Saturday, February 23, 2013

Our Health Care System - An Insider's View

Upon completing college back in the early 1970s, I served a large department store in NY to the accounting office. Working normal, naturally, I was afforded a company group insurance policy which included health benefits, along featuring dental, and life ppi. At that time we'd no HMOs, nor were there any physicians that didn't accept any legitimate insurance plan plan. During my child years, my parents always maintained insurance coverage on both me and my wife through Blue Cross/Blue Shield of NY. The insurance offered by my employer was way too through Blue Cross/Blue Protect of NY. It was touted in the form of best health insurance plan around at that time, and cost me personally nothing to enroll. The employer paid that premium in my plan, and although it did buy your yearly deductible, and then paid 80% up to a specified amount before spending 100%, being relatively healthy it posed no good economic hardship on myself, and I was easily willing to cover my deductible, and small up front costs for any tests or prescriptions I'll go ahead and have needed.

It wasn't until I relocated to colorado in the mid 1970s, that the very first time, I realized just what kind of our country needed to revamp its health and fitness system. Perhaps revamp is mostly a poor term for what i observed initially, but eventually it should become a very well suited term for what is always that the needed. Of course today what is needed is a complete overhaul of our own health care system, and a program that will allow everyone affordable and high quality health care. However, intiially, the programs if you wish were very good, and extremely affordable to those who worked fulltime. There obviously weren't countless small businesses out right now there, and even the ones which were, could at least afford some sort of health care coverage because of their families. While I was moving into southern California I pleased and married a young woman who had been afflicted with a rare types of Muscular Dystrophy, and was on Social Security Disability and state Supplemental Income. In addition she'd Medicare and Medi-Cal to help pay for her medical doctor fees and services which she much needed to keep her still living, and functioning.

Even during the time, it took almost an act of Congress to qualify for those programs, and you for about a redetermination every two years to ascertain if your conditions had a large. Every two years my wife was subjected to an unbiased medical exam with a Medicare approved physician would you reviewed all her medical records for the days previous two years, and is examined her, and then reported their findings to the Emotional Security Administration for review with his or her recommendations. Although my wife's condition was only getting worse, and other than short periods of remission where her disease is in check, she was that you do declining, and it was obvious will be would never be healed, still she would remain subjected to these exams every a couple of years until her death inside 1988. In was at this stage of time that I personally became involved in the health care field, and saw top notch just how insurance companies worked, at least as it came to health attention.

In 1981, I obtained a position at a famed Hospital and Health Care center in cali .. My job was a very Patient Financial Counselor, which entailed dialog with patients and/or their families either prior to classes, during admission or in order to discharge, in order to work out arrangements for payment of your unpaid portion of each of their hospital bills. In most cases the extent owing was anywhere from the few hundred dollars to two years thousand dollars depending upon the procedure done and how long actually spent in the hospital. If the patient was covered by a good private insurance carrier, it was usually small number of hundred dollars. In extremely where they were included in Medicare of Medi-Cal, the children ofter owed nothing. If he or she were indigent, and had no insurance at all, we had a social worker on staff who would attempt serviced them on some sort of emergency medical assistance to aid pay their debt outright. However, that would soon all change about the cut backs in Medicare, and other social programs throughout the Regan Administration. By way of a mid to late 1980s, insurance companies were demanding second professional opinions on certain procedures, and PPOs and HMOs began to spring up from coast to coast. It was the start to managed health care, which has its own pros and cons. The biggest advantage to the organisations who provided these programs towards the employees of course was the fees. Costs for PPOs and HMOs were far less than the traditional health care plans, and saved the employer big money per year in charges. It was the most popular point for them, but left many employees with underneath adequate coverage.

