Comments by "Xyz Same" (@xyzsame4081) on "Former Health Executive Spills The Beans On Industry Lies" video.
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Bud Grimfield he had become cynical as journalist (early on) and then used his talent to make money (in the insurance industry as PR person). Then he became increasingly uneasy, things got worse in the U.S. around 2005. Beginning with 2000 / 2001 a lot of manufacturing jobs were outsourced (China), Bush signed the deal beginning of 2002, and with the good jobs the plans were gone as well.
Not everyone experiences health problems right away, so it took a few years to show. End of 2007 a family with a Mercedes plan (their employer) needed a liver transplant for their 17 year old teenager. Cigna refused to pay. The doctors - at a renowed California clinic - had a liver that was a good match and were ready to go.
She had gotten treatments for leucamia, and had already had a bone marrow transplant. - Now, she wasn't the best of all cases, but her doctors saw a chance, and the plan covered transplants. Cigna's doctor examined the file and decided this was "experimental" and thus not covered.
(the surgery would have cost 450,000 USD, and then of course lifelong expensive medication - provided she would make it).
The family contacted the media and as always when there was a PR "situation" the reporters were connected to Potter, and he got more and more of these calls.
After a few days Cigna gave in because it had the potential to become a black-eye-event (PR lingo), and Potter (as a father) was very glad about the decision.
The doctors meanwhile had to give a pass on 2 good livers. Nataline died 5 hours after Cigna had given the green light, her organs had meanwhile begun to shut down and they could not have done the surgery anymore (not sure if they would have had a liver available for her right away).
Wendell Potter handed in his resignation the next day and left Cigna a few months later. Wrote books, makes speeches, appearances on media (but likely not on Corporate media).
He also testified in 2009 in Congress - not that it helped - the Obama admin did not consider his experiences with the industry.
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@whyamimrpink78 Oh really ? please tell me what advanced care is not available for citizens in France, Germany, Austria, Belgium, Netherlands, Australia .... Airlifts ? the new hepatitis cures or chemotherapies (which are both expensive). Liver transplants ? Brain surgery ?
I saw relatives being well taken care of in intense care, or for months in hospital (intense smoker, sadly toes needed to be amputated).
Or that the doctor upgraded from emergency ambulance (with doctor on board) to helicopter (because no emergency ambulance was available right away). That was erring on the side of caution, it wasn't an immenent heart attack, but a stomach problem.
8 hours drive with a doctor on board (airlift was not possible because of weather conditions). needed reanimation, surgery done (in a specialized hospital), my friend recovered even though it looked bleak that day. Took some rehab and his vocal chords had been damaged when they reanimated him so he needed for that rehab as well and it took more than 1 year to regain his normal voice.
I am pleased to announce he is doing fine and has been enjoying retirement the last 8 years.
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@whyamimrpink78 In the U.S. between 20 and 25 % of patients ration !! insuline. The long term damage of not managing diabetes properly can undo any good spectacular surgery in high-end clinics can do - on a systemic level. The few wealthy individuals are lucky and glad (but it is very questionable the person would not also have gotten excellent care in another first world nation).
There are few conditions / surgery scenarios that rare that you can have treatment only in one country or hospital - and if so it makes sense to BUY the services of the specialists outside the country (after all they will have the case load and therefore the routine. If it would be a common condition / scenario the other first world nations would offer excellent care for it as well).
Also: check out John Oliver's video on dialysis centers. These are the real death panels. Unthinkable ! in other first world countries.
Somehow the "more advanced care" does not lead to better outcomes - think higher life expectancy OR regarding infant mortality (the latter being a good indicator how the system works for low(er) income people.
Healthcare is standards, protocols and large numbers - you have got to get the basics right, the renowed clinics are not going to save the statistics if the country fails to cover the basics for everyone.
Good prevenitve care beats spectacular life saving surgery. Simple care if people have diabetes (or during pregnancy) beats using high tech and having top specialists (ideally a nation has both. solid performance of doctors overall, and the top specialists in the centers.
If a condition is more common it makes sense to train the doctors in it, provide the medication, have the testing for early diagnosis etc. The public non-profit healthcare insurers are often ALSO part of an agency that is responsible for sick leave (the companies pay and after some time the agency kicks in) or for disability.
you tell them a new method reduces stay in hospital, or the patients recover better or faster .... they will be all ears.
