Do you have any idea what the insurance industry would be like without regulation? I took classes to be reach specific goals while working for an insurance company for 20 years. I learned that there had to be regulation…health insurance had a history of taking advantage of the people they insured and with regulation it gained more respect and did business in a more responsible manner.

Bella, the insurance companies have contracts with health care institutions, doctors and other health care providers. Those contracts are for reimbursements…if you look at your EOB, you will see that the actual reimbusement is not what the provider billed for services but is actually what the contract between the provider and the insurance company had agreed upon as the actual amount to be paid and accepted.  I dealt with those contracts for 20 years.  Medicare reimbursement is the same. Almost all hospitals and doctors are Medicare based providers…meaning that is where they get their basic operating expenses…from Medicare. The private insurance reimbursements are like the cherry on the sundae for profit.

I think, and know, that people who don’t pay for health care in this country still get health care when they get sick. They go to emergency rooms. Continously. How do I know? I audited hospitals for a number of  years. The people in this country are paying for uninsured people’s health care with their taxes, increased charges for the services they receive from health care providers, and of course, larger premiums. Emergency rooms can not turn away people without insurance or resources. If they do, they will not receive money they need from Medicare and, also, state and county funds. That alone should make people wonder if there isn’t another way to handle the uninsured problem in our country.

Those uninsured go to the emergency room for many things, but when they have a stroke, a heart attack or other major medical event, they get the same care as the insured. Of course, it should be said the care is better at some emergency rooms than at others. But I have done discharge planning when I worked as a nurse case manager for many uninsured CVA patients who were placed on the state insurance when they were admitted to the hospital. That happens….does anyone against a public health care plan really understand how the health care for all  in this country is given?

About HMO’s. They have not succeeded in my part of the country because the people do not like them. HMO’s are for health maintenance. To keep the client (whatever you want to call them, i.e. the insured) well and in good health is the objective. The doctors don’t like it because they don’t get reimbursed for services provided. If their patient load is older patients with medical problems that come with the aging process they will not make as much money. They are paid only so much a year for the number of patients on the HMO, not for services rendered. So, when a patient (like one of my family members) needed to go to a specialist, getting a referral was difficult. I often wondered (not really) if that was a way to get the insured patient dissatisfied with the HMO plan? Surely doctors wouldn’t do that, would they? I’ve had doctors tell me that they don’t know what insurance a patient has. If that is the case why did doctors complain of only having 15 minutes allotted with their HMO patients? That is what they and the insurance company  considered the amount of time they  could spend with their HMO patients to make it most effective for the office monetarily. (Amount of time is an example only; it could be more or less, depending on the diagnoses codes used for the visit)

Oh, well, there is so much one needs to know about insurance and then one needs to understand the health care bill proposed to really talk or write about it, IMHO.

"If we get a strong public option in this country there will be a boom in entrepreneurship. THAT is the sort of recession buster we need, from the bottom up. "

So agree with you!!!  I know when my employer bid against other insurance companies for some of the Medicare business, "our" bids lost…they didn’t think they had to "give a little" to get the government contracts. Well, other insurance companies got the contracts and our Medicare subsidiary just closed..Glad I retired last year.

My employer just built a big, new complex overlooking the city. They had too much cash reserves according to a newspaper article prior to beginning the construction of the new complex. So instead of being audited by the state insurance commission the employees got a new building to work in. However, the company could not "give" enough back to get government contracts which meant loss of jobs for those in the Medicare subsidiary. Just the way business works, I guess.