My insurance won’t pay for the doctor I want
As he tries to put to rest several outrageous lies about health care reform, President Obama has said repeatedly that consumers who already have a health care plan they like, can keep it. And you can continue to choose your doctors. No one is going to interfere with the relationship between you and your doctor, he says.
Unfortunately, the president isn’t quite telling the truth. He’s fudging a bit. The simple truth is, he can’t guarantee that you get to keep your insurance. Under certain conditions, you could lose your insurance today, without health care reform. That’s the way the system works.
Nor can he guarantee that you get to choose your doctor. You don’t get to choose your doctors today, without health care reform. That’s the way the system works.
Let me illustrate with a personal example. First off, let me say that The Atlanta Journal-Constitution provides a pretty comprehensive health insurance plan. We are self-insured. The plan is managed by Aetna. And Aetna, like most big companies, negotiates with a group of doctors for certain rates. Those doctors are called “in network.” If you want to go outside the network, that’s fine. But prepare to pay heavily out of pocket for the privilege.
Having just relocated to Washington, I have to find a new pediatrician for my infant daughter. I sought recommendations from several acquaintances, and the same name came up repeatedly. (I’ll just call her Dr. Amy.)
I called Dr. Amy’s office and was given an immediate appointment. But I was also told she is “out-of-network” for Aetna.
Called Aetna. They explained I would pay several hundred dollars a year extra for the privilege of taking my baby girl to Dr. Amy.
So, I called another pediatrician who is “in-network.” She said she could see my baby at the end of October.
I have a choice to make: Pay through the nose for a highly recommended doctor who can see my baby immediately. Or, go to the doctor my insurance will pay for, which would mean my child would run months behind on her vaccination schedule. This isn’t a disaster, but it is certainly frustrating.
I think the president has been fudging on the absolute truth about your relationship with your insurance and your doctors under his proposals because he wants to satisfy those people who have perfect health insurance right now. I wonder how many people that could possibly be.
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108 comments Add your comment
Bobby McGreevey
August 25th, 2009
12:27 pm
435, I’m guessing.
Jen
August 25th, 2009
12:45 pm
Congratulations on having your daughter (by however means you expanded your family)! Welcome to the simulataneously terrible and delightful world of Parenthood!
And yes, I knew all that. And, like you, I am covered well enough and make enough money that this sort of thing isn’t a disaster.
But I am lucky.
Joey
August 25th, 2009
12:49 pm
I had an email conversation with Mike King, who was an Op-Ed Page writer at AJC until a couple of months ago. Our discussion was about Health Care and Insurance. I loved my insurance company he hated his, Aetna. He wanted National Healthcare now. I did not.
Why did he and you and everyone else at AJC fail to insist that your employer find a better insurance company? What is wrong with you people?
You all are so good at telling anyone and everyone what they should do. But you cannot even stand up for yourselves.
Why would we take your advise? Why?
norman ravitch
August 25th, 2009
12:54 pm
Cynthia: if you want to go outside your network you should pay more. Some doctors don’t accept payment from certain insurance companies because they get less than they believe they deserve.
stands for decibels
August 25th, 2009
1:28 pm
I loved my insurance company
If you did/do, Joey, you’d be the first human being on the planet that I’ve met who’s said that.
Chris Broe
August 25th, 2009
1:42 pm
My doctor tried to claim he was “out of network” concerning my condition once……….once.
Jim morrison
August 25th, 2009
1:47 pm
Again, another plug for the Socialist & Racist reporter at the AJC.
Songbird
August 25th, 2009
1:49 pm
I also work for a large, self-insured company and have a similar health plan only it’s managed by United Healthcare. You are exactly right about going out of network. It costs you, but sometimes its worth it depending on the doctor and the treatment needed. I would only do it if I felt the doctor/treatment I needed was worth the extra cost, i.e., is it life threatening to wait.
Everyone screaming about keeping the gov’t out of the healthcare and having the decision of treatment be just between them and the doctor is naive or stupid, because the insurance company is making the ultimate decision on what they will pay for. If you want something done anyway, then you can pay out of your pocket if you can afford it.
Duh
August 25th, 2009
2:00 pm
Help. Please. I need my gubment to save me!!! I’m too stupid to do it myself.
theROOSTER
August 25th, 2009
2:05 pm
That is exactly the point. That is called the free market. You are not prohibited in any way from seeing ‘Dr Amy’. You will just have to pay more to do so. The difference is that under the government plan you will not have that option. The government system will likely resemble what is currently in place for our military. You will be assigned a physician based upon your social security number, or some other type of unique identifier. Please talk to some of these Vets that have been in this system. It’s terrible. Most of the military doc’s are great, if you ever get a chance to see them.
Obama is right. Sort of.. Competition does lower prices. So, why not create a marketplace in which we can choose our coverage in the same manner as we choose our car insurance? First we have to get away from the employer provided insurance and go to an individual purchasing system. We let the consumer buy insurance across State lines in order to create more competition in the marketplace. There are literally thousands of providers around the country to choose from. You like government? Great. We will let them come up with three different plans. One that covers only emergencies, another with a PPO type system that covers emergencies + primary and preventive care, and then a third “platinum” type coverage for those who can afford it. The market can decide what price each of these plans will be and the individual can choose based on that price and comparing it with other companies. Higher risk patients, (like higher risk drivers) will pay more.. That’s how it is. How hard is that?
ctucker
August 25th, 2009
2:11 pm
Rooster, I’m a bit confused. Couldn’t a soldier also see the doctor he chose if he paid for it himself? Does the military strictly prohibit its personnel from paying for the own care?
Tea
August 25th, 2009
2:18 pm
Can one of you Einsteins with perfect health insurance explain to me how you have been able to obtain it? I am apparently one of the people who are too frieghtened, intellectually deficient and/or uninformed to be able to obtain it for myself. Either that or I’m just not rich enough to have perfect health insurance. Which is it?
Fitzgerald
August 25th, 2009
2:19 pm
Cynthia:
Thanks so much for describing the exact health care plan that will be in place if the current health care reform is passed. Nothing different, except you will be told by the government who to see, how much to pay, and how long it will be until you see a doctor. Good luck with that.