These agencies cooperate with the doctors representation, the university clinics, the non-profit hospitals to introduce new techniques, equipment (robots) etc. Of course the pharma industry will contact them to get new drugs on the list.
The hospitals are small and large, the large ones cover the most spectacular (emergency) treatments (severe burns or accidents, organ transplants, sewing limbs or fingers back on, severe cases of heart attacks, neonatal care).
Smaller hospitals provide the general normal care (think towns of 10,000 people and the surrounding area) but they often specialize in one plannable procedure as well. So they get a good reputation for hip surgery, eye surgery, a nice birth station with a personal touch, .... They can fill the beds and improve efficiency. They are non-profits and would be "bailed out" if they cannot stay within the budget - but normally they are expected to stay within their budget.
Getting people to do their yearly checkup when they are older than 50 years does more for outcomes (of the nation, and also the costs) than offering "advanced care" - for only those who can pay.
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The most important CHOICE of CONSUMERS is to NOT BUY at all. - The insurer (be it Medicare or private non-profit insurance orgs, or insurance companies are the gatekeepers to getting treatments. Only rich people could cope well w/o their coverage and take a gamble.
Mark Cuban the billionaire does have an insurance plan, 28,000 for a family plan per year, likely because it is easier admin wise when they come into a hospital or a doctor practice, and the rates of the doctors would be even higher if he paid everything out of pocket.
Since healthcare is a life and death issue, people cannot decide to not have healthcare services (and in practical terms that means insurance coverage).
So if the companies for consumer products / services collude (a few players in the field to "chose" from but ALL charge too much) the consumers can ABSTAIN FROM BUYING. Either because they are not willing to spend that much or because they cannot afford it and have to make do w/o. (if the price is fair, but they can't afford it - same - but it is not a life and death issue).
That restores a lot of power to consumers even if the product is complicated and the other side are powerfull large corporations. Which therefore have an incentive to offer the product at reasonable prices.
Does not work with internet providers in the U.S. (the service leans strongly towards natural monopoly and it shows) - but if push comes to shove a person could only use minimum internet and survive.
The providers in the U.S. for sure exploit their market position. but
a) that could be regulated - much easier to regulate that (if the politicians wanted to) compared to healthcare
(on principle even well intentioned lawmakers and engaged regulators cannot protect the patients / insured as long as the profit motive plays a role in complex scenarios. That is diagnosis, decision about treatment plans. Billing and the contracts also can be made complicated to put the consumers at a disadvantage. In single payer countries the for-profit motive has been removed from every situation with complexity.
b) The internet (or mobile phone or cable TV) service may be too expensive but it is nothing like the high costs in healthcare. Even cost efficient healthcare is expensive in a first world country.
Most wealthy nations need between 5,200 and 5,800 USD per person per year - vs. the U.S. with 10,260 USD - data 2017. "per person" = EVERY person from healthy baby to old person on life support.
So a family of four is to be calculated at 20,000 USD and upwards even if they did not even need the doctor this year. Or more than 40,000 in the U.S.
The spending includes ALL that is spent in the country, by the insured, resp. their insurer, out of pocket or subsidies by the government. Medicare needs lots of support because they have the most costly age group. (So the private insurers have already a cherrypicked pool. Only people between 0 - 64 years.) the lifelong contributions for Medicare deducted from the wage are not enough - certainly not with the high costs in the U.S. system (the rates that Medicare has to pay).
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The most important CHOICE of CONSUMERS is to NOT BUY at all. - The insurer (be it Medicare or private non-profit insurance orgs, or insurance companies are the gatekeepers to getting treatments. Only rich people could cope well w/o their coverage and take a gamble.
Mark Cuban the billionaire does have an insurance plan, 28,000 for a family plan per year, likely because it is easier admin wise when they come into a hospital or a doctor practice, and the rates of the doctors would be even higher if he paid everything out of pocket.
Since healthcare is a life and death issue, people cannot decide to not have healthcare services (and in practical terms that means insurance coverage).
So if the companies for consumer products / services collude (a few players in the field to "chose" from but ALL charge too much) the consumers can ABSTAIN FROM BUYING. Either because they are not willing to spend that much or because they cannot afford it and have to make do w/o. (if the price is fair, but they can't afford it - same - but it is not a life and death issue).
