Monday, January 25, 2010

It's Time to Take Off the Gloves!

Many of our readers have an idea about TSB's position on the current state of affairs with healthcare and as it relates to our industry. Fundamental changes must be made to tort reform, the power of the insurance industry, stricter guidelines and transparency within our industry, physician compromise, and patients being held accountable for managing their own health. Yet, what has opened up as a fight to control healthcare cost on the east coast in New York City between United Healthcare (the real evil empire) and Continuum Healthcare a consortium of five NYC hospitals could potentially affect 25 million people across this country.

Hospitals and United are in a bitter dispute over contract rates and United's demand that the hospital's notify the insurer within 24 hours after a patient's admission. If the hospital failed to do so, the reimbursements will be cut in half. This is meant to improve quality of care and allows for case managers to jump in right away.

Many of you know that the insurance industry is not in the business of providing healthcare, they are in the business of risk management. In many ways, the government has realized in order to minimize the cost of healthcare, they too must be in the risk management business, and many of us are unhappy. Yet, this dispute signals the beginning of ratcheting up of controls intended to cut costs. But could the insurance company be the only culprit in this calculating strategy, or, are the companies attempting to keep the premiums low to avoid being taxed on expensive plans?

William Golden, United's NY Chief Executive, was quoted as saying; "tension had been fanned by a greedy and intransigent hospital system." Isn't it interesting who is calling the kettle black? United Healthcare, you know the home of backdating stock and providing former CEO's with golden parachutes valued at over $300 million dollars, is complaining that they need to make healthcare affordable. Affordability usually means less access, procedural controls, and spending less on subscribers that have paid into a failing and falling system. While other insurance companies sit on the sidelines and carefully watch this unfold, what are we doing about it? It's time that the people start coalescing to protect our future. If the physician's are too weak to unite in an attempt to challenge the anti-trust laws, its time that the people's voice be heard.

With the rising cost of devices, pharmaceuticals, hospital operation costs, and union contracts it is becoming difficult to provide healthcare for people in inner cities across this country. Dr. Sam Ho Ho Ho, United Healtcare's Chief Medical Officer said that " the insurer's position was not motivated by money, that this was an attempt to improve outcomes." We must admire Dr. Ho for his ridiculous analogy using the quality of workmanship an automobile mechanic may perform on your car in comparison to what any physician and hospital provide. If the patient has a medical necessity, isn't it appropriate that the physician along with the hospital be compensated for their work?

Not only is there an attempt to implement this policy in NYC, it is happening in Oklahoma City, and Tennessee. Many of our readers believe that it is the governments intent to socialize medicine, when in reality it is the insurance industry's ultimate plan to socialize medicine by controlling what can be done, when can it be done, and who will do it. Physicians are so oblivious that the industry's intent is to make them employees of the insurers. Many of us ask the question; how does this impact us? Not only will this impact you in the future, it will also impact your ability to sell in hospitals at a reasonable price to earn an affordable living? The fact remains, the more the hospitals are squeezed, the more we will be squeezed.

So what can you do? The best way to send a message is to have your company start shopping around for a different insurance provider. If you have United, look at your options. Hurt them where it hurts the most, in their pocketbook. Call your Congressman or Senator and tell them to get off their soft asses, and start putting together a healthcare plan that is affordable and benefits the hard working people of this country, and not every special interest group on K Street. Call them and tell them you want to know which special interest groups are they taking money from and tell them its time to stop the madness. TSB wants to know what our readers think?


  1. So "risk management is where the money is." So what else is new? Cf. Dan Geer, 11+ years ago, admittedly in another context:
    Courtesy of my employer, my health insurance plan is what Aetna calls Open Choice. They took a bet, and lost. They've pre-certed me for ACDF for C6/7. I've even got a firm date and time, even though the surgeon is out-of-network. Now, does anyone have any useful advice for me regarding how to extract the maximum possible benefit for myself at the lowest possible cost to myself?
    Thanks for asking.

  2. It appears that BC/BS has denied an increasing amount of spine surgeries in the New England area. Has anyone else experienced this influx of denials? If so, have these denials been predominantly BC/BS or other insurance carriers? Thanks.