Tea
August 25th, 2009
2:28 pm
If health care in England (for instance) costs less than half as much per capita as the US, and English people enjoy better healthcare, what’s wrong with changing our system to be more like theirs ? (I’m defining “better” as a longer life expectancy, higher satisfaction rating and easier access to doctors). If we had that system now, the cost savings just THIS YEAR would MORE than pay for all the financial system bailouts. Imagine an extra 1 Trillion dollars a year the government could spend on education, research and tax reductions.
Truth
August 25th, 2009
2:28 pm
WOW…. Mrs. Tucker didn’t bring race into this column!
Deeeetroit
August 25th, 2009
2:29 pm
Hey Rooster you are right but why should I be forced to give up my employer provided coverage where I pay only a couple $$$ per pay and I have great coverage and I can see my DR. when I want, to be forced into some government run insurance where I will definitely recieve less and no doubt pay more. And you can’t compare car insurance to health insurance, Health is much much much more expensive and who has that type of money to pay for higher costs because you may be of a higher risk . Because I some how got cancer I should be forced to pay more obviously I would be considered a high risk through no fault of my own, I did not smoke but I happen to get cancer( which thank god I don’t have I was just using the scenario as an example) be categorized by what they can afford to pay for. There is no way this country can afford to pay for everyone to be insured and it not having any affect on the coverage I receive now with my employer.
RealityKing
August 25th, 2009
2:32 pm
Is Obama going to force Dr. Amy into the government option’s network?
Of course not, she and most other highly recommend doctors are not going to take part in the government option’s network because they will be paid less for their highly recommended services. In fact, they will end up catering to the rich and self-appointed elitists, like Cynthina, who can afford to pay those high out-of-network costs.
And don’t bet on keeping your private plan either. Because companies shop around for the most cost effective coverage each year. And you can bet that most companies will be forcing their employees onto the cheaper government option to save themselves few bucks. Especially liberally run organization that are prompting it like the AJC. The government option is the only option in their progressive eyes. And if you don’t like it you can just find another job(Good luck in Obamaville).
Which means Obama is telling nothing short of a bold face lie when he repeatedly says that Americans can keep their current plan and doctor if they so choose. Because the fact is, the average American will be forcefully scuffled into a government controlled HMO by emploers looking to save a few bucks, Where costs, and therefore quality, are regulated by politicians, not doctors.
Good to see you finally realizing this Cynthina..
dr oz
August 25th, 2009
2:38 pm
this is all moot. President Obama and his boys are about to fold on this whole deal. The insurance companies just haven’t hit the majic number yet. $$$
Tea
August 25th, 2009
2:46 pm
That’s what I think too oz. Rather than healthcare reform we’re just going heavily subsidize the existing system with tax dollars. Big Pharma has kicked in their nickle. Maybe it’ll cost HC ins companies half a buck. From where I sit, Obama has sold us out on HC reform.
RealityKing
August 25th, 2009
2:50 pm
Next time you in town Cynthina, you should take you new baby down to the Grady emergency room and see how long it takes you to see a qualified pediatrician. That’s what Obamacare will certainly bring to the majority of Americans. Which of course doesn’t include you or me, the self-appointed elitists among us who can afford the high out-of-network costs. But you should still experience what you’re advocating.., at least once.
Daniel
August 25th, 2009
2:57 pm
The key phrase is, You get to choose. Find a doctor that is willing to accept what you are willing to pay for your child’s care. Ask yourself this question, where do you get your hair cut? It is your decision. If someone is at the top of their field, why should they expect to be paid less than what they are worth? This conversation actually has nothing to with insurance, but your ability to provide the best care for your child. Find an employer with the best networks, but look inside yourself first
Tired of BS
August 25th, 2009
3:01 pm
Mrs. Tucker I am surprised that you would choose Obamacare. You think it’s difficult to deal with finding a pediatrian now…. just wait ’til your man controls everything. You will have a nice long wait before you are able to see a doctor. Go ahead and keep wishing…. and pray your baby never gets sick.
Tea
August 25th, 2009
3:05 pm
Well, in traditional capitalist system that would be true Daniel, but like many, many American industries, the Healthcare industry does not provide enough competition to support “normal” supply and demand market behavior. This is a fundamental point that is not receiving enough focus in our country’s healthcare debate. The reason HC is so expensive is because our system has many unnecessary layers of non-caregiving middle men who inflate the overall cost. We are paying for their profits, not for healthcare. If we were just paying for healthcare the cost would be orders of magnitude less that what it currently costs us.
bob
August 25th, 2009
3:07 pm
Tea, you said we could save a Trillion by switching to gov healthcare and then tell us what GOV could do with that money. What is the use of putting my healthcare in the hands of gov if they are going to spend the money anyway.
bob
August 25th, 2009
3:10 pm
Tea, you asked what your problem was in finding good healthcare and gave a few examples. After reading your posts, I would go with the intellectually deficient.
theROOSTER
August 25th, 2009
3:37 pm
ctucker,
Yes, in most instances military members are allowed to seek private care if military care is unavailable. Some remote locations do not have military hospitals, or may not provide some specific type of assistance the member needs. There is also nothing to stop a military member from purchasing their own private insurance. However, if a military member were to seek out a private doctor on their own, the would likely have to pay out of pocket for that care, unless the visit was pre-approved by Tricare or the member’s PCP.
D-troit,
You are missing the point entirely.. You don’t want to be dependent on the gov’t for healthcare, yet you are totally dependent on your employer. Why can’t you be self-sufficient and research and purchase your own plan. Maybe your employer would let you keep your plan.. That’s fine. But, why is your health the responsibility of anyone but you? Does your employer pay your homeowners insurance?
And yes, you can compare them. The free market way we buy auto insurance is a great template. The govt could still play a roll by mandating coverage for each specific plan. For those below the poverty line, a tax credit is given for the amount equal of the basic care plan.
Duh
August 25th, 2009
3:38 pm
Your choice, if you are a decent parent, is to sacrifice something else so you’ll have the extra “several hundred dollars a year” to see the doctor you want in the timeframe you want.
Just cancel your cell phone, don’t eat out so much, don’t get your hair and nails did. It’s easy, really.
The Last Believer
August 25th, 2009
3:38 pm
Dang, I wonder how civilization survived up until now. How did they manage it for all these centuries? What? What was that I just heard someone mumble under their breath? “Be responsible for yourself?” “Act mature?” “Work hard?” “Accept the consequences of your stupidity and move on with your life?”
