P.A.C.E.
Protect All Children's EnvironmentE.M.T. O'Nan, Director
396 Sugar Cove Road
Marion, NC 28752pace@mcdowell.main.nc.us
tel: 828-724-4221
fax: 828-724-4177
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No Free Lunch
Our 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 competition.
- 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 Insurance Commission? 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)?
HISTORY
Between 1940 and 1960 spending on health care in the United States rose from
4% to 5.2% of the gross domestic product (GDP).
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.
1 - 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.
2 - 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.
3 - 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.
4 - 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.
5 - 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.
CURRENT STATUS
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
Medicare.
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 negligence or malractice. If our Insurance cost is to high because of the "so called experts"
playing games with our health, we may even loose our jobs and, along with them, 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 saving.
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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