Comments on SICKO Michael Moore movie.
ssdr18
Posts: 121
This is my comment to him and wondered what others thought:
6/20/07
Dear Mr. Moore:
Congratulations on your documentary, ‘Sicko’. As a physician in private practice for 18 years in New York City, I feel a need to comment.
First off, you barely uncovered the actual corruptness of the health insurance industry in this country. We all know about the denials made by insurance companies. They have a predetermined guideline and anything that does not meet their criteria are denied. In order for a reversal they require an appeal. This is actually not corrupt. The guidelines are documented prior to someone signing up for a certain plan.
Are you aware however about the actual scams and shenanigans they pull. In 1997 are you aware that Oxford did not pay physicians for about 6 months. Each time a physician would call regarding an outstanding claim, they were told by a customer service representative that the check had been sent out. Check numbers and actual dates of the checks were given. They would then follow up with a statement that the check must have been “lost in the mail”, and they will stop payment on it, however it would take approximately 90 days before another check could be reissued. I can tell you personally hundreds of my checks were “lost in the mail” , and thousands of dollars were in arrears. After six months I had to hire legal representation and threaten to sue so that I can pay the bills needed to continue to operate my medical practice. The American Psychiatric Association finally did step in and the matter was resolved.
In 2003 Oxford pulled another shenanigan in order to obtain money. They decided to conduct an audit in the New York City area. They asked for notes on 110 random patients, and chose 5 random dates of service. They had us (over 300 mental health professionals were involved in this audit; including psychiatrists, psychologists, and social workers) photocopy these notes, of course on our dime and time, and mail them. They then had some unknown person review the notes, and decide whether the billed session was appropriately coded and billed for. They would make a rash decision based purely on what words were included in the note. For example, if a patient seen for both weekly psychotherapy and medication management did not have the word medication mentioned in that progress note, even if that word or the drug name were written in the medication record kept in the chart, a conclusion was made that that visit should have been billed at a lesser reimbursement rate. They then came up with an amount that was inappropriate billed, multiplied that amount by the total number of patient visits seen by all Oxford patients over a 10 year period, and came up with some astronomical number they demanded refunded to them. Confidentiality matters were not taken into account, and highly confidential reports were sent out to strangers at the insurance company at their demand. Individual practitioners had to hire their own legal counsel, as we do not have a union, to defend against this. Eventually this whole witch-hunt was dropped, but that was after thousands of dollars were spent individually on legal counsel, and preparing of the paperwork.
Do you also realize that in the last 15 plus years, our fee per visit have not been increased. We are receiving the same reimbursement or a lower fee for a 45 minute session than we received in 1993. For example, when I started working with Cigna Health Plans they were paying $120 for a 45 minute session. In the late 1990’s this fee was reduced to $95. My own individual health insurance plan however continues to increase at a greatly inflated rate. It seems to increase at about $60 to $75 per monthly payment or almost $1000 per year. Doctors have not seen a penny of this money.
Other tactics they use in order to avoid payment, although legal, is just to keep people on hold, sometimes up to an hour or more. On one very sad occasion, several years ago, I needed to have the hospitalization of a patient approved before I could send him to the hospital. This patient I felt potentially could be suicidal, as his condition was progressively worsening over the course of a week, and having treated him for the six months prior, knew this change in mental state could potentially be serious. I continued to try to engage him, while listening to the music when kept on hold; a difficult feat when speaking with an acutely depressed and potentially suicidal patient. Finally, after one hour on hold, someone picked up; I reviewed the case and hospitalization was approved. During that time however this patient decided he did not wish to go into the hospital. His family was called and they did not wish for him to go as well. They came to pick him up and agreed to stay with him and he made an appointment for the following day. The following morning I received a call informing me that this patient had indeed jumped in front of a train, leaving behind a wife and two small children. No, there was no law suit against me, or the insurance company for that matter, and I cannot guarantee if he went to the hospital he would have agreed to stay or what the outcome would have been. I only know that before I made that phone call he agreed to go, and it was while I was on hold so long he changed his mind. Without family support or his agreement, I was not able to commit him involuntarily. This long hold time or the tactic of transferring to an average of 4 departments before getting to the proper medication approval department, is also how the companies minimize approval of certain of the more expensive second tier medications.
We clearly do have a crisis at hand. Despite the lack of change or decrease in gross income received, expenses continue to rise. Speaking personally, my office rent went up $1000 per month when my lease expired in 1999. My malpractice insurance is higher. The reason so many doctors have either stopped accepting insurance or stopped practicing is all because of this crisis. In addition, if one needs to see so many more patients per unit time in order to meet expenses, that you compromise integrity and medical abilities, then why practice medicine. This is why so many of my colleagues have stopped practicing after studying for more than 10 years. If one is fortunate to be able to sustain a full time practice, and earn a living without accepting insurance, yet in turn be able to practice good medicine, then that is what will be done. It is why if you have money in this country, you will receive good healthcare. That is the shame.
