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Can Employers and Patients Trust the Healthcare Insurance Industry? Part 3

Stanley Feld M.D.,FACP,MACE

Medicare Part D is the drug benefit insurance for Medicare recipients.
The government constructed a program where the healthcare insurance industry sells insurance to provide prescription drug coverage.

There are various plans available from various healthcare insurance companies charging various prices. The healthcare insurance industry would call it competitive pricing. However, without real price transparency, multiple pricing is meaningless. The real important price is the price the patient is charged against his doughnut verses the price the healthcare insurance company pays the pharmacist. The various plans are confusing, to say the least. The plan outlines have been standardized by the government. The prices for the various healthcare companies’ plans have not been standardized.

If we drill down deeper, the price the healthcare insurance company pays the pharmacy has not been standardized. The industry negotiates that price with the various pharmacy chains. The price the healthcare insurance company charges the patient is applied against the patient’s doughnut. The patients’ doughnut (coverage gap) kicks in after the patient purchases $2200.00 of drugs. Therefore, the higher the price the healthcare insurance company charges the patient’s account for a medication the faster the patient hits the doughnut and the faster the patient pays full price for the medication. The price the healthcare insurance company applies to the patient’s doughnut has nothing to do with the price the healthcare insurance company paid the pharmacy for the drug. This is the place the fairness to the patient breaks down. Many seniors who have purchased these plans, in order to feel financially secure, are now discovering the deception in these various Medicare Part D plans.

Richard Jellicoe writes; I have Medicare Part D from AARP. UnitedHealthcare
is the carrier.
UnitedHealthcare offer drugs with co-pay almost twice what I can get the same drug via cash. I guess that is how UnitedHealthcare can pay its fired CEO $5 million a year in retirement.”

He goes on to say:“What amazes me is that AARP endorsed this company when it was time for 2007 Medicare sign up and it was not till many months later that AARP acknowledged that it’s endorsement of UnitedHealth care was a paid endorsement. And AARP is supposed to help the seniors.”

Consumers can not assume the government will protect them. It has not in the past. You can not assume that organizations like AARP who advertise that they will protect you will protect you. Consumers must become sophisticated buyers of healthcare products. Consumers have trained themselves to become sophisticated buyers of other products such as automobiles, electronics, food, clothing, and housing. They have learned to receive good value and have created competition among vendors for their dollars.
The healthcare insurance industry continually says that consumers are not capable of dealing with healthcare pricing. If you think about it our most precious possession is our health. We should be most responsible for our health and the price we pay to maintain it. I know consumers can be very smart about healthcare consumption if they owned their healthcare dollar.

Mr. Jellicoe goes on to say “I have been reading everything I can find on UnitedHealth Care. I have been amazed on how those in the know understand the lack of ethics at this company. The thought of 90% of Nevada being under the control of this corrupt company frankly scares me to death.”

Mr Jellicoe, you have defined a monopoly. Our government is supposed to be working for us and not for the healthcare insurance industry. Consumers have to demand that our government does something about your complaint. The problem is most consumers are not aware of these abuses. Our sources of information (mass media) do not provide detailed information. Detailed information does not hold our attention and attract advertisement revenue. We are an inpatient, sound bite society seeking sensational stories. However we become very concerned when an issue affects us directly. The broken healthcare system is directly affecting us all now. I believe as a people we are very smart. We are starting to demand a solution. However, the government has put the fox in the hen house to protect the hens. The hens will not be protected.
One of the reasons I am writing this blog is to try to get the people who are not sick to pay attention to what is going on. The healthcare system needs to be fixed before we get sick and need medical care and medical drug benefits.

Many years ago a well connected patient of mine was an advisor to several U.S. Presidents. He was working on stopping drug trafficking to the United States from Mexico and South America. Hundreds of millions of dollars was laundered through Miami banks. His assignment was to convince the banks to stop laundering drug money. One day I asked him why congress doesn’t just pass a law revoking the banking permits.
In his frustration, he said “most people do not know what they vote for. They do not express their opinions to how their congresspersons should vote in congress.” He said the law could not be passed because of the banking lobbys’ influence in congress. He also said” we as a people get what we deserve. We have the right to demand the appropriate action. We do not exercise that right. Until we start paying attention to what is going on and get rid of the politicians who do not do what is right out of power nothing will change”.

“All of the news in the press is about unimportant issues. Th “news” is a distractions from the real needs of the people. None of the important issues are covered in detail so that we rarely know the real issues. “

It is important to notice that the only easy way Mr. Richard Jellicoe can express his frustration is through the new media, the blogosphere. Will the new media be effective? I hope it will. Americans’ are not a stupid people. Our freedom of speech is precious. Social networking of a concerned population will change the paradigm of healthcare insurance to a consumer driven healthcare paradigm.

  • Dwight Brisco

    Controll your health costs by asking questions
    We all complain about the cost of healthcare, but you could be adding to the costs by not asking questions:
    1) If your doctor is prescribing you drugs, ask if there is a generic version available.
    2) If you’ve been requested to go to a different location for lab tests, inquire if the services can be performed by your plan’s network provider.
    3) If you’re a Medicare supplement recipient, inquire if the doctor or hospital either accepts Medicare’s assignment or if they bill more than what Medicare will pay; This one inquiry could save you possible thousands of dollars.

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