If an employer for example opted on an HMO plan, the employees found themselves in many cases looking for a new doctor as their doctor wasn't area of the HMO plan. At least with those who lucked out with any PPO plan could still see their very own doctors of choice. The insurance just didn't pay where they would if a dr was enrolled in their own personal plans. With the HMOs, you had to select a primary care physician who needed to be a participating physician in plans, or they would not pay the doctor's penalties. In addition if you had to see a specialist, your primary care physician had for an authorization from the insurance agency for that visit. The same held wonderful for many procedures you may want to have, and again it was to primary care physician to seek out prior authorization, or the patient was stuck with paying the entire bill. It was during this period that medical groups or clinics started to spring up from coast to coast, owned and operated by the HMOs. It was their attempt to control health care charges, and manage health care for its patients. Since the inception of HMOs there's been all types of lawsuits filed about the HMOs for wrongful deaths plus for lack of necessary fix for their patients, but still they are going strong.

The question I pose is, when does health care offset the is true of? If a doctor deems it required by the a patient to undergo the medical treatment plan to help save their lives, or to give them a better existence, costs should be for the secondary concern, and the patient's well being should be placed first off. Unfortunately, that is not always the case. Yes, I agree there are people who abuse your body, and run to the closest emergency room for every little ache and pain if they're covered by a public medical program such as Medicare and Medicaid, but what about the ones who truly do look for emergency services, and often hold on hours to be seen becoming emergency room is filled with non emergent cases since they know they cannot be thwarted just because they shouldn't have insurance or public insurance provider programs. The publicly funded programs act like Medicare and Medicaid have to start to review these non emergent cases, and refuse compensating those services making the person liable for any and all costs incurred for people visits.

In the 1990s, through Clinton administration there the push on for a total overhaul of the medical experts system in this country. The concept behind the idea was to somewhat of a feasible way to feasible affordable, good quality health care to all Americans, not really those who could finance it, or those who were already on publicly funded programs from the Medicare or Medicaid. And, there was a proposal that might allow the insurance companies to develop government subsidies to cancel out the costs of insuring those who were thought to be high risk, or chronic patients. Several models any investigated, and in an attempt to destroy any hope of resolving individual, lobbyists and special attention groups claimed that it'd be a form of socialized medicine and costs taxpayers millions, and would not necessarily offer more robust health care. In the end really the only positive thing that came out of the whole deboggle, was guaranteed general practitioners for children, and the allowing diverse either parent to take time off from work after a child's birth without worry about losing their job merely seniority. Even the bill which affords proper care for children needs additional funding and also been lacking due you might want to political pressure and budget restraints over the past few years.

In recent years we're also so concerned about fighting terrorism around the world, and our military this political efforts in Iraq and Afghanistan at the cost of billions of $, that the overhaul regarding reconstruction of America's researchers system has been put on the back burner. Even with a Democratically although Congress, the health care system never gained any further speak, nor has it been ascribed anyone's priority list. Only in recent months with the primary elections is able to question of providing affordable medical for all Americans back once again resurfaced and been integrated the candidates priority internet. There is no question in their normal author's mind that something has to be done to protect Americans in the house high costs of cosmetic surgeons, and the ability in order to good quality health care services no matter the persons financial situation. I am not proposing a socialized medical help system, nor am I in support of allowing non citizens come to be free participation in such system devised. However, for folks hard working Americans individual hold down jobs and also pay their taxes, and individuals with families, need some type of guarantee, that they can purchase good quality health care these need it, and at an affordable price.

No one wants uncover people dying or not enjoying a brand new of life just basically because they cannot afford to surf to the physician when they really need to, or afford their prescription medication that keeps them alive or healthier and stronger. However, we cannot afford to keep going how we are just because i am a free enterprise system and invite for competition between internet marketers. While the health care marketplace is a business, just like public utilities, the govt does put controls up prices and price is altered, and perhaps a matching program with the medical field would work the equally. I just have a hard time swallowing the fact that there are billions of tax dollars to spend overseas on wars we cannot win, or have no need to be involved in, moreover the stuffing of another person's pocket, yet we cannot provide affordable quality health care for our own citizens only at home. While this using an just my opinion, I think there are many Americans out there who feel the same way, but believe that we will be in the minority, in which no one in New york, is really listening in order to us. Perhaps this next national election shows the bureaucrats in Washington that it's not necessarily the case, and really send a contact to our political leaders it will be time for a fantastic change.

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