What do these mean, insensitive statements mean? I need a handsome, smooth talking politician to help me figure out my life and to make everything okay for me. After all, I deserve to be taken care of. Other people have more than me, and it’s not fair.
So, somebody go fix my healthcare, because it’s not my responsibility to get an education, a job with benefits or take any responsibilty for my actions.
There, I feel better now.
Jackie
August 25th, 2009
3:40 pm
Cynthia’s dilemma is why a single-payer system is needed.
If everyone were part of the same risk pool, then it would not matter which doctor you choose because they would be compensated by the system for services rendered.
HMO, PPO and HSA are methods set up to provide a means of selection by the insurance company to help “control costs.” The insurance company has negotiated with the doctors and hospitals for the amount the will be compensated for specific services. If someone with another carrier that has negotiated a different rate will be charged for the negotiated rate of that carrier.
Essentially, doctors and hospitals are sub-contractors of the health insurance companies.
Larry
August 25th, 2009
3:53 pm
Don’t let the facts get in the way people, just keep spreading the GOP lies!
No one can say what is in the new heath care bill, because there is NO bill. Several proposals are floating around, different bills but nothing you can say is final. How can another choice be so bad?
We know the insurance companies have been raping and robbing us for the last 50 years and it will never get any better without some competition. Why are the insurance companies so afraid of competition? What happened to the Free Market System? If we have the best system in the world how could a public OPTION hurt anything?
I have what is considered a good employer provided policy, but it cost more and covers less every year. The insurance companies have had their chance and failed miserably!
RealityKing
August 25th, 2009
3:53 pm
The funny thing is that I too have Aetna with my company. An insurance that is accepted by our highly recommended doctors. In fact, insurance that worked well for us the Sunday before last when my 3 year old woke up at 4 am with a very high fever. We cooled him down a bit with ice chips and immediately called the 24hr on-duty nurse. Yes, private insurance provides that service. And she was great, graciously calling us back twice for updates before finally calling at 8:30 with a 10 am appt, for our highly recommended pediatrician. Needless to say.., we had a prescription for antibiotics by 10:30, filled and administered by 11. You see strep throat is a nasty virus for young children, one that can be very debilitating if not treated quickly.
But I am not fooled by a nurses graciously soothing voice. I know high insurance premiums are the only thing that enables this type of quality service, for 85% of America. A quality of service no government controlled entity could/has ever afforded in any format. A quality of service that Obama can now only hollowly promise with words elegantly read from his teleprompter. No.., I am not a fool for Obamacare.
theROOSTER
August 25th, 2009
3:56 pm
Jackie,
Why are we all apart of the same risk pool, when we do not all carry the same risks. Why should you you be forced to pay for someone elses rehab, when it was their own bad decisions that landed them there?
A single payer system leads to rationing. That is simple supply and demand. There will be way too many patients and not enough providers. That’s the hard truth. Can you imagine having the swine flu in a single payer system? Everyone with free healthcare? Everyone with a sniffle will be lined up outside an emergency room preventing those who actually need treatment from getting it.
gttim
August 25th, 2009
4:00 pm
Funny, my dad has government insurance. It is called Medicare. He chooses what doctor he wants to see. He has had all his treatments covered. He has supplemental insurance from a private company to pay for whatever Medicare does not cover- deductibles, co-pays and excess. Never once has the government dictated treatment to him or his doctor. After having private insurance for decades, he loves his government insurance.
The military system somebody is tossing around here is not what the public option will be, The public option will pretty much be Medicare for everyone, which is an idea I love! My work provided insurance pays very l little, refuses to pay for people’s treatments, has outrageous deductibles and is overly expensive. I will gladly pay premiums for the pubic option, while you will be free to keep your private insurance and you own doctors.
Cutty
August 25th, 2009
4:01 pm
Some of you people are absolute morons. Some of you don’t even have health insurance but will defend the industry to the end. Costs have risen, people pay premiums for years and then get dropped when they become sick, yet some of you would rather do nothing. Republicans are now opposed to any cuts whatsoever to Medicare even though that is the fiscally correct thing to do so the program will be around when I retire. So no you people were against socialistic medicine before you were for it. Nothing but politics. Republicans have been in control of Congress and the White House for much of the last 20 years and have done nothing to curb the skyrocketing costs. I have employer-based insurance and pay over $500/ mo for a family of four. In the span of a year, we may go to the doctor a total of 10 times. Its a complete rip off and you turds are defending it. Then will complain in 2012 that Obama didn’t try to do anything to address the problem. Enjoy you increasing health care costs, which surely will rise in the next few years if nothing is done. You people deserve it.
gttim
August 25th, 2009
4:03 pm
Of course, can anybody tell me what the private insurance company ads to the health care equation for their 30% take of medical spending? What do they do to make people better? What do they do to make health care more affordable? What do they do to health care more available? What do they do to earn 30% of health care dollars?
rdh
August 25th, 2009
4:07 pm
Do you really believe that, under a government option, you will get to see any doctor you want? And what if all of us want to see the same, best doctor in a given geographic area or specialty? (Who is the best doctor in Atlanta? That is the guy I am going to see under a government plan!) We can’t all go to the same heart specialist or pediatrician. There will be rules and limitations, and anyone who can’t see that is dreaming. Cynthia, everyone will want to see Dr. Amy when this is all said and done, so her time and patients will be determined by a government panel.
rdh
August 25th, 2009
4:11 pm
gttim – Medicaire is broke. Spare us using IT as a model for a government run plan
Cutty – The Republicans don’t get a say in this. They were told by the president that he doesn’t want to hear from them, and their ideas are not allowed on the House floor. You can’t blame the Republicans for lack of support if you won’t even listen to what they have to say
the evil rich
August 25th, 2009
4:25 pm
Cynthia, how much does the DNC pay you for this propaganda?
tj
August 25th, 2009
4:38 pm
Medicare is going broke, what to you think will happen to a public option ?? Say NO to healthcare Reform!
Joey
August 25th, 2009
4:54 pm
dB: I do.
Jay "Numbnuts" Bookwoman
August 25th, 2009
5:47 pm
Hmmm, I find it hard to believe there are only two pediatricians in DC. Furthermore, I find it hard to believe that you can’t find a DR. (to your liking) within your network, that can get your baby in sooner. Here’s a novel idea – refuse your coverage through your employer and Aetna and GO BUY YOUR OWN INSURANCE. YOUR BABY IS WORTH IT RIGHT?!?!?!?!?
