What McCain Forgot: Health Insurance Bureaucrats Are Already In Your Doctor’s Office
What McCain Forgot: Health Insurance Bureaucrats Are Already In Your Doctor’s Office
In his acceptance speech last Thursday, Sen. John McCain (R-AZ) rallied against “government bureaucrats” injecting themselves into the patient-doctor consult, limiting care, and rationing treatments. But if McCain believes that bureaucrats are the third wheel in the confidential patient-doctor relationship, then the senator — who, as a beneficiary of government-run health care has probably never had to appeal a denied insurance claim to an HMO — may be surprised to learn that insurance company bureaucrats are already crashing the date.
A study of the independent medical review process (IMR) in California revealed that “among all areas of dispute, IMR upheld the original HMO decision at least half the time in most clinical areas and for most services, but nonetheless, fully one-third of HMO denials were overturned. “This suggests that the external IMR process adds some patient protection to California’s health care system,” the study concluded.
Currently, “41 states (plus the District of Columbia)” offer consumers the “option of an external appeal.” According to the Kaiser Family Foundation, “the insurers are overruled in about half of cases, with the rate of patient victory ranging from a high of 72% in Connecticut to a low of 21% in Arizona and Minnesota.”
Stories of HMO nightmares abound. After listening to McCain’s acceptance speech, Thomas Hayes wrote an open letter to the senator, reminding him that insurance companies often deny medical claims:
After struggling with many courses of treatment over the years, her Urologist has settled on a particularly effective medicine. But her insurance provider, Health Partners, decided that was too expensive, and since she was a woman of a certain age they determined that she could just as effectively be treated with another class of less-expensive drug.
They didn’t consult with her Urologist, mind you, they just decided she was obviously one of those middle-aged women who has bladder/incontinence issues, and that she’d have to change to another medical treatment. After all, they’d paid for 5 years of an effective course of therapy already, so it was time to try something cheaper. It didn’t work. So they proposed another drug. It didn’t work. They proposed a third alternative. You guessed it: no success.
It’s unclear if McCain’s health care proposal, which shreds consumer protections by allowing insurance companies to market national policies from states with minimal consumer protections, would undermine the internal and external review processes. Would insurance companies be able to move to one of the 9 states that do not have a mandatory review process and deny claims without ever being audited? McCain’s health care rhetoric suggests that they might:
I offer a genuinely conservative vision for health care reform, which preserves the most essential value of American lives — freedom…In health care, we believe in enhancing the freedom of individuals to receive necessary and desired care. We do not believe in coercion and the use of state power to mandate care, coverage or costs. [Des Moines, 10/11/2007]
2 Responses to “What McCain Forgot: Health Insurance Bureaucrats Are Already In Your Doctor’s Office”
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I find the myth about government interference amazing. Certainly it can happen but as a practical matter, in Canada, my family has never had any interaction from government in any medical matter. This is not because of great health. There has been cancer, heart conditions, etc. The doctor / hospital makes all decisions, presumably within some guidance of approved procedures but never have we had a doctor even hint that anything would be an issue with government limitation. One hears that some experimental, very expensive drugs are not approved, etc. but never have I heard of limitations on routine or essential services. People complain of line ups, waiting lists. There are issues, far fewer than Americans are told by insurance lobbyists wanting to prevent a loss of this gold mine for them. In fact, an emerging area of coverage here is premium care, private coverage to address issues of waiting lists or new or unconventional procedures. There is room for those wanting to get exceptional treatment at their expense. The proof of the merits of our approach is in the superior health statistics for Canadians relative to Americans. McCain and others are scamming you by hiding the denial of care behind phony issues of freedom. In Canada, it is not the government providing the care, it is government paying the cost of care provided by hospital corporations, doctor owned clinics, etc. and of course using my taxes to do so, much more efficiently and far cheaper than your system of profit driven denial of service by heartless companies. The stupid argument that this is socialist is as dumb as arguing basic education should be private, road maintenance in front of my house should be private, or victims of rape should pay for their rape kit.
September 12th, 2008 at 4:35 pmI guffawed when John McCon spewed his government bureaucrat line. I have multiple corporate bureaucrats doing the job already. If I want to see a specialist, one pencil pusher must give permission. Getting prescriptions requires a pharmacy benefit manager, otherwise known as an Rx corporate bureaucrat.
Give it a rest John. You’re greasing the skids for me to pay it all. The corporate crats aren’t going anywhere.
September 13th, 2008 at 3:01 pm