidence" or "reasonable doubt," that either
> the
> | > | carrier, the doctor, the hospital or some combination screwed the
> pooch.
> | > |
> | > | And even the "get something for nothing" argument has now carried
> over
> | > to
> | > | patients expecting their policies to cover what they say they'll
> cover,
> | > so
> | > | I'm guessing the current plan is to pay your premiums and never mind
> | > getting
> | > | anything paid for, as stipulated in the policy, at all.
> | > |
> | > | Why would one NOT want to change that controller?
> | >
> | > I'll make it simple: Under the current system if the hospital or
> doctor
> | > makes a mistake can you sue them? Yes. Your insurance company will
> even
> | > supply a lawyer. Under the current system if the VA hospital or doctor
> | > makes
> | > a mistake can you sue them? No. Do you really want to lower healthcare
> | > costs? Push for tort reforms. (the lawyer lobby will not hear of it)
> | >
> |
> | Yet, there was a recent court ruling that held punitive damages could
> not
> be
> | used to punish a company that had been found liable in a particular
> claim.
>
> Do you mean the lady that was paid just 6 million last week or the one who
> collected millions from McDonalds because she was stupid enough to try and
> hold a hot cop of coffee with her crotch and drive?
>
No. This one was from a hurricane case. But, interesting that you bring up
the Mickey D's lady. Are you aware that she was simply one of 800 potential
plaintiffs in that particular case? Or, that the customers of that
particular Mickey D's had been complaining about the temperature of that
coffee for quite some time before taking their complaints to the Health
Department, who measured the temperature at just under 200 degrees at time
of serving.
That particular Mickey D's refused requests of even their customers, so that
lawsuit was about the only recourse left, and the lady that so many have had
so much fun with over the years got third degree scald burns in her crotch!
> |
> | Say what?
> |
> | The abuses of tort law abound, but tort reform that severely limits an
> | injured party's ability to collect damages is like using a sixteen pound
> | sledge as a tack hammer.
>
> I'm talking about limiting what you can sue for. Ok a sterilized mouse in
> a
> can of green beans is gross but shouldn't be worth 10 millon to the person
> who found it.
>
And for every case where a ridiculous sum of money is litigated, another
several hundred very similar cases are flat thrown out of court. And, many
of the settlements are made simply because the corporation doesn't want to
be bothered with fighting the battle.
A much better method of limiting frivilous lawsuits, IMHO, would be
legislation that allows a counter-suit on those grounds. If you, the
original plaintiff, lose, you not only lose your lawsuit, but you get to pay
the corporation's legal bills.
Might even include the plaintiff's lawyer in there too while you're at it,
and with that consideration, the number of just flat-out ridiculous lawsuits
would disappear overnight without limiting anybody's right to sue at all.
If ya wanna take up the court's time, you best bring a good case, or it
might wind up costing you big time.
>
> |
> | As you noted in another post, the simplest way to avoid a long wait in
> the
> | ER for a dog bite is to avoid getting bitten by a dog. Same could be
> said
> | for the docs, hospitals and pharmacies that get sued over and over and
> over
> | and over, and lose more often than not, driving up the cost of insurance
> for
> | docs that are doing business in a forthright and professional manner.
>
> Go and try and find an OB doctor. There are very few. Why? Because people
> sue them daily if little Suzy is born with a hangnail.
>
Oh yes, I've heard all the crodocile tear stories. I also know several
OB/GYNS still in thriving practices, in spite of the high cost of
malpractice insurance, who don't get sued at all.
> |
> | Wanna avoid a lawsuit? Don't screw up and leave crap behind in a
> surgical
> | wound.
>
> True.
>
> Don't give a patient the wrong drugs, causing her skin to slough off
> | and ending in her death (a fairly recent Nashville case).
>
> Yep that was a nasty one. Hidden allergies can be nasty. Medical people
> are
> human also and all humans make mistakes. Our mistakes are more messy and
> mean deep pockets.
>
But, this one wasn't hidden. If memory serves, the drug in question was
Sulfa, and her doctor knew about it. Her pharmacy, Walgreens, knew about it,
and apparently none of them bothered to check their lists and by the time
she knew what was going on it was way past too late.
