Whit's Whittlings 2007-07-10T10:28:28-05:00

Sick and Tired of HMOs http://bushsyndrome.blogstream.com/v1/pid/237941.html

Sick and Tired of HMOs At sports events Americans are fond of holding up an index finger and proclaiming that their team is number 1. But when it concerns health care, they dont have enough fingers to show their nations position in the world - number 37. Were 37th - were 37th of 191 countries ranked by the World Health Organization. Try saying that a few times and still be proud. And yet when it comes to spending on health care, we can hold up that index finger again, because our nation is number 1 - increasing from 7.6 % of our GNP in 1971 to 16% in 2006, with estimates approaching 20% within the next ten years. Compare that with the UK at 6%, France at 11%, and Canada at about 10% of their GNP in 2006. Both the French and Canadian systems rank in the Top 10 of the world's best health-care systems, according to the World Health Organization. A little over a year ago, Michael Moore invited American citizens to send in their health care horror stories. Within a week his Web site was inundated with 25,000 emails. Moore's film titled "Sicko," which opened nationwide last Friday, is filled with horror stories of people who were deprived of medical service because they couldnt afford it or had not been able to navigate the murky waters of managed care in the United States.

The following statistics are based on facts: 1. Up to 47 million Americans, an increase of 5 million since Bush became president, are not covered by health insurance. (Centers for Disease Control and Prevention). According to Tommy Thomson, ex-secretary of Health and Human services (HHS), the number of uninsured will reach 54 million by the year 2010, and health insurance coverage by small businesses will decline from 74% in 2005 to 60% in 2015.

2. 18,000 Americans die every year because they have no health insurance. (Institute of Medicine)

3. Our infant mortality is higher and our life expectancy is lower than those in most of the other industrial nations.

4. Spending for overhead in most private health insurance plans can take up to 30% of every dollar invested. Overhead includes profit and administrative costs. Compare that to Medicare, an extremely efficient health-care delivery system, which has an overhead rate of only 1 percent.

5. John Markman reported in 2004 in MSN Money that in Southern California anger at CEOs reached the boiling point over the discovery that the proposed purchase of local insurer WellPoint Health Networks by Indiana-based Anthem could trigger $357 million in bonuses to WellPoint executives. Chief executive Leonard Schaeffer alone would pocket $37 million in cash, plus $45 million in pension rights. All this at a time when HMOs were increasing premiums due to the allegedly rising cost of health care.

6. Americans spend $2 trillion a year on health care.

7. As ironic as it might seem, Guantanamo detainees have access to better medical care than the soldiers who guard them.

8. There are four times as many health care lobbyists as there are congressmen, and with multimillion-dollar campaign donations at stake, the prospect of universal care seems a distant hope. The United States does rank highest in the patient satisfaction category. Americans do have shorter wait times than everyone but Germans when it comes to non-emergency elective surgery such as hip replacements, cataract removal or knee repair. The reason is that becoming a specialist means earning around three times as much as a primary care physician. As a result, we now have a shortage of primary care physicians and an oversupply of specialists.

Americans face countless problems with their HMOs. Here are three of the major ones:

1. Members of HMOs encounter a health care system in which they allow insurance companies, which by definition are designed as profit-making entities, to come between the patient, the doctor, and the hospital. Insurance companies can increase their profits by denying the health care claims of members in the organization. Therefore, health insurance companies are not interested in the health of the patient but in the bottom line. Their interests run contrary to the interests of the patient.

2. Members of HMOs may be denied coverage for pre-existing conditions -- or retrospectively denied coverage for pre-existing conditions they never knew about.

3. HMOs employ teams of investigators to disallow claimants on technical grounds and some offer medical directors financial incentives to deny drugs and treatments that -- by definition -- cut into corporate profits.

And then there are the horror stories such as the following revealed in Sicko: 1. A carpenter has to choose between replacing two severed fingers: A middle finger for $60,000 or his ring finger for $12,000. Being financially strapped with no health insurance and as Moore points out a romantic, the patient opts for the discounted ring finger to be replaced.

2. A girl, unconscious in a car wreck, is denied reimbursement benefits because she didnt call to request permission for an ambulance, as her HMO requires.

3. A young man casually stitches up a huge gash in his own leg with needle and thread to avoid another enormous medical bill. Our current health care system began in World War II when prices and wages were frozen. There was a shortage of workers, and companies tried to recruit workers by offering fringe benefits such as free health insurance. Health Maintenance Organizations (HMOs) began during the Nixon Administration when Henry J. Kaiser, a powerful California industrialist came up with the idea of a profit-driven, assembly-line health care treatment for humans. With Kaiser Permanente, Health Maintenance Organizations (HMOs) were born. The result was supposed to be a lower cost for health care. Near the end of Sicko Moore asks, Who are we? Indeed, who are we? What do we stand for as Americans? We are the wealthiest nation on earth, even though 1% of Americans (3 million) own 50% of the wealth, with the other 50% distributed among the other 99% ( 297 million) of our citizens. When it comes to health care, who are we and what do we stand for?

Note: If you want to read a personal account of an experience with the sad state of our health care system by another blogger on Blogstream, go to Sherry's Cherries and read her post for July 5.