The movie unfortunately did present some fallacies in its depiction of healthcare in Europe. It is not true that patients don’t wait to see a doctor there but rather there is a priority wait list based on need. I had a few patient’s that actually moved to England and flew back to see me as they were not able to obtain their medication there and were put on a three month waiting list to see a psychiatrist.
I do not have an answer to this crisis, however at this time I do believe this is an absolute crisis. What I do predict is that many of our more intelligent children will steer away from a career in medicine. How unfortunate. We depend on the minds of the intellectually gifted to come up with creative ideas to help prolong life and in healing. I will say that I love being a physician, and it has been my interest from a young age. I never became a physician to become rich, and presently live a very meager life. The idea of someone else paying and taking care of all the business aspects of my practice, paying me a salary, yet letting me practice medicine as an individual practitioner, not in a clinic setting, is not without appeal. I would hate however for our medical system to become solely clinics, as in general the care then becomes substandard.
Perhaps as a first step then, there should be serious investigation of the insurance companies as they stand, as well as much greater regulation. Perhaps their should be a reasonable and customary health insurance fee, as they impose on individual practitioners. Perhaps then health care will become affordable and available to a great many more people. In essence, maybe the goal should not be to make people on Wall Street richer.
In closing, I do want to thank you for your extraordinary effort in at least attempting to open up the eyes of many to this crisis. Maybe the next time around you can focus even a little more on the corruptness.
Respectfully yours,
6/20/07
Dear Mr. Moore:
Congratulations on your documentary, ‘Sicko’. As a physician in private practice for 18 years in New York City, I feel a need to comment.
First off, you barely uncovered the actual corruptness of the health insurance industry in this country. We all know about the denials made by insurance companies. They have a predetermined guideline and anything that does not meet their criteria are denied. In order for a reversal they require an appeal. This is actually not corrupt. The guidelines are documented prior to someone signing up for a certain plan.
Are you aware however about the actual scams and shenanigans they pull. In 1997 are you aware that Oxford did not pay physicians for about 6 months. Each time a physician would call regarding an outstanding claim, they were told by a customer service representative that the check had been sent out. Check numbers and actual dates of the checks were given. They would then follow up with a statement that the check must have been “lost in the mail”, and they will stop payment on it, however it would take approximately 90 days before another check could be reissued. I can tell you personally hundreds of my checks were “lost in the mail” , and thousands of dollars were in arrears. After six months I had to hire legal representation and threaten to sue so that I can pay the bills needed to continue to operate my medical practice. The American Psychiatric Association finally did step in and the matter was resolved.
In 2003 Oxford pulled another shenanigan in order to obtain money. They decided to conduct an audit in the New York City area. They asked for notes on 110 random patients, and chose 5 random dates of service. They had us (over 300 mental health professionals were involved in this audit; including psychiatrists, psychologists, and social workers) photocopy these notes, of course on our dime and time, and mail them. They then had some unknown person review the notes, and decide whether the billed session was appropriately coded and billed for. They would make a rash decision based purely on what words were included in the note. For example, if a patient seen for both weekly psychotherapy and medication management did not have the word medication mentioned in that progress note, even if that word or the drug name were written in the medication record kept in the chart, a conclusion was made that that visit should have been billed at a lesser reimbursement rate. They then came up with an amount that was inappropriate billed, multiplied that amount by the total number of patient visits seen by all Oxford patients over a 10 year period, and came up with some astronomical number they demanded refunded to them. Confidentiality matters were not taken into account, and highly confidential reports were sent out to strangers at the insurance company at their demand. Individual practitioners had to hire their own legal counsel, as we do not have a union, to defend against this. Eventually this whole witch-hunt was dropped, but that was after thousands of dollars were spent individually on legal counsel, and preparing of the paperwork.
Do you also realize that in the last 15 plus years, our fee per visit have not been increased. We are receiving the same reimbursement or a lower fee for a 45 minute session than we received in 1993. For example, when I started working with Cigna Health Plans they were paying $120 for a 45 minute session. In the late 1990’s this fee was reduced to $95. My own individual health insurance plan however continues to increase at a greatly inflated rate. It seems to increase at about $60 to $75 per monthly payment or almost $1000 per year. Doctors have not seen a penny of this money.
