In the strangest of places

I know I post a lot about health insurance reform lately. Everyone has a vested interest in the topic, but for me it's extra fun that there's a public debate about it, because of my background.

I've worked in health care for 25 years--well, actually, since I was 11, but there were breaks between age 11 and age 17. During that time I've been involved in many aspects of the health care system.

I've taken minutes in peer review meetings, in which doctors discuss potential mistakes made in individual cases. In the mid-80's I was involved with the creation of an early IPA, which is a group of physicians (like Brown & Toland in the Bay Area) banding together to improve their negotiating power against HMOs. I've been the director of Health Information Management at a large multi-facility enterprise; among other things, HIMS is the department that does all the coding of medical diagnoses for reimbursement by insurance companies, Medicare etc., so I had intimate knowledge of how hospitals make their money and how Medicare, HMOs and other insurance companies work. In fact, when I was earning my degree in health information management, the DRG system of Medicare reimbursement had just gone into effect, so I was right in the center of the hospital system's adjustment to the way Medicare reimbursement works now. Also, HMOs were catching fire in the west as a new, rapidly expanding "cost-containment" tool then, so I watched hospitals and physicians adjust (more like contort) their patient care practices around this new way of doing Business with a capital B. I worked in a hospital department that was once called Utilization Review, which was like an internal insurance company compensation board--nurses and social workers who evaluated patients' coverage and the hospital's risk of losing money, and worked to get patients out of the hospital before their coverage ran out. In my personal conversations with the physicians I work with, I've heard a lot about how health insurance companies impact physician practices and individual doctors' finances. And in the meetings I now moderate, I hear plenty about how cancer patient care is affected by what kind of coverage patients have or don't have. And in addition to the several hospitals I currently contract with, I work in a facility that's completely owned, run and financed by the government, which is part of a giant government-run health care system. Socialized medicine for a certain group of patients, you might say.

On the personal side, my dad, uncle, and three cousins are/were physicians. My husband and I have health issues and we are active consumers of health care and health insurance resources. I've been insured by jobs, student health plans, and until very recently was paying nearly $1700 a month for a health insurance plan as a self-employed person. I've never been uninsured, and thank God, because I definitely do not qualify for any health insurance plan on the planet unless an employer is mandated to insure me.

So when I put all that together, I guess it makes sense that I would have a particular interest, not just in the topic of health care in general, but specifically in the topic of how health care is paid for in this country. And when I look at the breadth of my experience in the industry, I guess I feel like my opinions might have some weight. That is probably why I've been harping on this subject more than other "political" topics that I also care very much about.

http://www.cnn.com/2009/POLITICS/08/17/potter.health.insurance/index.html

Excerpt:

I explained during the press conference with Rep. Slaughter how the industry funnels millions of its policyholders' premiums to big public relations firms that provide talking points to conservative talk show hosts, business groups and politicians. I also described how the PR firms set up front groups, again using your premium dollars and mine, to scare people away from reform.

What I'm trying to do as I write and speak out against the insurance industry I was a part of for nearly two decades is to inform Americans that when they hear isolated stories of long waiting times to see doctors in Canada and allegations that care in other systems is rationed by "government bureaucrats," someone associated with the insurance industry wrote the original script.

I'm so excited that the national health care discussion is at least on the table again, politically speaking. I watched a Noam Chomsky clip the other day in which he said that it's now politically feasible to discuss it since big corporations are complaining about their bottom line with the uncontrolled increases in health insurance premiums for their employees. He said that the vast majority of Americans (70-80%) have indicated that they were interested or strongly interested in universal health care for decades, and "in a working democracy" that would be reason enough for politicians to address it, but not in this country. :\

Anyway, here is an interesting post in which the OP asks people who live in other countries what their health care experience is like:

http://community.livejournal.com/ontd_political/3361941.html

I would love to do a version of the same. I've always wanted to be a researcher/sociologist/person who polls other people for a living. Among other things.

http://online.wsj.com/article/SB122152292213639569.html

http://community.livejournal.com/ontd_political/778178.html

The funny thing about that second link is that it is closely related to something I posted in 2004:

http://spread-word.livejournal.com/1752.html