What is the problem with working on health care reform?

WHAT is wrong with Congress that they cannot seem to work out some plan for health care reform?

And WHY do they keep telling us that any plan will most likely raise our taxes by a great amount?

Is it just to scare us so they can avoid doing any reform work? Is it as a sop to the insurance companies, who provide so much in the way of campaign contributions?

First, our present system works like this. MILLIONS of people have 'private' health insurance. That is, those people either belong to some "plan" through their employer or they have coverage that they totally pay for out-of-pocket.

Second, the present system is FOR PROFIT. That means the insurance companies, using the PREMIUMS paid by the insured, pay a negotiated amount for every covered service. THAT means the insurance companies make a deal with all the doctors (and other providers) who participate in any given plan, to pay a certain percentage of the billed amount for office visits, surgeries, any kind of treatments etc. provided by doctors.

That means that if your DOCTOR charges $100 for an office visit, the insurace company may negotiate with the doctor to pay $65 for each office visit, and you (the insured) pay a co-pay of $10-30 (or more) for each office visit. What THAT means is that your doctor agrees to accept the amount the company will pay, PLUS your co-pay as total payment for the office visit, even though a person with NO insurance must pay the entire $100.

Please pay attention!

The same applies to ALL medical care. Hospitals negotiate. Other providers (like labs, imaging facilities etc) ALL negotiate how much they will accept from the COMPANY and how much your CO-PAY will be.

Now, the premiums you pay to the company are called PREMIUMS for a reason. A premium is an amount of money paid OVER AND ABOVE the cost of some goods or services! THAT means that your insurance company, after negotiating what THEY will pay to your care providers, and after perhaps not APPROVING some treatments (no matter how necessary) and after PAYING for every charge for some good or service they have negotiated, ARE MAKING A HUGE PROFIT. THAT means that even after ALL medical claims are PAID, the insurance company is still getting RICH off the backs of those who pay the PREMIUMS (YOU!!!!)

Now, with reference to who makes the decisions for your health care. Is there ANYONE who thinks that for every single claim you have for some medical office visit, treatment, prescription, etc, there is some DOCTOR who sits in an office and decides if the treatment, medication etc is NECESSARY and thus will be paid for? DREAM ON.

The way it works is this. A board of doctors or some medical group decides on what treatments, medications, etc to PAY FOR, how much (by negotiating) will be paid for each thing. THEN, when a CLAIM is filed by your provider (doctor, imaging office, pharmacist, etc) a CLAIME SPECIALIST (a CLERK) processes the claim! A doctor does NOT make your medical decisions (as fas as the insurance company is concerned)! The decisions are made WAY IN ADVANCE, and apply to EVERYONE, not just you. And YOUR DOCTOR makes decisions sometimes based on what your PLAN will cover! Patients also make decisions for their own care based on what their plan will pay!

So, based on criteris set for the entire GROUP, the claims specialist processes the claim, and determines (based on your PLAN) how much will be paid, or if the claim will be paid at all or denied for some reason. And even after paying all the CLERKS to process claims, the insurance companies are STILL making a huge PROFIT.

So, what THAT means is thatYOU are not only paying for the medical care you receive from doctors, for the medications you get from your pharmacist, but also for all the expenses of running the insurance companies (paying the salaries of all the clerks etc) AND creating a huge profit for the insurance companies that enables the CEOs and head honchos to get RICH and creates a HUGE profit for the shareholders in the insurance companies. YOU ARE PAYING FOR THAT.

So, let's look at how a single payer, government national health plan would work, if organized correctly.

First, a BOARD OF DOCTORS and medical professionals (just like in the current system) would make decisions about acceptable treatments and medications that would be paid for under a single payer system. In other words, it would be based on exactly the same criteria as our present system. And no, a doctor will NOT be sitting in some office processing claims. A CLERK would do so. JUST LIKE OUR PRESENT SYSTEM!!!!! And, just luke our present system, our DOCTORS (and we the patients) might often make decisionos on treatment plans and medications, based on the items allowed by the PLAN!

Second, ALL the people covered under such a plan could pay SOMETHING toward the cost of the plan. Employed people could pay a premium (and possible LESS than they are currently paying) to be covered. Employers could pay a portion of the cost, exactly like they do now, except perhaps somewhat less than they currently pay. Why could the premiums be less? Becausae the COST of the national system would ONLY be to (1) pay those who process claims, the clerks, and (2) the cost to pay the doctors and pharmacists etc for the actual care. There would NOT be that huge profit that SOMEONE (you) now have to pay for. This would also allow SMALL employers and their employees to pay into the system for coverage. RATES could be somewhat based on the size of the employer's company, much as the premiums for coverage under our present system. (large employers negotiate a much better rate than a small company)

Now, for perhaps the most controversial part of national health care. Who will pay for the unemployed, the indigent, the elderly, the really poor and all those 'not on the grid' who could not even afford small premiums for national coverage. Well, who pays for them now?


WE ALL DO.

Under our present system those without coverage are getting health care from a number of umbrella agencies. Clinics, medicaid, emergency room visits, etc.

And, remember, we ALL pay for health care for EVERYONE in our plan, if we have private comverage!

Think not? Ask yourself this. If you work for a company for 20 years, and never once have to see a doctor, but have paid health care plan premiums for those 20 years, what happens to the money? When you retire does the company give you back your premiums? Don't hold your breath! ALL the premiums paid to insurance companies goes to pay ALL the claims of ALL covered people! NO ONE gets their money back if they never use the system.

So, in effect, YOU are paying for the health care of EVERY person in your plan!!!!!

So, CONGRESS needs to get with it and work out some health care reform plan that will (1) give EVERYONE coverage, and (2) finance the coverage by those covered and businesses paying premiums to the government.

Remember this. If the insurance companies are providing coverage now and still making a profit, the government could at least nearly break even, based on all citizens paying a portion of the cost.