I am watching the Denzel Washington film "John Q" once again and this movie has seriously made me think about insurance companies, hospitals and their policies, and HMOs so I have some questions. What exactly is an HMO? Can hospitals actually send you home to die if you cannot pay for whatever procedure you need? Do transplants actually cost a quarter of a million dollars? If they do cost that much, is there any insurance company or HMO that will pay for such an expensive surgery? Are there no laws to protect people against bad medical practices? Does the kind of medical care you receive depend on which type of hospital you go to? I may have more questions later on.
An HMO is where an insurance company or the like contracts with hospitals, doctors, labs, whathaveyou for medical procedures for its members. The physicians, hospitals, whatever agree to provide these services for a set fee, and the HMO covers these procedures only with these physicians, hospitals, etc. Treatment received outside the group is covered at a much lower rate (i.e. it costs the person who receives treatment much more). Traditionally, insurance let you pick whoever and wherever you wanted to go for treatment. In the HMO, you can only go to doctors, etc. the HMO has contracted with in order to receive your full coverage. There is some gray area. Technically, if you have a life threatening condition, the law requires treatment regardless of whether the patient has insurance or can afford payment. But usually that equates to the patient being in imminent danger of death. A person who has three months to live without a transplant may not qualify until it's too late to do anything about it. They can cost that much and more. They do. I doubt they like to do so, though. Sure, there are lots of laws. Sadly, medical care can vary widely from one hospital to another. Treatment can vary from patient to patient in the same hospital. A sad fact of the medical profession is that it has become so much of a business. When I was a kid, you went to the local hospital that was either owned by the county or some locally-based religious organization. While the hospitals strove to make a profit, that was secondary to patient care. These days, massive chains have come through and purchased hospital after hospital. And those they haven't purchased, they've often managed to finagle operating agreements from (so they run the place, and might as well own it). Profits are at the top of the list, and, too often, patient care (and employee care, for that matter) is much further down the list. And, for some reason, despite injecting all this competition and business-like practices into medicine, it costs patients more than ever. And the costs continue to rise faster than just about any other segment of the economy.
great point, mrpaige...i'm not sure what the answer is, but i'm pretty sure we don't have the right one yet.
I'm in pretty much agreement with what mrpaige has stated, but need to make one additional comment.... No doubt...costs are rising and a large portion of that is attributable to business practices within the industry. However, we would be short-sighted to not also note that as a country we have extremely large segment of our population approaching 50 and beyond. I recall hearing that on the 50th anniversary of the end of WW II, there would be well over a decade of someone in the US turning 50 years of age every 7 seconds. Imbedded in the aging of the Baby Boomers is (IMO) the fact that few people took responsibility for their own well-being. This in part can be attributed to the nature of our health care system which is to repair what has been broken as opposed to the maintenance of what is already healthy (preventive physcal maintenance).
There's an article in Forbes this month talking about the rise of probably unnecessary elective surgery going on. Things like spinal fusions to allieviate pain, gastric bypass, hysterectomies, etc. which are done in ever increasing numbers at relatively high cost with dubious benefit to the patient and, oftentimes, a cheaper, easier non-surgical treatments available. That's kind of related to what you've mentioned here.