Jay "Numbnuts" Bookwoman
August 25th, 2009
5:54 pm
Here’s another thing to chew on… What makes you think that those highly sought after doctors are going to stay in the governments network? After a few times of the government telling the doctors what to charge – they will bolt. You will see many not excepting any insurance period and we will have to pay out of pocket. So guess what? Those sought after doctors will still be out of reach for you SINTHIA.
Jay "Numbnuts" Bookwoman
August 25th, 2009
5:57 pm
“accepting” not “excepting”
Eddy
August 25th, 2009
6:19 pm
If there is a doctor that you want to see Cynthia but is not in the network, pay for the doctor’s visit out of your pocket. I had Cigna. My oncologist referred me to a surgical-oncologist for a consultation. Doctor did not take Cigna. I escalated this to the patient advocate within Cigna to no avail. So I called the surgeon’s office, explained what I wanted (a consultation for cancer surgery) and asked what the cost of visit was going to be. I went, had the consult and paid for the visit. What’s so hard to figure out? You are supposed to be the adult. Your baby is the infant. Act like an adult and quit making a fuss over a non-issue. If you believe that Obama’s plan is going to be the answer, you should seek help immediately. Dr. Amy could refer you to an in-network shrink or one that is out of network and you can then choose. Only two choices…in or out. One’s cost is a copay the other’s cost will be significantly more.
In the Middle
August 25th, 2009
6:26 pm
If the status quo is the way to go, then what’s wrong with this picture:
Laid off a year ago (real estate/architecture), go on COBRA. Still no jobs around, so we start new businesses (great! – how American, right?). COBRA will run out so we shop for individual coverage (because we’re willing and able to work and pay for it, and the new businesses don’t qualify for group insurance). Only to find out that company after company refuses to cover our 7 year old daughter. At all. Why? “Too many UTIs”. WHAT??? There’s nothing wrong with her. We even paid ourselves to have her kidneys tested to prove this. We are told that the companies calculate that the cost of her going to the doctor a couple of times a year to get a prescription for antibiotics exceeds the premiums they would collect. So we say “fine — we’ll pay for her UTIs”. And they say, “No, sorry. No insurance for her.” This goes on for nearly a year. So we faced having to let her go without insurance for 6 months until she becomes eligible for PeachCare. Thankfully, we found a company to take her. Never mind the fact that we could pay a healthy mortgage with the premium.
The problem with the “individual private market” is that the risk pool is not large enough to entice them to accept even healthy children. People are hopelessly tethered to getting their health insurance from an employer. Way to stifle entrepreneurship! Why would anyone jump from a McJob to start their own company if they had a family and knew that it potentially meant health care calamity? Someone who supports “the current system” needs to address this scenario with a compelling argument.
I Report/ Vast White Wing Conspirator (-: You Whine )-:
August 25th, 2009
6:39 pm
Wait a minute, I thought babies were a wanton destruction on the “environment?”
Now a lib wants to care for one?
I’m so confused.
Mine
August 25th, 2009
6:47 pm
“He’s fudging a bit.” Cynthia – how dare you speak negative about “The One”. One can now only surmise that you’re racist!!!
luckydog
August 25th, 2009
6:54 pm
There are only 2 pediatricians in DC? Only 1 on your plan? You got a sorry plan!
tonya williams
August 25th, 2009
6:57 pm
I wish this was the biggest problem I had. Thanks to the wonderful insurance commissioner of Georgia, I have an “enhanced conversion policy” which means that since I came off Cobra in July, and the fact I can not get private insurance due to pre-existing medical conditions, I am not eligible for the state mandated plan which would cost me around $500 a month. Instead, my “enhanced” coverage cost me $26,000 a year, and no that’s not a typo. Also, I get no benefit of a prescription drug card or reduced benefit costs from doctors or hospitals. How convenient, that way I’ll reach my lifetime limit of 2 million dollar much quicker. Who was the policy enhanced for? Cigna. Just ask our insurance commissioner how much he received from them in political contributions. People have no idea the turmoil that is going to happen when Cobra expires for so many of the people who have relied on it, or what will happen to the people who have been forced to take early retirement and won’t be able to purchase health insurance. If you don’t think this problem is going to affect everyone, you are in for a big surprise.
Arthur Blank
August 25th, 2009
7:13 pm
Wheres the father? He cant help pay? Do you know who the father is?
In the Middle
August 25th, 2009
7:38 pm
Tonya -
The problem is that people like us don’t come up in this sordid debate. It is just assumed, and sometimes even stated, that anyone who has any difficulty with health insurance is either in this country illegally or is too lazy to get a job. Then it becomes a rant about what “society” owes or doesn’t owe to such people. Cable news needs to stop giving microphones to this nonsense (which just gives the blowhards on both ends of the spectrum a soapbox) and start covering the stories like mine and Tonya’s — because she’s right. Before too long it may be you in these shoes. We’re letting the focus of this discussion get away. There are real problems with our current health insurance infrastructure for *working* U.S. citizens who don’t think we’re owed a free lunch. Can someone PLEASE talk about this?
Southern confederated Taliban GOP
August 25th, 2009
7:54 pm
They (GOP) will not listen to reason. Did they ask us if we wanted this war? or how much it will cost? But when it comes to bombs and guns they will spend money like crazy. all on the Ole credit card. But when it come to helping people on health care and making insurance company do half azz they rise holly hell. health care is raising 3 time the rate of inflation and the bone heads wing nut want it to stay the same. reasoning? 51 votes in the senate 218 in the house time to end the madness. The blue cotton ball blue dog are 007 republican. why vote for them as a Democrat when they are 007 republican never again (public choice or you are gone. vote for us or we will vote for some one else are not vote at all. Democrat have no balls at all. I do say the GOP stand together even when they are wrong as hell, they GOT BALLS!!!!
Dem”s Ball less wimps!! stand you up and win wimp out and you clowns are guaranteed to lose bank on it!!
Ron
August 25th, 2009
8:10 pm
If Cynthia implies she only has a choice between Dr. Amy and the in network Dr. that can’t see her child until end of Oct. let’s at least act as though we believe that. It makes as much sense as the remainder of the article.
