SicKo- Seen it?
 

I saw it over the weekend, and I had no idea it was going to be about Universal Healthcare. I thought that was awesome....

Not that I think it would work under the current powers-that-be.....but it would be great to work towards.


What do you think?

:D

Still friends? Ok, I'm just going to back away very slowly.....


If this poll doesn't turn out right it's Shawnee's fault!;)

Right heree. http://cellar.org/showthread.php?t=14493

Yea......I was afraid of that....*sorry*.....

:blush:

but in my own defense....mine includes a poll and a genuine request to hear informed (or uninformed) opinions.

I saw it. It made me think- the Milgram experiment was intended to discover how far someone would go when "just following orders." I always had a feeling about it that the subject of the experiment had a reasonable expectation that the "victim" would be fine, just because it was a Yale University study.

HMOs have set up (and, from the Nixon call, deliberately from the offset) a Milgram experiment for real, where the subjects know without a doubt that their action will kill someone. And they do it, because it's a job. The scenes with the woman who weeded out claims were some of the most powerful in the film.

I got a better Milgram Experiment: How much money can a fat liar make by hating freedom? [/"patriotic" commentary]

I think that Peggy Fino (Blue Cross/Humana) was her name...my dad works for them right now and I'm thinking of asking him some straight-forward questons. (that's the only way for him to give an answer)

He's some sort of director for southern branches....An administrator should have some good answers for me.

Michael Moore abuses America and is not remotely constructive. Which is why middle America abuses Moore right back, and more power to them.

I make a point of absolutely never putting money in Michael Moore's pocket.

The question is what are your hands doing in Michael Moore's pockets in the first place?

My wife worked in managed care for a while.
The most broken system one can possibly imagine.

What about healthcare reform? Can talking about it be constructive without molesting Michael Moore's pockets?

Is there a way to set up a health care system in which capitalist pressures would lead to HMOs actually competing to cover sick people, rather than accepting their dues when they're healthy and then dropping them at the first sign of illness?

Capitalism only works if the pressures of competition push things in a good direction. Is there a way to organize health insurance along those lines?

Yes there is, my wife talked about it all the time. Set it up so they directly compete and cannot work together, which they do.
She used to have such a hard time, so upset after fighting for people's lives with terrible people who wanted to deny surgeries for things like someone's pancreas or liver.
There is no system for the patient.

How would stopping collusion change the fact that their best business model is to not pay out? If collusion were successfully eliminated, the theory would be that one (or more) of them would actually start paying claims, word would get out, and they would get all the business, right? Couldn't a company do that now, and steal all the business away from the cartel?

I think that the people who want to deny surgeries are in all of the companies, regardless of collusion. In a country where shareholders can sue successfully if a company fails to do something that could have helped the bottom line, how can you prevent it?

Maybe "Insurance" is a poor concept when it comes to Health in the first place. Back to step 1.

We want guarantees against possible losses, which is why we buy insurance.

When we look at our health and the health of our families (and typical needs) the losses are definite.

What in the hell are we doing?

There is nothing wrong with that, the companies just need to pay when the time comes.

That's what I'm wondering. Insurance is supposed to work when the majority of subscribers never need it, so there are large sums available for the few who do. Is that model valid for healthcare? HMOs are forcing it into the model by discouraging or preventing payouts. If they did pay claims, would it work?

I'm also inclined to think, unless proven otherwise, that corporations are set up as one entity, and that one body is socio-pathic.
Maybe something as important as life or death never should have been put in the hands of a socio-pathic corporation (even though the individuals working there are harmless and just doing their job).
Their job is to take your money! Any way possible! Quickly!
Do we really want them to make the major decisions about our life and death too?

How is it that prosecuting a war is so important it requires state funding (ie, the army) yet healthcare is left to the profit model?

If they pay, they don't make as much money - thats what they think they are there for. If they go into direct competition, then some companies will only take the much lower risk clients leaving many uninsured or paying more.

Y'know I think the market is good for driving clinical development along, but it fails miserably at delivering healthcare as it is needed by patients.

