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I too take a different perspective coming from the healthcare industry where I am a pharmacist. The problem with healthcare is that more and more physicians are dropping government plans because Medicare and Medicaid are paying less and less for services rendered in physician offices. I am concerned that a governmental solution will follow the same path as Medicaid and Medicare where instead of the dealing with commercial business practices common in non-government plans, we are faced with a purely political processes that rely on shady deals and lobbyist influence of our congress leaders to choose the national plan benefit.

And while 16% of our economy is in healthcare, the growth in healthcare services available to people makes it easy to see why the cost has grown. Many cancers today can be cured that were fatal 25 years ago. Advances in reconstructive surgery and artificial joints are freeing people who previously were scarred or crippled for life. As a compassionate nation, why wouldn’t we consider the additional costs for these new technologies a good investment? I think the 16% we spend in healthcare goes alot further in improving the quality of life in our nation than the 16$ we spend in the auto industry. Yet nobody feels we spend too much as a nation on cars.

Finally, as a pharmacist, I am amazed at how many of our citizens in the US abuse the healthcare services and increase costs by accessing inappropriate levels of service for medical conditions that are not warranted (i.e. ER visits for sore throats, etc) or seek healthcare for more reasons than to treat illness (i.e. cosmetic reasons, etc). And the programs that have the most abuse and fraud are the government plans like Medicaid, Medicare, and CHIP programs. I do not believe that a national program run by the government will be run cheaper, but I am certain it will be more expensive with more waste and abuse than what occurs in the healthcare industry today.

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Thank you, Patricia, for adding some words of sanity to this site! I joined this group as a mother of seven, thinking that it would serve the best interests of families, only to find that it is really a liberal site aimed at more government control over our lives. More government always means less freedom for parents to determine and choose what is best for their children.

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I see this issue from a slightly different perspective. I work in the billing department of a medical school. I agree all families need health insurance coverage, but I don’t want to see a plan that squeezes health care professionals and adds more administrative red tape to the system. What is needed is a system of universal basic benefits that are mandated so that the benefits are standardized. I spend the majority of my day talking with insurance companies asking very detailed, specific questions about patients’ benefits. No two insurance policies are alike and a lot of time, labor, and mental stress goes into deciphering the minute details of policies just so providers can get paid. Even more time and manpower is spent trying to get the insurance companies to pay once the services have been rendered to patients. Unfortunately it is the public insurance plans that cause the most problem. The companies who contract with states to handle claims only make a profit if they do not administer benefits in good faith. So, they require special authorizations allowing only certain codes to be billed and only a very narrow set of services to be offered. Then they deny claims for because the health care providers did not call in advance for a special authorization to treat the patient. These insurance companies set a very narrow time limitation for filing claims and use that excuse to deny payments. They also require forms to be completed which require extensive time and signatures before they will allow for continued treatment to be authorized. This requirement is also a means to deny payments. Most patients don’t begin to understand their medical insurance benefits. And when the insurance companies do not pay, the patients blame the providers, NOT the insurance companies. Supposedly, it is the providers fault they did not receive payments because afterall the providers did not dot the i’s or cross the t’s. Patients take no responsibility for keeping their health coverage information current with their physicians. Insurance companies should definitely not be for profit. They should be set up to break even, as not-profit organizations. And, they should not be allowed to determine what basic benefits can be excluded from coverage. An example is mental health benefits. Most insurance companies limit the number of visits that will be reimbursed in a plan year, pay a lower benefit so the patient has higher out-of-pocket expenses, require an authorization just to receive any benefits, or have an additional deductible for mental health services. Most people suffering from mental disorders need regular follow up care to monitor their medication regimen. It is much more sensible to pay for regular office visits and keep patients on their medication than it is to pay for costly, repeating hospital stays on mental wards. But, the restrictions placed on benefits for mental health care are like trying to navigate through a massive maze backwards! The administrative nightmare that engulfs our healthcare system has to end. Contracting with the same insurance companies that now exist to provide a private plan is only going to squeeze out the providers because the providers will be made to write off fees when these insurance companies use every trick known to deny payment of benefits to health care providers. If the system is going to succeed, the current practices have to stop. The administration piece of filing claims and receiving insurance payments as well as all the administrative roadblocks set up to sock it to the providers has to be removed or any attempts at health care reform will be an utter failure!

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