Comments on: Milton Friedman on Health Insurance

By: Anonymous

Anonymous — Fri, 13 Nov 2009 02:31:00 +0000

Removal of government interference is exactly what I advocate. I also advocate beneficiary ownership of premium dollars that become medical savings accounts, e.g., a universal FIRST PARTY PAYOR SYSTEM, rather than our current near-universal third party payor system (public and private). I advocate empowering the patient with dollars and information. Unfortunately, my statement is not opinion. It is my daily reality. I am a physician (endocrinologist) who spends a good share of my time appealing denials of coverage for such things as Januvia, Byetta, Insulin pumps, Continuous Glucose monitoring systems for home use, even such generics as Metformin and glyburide, with completely inappropriate restrictions by managed care and government formularies. Both private insurance companies and Medicare intermediaries routinely lie to patients about their coverage. I have had bitter conversations with medical directors over inappropriate denials of care, and have even gotten medical directors fired over their denial decisions, and some have had their medical licensure in jeopardy. Unfortunately, private insurers routinely and with imunity violate state laws, inasmuch as patients rarely challenge the decisions or file complaints with State Insurance commissions. The insurers stack the deck on indications for treatment (once an insurance company denied a thyroidectomy for a patient with a massive goiter that was growing, and gave as the only criteria for thyroidectomy acute asphyxiation. That was true in the 19th century, in the pre-anesthesia and pre-antibiotic era, but not for 20th Century or 21st century medicine. The famous Millman and Roberts criteria were put together on the dime of the private insurance industry and stacked to their benefit. I would much prefer to discuss treatment options with the patient, provide the information to the patient, and let the patient decide what course he or she prefers, with as much information as possible. I don’t like insurance companies offering coverage and yet denying coverage when care is needed. However, a government system is worse because one has no recourse whatsoever. The committee under medicare that issues HCPCS codes, required for reimbursement, for 5 years has steadfastly refused to provide a code for Continous Glucose Monitors for home use. I had a patient die this month (a Medicare patient)who desparately needed one of these, who had had brittle insulin dependent diabetes for 40 years, and had hypoglycemic unawareness, with frequent severe hypoglycemic episodes with coma. It was only a matter of time before he had a severe episode with coma and was not discovered and died. Indeed, that just happened, with irreversible coma. His family adhered to his wishes and turned off life support after a week in the ICU. This was a needless death. I spent years trying to communicate with Medicare (the committee would brook no input whatsoever), wrote letters to the media, including the WSJ (Varadarajan was the editor at the time) who refused to publish my letters, same with local papers, even the advisor to the committee, Alan Garber of Stanford University, agreed that the devices should be covered, but could do nothing to persuade the committee. To this day, they are not covered.
Surveys are what they are, and Americans are much more satisfied with their coverage than they would be with a government system, which I applaud. Nevertheless, I am handcuffed on a daily basis in providing optimal care to my patients, by insurance companies, the government. The circumstances would be different in that patients would have a choice if they controlled the resources. I could better live with a patient refusing care than an insurance company or government refusing to cover needed care. In fact, when patients have resources and information, they often make far better decisions that insurers, certainly than the government, and often better than physicians. Power to the Patients!!!!

By: John Dewey

John Dewey — Thu, 12 Nov 2009 21:57:00 +0000

The marketplace has likewise emerged to deliver safe and reliable hospitals, safe and reliable medical practitioners. That has nothing to do with the complexity and array of medical decisions faced by consumers. Furthermore, there are only a couple dozen automobile manufacturers, so it is not a difficult task to assemble quality data about their products. There are millions of medical practitioners in the U.S.

By: John Dewey

John Dewey — Thu, 12 Nov 2009 21:50:00 +0000

seth: “That’s the same logic that was used in the mortgage business. They can’t figure it out, but let’s loan them money and regulate it.”

You will find nothing in my comments about regulating health insurance. That is not part of the logic I offerred.

I’m not objecting to those who would choose to not take advantage of group health insurance coverage. I’m not advocating government mandated coverage.

If third party payment and employment based insurance were less effective and less efficient, a free market would eliminate such arrangements. However, as I pointed out earlier, employer based group health insurance was growing in the decade before government interference was introduced in 1943.

By: John Dewey

John Dewey — Thu, 12 Nov 2009 21:37:00 +0000

Then advocate removal of government interference. If your proposed system is truly better, the free market will ensure it is adopted.

“Currently, insurance companies deny care, mostly, on usually specious grounds”

That’s opinion, not fact. Surveys have shown that most Americans who are enrolled in group health insurance plans are satisfied with their coverage.

By: John Dewey

John Dewey — Thu, 12 Nov 2009 21:33:00 +0000

I don’t have data, but my guess is that routine doctor visits make up a very small portion of insured medical care costs.

I just read that IBM last month removed the employee copay for routine primary care physician visits. They actively promote such medical care because they believe it ensures more serious problems are uncovered earlier. IBM believes that routine visits actually reduce the overall cost of providing health insurance coverage.