In the debate concerning universal health care versus affordable health care, who do you think is the culprit in the cost of staying healthy?

I go with insurance companies. They are a middleman and make huge profits. I’m not sure why they are needed.

I also suspect pharm. companies since they have huge investments in research, college and hospital funding.

It’s easy to blame big pharma and hmos, and they are responsible to a large degree. But there’s a huge big picture that includes metropolitan sprawl, agribusiness and factory farming, labor laws and productivity demands, fearmongering in the media, and on and on. If people were easily able to adopt healthier and lower stress behaviors, that would simultaneously improve the health of populations and drive costs down.

Just look at the difference in the health of populations that live in dense urban areas where walking is habitual versus their suburbs. If healthier food had the same status and availability as McDonald’s and Coca-Cola (especially in poverty zones which seem across the board to be nutritionally deficient), that would certainly prevent many chronic diseases. If American culture offered a more balanced outlook on work and fear, that would surely improve immune systems.

All that being said, there’s no doubt that the game in any health care discussion in D.C. is that “single payer is off the table,” because the HMOs and big pharma want it that way. (In fact, the AMA was against it in the ‘50s and Ronald Reagan was their spokesperson.) They’re making too much money and maintain too much control with their current racket to give it up.

Why don’t we throw lawyers into the mix, too. Malpractice insurance is so high in some states that it’s not even cost effective to practice certain kinds of medicine there. For instance, my OB/GYN’s office in Maryland used to offer Nurse Midwives to their patients. The malpractice insurance got so ridiculous that they could no longer afford to practice there. Such a shame.

I can’t say who’s to blame for the cost. But I know my insurance company misrepresented themselves and their policy to me before I even bought their insurance.

me: hey I’m going to be getting this vaccine, is it one of the essential vaccines the policy covers?

them: yes

a month later I get a bill for the shot. And it’s not even partially covered. The lying bastards.

That’s Anthem Blue Cross everyone. Shortly after I got their insurance a suit was brought against them for misrepresenting their company, not honoring peoples insurance, dropping insured people when they filed legitimate claims and delaying approval on essential medical care.

The healthcare should never be balanced against profit.

Insurance companies, when they were allowed to get in both the insuring business and become medical providers. Originally, a policy would be written to pay the insured when a claim is filed and verified. The premiums paid by the policy holders would be put into a pool which would be used to pay claims. In theory, more policy holders would never make a claim, so their premiums would go toward the low percentage of claims against the insurer.

For example: a policy holder (insured) is injured and hospitalization is required. The insurance company (insurer), upon verification of the claim, pays the insured. The amount is determined by the terms of the contract (policy). This is how insurance worked for years, and it seemed to work just fine. Then things changed, little by little.

First, the insurance companies were allowed to use the premiums paid as part of the profit. That meant that payment of claims would be considered losses, to be limited like other costs of doing business.

Second, insurance companies were allowed to diversify. Many insurance companies (like many Blue Cross/Blue Shield companies), in addition to being insurance providers, became health care providers, thereby becoming both payor and payee.

Third, Insurance companies were able hike rates almost at will. So, if I was hospitalized, my payment went directly to the hospital (owned and_insured_ by the insurance company) who would, in turn, pay the medical professionals (who were employed and insured by the insurance company).

Insurance companies, absolutely. They make a free market impossible as far as health care.

I don’t know who the culprit is, but there has to be a much better system. Our daughter has been in the hospital alot and her bills are expensive, I’m pretty sure our insurance has paid out close to a million for her already, but what strikes me is how it all works. Because we see doctors that are “contracted” with the insurance, the insurance only pays them so much and we get a break. So a surgery that the doctor charged $10,000 for, the insurance company drops the price to $1,000 because that is what is allowed “contractually”. So some of her surgeons are now going “out of network” because they don’t get paid enough, but still want to be affiliated with that hospital and they end up getting more from the insurance company because since they are out of network, insurance pays a percentage of what they bill, (like 70 % in our case), so a $10,000 bill would get paid $7,000, but we would be responsible for $3000. Then the doctors tell us they will waive the 3000 because they are making out better this way. So frustrating to me, why can’t there be a standard rate regardless?

In all of her bills, the surgeons and doctors make squat, at least in my opinion for what they do, those bills have only totalled about 50,000. It’s the hospital that makes bank. And that doesn’t get negotiated. I guess that’s to pay the nursing staff, etc.

We need a much better system.

@miasmom hope your daughter is doing better and continues to improve

One of the many reasons Doctors and hospitals have to charge so much for their services (in my humble opinion) is the increase in malpractice insurance. If the insurance companies were regulated again, or were to operate on an other-than-profit basis, I think we would all be better off. when we have a system in which one entity, with profit as a motive, provides health insurance (and dictates premium rates), and that same entity owns the health care provider facility (and dictates rates for services), and that same entity employs medical staff (and for all practical purposes, dictates payment terms), and provides medical staff with malpractice insurance (again dictating rates),... well I thin you can see where I’m going.