EJ Moosa
August 25th, 2009
8:46 pm
“I want to see the doctor I want at the price I am willing to pay”.
Who owns who in this scenario? 21st Century Slavery is on the way.
stands for decibels
August 25th, 2009
8:50 pm
Now a lib wants to care for one?
Don’t confuse the mother who writes this column for yours, Andy.
Dr. R
August 25th, 2009
8:58 pm
You still have a choice in doctors; you just don’t get to choose what you pay. Just as I don’t get to choose what I pay when I shop for a Cadillac instead of a Ford Escort. You have options. You could change jobs. You could buy private insurance. Or you can pay out of pocket. All are options, even if you don’t like them. On the other hand, when government taxes pay for our health care, which doctor you go to might be the ONLY choice you get. Provided she even stays in practice, which she might not if there isn’t ehough money in it to justify years of medical school and sacrifice. Bottom line is, you want choice and cheap health care, and you want me to help you pay for your daughter’s doctor visits, which I would be doing under a taxpayer-funded plan. I won’t ask you to buy my food, my shelter, my clothing or my Goody’s powders, so don’t ask me to pay for yours.
theROOSTER
August 25th, 2009
9:01 pm
In the middle,
I don’t think that anyone is arguing that the current system is perfect. I think that this argument has transcended healthcare. Our government is looking to redefine the role it plays in the lives of everyday citizens. As a libertarian, I tend to believe it is simply not the role of the federal government to provide you or your daughter with healthcare. That is your job. It is the role of government to regulate markets in such a way that it does not give favor to a single company or group of companies. Healthcare insurance companies have spent billions of dollars in campaign contributions to entice congress to pass regulation that limits competition. Right now you are not allowed to shop for insurance in Florida where you may find better rates, or someone who is willing to accept your risk at a lower cost to you. As a business owner, you are not allowed to pool through your local chamber of commerce and buy health insurance as a group. Why not? Those seem like perfectly acceptable free market solutions that would lower both cost and risk to insurance companies. In a free market there will always be someone whom is willing to accept risk if there is some chance at reward. It’s called an investment.
There certainly does need to be radical reform in health insurance, but not in the form of a government takeover. Government is the problem, not the solution. A single-payer system in a society where only 64% of citizens pay income taxes is not only unfair, but also unsustainable. Why should we require this 64% to shoulder the burden of the 36% whom don’t even pay into the system in the first place? Our projected total deficit in 2019 has expanded to $9T without Healthcare reform. Add on another $1T if this legislation is passed. That’s insane! We need radical change in the size of our government.
dj
August 25th, 2009
9:06 pm
Is it possible that you could have found another doctor? I doubt there are just two in Washington.
Danforth
August 25th, 2009
9:10 pm
Tonya and In the Middle, that is exactly the problem. Everybody says shop around for the best plan, but you end up seriously coming out the pocket. I hate insurance. Auto, life, and health are nothing but a rip off because when you need them, they mess you over. And yet so many people on here defend these lousy industries. If you get in an auto accident, you still pay 500 dollars of a deductible. You go to the doctor, and you still pay a deductible. What is wrong with this picture?
Jay "Numbnuts" Bookwoman
August 25th, 2009
9:14 pm
You should have thought about the healthcare issue for your child before you had it. If you can’t take care of your offspring, you shouldn’t have had them.
Dr. R
August 25th, 2009
9:17 pm
To expand on Rooster’s comments, the health care debate is indeed the tip of the iceberg in a bigger debate: Just how much freedom do we really want? True liberty offers no guarantees: you enter the cold, cruel world alone and succeed or fail on your own skills, hard work and luck. Many of us are willing to take our chances with freedom. To others, it is simply too scary to go it alone, so they want society (i.e., government, i.e., taxpayers) to ease the path as much as possible. Their security if more important than their liberty.
Jay "Numbnuts" Bookwoman
August 25th, 2009
9:18 pm
Danforth – You could have zero deductible if you told the insurance companies that you were willing to pay more in premiums… alot more. Deductables are in place so that you may have lower premiums. If you don’t use your insurance you don’t pay a deductible. People by general nature abuse insurance. Everyone thinks just because they have it, that they can use it for ANYTHING and EVERYTHING. That’s not what it’s for.
Jay "Numbnuts" Bookwoman
August 25th, 2009
9:30 pm
Since Sinthia is soooo destitute, I’m sure she and her child can qualify for an existing government run program that can immunize her child fairly soon. Fascinating how, she only now thinks about her child’s shots. What happened to thinking ahead?
Dr. R
August 25th, 2009
9:39 pm
Anyway, CT, you shopped for a doctor the way people shop for other products they need. Why can’t we do that for insurance? Frankly, the model that ties us to what our employer offers is outdated and should be replaced by an even freer market. Does the AJC (I’m sorry, the DJC) provide your car insurance? Your home insurance? Your pest control? So why is health care something apart from every other free-market commodity? The answer is because someone — Ted Kennedy maybe — decided a few years ago that it was “a right” and therefore set apart from everything else we buy on our own. If we turned loose of that notion and reformed how we get insurance on the market, we might get more choices and lower costs.
zinkit
August 25th, 2009
10:21 pm
Hope we all understand that health care is going to cost us $$$….PERIOD….get over it..you either pay insurance or you pay taxes/higher insurance preminums/lower medicare pays or higher deductables… for all those going to the ER that do not carry insurance…PERIOD
zinkit
August 25th, 2009
10:23 pm
Bobby maybe 535 + 2…lol
Just because
August 25th, 2009
10:59 pm
Being such an influential person as yourself why didn’t you ask the doc that was so highly recommended and out-of-network if he would accept the network rate. . . you might be surprise; he might of agreed to do so for you . . .since you are such a influential person.
George P Burdell
August 25th, 2009
11:17 pm
I do have “perfect insurance”. My company, a very large software company. Ok, THE software company provides our insurance through Blue Cross Blue Shield. We don’t pay for anything ourselves. No monthly payroll deductions, no co-pays, no differences for in or out of network providers. I’m blessed to work for a company who is willing to pay the premium cost of that level of insurance. I’ve worked for other companies who provided varying levels of coverage. In every case, it’s what the company decides they can afford that determines how good the benefits are for you. As previous posters have stated, you have a choice of who to see. The difference in cost between a “preferred” provider and the one you want to see is yours to bear. You have other options such as changing jobs, trying to get your employer to negotiate a better deal with their provider, using a health spending account to pay out of pocket expenses with pre-tax dollars (if your employer offers such a plan).
