When the sad truth is that Doctors in the American Health Care System are mere "Advisors" and the Insurance Companies are Now and Always have been the "Decider's".
Take the case of five-year-old Kyler Van Nocker...
Kyler's Doctor along with a team of medical experts prescribed MIBG Therapy. A treatment that has been used very successfully in Europe. Doctors said the boy needed this treatment if they were going to save his life.
In direct contradiction of the advice of medical professionals however, the HealthAmerica Insurance Company, a division of Coventry Health Care* denied the treatment, calling it "experimental" and "not medically necessary." - Which of course in layman's terms means - it's too expensive.
The company is obviously engaging in the time honored industry practice of "Delay and Deny". A tactic frequently used with expensive cancer treatments in the hopes that, in the meantime - The Patient Will Just Die!
This is a perfect example of why our "For-Profit" Health Care System is Terminally Flawed.
As a self-employed small business owner, most of my adult life, I definitely believe in Capitalism and Free Enterprise, but not when it comes to Health Care. Profit motives should have no place in the human health care system.
As a society, Our Humanity causes us to spare no expense when it comes to treating beached marine life, wounded animals or endangered species. But somehow we manage to look the other way when Men, Women and even Children fall through the cracks of our profit driven health care system.
Now I ask you, How Sad is That?
*The Dow Jones Newswires reports today that Coventry Health Care's fourth-quarter earnings rose 24%, beating profit expectations, as overall membership rose while medical costs fell.
"Coventry's medical-loss ratio, or the percentage of premium revenue used to pay patient bills, declined [to] 83.2% from 83.8% a year earlier and 84.4% in the prior quarter," notes Dow.
This has helped boost Coventry Health Care's profits to $109.1 million, or 74 cents a share, up from $88.2 million, or 60 cents, a year earlier. Revenue increased 15% to $3.43 billion as premium revenue rose 17%.
According to CNBC, Company Chairman and CEO Alan F. Weiss stands to make $23 million in salary, compensation and bonuses.
How nice that little five-year-old Kyler Van Nocker was able to help with that. Kyler's mom and dad and the entire Van Nocker family must be proud. - Just Thinking
Please feel free to comment below or email me direct at eddieoreilly@hotmail.com and your comment will be posted.
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You're so obviously a socialist. It's disgusting!
ReplyDeleteI'm hardly a Socialist, truth is I've been a Capitalist my entire life!
ReplyDeleteI am a Humanist, however , and as such I believe in Humanitarianism. The doctrine that people's duty is to promote human welfare!
I have known Eddie O'Reilly for thirty years, he was my employer for the greater part of eighteen year, providing the opportunity for myself as well as countless others to earn a very decent living.
ReplyDeleteAs a business man he can be and mostly is a ruthless competitor but his practices are ALWAYS honest, above board and beyond reproach.
As a man he is similarly honest, above board and beyond reproach.
I have heard him called many names by his competitors and detractors, have heard many unkind words and adjectives used to describe him, some of which I would even tend to agree with, if you have no work ethic or loyalty then Mr. O'Reilly is definitely a SOB. But, I have never once heard anyone prior an above comment, refer to Eddie as a socialist. The thought of Eddie and a Socialist in the same room is almost frightening and gives due cause to gird one's loins.
He truly is a Capitalist, as fine and decent an example as I can imagine, who's integrity and Humanitarianism is acknowledged by even his harshest critics.
When I was 12 years old I was involved in a bad tractor accident on my grand father's farm in Virginia. The local hospital told my mother I would die since my face was completely crushed. They told her the only place that could possibly save me was Duke University Hospital 90 miles away. So they loaded me into and ambulance and off to Duke I went. Two years later I walked out for the first time at no cost. I was blind for 18 months in both eyes, learned braille and was on a list for a seeing eye dog. Woke up one morning and right eye started seeing.
ReplyDeleteSince the accident they performed well over 200 operations on my face as they put my jaws, cheek bones and nose back together again. I went back as an out patient till I was 16 years old. Total cost was 30K and we never received a bill from any doctor only the hospital that was willing to take payments.
So I guess one could argue that back then insurance worked. But, today as a result I can't get insurance due to pre existing conditions so I've only had health insurance once in my life. Paid the premium for years until I needed it at which time they dropped me for pre existing.
The same thing happened to my wife 2 years ago after a stroke.
I still remember how it worked before insurance. Doctor's made house calls, I know ours did. They also charged way less but then there has been a lot of inflation since then.
ReplyDeleteWe have to get the devil insurance companies out. They stand between us and medical care,
ReplyDeleteand siphon off all our money so we can't afford topay the docs.
Blood sucking vampires.
You're correct. Throw out the demonic, capitalistic insurance companies and bring in the blood sucking, spawn of satan politicians to stand between us and health care. At least that's what yo mama obama says is the right thing to do.
ReplyDeleteMy husband and I are both in our 70s. We're fortunate enough therefore to be on that government run health care program known as Medicare. Neither of us has ever been turned down for any procedure or therapy that our doctors have recommended.
ReplyDelete"Medicare Advantage" however (that small part of senior care that is not controlled by the government but rather big insurance companies) turns down, rejects, disputes, and delays claims all the time.
So I really don't understand why so many people are scared of government run health care. I say Medicare for everyone - The Time Has Come!
I have to agree with Billy's comments up near the top. I worked for Eddie O'Rielly for about two years and it's true sometimes he could be a real prick. Hair trigger temper with lots of yelling but if you did your work and didn't fuck around he was a great boss and believe me, definitely not a socialist.
ReplyDeleteI didn't realize it then but as I look back on it now it was probably the best job I ever had and the most money I've ever made.
It's true, doctors are not in charge of health care decisions insurance companies are and the even sadder truth is that Kyler is certainly not alone in having his claim denied by a major health insurer.
ReplyDeleteThe California Nurses Association recently released a comprehensive study of claim denials across California. The study found that the six largest insurers in California rejected 47.7 million claims in the first half of 2009, nearly 22 percent of all claims submitted. And that doesn't include all the treatments and claims that were unnecessarily delayed for superfluous reasons like trivial errors in paperwork.
Letting the patient die in the interim is after all, always in the best interest of the insurance companies bottom line.
Nationalizing health care and removing the profit motive is obviously the only humane thing to do and if that's socialism then so be it.
I recently read that the United States is the only major democracy that does not have some kind of national health care program. To me that speaks volumes about the influence corporate greed has over our Congress.
ReplyDelete