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So one of my friends was ranting about prescription drugs and how the insurance company would not cover his wife's drug any more, there is no generic, they want her to try something completely different as it is cheaper.
One of my other (RW) friends replied to him:
From what I am told, doctors used to make house calls. They used to work with their patients on prices. They knew them by name, and their familes. People stayed with one doctor their entire lives. Everything was cozy, warm and fuzzy.
Then we got insurance to assist with catastrophic costs. What a great idea! As an aside, that is what happens when statisticians study warfare (actuarial tables, the foundation of modern insurance, are an odd offshoot of the Napolenoic wars). To be more and more competitive, insurance companies started offering more and more coverages. That's just good business, offer more and more to the customer. Insurance evolved into something that covered almost EVERYTHING.
Being businesses, insurance companies started investing their revenues into the stock market. Sounds selfish on its face, but it makes sense from a business perspective. It allows them to diversify and spread out their own risk, for when they do need to cover someone. Dividends paid to them from their stocks go back into the pot. And yes, some of it goes to the executives. That is another point to haggle, but it only makes sense to pay the people who make the money. ... See More
Insurance companies started putting their own regulations into place, insisting that doctors rule out this or that before prescribing certain drugs or procedures. Back to those statisticians and actuarial tables again. Doctors had to become less personal and build their own bureaucratic processes to deal with the insurance companies. Enter the professions of medical coder/biller and such.
Soon thereafter, the government got involved and started regulating insurance. Maybe they saw abuses (executives being paid "too much"), maybe they saw an opportunity to get more revenue, maybe they just hate the idea that insurance companies are "making money" on the backs of the sick. Either way, they regulated. Kennedy (D) gave us HMOs, ostentibly to increase regulation and save costs.
Regulation sure increased, but the costs did too. Now insurance companies have to watch their own behinds and are second guessed. They have a bureaucratic machine that is two or three times larger than their actual service machine, by some accounts. And that is on top of the brueaucratic machine in the doctor's office to deal with the insurance companies!!
The government also gave us medicaid and medicare. We have to cover the poor, right? Regulations required cost considerations to be tied to medicaid and medicare rates.
Enter, (Friend's wife's name) and her issue. IF there is a cheaper med out there, that is the one the government will insist on in the regulatory scheme. That is the one for which they may reimburse. That is the one the insurance company will insist on. By the time all that insisting gets to the doctor, he has almost nio choice ... if we even know who he really is anymore.
The solution? Heck, I dunno. Maybe something like ... get government out of our lives? Costs went up, drastically, AFTER the government got involved.
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Write some replies and I will pass them along :)
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