Under a national health care plan’s provider, you have no choices or options.
Your personal example is also a very weak one and not atypical. Most of the in-network providers are booked up because they are willing to discount their services and thus attract a lot of patients, especially new ones like yourself. They are seeing a high volume of patients to make up for the lowered rates. The less busy ones probably are that way by choice. Not all physicians want to see a large volume of patients.
Oh, one other thing, the local health department probably provides vaccinations on short notice. But you’ll be down there with all the hoi polloi which probably isn’t your cup of tea.
In the Middle
August 25th, 2009
11:32 pm
Rooster, thank you for raising very pertinent issues. What you say about small businesses being allowed to pool through Chambers of Commerce is right on the money (also alumni associations and other groups). But what you are objecting to after these cogent observations is a totally run government health care system, which is something that’s NOT on the table (but people have sure been led to believe otherwise). I do NOT favor a single payer system. But two months ago when I couldn’t find a private company willing to insure my whole family I absolutely would have considered buying coverage from some form of government insurance, just to keep coverage going until I could get something better. Not because I want someone else to pay my bills (I can pay them myself, thank you), but because the private companies WOULDN’T SELL IT TO US! They knew they could reject her, and we’d have no choice but to let her go uninsured or do one of the insane “conversions” Tonya mentions — either way they get to jack us up to the tune of whatever suits them. Now, if they knew that I could go buy (yes, I said BUY, not “get for free”) coverage for her from a government entity, don’t you think they would have whistled a different tune? Charged us a little more than “standard” maybe, but I think they would have been willing to actually sell us a family policy if they knew I had options. And I personally would be willing to pay more to buy the private insurance if it offers the coverage I’m looking for. People talk a whole lot about being able to “shop around”, but right now you really can’t. It’s either employer-based plans, or individual policies. Try shopping around for an individual family policy if you have a child with asthma. You won’t get one (they’ll cover everyone except that child).
Here’s what I don’t understand: why does what I suggest here, about having the option to purchase insurance from a state or fed group equal “single payer system”? Why is this greeted with such profound paranoia? (NOT accusing you of being paranoid, Rooster, but this thread has attracted a cadre who clearly are ).
Jackie
August 25th, 2009
11:53 pm
@theRooster
You answered my post with the following:
“Why are we all apart of the same risk pool, when we do not all carry the same risks. Why should you you be forced to pay for someone elses rehab, when it was their own bad decisions that landed them there?
A single payer system leads to rationing. That is simple supply and demand. There will be way too many patients and not enough providers. That’s the hard truth. Can you imagine having the swine flu in a single payer system? Everyone with free healthcare? Everyone with a sniffle will be lined up outside an emergency room preventing those who actually need treatment from getting it.”
I did not say that we were all part of the same risk pool. My statement was:
“If everyone were part of the same risk pool, then it would not matter which doctor you choose because they would be compensated by the system for services rendered.”
The difference is I was speaking of how insurance works, based on performance and acceptance. This is basic contract law that indicates if we purchase an insurance contract, the insurance company is required to perform to the stipulations in that contract.
Secondly, the risk pool is an accumulation of all that are a part of the pool or group that will give the insurance company financial responsibility to cover those items in the contract. For example, if 100 people choose to cover themselves with insurance Company A, then, the risk pool for Company A contains 100 individual contracts. Underwriting standards are used to determine probabilities and severity of loss, determining what premium each person is required to pay to cover potential losses, maintaining loss reserves and allow for company profits.
By Cynthia Tucker not having a contract with the insurance carrier that essentially controls the doctor she wishes to uses to have her child checked, she will have to pay additional costs for those services. Wonder why that is the case when the underlying presumption of the insurance companies are reasonable and customary. Further, the insurance company is essentially the one the restricts medical coverage because they have a contract with the doctors and hospitals and they control when, where and how each of us are medically treated.
So, with a single payer system, you would be allowed to pay your money to satisfy your contract and you would be able to choose any doctor that has the time to see you.
I think that should explain the difference between your understanding of the function and the actual execution of the action taken.
Madison
August 26th, 2009
12:07 am
stands for decibels,, Care to meet another person that loved their insurance company. I had great insurance until the age of 65, then comes Medicare. My old insurance is still covering my wife, who has terminal cancer, and they have been wonderful. They have never refused any treatment, no matter the cost, and even asked if we needed a person assigned to our case to help keep track of the Doctors appointments. If my wife lives until next year she will have to go on Medicare. I think we will then probably have to look at selling our home to continue all of her treatments, which I have no problem with but really shouldn’t have to, because I’m sure Medicare is going to balk at the super large payments!
Piso Mojado
August 26th, 2009
12:45 am
Cynthia, you made some bad health insurance decisions along the way. Sorry. Actually planning out one’s insurance options long before you need them, and ensuring that your decisions fall within the requirements of your plan, seems to me like common sense. But that’s where the problem is these days, isn’t it? Individual treatment costs being driven up and up and up by decisions made by clueless policy holders.
SANDI
August 26th, 2009
1:12 am
I AM SO SICK (PARDON THE PUN) OF HEARING WHAT OBAMA IS TRYING TO DO WITH “HEALTHCARE” FOR EVERYONE. WHAT ABOUT THE MILLIONS TAXPAYERS COULD SAVE WITH PROVIDING CARE TO THOSE IN THE PRISON SYSTEM? LET’S HEAR WHAT YOU WANT TO DO ABOUT THE SCUM BAGS WHO LIVE OFF THE TAX PAYER WITH I HEAR QUALITY HEALTHCARE. KILL THEM AND LET’S SPEND THE MILLIONS ON THOSE WHO DESERVE IT.
My dogma was run over by my karma
August 26th, 2009
1:46 am
The swimmer just died. He will be cremated, and Massachusetts authorities estimate he will burn until Christmas or when health care passes. Dewars and Glenlivet scotch will be given money from the stimulus package to make up for the loss of the swimmer. When asked for comment, Mary Jo Kopecne said “blub, blub, blubb”.
