Insurance Firms' Healthcare ROle

Originally published in "Brooklyn Daily Eagle"


By Raanan Geberer


What’s missing from the debate on President Obama’s healthcare-reform plan?

Any mention of the big insurance companies, it seems. Just about the only time they were mentioned was in Obama’s initial speech on the subject, when he said that “people who like their health insurance won’t have to give it up.”

Both Democrats and Republicans have said that the current healthcare system needs fixing, but they never mention what brought the nation’s healthcare system to its current state.

As I see it, the trouble started back in the mid- or late 1980s, when the insurance companies began to switch to managed care. When I got my first managed-care plan, I was actually happy. Before that, because I took (and still take) multiple asthma medications, I had to pay the full price, then submit a bill and wait until I got a refund for, I believe, 80 percent of the price. Now, I didn’t have to pay anything up front except for a co-payment.

However, managed care had its down side. If someone wanted to go to, say, a neurologist or a pulmonary doctor, one had to go to the primary care doctor and ask his permission. In some cases this was no problem, but many doctors were and are very reluctant to refer patients to specialists except in cases of life-threatening conditions.

According to some reports, which I can’t confirm but can’t find denial of either, in many networks doctors are penalized for making too many referrals to specialists. And according to the “California Physician” web site, in 2007, United Healthcare decided to fine physicians who refer patients to out-of-network doctors.

One thing I do know is that this is true for drugs. For years, my doctor prescribed Lipitor. About a year ago, I began getting all sorts of phone calls and messages about why I should use a cheaper, “preferred” drug. Then I was told by the pharmacist that I had to get a new prescription every single time I asked for Lipitor. Eventually, I got tired of this and asked my doctor to prescribe the cheaper drug — even though some surveys show that Lipitor is slightly more effective.

The more illnesses, prescriptions and/or operations you have, the more likely it is that you will have serious problems with your HMO. A while ago my wife had a sinus operation. She soon received a letter saying that her doctor had never given a referral to the surgeon for the operation (he obviously did, otherwise the surgery would not have taken place). It took about 10 e-mails back and forth to straighten that out.

There seems to be a double standard for criticizing corporations in this country: everyone loves to slam the Big Three auto companies, but no one dares criticize either the big investment banks or the big insurance companies. If President Obama really wants more support for his healthcare measures, he must criticize the insurance companies publicly. Not only will this gain support among the average person, it will focus the spotlight on the ties legislators who oppose the plan have with the insurance companies and how much money they have received in campaign contributions. Then it would be their turn to be on the defensive.