HM, there are lots of forms of insurance that are profitable. I think the biggest problem with health insurance is the loss of competition due to health insurance being a standard employment benefit. I can't reasonably change providers even if I'm unhappy with them, because my employer (my husband's employer, whatever) chooses the plan. And their main concern is cost; employee satisfaction is somewhere in there but definitely not as important.

In my ideal health care system, 2 major changes need to occur:

1.) No more employer-provided benefits. Everyone pays for their own insurance (salaries are raised accordingly to reflect this change), and they are free to shop around among providers.

2.) Catastrophic coverage becomes the norm. The insurance model in general is designed to cover disasters, not generally subsidize everything so you pay a $15 copay on your $35 prescription. No other type of insurance does this--my auto insurance doesn't have me pay a copay on my oil changes, they just cover the unexpected $2000 wreck. And auto insurance is competitive and profitable for the providers.

As a member of Tricare (the military insurance company, the closest thing we have to socialized medicine), under my father, I'll have to say... I dont think I trust the government with our insurance. They do great in Britain, France... prettymuch everywhere except here, but I dont know if we can do it. Too much bureaucracy, too much bullshit.

But there's no better solution, I don't think. The current system sure as hell's broke.

Yes, but they are against events that are unlikely. What are the chances that someone in your family will be hospitalized at some point?

The chances are pretty good. But that doesn't matter. The amount spent on them is likely to be less than the total amount of (somebody's) hospital care I pay for (one way or another) over my lifetime. You can't just pretend medical care is cheaper than it is. Someone's always paying for it.

No, that's the problem. HMO's aren't paying for it. They are denying claims in order to maximize profits - perhaps even to be profitable at all.

If the primary goal is profit, is there a way to organize things so an emergent goal is to pay all valid claims? They seem antithetical to me.

How do insurance companies make money on life insurance? Not much uncertainty there.


I know I'll never pay in more than I get out (I guess, maybe I'm wrong. But it seems like a million dollar policy would far exceed my total payments. I don't know, actually, I don't have a million dollar policy anyway.)

Million dollar policies are almost always "term" policies. They expire once you get past a certain age--usually 10, 20 years after the policy was initiated, something like that. You live past then, you basically lose all the money you paid in. And your personal price is quoted to you based on your age, health, a whole variety of risk factors. It's exactly like odds-making in Las Vegas. Most people lose a little, some people win big (er, well, their families do) and the house always wins a little. Policies that last until-you-die-no-matter-what usually only pay out ten thousand dollars or so, definitely less than you paid over your lifetime.

Only when bad customer service (i.e. not paying valid claims) = loss of profit. And that will only happen when the customers are able to dump their providers.

When I said "someone's always paying for it," I meant that there's no way around the fact that healthcare is expensive--even when it's subsidized by the government, "we" are still paying for it in taxes. People have to get used to the idea that health insurance costs about a thousand dollars a month, and just because their employers are paying that cost now doesn't mean it's not coming out of their salary in the end.

I've thought this before too, but what about the "stitch in time saves a dime" argument? If someone has to shell out $300 to have a regular preventative care doctor's visit instead of $25, they are less likely to get those regular checkups, and less likely to seek medical attention until the problem is severe and much more costly to remedy. There should be a financial incentive to take care of yourself. (I cringe typing that, because good health should be enough of a reward, but I honestly think for most people money is a bigger motivator.)

When I had no insurance, docs would routinely change their invoice to charge me less, such as turning a standard examination to a minor consultation.

The ER had no similar consideration though.

Yep, if insurance weren't such an overblown scam, a regular doctor's visit wouldn't cost $300 in the first place. Maybe it would still cost too much for some people to consider preventative medicine worth it, I don't know. But I figure those types of people wouldn't listen when their doctor told them they had to change their diet/exercise more/stop drinking anyway...

I won't be putting any money in MM pockets. The guy is an idiot even if the subject is an important one.

I like MM- because he's asking real questions regardless of his weight.