That restores a lot of power to consumers even if the product is complicated and the other side are powerfull large corporations. Which therefore have an incentive to offer the product at reasonable prices.
Does not work with internet providers in the U.S. (the service leans strongly towards natural monopoly and it shows) - but if push comes to shove a person could only use minimum internet and survive.
The providers in the U.S. for sure exploit their market position. but
a) that could be regulated - much easier to regulate that (if the politicians wanted to) compared to healthcare
(on principle even well intentioned lawmakers and engaged regulators cannot protect the patients / insured as long as the profit motive plays a role in complex scenarios. That is diagnosis, decision about treatment plans. Billing and the contracts also can be made complicated to put the consumers at a disadvantage. In single payer countries the for-profit motive has been removed from every situation with complexity.
b) The internet (or mobile phone or cable TV) service may be too expensive but it is nothing like the high costs in healthcare. Even cost efficient healthcare provided by a system with public non-profit players (insurance agency, hospitals) costs a lot in a first world country.
Most wealthy nations need between 5,200 and 5,800 USD per person per year - vs. the U.S. with 10,260 USD - data 2017. "per person" = EVERY person from healthy baby to old person on life support.
So a family of four is to be calculated at 20,000 USD and upwards even if they did not even need the doctor this year. Or more than 40,000 in the U.S.
The spending includes ALL that is spent in the country, by the insured, resp. their insurer, out of pocket or subsidies by the government.
Medicare needs lots of support because they have the most costly age group. (So the private insurers have already a cherrypicked pool. Only people between 0 - 64 years.) the lifelong contributions for Medicare deducted from the wage are not enough - certainly not with the high costs in the U.S. system (the rates that Medicare currently has to pay).
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The most important CHOICE of CONSUMERS is to NOT BUY at all. - The insurer (be it Medicare or private non-profit insurance orgs, or insurance companies are the gatekeepers to getting treatments. Only rich people could cope well w/o their coverage and take a gamble.
Mark Cuban the billionaire does have an insurance plan, 28,000 for a family plan per year, likely because it is easier admin wise when they come into a hospital or a doctor practice, and the rates of the doctors would be even higher if he paid everything out of pocket.
Since healthcare is a life and death issue, people cannot decide to not have healthcare services (and in practical terms that means insurance coverage).
So if the companies for consumer products / services collude (a few players in the field to "chose" from but ALL charge too much) the consumers can ABSTAIN FROM BUYING. Either because they are not willing to spend that much or because they cannot afford it and have to make do w/o. (if the price is fair, but they can't afford it - same - but it is not a life and death issue).
That restores a lot of power to consumers even if the product is complicated and the other side are powerfull large corporations. Which therefore have an incentive to offer the product at reasonable prices.
Does not work with internet providers in the U.S. (the service leans strongly towards natural monopoly and it shows) - but if push comes to shove a person could only use minimum internet and survive.
The providers in the U.S. for sure exploit their market position. but
a) that could be regulated - much easier to regulate that (if the politicians wanted to) compared to healthcare
(on principle even well intentioned lawmakers and engaged regulators cannot protect the patients / insured as long as the profit motive plays a role in complex scenarios. That is diagnosis, decision about treatment plans. Billing and the contracts also can be made complicated to put the consumers at a disadvantage. In single payer countries the for-profit motive has been removed from every situation with complexity.
b) The internet (or mobile phone or cable TV) service may be too expensive but it is nothing like the high costs in healthcare. Even cost efficient healthcare is expensive in a first world country.
Most wealthy nations need between 5,200 and 5,800 USD per person per year - vs. the U.S. with 10,260 USD - data 2017. "per person" = EVERY person from healthy baby to old person on life support.
So a family of four is to be calculated at 20,000 USD and upwards even if they did not need the doctor this year. Or more than 40,000 in the U.S.
The spending includes ALL that is spent in the country, by the insured, resp. their insurer, out of pocket or subsidies by the government.
Medicare needs lots of support because they have the most costly age group. (So the private insurers have already a cherrypicked pool. Only people between 0 - 64 years.) the lifelong contributions for Medicare deducted from the wage are not enough - certainly not with the high costs in the U.S. system (the rates that Medicare has to pay).
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