My dogma was run over by my karma
August 26th, 2009
1:48 am
The swimmer just died. He will be cremated, and Massachusetts authorities estimate he will burn until Christmas or when health care passes. Dewars and Glenlivet scotch will be given money from the stimulus package to make up for the loss of the swimmer. When asked for comment, Mary Jo Kopecne said “blub, blub, blubb”.
lol
Woodrow
August 26th, 2009
3:03 am
I think some folks are seeing insurance the wrong way here. It’s INSURANCE within the pre-agreed upon policy. It’s not a guarantee that all your bills will be paid for the rest of your life. If you don’t like the policy, don’t get it. If you don’t like the insurance company your company offers (if they do), pay cash. If you can’t afford it, how is that the doctors fault? I can’t afford a yacht, I don’t blame boat manufacturers. If you want it, strive to get it. Improve yourself and get a raise. Seems Cynthias marketable skills have landed her in a job that has benefits she doesn’t like. That’s nobodys fault but hers.
Not From Georgia
August 26th, 2009
3:17 am
Great column, just too bad that our elected officials are also obligated to the corporate interests who control the health plans and medical premiums. President Obama needs to toughen up and work on persuading the Democrats to join as a solid force to give all U.S. citizens access to a more patient-centered national health plan that will benefit everyone, including the 47 million uninsured who are the most vulnerable patients. Shame on the Congress and our federal officials who oppose any kind of reform because they are already covered under some ideal plans!
ken
August 26th, 2009
6:10 am
We moved from Michigan last year to Cumming and my wife and I needed to find all new Doctors, being seniors that meant finding several of them. Not one of them told me to wait 2 months.
Do you think that a health plan for all will shorten the time? if so I have a bridge to sell you.
Please try and let your fingers do the walking.
John
August 26th, 2009
6:42 am
Cynthia, quit your whining about socialized health care. You are going to educate your kid via socialized education where everyone without any kids gets to pay for the education of your mutant spawn whether we want to or not. PAY FOR YOUR OWN KID’S EDUCATION !!! There is a word for people who leech off of other people for their own benefit, PARASITE
Jim K.
August 26th, 2009
7:03 am
Cynthia, you’re complaining about not having a “payment plan”, not an “insurance plan”. Seems insurance to you means paying for everything, including routine visits. I’m curious, if your car needs the oil changed so your engine won’t seize two years for now, do you have an insurance policy to cover the cost of that oil change? If your house needs a new roof to prevent water from coming in, does your homeowners cover that? Both rhetorical, of course. Why, then, would you expect your health insurance to pay for routine medical care?
You want someone else to pay for regular maintenance, on your terms, on your schedule. That’s a payment plan, not insurance.
stands for decibels
August 26th, 2009
7:35 am
Care to meet another person that loved their insurance company.
It sounds like you love whomever’s actually footing the bill for this coverage.
William
August 26th, 2009
8:36 am
ctucker:
Did you pay for your college?
theROOSTER
August 26th, 2009
8:40 am
@Jackie, I won’t pretend to understand the complexities of the insurance industry. But, I do understand economics and a single-payer system is not sustainable.
@In The Middle, That’s true. The Pres. has said he is not offering a universal, or single-payer system, but a government option. However, you cannot convince me that the government option is the Trojan Horse for total gov’t takeover. Here’s why: Let’s say the firm I own employs 50 people fulltime. The gov’t is going to mandate that I provide health insurance for all 50 employees, or I will pay a fine of $2k (for math’s sake). So, not covering my employees will cost me about $100k a year. I have an aging work force that ranges from 38-55 y.o. So, their insurance costs me an average of $3.5K per person (low-balling), per year ($175K). By those numbers, I can save $1.5k per employee ($75K total) by pushing them into the gov’t plan. I can then spend that $75k expanding my work force or to start health savings accounts for my existing workforce. I will most likely use the additional savings to cover the tax increases that will be levied on me next year. Do you think I am the only one with this idea? I doesn’t hurt me, I’m keeping my insurance.
Jim morrison
August 26th, 2009
8:56 am
Yeah, lets get government to run healthcare since they have done such a good job with medicare and medicade, and oh yeah, social security.
Wake up America! We do not need to become government dependent.
The Socialist Racist does not have a solution! We 1st need to get 14M illegals out of this country that continue to sponge off of taxpayer dollars.
Enough Said!
Michael
August 26th, 2009
9:11 am
Please tell me where in the constitution it states you are entitled to healthcare. It does not! Please tell me where it says your employer has to provide you healthcare? It does not. So if you are getting healthcare through your employer be happy. Nothing is perfect. If you want a better doctor then what your plan provides, pay for it. It is not my job for my taxes to pay for healthcare. You should provide for yourself. If you bring a kid into this world as a single parent, it is not my job to pay for his birth, his daycare, etc. I don’t have children but I am being forced by my taxes to raise everyone who cant’ afford them. Now you are asking me to take more of my taxes to pay for healthcare for you, your family, illegaly aliens, etc. Enough! Be responsible and take care of yourself!
Stephen White
August 26th, 2009
9:13 am
I don’t think we are grasping the significance of public health in this debate. There is a difference between being healthy and having health insurance as an individual and being protected from medical conditions one cannot avoid getting if one lives in a large uninsured community. H1N1 will not ask, Should I attack this person who has insurance or that one who does not? And my having insurance will not generate the awareness and treatment necessary to prevent an outbreak. If flu shots protect against an outbreak, then they should be paid for out of the public purse. Similarly for all necessary and effective immunizations.
My having insurance will not shield me from the terrible tragedy of individuals walking the streets with “untreated” mental illness (See “The Soloist.”) It is not socialistic to be compassionate. Was Jesus a socialist?
50 million medically uninsured people could be a threat to economic stability if a health crisis occurred. And if the tragedy were great enough, the cost of a national heath insurance program would pale in significance to the outcomes. Viruses are color-blind, sex-blind, etc.
Stephen White
August 26th, 2009
9:14 am
Enter your comments here
zeke
August 26th, 2009
9:21 am
Well C.T., you can rant and rave all you want! Truth is you have the option of paying and going to a different doctor if that is your wish, to get an immediate appointment! Under Obama’s plan, what a lie, he has no plan, this is Pelosi’s and Reid’s plans, you might get an appointment in 6 to 9 months, even for life threatening conditions! WISE UP AND STOP YOUR LIBERAL CRAP! Research the truth! Then use your intelligence in a much wiser conclusion!
