Discussion Board

Good lead article. I wish Dr. McDougall was the insurance commissioner in chief!

And, Mary's recipes are looking fabulous. There's a miso pesto I can't wait to try. Lots of basil in the garden!

I was reading and got all excited, I thought that maybe Dr. McD actually had a bunch of doctors ready to roll. I would love to be able to choose his option rather than the Blues!

First, I'd love to have a McDougall-friendly doctor. There are none here in Michigan that I have found.

It was a great lead article. It would be wonderful to have a whole network of healthcare based on the McDougall plan.

I also really, really liked the title: "Real Healthcare Reform Has Health As the Primary Goal." I agree with that 100%!

That reminds me, when I was reading the article, a lightbulb went off in my head. Insurance companies get a CUT of the charges, so they have nothing to gain if I don't go to the doctor, or when I don't want a colonoscopy and a mammogram. They make money when I have lots of tests? Who knew.

I keep getting these reminders from BC/BS to go to the site and use their program to help with lifestyle changes. One of their bits of advice is to go have my mammogram and a colonoscopy. We are worried that they will start to decrease benefits or raise our premiums if we refuse these tests. This year, we had to complete the health assessment and talk to a "nurse" of we had to pay a higher premium. Who knows what else is coming next time.

I wish we could have health savings accounts and catastrophic coverage, with help for people who have no income or low income, of course. If we were in charge of where the money is spent, things would shape up in no time at all. I sure would spend my health savings account money on a trip to see Dr. McDougall for the 10 day program.

One thing that stuck out to me was doctors not wanting to advise dietary change because it was easier for them to do surgery or prescribe a drug. It reminded me of two conversations I had--one was w/a dentist who was chosing to specialize in root canals or orthodontics. He chose root canals because he said he wanted to do a job, and have it done and not have to rely on patient compliance, like orthodontists do. The other conversation was with my daughter's surgeon--after he came out of surgery and told us everything went well, he explained all of our post-op instructions (how to care for the stitches, what positions she needed to sleep in, etc)--and then he took a breath and said, "this is the hard part for me. In surgery, I'm in control, and now I'm not anymore."

Unfortunately, a lot of people base legitimacy of something on whether or not insurance companies cover it. Although I do feel that (unfortunately) many people would rather have surgery than change their lifestyle, I absolutely believe they should be given the information so they have informed choice.

This part confuses me. If insurance companies are paying the hospitals and doctors, how are they then getting money back?

From the newsletter:

"We went back and forth for a few more minutes and then he made his position irrefutably clear to me. Obviously frustrated by my persistence he said, “You don’t get it, McDougall, you don’t understand the business. We take a piece of the pie and the bigger the pie the more we get.” An estimated 30% of the premiums collected from the insured, their employers, and the taxpayers go to administrative costs, including the salary of these insurance company employees who were denying payment for the McDougall Program. "

I am a registered nurse who worked for many years in hospitals, doctor's office, and home care and didn't realize this. It's very interesting.

Mr. D and I keep telling each other that we are getting ourselves out of the medical business. Our doctor doesn't like it and we are looking for someone more cooperative but just can't find one. They all want to sell us supplements or do procedures and prescribe stuff. I have suspected for a while now that it's sort of a racket, which sounds kind of kooky, but maybe I'm not all that much of a kook.

I don't think it's a direct cut like a commission. Rather, the more expensive the care, the more they can justify high premiums that need to be charged up front.

Okay...so the more expensive overall care is, the more they can continue to raise rates, is that it?

It's more like the insurance company is a middle man, made necessary by how expensive health care is, because for years we haven't cared how much health care cost because our insurance paid for it.

I found out both here in Arizona and in Florida, if you say you are a self pay, they discount the service to what medicare pays for a procedure.

For example, a dr. visit in Florida cost 80.00, as a self pay it was 49.00.
I had complete bloodwork done there in 2007 and the tests which were over 800.00 were 450. if I did them at Florida Hospital. I really didn't want to have them done there since I was there for my daughters wedding but they told me if I took the papers out of state, that AZ doesn't discount or use papers from another state, so I scheduled an appointment and did them there....

My leg doppler and carotid artery test... I just did the carotid artery one since I was paying for it, and it went from 350.00 to 137.00 as a self pay. Here my dr. appointments are 59.00.

So where and who gets the rest of the money they charge??

Maybe that is the difference in cost that they incur for billing insurance and waiting for the payment. Doctors offices and hospitals have staff that do nothing but deal with insurance companies.

I guess getting cash right away is better than waiting to get paid and all the paperwork....and the medical coding is usually wrong so it goes back and forth!

Pretty much. And it still takes just one claim payer to process a bill whether it is $50, $500, or $5,000. So, (within a certain range of claim volumes) the fixed costs to the insurance company stay the same and more of the premium flows to the bottom line - or more likely to the CEO and other management's compensation.

IMO, there is no way that under the current system, we will have anything that is actually "health" care. It is completely contrary to the way the system is set up, and band aids are not going to work.

Dr. McDougall mentions Kaiser and the profit motive they might have to keep people healthy. Yet it still fails. I think that is due to the fear of litigation if they don't do what everyone else is doing. Another point Dr. McD makes. So, it seems unlikely that one maverick company is going to be able to change much. Our whole approach needs to be torn down and rebuilt. But that is scary to most folks - especially if they don't know how to stay healthy like we do.

I try not to get too outraged or crazy over this. I just try to do my best for myself and loved ones, stay out of the system as much as possible (while staying grateful that I have access to care I actually need), and watch to see if we move any closer to a solution.

I grew up in the Kaiser system (it worked very well for us), and I thought the doctors were on salary--is that still the case?