And I've come to a decision about healthcare. Insurance is not set up in it's essence for reocurring charges. We can set our watches by yearly exams we need, prescriptions that have to be filled, and the time we need off to do it. And these are just the reocurring charges for things we already know about.
We need programs rather than insurance.
My taxes need to start going towards something that I think is an inalienable right to all citizens.
Our lives hang on a thin thread when we have corporate controlling the very fibers of our existence; our bodies.
How terrible that ill health only counts against you. Talk about adding insult to injury......
I hope people wake up soon. It's like no one can tell they are having the same nightmare. Sorry to wax metaphysical poetics here....
No insurance has become such a dirty word......like poor people don't have the right to live.
I call bullshit. I'm with Dana on the profiteer thing. It's like asking a salesman for a life saving operation. WTF? Hey they're never in that business especially when they start throwing around buzz terms like consumer-centric models of development.
Life, liberty, and the pursuit of happiness is becoming such a joke.
I can buy all the health policies I want, but who in the hell is going to make sure that I stay alive to pay for it?
Not them....this is why by their own designs they don't even make sense anymore.

For the record ...

I am a hospital employee.

One of my primary duties is the initial negotiation with the HMO to determine authorization of services.

I have never turned away a patient because their insurance company refused us payment at the front end. Refusal to authorize services rarely happens. There is a simple appeals process, and we typically win the appeals.

Up to 50% of the patients I see have no insurance coverage when they come in the door.

I don't care. If they need inpatient psychiatric treatment, they get inpatient psychiatric treatment. And, if they are medical assistance eligible, they can establish benefits if they bother to follow up with the medicaid office after they leave.

We eat about $1 million per year in unfunded care (this excludes treatment that can be charged off to what's called "Charity Care," which is a tax break.)

I think it should be the other way around. You as the health professional should have the authority to determine services. Period. What a waste of time. Is that what our professionals are doing? Wasting their training and time on haggling with insurance companies?

Pretty much, the insured/patient too - I spent over an hour on the phone twice and sent insurance information 3 times for an ER visit for my son. BTW, a possible broken hand/finger - 2 X-rays and a 2 hour wait followed by a "nope nothings broken - take some ibuprophen & have a nice day" - - - $2340
Are you freakin kidding me????

You must have thought it could have been broken, or you wouldn't have visited the hospital. If you could have taken care of it yourself, you had the option of not going to the hospital. But, wait, you don't have an X-Ray machine at home, do you? Oh, that's why you went to the hospital. So, you utilized their service, voluntarily, and now you don't want to pay for it?

X-Ray equipment isn't cheap. X-Ray techs don't work for free. Radiologists don't look at the films as a favor to you.

No one wants to pay exorbitant rates just because something is an emergency.
My chiropractor charged me 75 bucks to look at my back. (x-rays included)
Oh, and he fixed it too.
I was very glad to pay it.

Can you show up 24/7 at your chiropractor's office with a broken finger? . . . Guess you'll be needing those hospitals to stay in business.

Who is talking about putting hospitals out of business? Why jump to outlandish conclusions to try and make a point?

Don't try to Alpha cellarite my a**.

The rates are too costly by even completely immodest standards- so get off me.

'hospital' and 'business' are two concepts that shouldn't be sharing a sentence if you ask me.

Flint works in IT in a health facility. He is part of the overhead. So when you pay $2000 plus for a simple visit, you are paying for Flint.

My hospital does give me that authority, as I explained in my original post. Our inpatient physicians also have that authority.

Any medical doctor also has that authority in a medical setting ... and also a requirement of the federal government.

Hmmm....I'm sorry, I read- negotiation to determine authorization.
What are you negotiating?
What are you appealing?
You are right....I am totally lost...
I also have another question....
Is it that costly to provide an emergency service? Or are, we that pay our bills, helping to eat the cost for the 50 percent that don't?

MM's weight is not an issue and bringing it up says a LOT about those who do it.

I like Moore. I used to watch him years ago when he had that little weekly show that went out in US and UK in the 90s ( I think). I know he comes in for a lot of stick, but I really think he fights the battles he believes in with these films. The issues he tackles are issues which need to be talked about.