Kevin
August 26th, 2009
9:21 am
The other item President Obama is fudging on is whether your employer will keep their insurance plan if paying the penalty for not having health insurance costs less. Taking Ms. Tucker’s example, if the AJC is paying on average say $10,000 per employee per year which would consist of all claims plus the administrative fee to Aetna versus paying a penalty of say $1,000 per employee for not providing health insurance, than it is likely the AJC will drop coverage.
But here is the further wrinkle. Say 80% of the companies who provide health insurance for their employees drop their coverage and their employees are enrolled in the government option. At that point, the costs of the public option plan increases exponentially and how does that get paid for? Increase the penalty per employee that each company pays.
So it seems to me that Mr. Obama is fudging on two items: (1) your employer provided health insurace may be terminated and (2) the public option will be financed by the penalty per employee that will be paid by the companies that have dropped their coverage.
hryder
August 26th, 2009
9:34 am
I am not lucky. We, my wife and I, worked diligently for years following what we believed to be the best recommended courses of action regarding health care, insurance, and practices. We are satisfied with our choices and both in excellent health. We took the same course of action regarding finances. We both resent and are deeply offended by people who express, some even demand, that our monetary achievements be confiscated(through taxes and/or deleting other government services) to provide others the same current benefits that we have in our retirement. These same people drank, smoked, overate, avoided exercise, and spent more than they earned. We are entitled to life, liberty, and the pursuit of happiness. Notice the word pursuit, happiness is not a guarentee. You want happiness, earn happiness. Just do not expect me or anyone else to be REQUIRED to fund your pursuit. In short, Get your hands out of our pockets!!
ihorizon
August 26th, 2009
10:08 am
Let’s bring back the good ole country doctor who has everyone’s needs at heart!
b6542
August 26th, 2009
10:24 am
Outrageous lies ? Cynthia have you read the house bill??
In the Middle
August 26th, 2009
10:30 am
@Rooster – I understand the argument, but do not buy that private insurance companies will go out of business. They, and the employers, will find ways to be more competitive. They will find ways to pool together in groups, as you suggest. Also, why not allow companies to provide HSAs and let those who have HSAs pool together if they wish to purchase private insurance as a group? All of these options provide for a lot more competition than we have now.
Fear of the government boogeyman is causing the national dialogue to go off the rails. There’s just too much hyperventilating over “government takeover” and not enough of what you and I are engaging in. My fear is that we’ll wind up throwing out the baby with the bath water and wind up no better off than we are now, and have whipped up the rabid paranoid fringe in the process.
George
August 26th, 2009
10:33 am
I believe we should implement the Logan’s Run solution. We can use current RF device technology for tracking purposes. But before that, all males should serve in the military for 7 years. Afghanistan will be a tough nut to crack but well have to make those sacrifices to ensure world democracy and freedom…at any expense.
Ask not what what your government can do for you but what you can do for your government. because the federal government is ultimately what matters most. You must understand this without confusion or qualm.
Just because
August 26th, 2009
11:04 am
Do you know why health insurance companies have pre-existing limitations? To prevent people from waiting until they have something drastically wrong with themselves from enrolling in health insurance. That’s like if you have a car and don’t have insurance then have an accident. Take your cell phone at the scene of the accident and call an insurance company and say . . hey I’ve just had an accident and I want insurance to cover it. Why should the premium holders who have paid their insurance premiums faithfully even when they are not sick have to cover someone who suddenlty has an accident (or gets sick in the case of health insurance) and who hasn’t paid any premiums into the insurance pool have to carry that burden.
Another thing, insurance companies have networks for the purpose of negotiating rates with providers to get the insurers the best rates. We all have choices to make when it comes to health care . . we can go in-network or out-of-network, but at least it is our choice to make and shouldn’t be the government’s.
And, finally . . . no insurance company . . . whether it is health insurance, auto insurance, homeowners insurance covers EVERYTHING! So when Obama speaks about having no-pre-existing limitations and covering everything . . . he is speaking out of both sides of his mouth. He believes the insurance companies are dishonest. . . I believe he and Congress are dishonest.
Chip
August 26th, 2009
11:08 am
I’m confused. You start out by stating that “You don’t get to choose your doctors today, without health care reform,” and then go on to give an example of the opportunity to choose between two doctors based upon quality, convenience, and price.
HereinDC
August 26th, 2009
3:39 pm
Cynthia needs to put this on You-Tube.
30 second to tell your story!
SF
August 26th, 2009
5:32 pm
I think what we should do is take everyones employer paid healthcare away. Why should the company you work for give you health insurance? They give you a paycheck. Pull yourself up by your bootstraps and pay for it yourself ! If you are a couple over 50 in NJ it’s only $1500- a month. About the same if you are young and have a family.
Then we should take away those free loading federal and state employees insurance which we are paying for. Next stop is to take this stupid medicare away NOW! You should like that HRyder. You old retired folks should have saved enough money to pay the $2000- a month health insurance policy that is out there for you to purchase for your age group.You know you don’t have to accept Medicare you can just get your own policy.
And let’s stop this stupid, stupid medicaid. I mean all those underprivileged folks don’t need to be healthy just let them rot. Survival of the fittest.
Now everyone in America would be on a level playing field and we can all go out and buy our own health insurance. How many of you totally, stand on your own two feet folks out there are going to be screaming for someone in this government to do something!! When you will be spending a third to a half of what you make just on a health insurance policy and on a policy where the insurer will fight you all the way to your death, to not pay when you need it?
That is the health reform I want to see. People walking in 47 million others shoes for a while.
CCR
August 26th, 2009
7:04 pm
In response to Joey’s comment, in which he asked, “Why would we take your advise?” I think we would take their advice because Cynthia, and most other journalists, know how to spell “advice.” The average American adult should know that the noun “advice” has a C and the verb “advise” has an S.
If you don’t know this, I am reluctant to take your advice. And I would never take your “advise.”
Just because
August 26th, 2009
8:00 pm
SF . . . that wouldn’t make everyone on the same playing field . . . you’re not so smart. There still would be some people with more money than others and how are whites on the same playing field with minorities when they have an edge with affirmative action, etc. How about the atheletes who are paid mega bucks! Oh, least we should forget the unions who are know for their benefit-fill health insurance coverage. What you need to learn (as does the democrats) . . . life isn’t fair; some people don’t have the motivation to get up and go to work everyday; some people do! Get over it!!!