No Free Lunch
health Care System is in Trouble
- Remember when--- our employer arranged for and paid part
of our Medical Insurance.Between 1940 and 1960 spending
on health care in the United States rose from 4% to 5.2%
of the gross domestic product (GDP).
- Remember when --- our employer paid for a higher per
centage of our Medical Insurance. Before the 1960's most
medical care was paid for by individuals. Insurance was
primarily for large expenses like hospitalization. There
was an open market and prices were held down by
- Remember when --- When the Medicare bill was passed
during the Johnson administration. Medicare policy, as
defined by congress, paid hospitals and physicians
whatever they asked for with no questions asked.
- Remember when --- Your Employer made the announcement
that Medical Insurance would be switched to a "Self
Insurance Plan" to save the company Money.
- Remember when --- you received a notice from your
"Insurance Provider" that Medical Expenses were
not covered under their "Medical Contract".
- Did you know --- "Self Insurance Plans" are not
under the control or supervision of the North Carolina
- Did you know --- Your Employer may have included in their
"Contract" the right to refuse to pay for any
Medical Expenses. The final decision is Your Employers.
- Did you know --- your insurance may get a discount from
your medical provider and pay less than their agreed
percentage (80% for instance) but you are still expected
to pay your percentage (20% for instance).
Between 1940 and 1960 spending on health care in the United
States rose from 4% to 5.2% of the gross domestic product
In the subsequent 35 years it has risen to over 15% of the
GDP. Before the 1960's most medical care was paid for by
individuals. Insurance was primarily for large expenses like
hospitalization. There was an open market and prices were held
down by competition. When the Medicare bill was passed during the
Johnson administration several things happened which helped fuel
the fire of health costs. Some of these things were beneficial
for the general health of the American citizen but many were only
beneficial to the pocket books of the medical and legal systems.
Following are the major reasons that caused "managed
care" to become the dominant force in American health care.
- Medicare policy, as defined by congress, paid hospitals
and physicians whatever they asked for with no questions
asked. Hospitals spent whatever they wanted to spend and
simply passed the bill on to Medicare and the insurance
companies. Back in that era most insurance coverage was
for hospitalization only.
- Next, many individuals over the age of 65, who had used
health care frugally prior to Medicare, began to see
their physicians for more trivial problems. The change
was helpful for the individuals who couldn't afford care
prior to this time.
- The insurance companies initiated the policy of paying
the hospitals the same as Medicare reimbursement which,
if you remember from above, was whatever the hospitals
asked for. It didn't matter to insurance companies at
that time, though, because they had no reason to hold
back costs. It was easier to adjust premiums. They made
money by setting premiums at a level that guaranteed that
the system was profitable.
- Eventually, as people saw doctors and hospitals making
windfall profits, the legal profession and individuals
who might have some complaint against the medical system
began cashing in on the profits through lawsuits
- Although there are numerous other reasons for the
exorbitant escalation in medical care costs over the past
30 years the final major reason is the advance in
technology. Government and insurance company policy of
paying for this technology, without question, was the
driving force in the quick advance of the technology.
That policy has led to a medical system that is second to
none but at a price that is astronomically higher than
any other on earth. We have been subsidizing the rest of
the world in technological and pharmaceutical advances.
We pay for it, as individuals, through higher drug and
health care costs in addition to higher taxes.
The current state of American Health Care is overwhelmingly
driven by cost.
Our Employers are faced with the overwhelming cost of
Providing Medical Care for their Employees. We as Employees are
faced with the surprise that our "so called insurance"
will not pay for chemically induced illness or injury.
Doctors struggle to diagnose an illness that they are not
trained to recognize but are trained (under the Cullen
Definition) to prove that your illness was caused by something
other than chemicals. The cost of Medical care and Workers
compensation is being shifted to Social Security Disability and
It's about time that we as chemically injured, get
"Appropriate Medical Care" by Qualified Physicians.
Doctors that consume Thousands of Dollars of our Insurance money
with the intention of trying to avoid a Chemically Induced Injury
diagnosis should be sued for Negligent or Mal Practice. If our
Insurance cost is to high because of the "so called
experts" playing games with our health, we may even loose
our jobs --- then our Medical Care (Insurance).
How about a new rule for the "Experts". No Diagnosis
- No Pay.
Managed Care is the new catch phrase. It is being touted as
the savior of the health care system. But, Managed Care is being
quickly recognized for what it is. Saving money at the expense of
people's lives and health is unconscionable. The reality is
turning out to be that, although there is some money being saved,
there is more cost shifting than cost
We, as a patient, have the undesirable option of either
changing doctors every time the insurance changes or paying
expenses out of our own pocket. But remember, "There Is No
Free Lunch". We will pay much of the cost of Medical Care.
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