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Tell me about the HIAA(7 posts)

Tell me about the HIAAKristin
Apr 28, 2003 12:42 PM
Who are these people who determine the value of medical care? Are they regulated at all? Are they bloated at the top? Buying luxury yachts in the Carribean while I slave away day after day in a 4x5? Some of their determinations are outrageously low. Low enough that a medical professional couldn't pay off med school AND pay a mortgage too. And who gets to make up the difference? Not the provider, but me!!! Dammit.
No takers, huh?Kristin
Apr 29, 2003 6:47 AM
Is it because no one know who they are, or because no one cares? The opening line on the "About Us" page on thier website mentions something about how they lobby for Heath Insurers for the greater good of the consumer. What? Sounded pretty lame to me. Does this organization do any good for the consumer in the end, or do they just help the fat insurers get fatter?
I'll try.Len J
Apr 29, 2003 7:30 AM
There was a recognition in the early 80's that our health care system was bloated with no incentive to control costs. All Insurance reimbursements were on a "Cost plus" basis which guaranteed that health care providers would get their costs reimbursed plus a profit no matter how inefficiently they performed. In addition, because the "Markup" on costs were fixed percentages, providers actually got reimbursed more the mor inefficient they operated (the highrer their costs). New Jersey was one of the first states to switch their state reimbursement to something based on "Prospective payments" IN this type of reimbursement, a fixed payment for services is preset. Providers that can perform the service for less make money, those that can't, lose money. Initially these rates were set based on survey data and studies that set them based on "what was possible" and ended up attempting to move health care to a more efficient model. Some of the positive outcomes of this type of approach were technologies like arthascopy for knee surgery which reduced length of stay (and therefor costs) for knee surgery. I was personally involved in this & know that this technology was developed specifically to take advantage of the reimbursment rate changes. The federal program switched to prospective payments in mid 80's.

Private Insurers followed the federal government with adoption of prospective payments as a method of reimbursing soon after. Unfortunatly they have attempted to squeeze costs to a degree unanticipated.

HIAA is however a symptom of a deeper issue. The insurance industry is being squeezed by their cutomemers (Businesses who pay for the majority of health care in this country) to reduce costs, and this is their solution. The real issue that no one want to deal with is the fact that spending on health care is alimited resource, and as such has to be "Rationed". By rationed, I mean that we as a society have to acknowledge that we can't afford to give all care available to all people (Unless we change our societal priorities and use the defense budget, but that's another discussion). We can't afford to give everyone every available care. Statistics show that 65% of all medical care dollars are spent in the last 3 weeks of life. How many of these dollars are spent effectively? Who should choose who gets what & when? These are very tough questions and we have been unwilling to have a legitimate debate on them and so we use Insurance companies to try to control costs (and in effect access).

Before anyone gets too worked up, I'm not saying that the insurance industry doesn't need reforming, I'm just saying that there is a more fundamental problem that can only be addressed by making some very hard choices. Choices that we probably won't make until the crisis escalates.

Just my .02

Thanks LenKristin
Apr 29, 2003 8:39 AM
That was a very informative and well written response. It helps me to understand why it is the way it is today. I was in highshcool when all of these changes were occuring in the's 80's and I only remember that people were pretty fed up at doctor's fees. But when we (the masses) cried out for a solution, it wasn't this!! The "healthy" masses pay more for medical care than they would have in the 80's...certainly no less. And the tables turned on the provider level. An MD friend of mine was recently in a car rental agency. She earns a middle class income and rented a compact car. Next to her was an employee of BlueSheild who asked for an upgrade to the luxury class.

Some how I sense that I'm learning what every 30-something, independant American learns. Classes are a fact of life, and middle of the road is neither excellent or poor. Now if I can learn the key to contentment and not fret so much when they take me $$$'s.
Pardon me...53T
Apr 29, 2003 10:45 AM
...while I defend my country from your scathing criticism.

Classes are in fact part of every society, the US was never intended to be and never will be a classless society. In fact the only classless societies I know of are where everyone is dirt poor, like early 80's Somalia. The one big advantage we have here is the lack of permanent classes, or "casts" as they are know as in some quarters.

For example, nobody would raise an eyebrow if Joe Executive opened the corporate door and found you standing there pitching a new health maintenance program for his employees. He just might buy and you just might get rich. Just so you know, this doesn't happen in many other countries. In may places you would be prohibited from such a venture due to your gender, race, hair color, parentage, religion, or a host of other reasons.

Doctors have to rent conpact cars now. Well, excuse me if us engineers don't cry for them. We have been renting compacts for decades. Next year we go after the lawyers.

What you are seeing is capitalism. Doctors, lawyers engineers, are a the root, not capitalists, they are professionals. Sure they put the tuition money at risk in hope of reward, but that still gets payed back through what you call "middle class" salaries and better job security than non-professionals. (Where I come from, if you work for your salary you are "working class"). True capitalists are the ones who invest, totally at risk, in companies like Blue Cross. These companies then form organizations that return a profit to the capitalists.

The middle of the road is indeed neither poor nor rich, but your conception of poor is not universal. I just returned from South America, where living conditions are not overlapped by any part of US socio-economic spectrum. The poorest Americans have it better than thousands of third world residents. Count your blesings.
Your post couldn't be more off-baseKristin
Apr 29, 2003 11:23 AM
Hello? I'm really quite frustrated over your post. Its as if you're talking to someone else entirely. I never wrote any of the thoughts that you're accusing me of having. Nor was my post a "scathing criticism" of anything. It was really an internal reflection about my frustration over never being able to get ahead financially and my desire to learn to be content regardless. So what's up? Could you to answer the following questions for me:

1. What gave you the impression that I was insulting the US? (When I posted this I was speaking in very general terms, though I'm from the US and that does impact my perspective.)

2. What gave you the impression that I am not grateful for my situation?

3. What gave you the impression that I think badly about the poor?

4. When did I say it was a bad thing that a doctor had to rent a compact car? I was simply pointing out the change in roles between the insurance guy and the MD. In the 80's it would have been the other way around.

I feel like I set off some kinda land mine here. What did I say that pissed you off??
Could I?53T
May 5, 2003 1:39 PM
Sorry to come off so hard, but your post wasn't an internal reflection, you posted it on the internet.

1) You didn't just state that classes are a fact of life, you lamented the fact. Not to mention that the term "fact of life" is almost universally used for "evils we must live with". You did not insult the US (and I didn't accuse you doing so), you criticized it. There is a difference. You are resigned to accept the US situation, ergo you feel there could be a better system, and this is a criticism.

2) You didn't mention being grateful for your situation. In your latest post you express frustration that you have financial goals not yet realized. If I gave you the impression that I thought you were ungrateful by telling you to count your blessings, perhaps it is your conscience you are listening to. I'll rephrase "count your blessings out loud"

3) I do not think that you think badly about the poor. I couldn't find any reference to that in my post.

4) "But when we (the masses) cried out for a solution, it wasn't this!!" This comment of yours really set the tone of your post in my ears. You seem to be railing against the entire health care system as it stands today. The rest of your post reads like a list of particular features that you find unsatisfactory.

I'm not making this stuff up, I read it in your post. Perhaps the "land mine" you set off was in trying to contrast the US of 2003 with some other system that was devoid of classes. All the classless societies I know of, real or fictional, are anti-American in nature. I'm not pissed off, just letting you know how I feel.