I give MM respect for this:

(It isn't what it seems like)

You respect Moore for a music video? :whofart:

I said "give respect", not "I respect".

This would be funny if it were a joke.
Ok.... I'm going to laugh anyway!
:D

I'm missing something.
Did he direct it and you think the cinematography and editing are good?

Whenever a patient arrives at a hospital for services, after they are evaluated, there's a lot of stuff that goes on behind the scenes that patients don't know about. One of those things is presenting the clinical information to the insurance provider to notify them of the patient's need for treatment. Typically between one and five days of inpatient treatment get authorized at the "front door," with concurrent review handled by treatment staff on the inpatient unit.

Psychiatric Emergency Care and Medical Emergency Care are two different creatures, with different billing structures. I know that we're pretty cheap as far as things go ... our actual billable rate for an evaluation, for example, is around $100. Our inpatient treatment day rate is $1000. We do not get paid that much by insurance companies. I think that we end up with around $350/day for acute psychiatric treatment for patients with insurance.

Medical Emergency Room treatment is very expensive, which is why it's a bad idea to use the ER as your family doctor. That many uninsured people do this is one of the reasons that ERs are overloaded. A friend of mine is an ER doc and has been discussing ways around this ... having a triage doctor or nurse practitioner who can refer non-emergent patients to a "clinic" that exists side by side with the ER.

I'm a RATM fan.

It wasn't a great video but it bad by any means.

I never said I didn't want to pay for it, I thought it was a lot of money for the amount of time we were actually "seen" - thats all.

Oh, in that case, I guess its ok.:yelgreedy

And the perennial answer is nothing. I might touch him with a sculling oar -- hard, and repeatedly -- for his intellectual dishonesties in Fahrenheit 9-11 and his "expose" on the NRA. Really, MM doesn't do nonfiction... not at bottom. It's not so much that his ass is fat -- it's his head.

You're not paying for the "time" you were "seen" - you are paying for diagnostic services, IE "is this finger broken or not?" - information you needed and could not get on your own. So, you required professional services. To provide the sevices that anyone, at any time, needs to be available, requires massive amounts of resources on behalf of the facility.

Since the finger wasn't broken, maybe you feel your "time" was wasted, IE "they didn't do anything!" The truth is: a team of professional healthcare providers coordinated to provide you with the answer you needed: the finger isn't broken. In hindsight, with the answers provided by the facility via their technological infrastructure and staff of trained professionals, you have the luxury of saying "I waited around for two hours, and they didn't do anything!"

On the flipside, what if the finger had been broken? Would your "time" have been "wasted" then? Hindsight is 20/20.
I would never try to alpha cellarite anyone, I'm a black sheep! But that was funny enough for the Hall of Fame.
...to dick around on The Cellar for half the day...

Also, you essentially ask if our feller dwellers have seen Sicko. NB's asks if we have heard of it, and by now, who hasn't?

I don't understand the video's meaning either. Is it just that it's made documentary style or what?

Flint- I will now take a bow.

Wolf- Are we or are we not (people that pay their bills) eating the cost of healthcare for the people that are uninsured and do not?

1000 dollars a day sounds like a lot to pay........See?..... I can not afford for any of you to drive me mad.....

Thank you for trying to answer some of my questions- but you seem to think that that system is working.......?
You're descriptions only seem to validate what I thought in the first place......

I've not seen it yet as I'm not readily able to get to a theater.

I watched it tonight. I thought it was very good and really raised some interesting points. Also, it briefly featured my political hero (Tony Benn) talking with Moore about the British system. He's a wonderful man. He was the white haired, softly spoken, old English gent.

I've said it before, I'll say it again: I like Moore. I think, his motives are basically good. I believe that he believes in the fight. I believe he has an overarching sense of compassion and humanity and that comes through in his film making.

I found the film very moving. I also found it informative and funny.

Any Good?
 

Is it worth going to see? For those who did see it, how was it? I know that is a real general question for a documentary movie such as this one, but that's the easiest way to phrase it.