Other tactics they use in order to avoid payment, although legal, is just to keep people on hold, sometimes up to an hour or more. On one very sad occasion, several years ago, I needed to have the hospitalization of a patient approved before I could send him to the hospital. This patient I felt potentially could be suicidal, as his condition was progressively worsening over the course of a week, and having treated him for the six months prior, knew this change in mental state could potentially be serious. I continued to try to engage him, while listening to the music when kept on hold; a difficult feat when speaking with an acutely depressed and potentially suicidal patient. Finally, after one hour on hold, someone picked up; I reviewed the case and hospitalization was approved. During that time however this patient decided he did not wish to go into the hospital. His family was called and they did not wish for him to go as well. They came to pick him up and agreed to stay with him and he made an appointment for the following day. The following morning I received a call informing me that this patient had indeed jumped in front of a train, leaving behind a wife and two small children. No, there was no law suit against me, or the insurance company for that matter, and I cannot guarantee if he went to the hospital he would have agreed to stay or what the outcome would have been. I only know that before I made that phone call he agreed to go, and it was while I was on hold so long he changed his mind. Without family support or his agreement, I was not able to commit him involuntarily. This long hold time or the tactic of transferring to an average of 4 departments before getting to the proper medication approval department, is also how the companies minimize approval of certain of the more expensive second tier medications.
We clearly do have a crisis at hand. Despite the lack of change or decrease in gross income received, expenses continue to rise. Speaking personally, my office rent went up $1000 per month when my lease expired in 1999. My malpractice insurance is higher. The reason so many doctors have either stopped accepting insurance or stopped practicing is all because of this crisis. In addition, if one needs to see so many more patients per unit time in order to meet expenses, that you compromise integrity and medical abilities, then why practice medicine. This is why so many of my colleagues have stopped practicing after studying for more than 10 years. If one is fortunate to be able to sustain a full time practice, and earn a living without accepting insurance, yet in turn be able to practice good medicine, then that is what will be done. It is why if you have money in this country, you will receive good healthcare. That is the shame.
The movie unfortunately did present some fallacies in its depiction of healthcare in Europe. It is not true that patients don’t wait to see a doctor there but rather there is a priority wait list based on need. I had a few patient’s that actually moved to England and flew back to see me as they were not able to obtain their medication there and were put on a three month waiting list to see a psychiatrist.
I do not have an answer to this crisis, however at this time I do believe this is an absolute crisis. What I do predict is that many of our more intelligent children will steer away from a career in medicine. How unfortunate. We depend on the minds of the intellectually gifted to come up with creative ideas to help prolong life and in healing. I will say that I love being a physician, and it has been my interest from a young age. I never became a physician to become rich, and presently live a very meager life. The idea of someone else paying and taking care of all the business aspects of my practice, paying me a salary, yet letting me practice medicine as an individual practitioner, not in a clinic setting, is not without appeal. I would hate however for our medical system to become solely clinics, as in general the care then becomes substandard.
Perhaps as a first step then, there should be serious investigation of the insurance companies as they stand, as well as much greater regulation. Perhaps their should be a reasonable and customary health insurance fee, as they impose on individual practitioners. Perhaps then health care will become affordable and available to a great many more people. In essence, maybe the goal should not be to make people on Wall Street richer.
In closing, I do want to thank you for your extraordinary effort in at least attempting to open up the eyes of many to this crisis. Maybe the next time around you can focus even a little more on the corruptness.
Respectfully yours,
Post edited by Unknown User on
0
Comments
I'm guessing that there are doctors that take advantage of the medicare/insurance payments and would resist any change, but the more people can expose how things really work, the better.
I just really don't know what the best solution is...
was like a picture
of a sunny day
“We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses.”
― Abraham Lincoln
Dear Viewer,
You claim to have seen my movie prior to it's screening. I'll see you in court.
Michael Moore
Let's get rid of it.
...are those who've helped us.
Right 'round the corner could be bigger than ourselves.
Insurance companies take much more money from Americans, then any collection of service providers ever would. They take their cut and spread the rest among the corrupt.
The beneficiaries will not allow us to get rid of them.
Sadly the "beneficiaries" are not the policy holders.
people need to be more careful about what they ask for; they just may get it.
Do you think you're fully covered and safe right now?....think again...
Insurance companies make shit up (just to screw you) on the fly.
Having "car type" insurance for your health coverage is nuts. You just know you're going to get bent over at some point.
The first rule of insurance is: you always get screwed at some point with insurance no matter what.
The countries that have socialized health care....take a look a them are they burdened by health care costs?
I know most, if not all, doctors want to work in a socialized system where they can actually help people out of instinct...most likely the reason they became doctors in the first place...
and reveling in it's loyalty. It's made by forming coalitions
over specific principles, goals, and policies.
http://i36.tinypic.com/66j31x.jpg
(\__/)
( o.O)
(")_(")
socialized medicine is just like insurance except the government takes the money from you to pay the premium; plus cover their administrative costs. my meds are $2623/month without insurance so if you want to pitch in i'll pm you the address.
Apparently there is a difference....someone has made a documentary about it even
Are your meds worth that price? no...definitely not.
I will only ever live in a country with socialized health care.
I like how the lady in Sicko was able to pick up her asthma inhaler for $5 in Cuba but in America the exact same inhaler is over $120....
It's all a huge scam...
and reveling in it's loyalty. It's made by forming coalitions
over specific principles, goals, and policies.
http://i36.tinypic.com/66j31x.jpg
(\__/)
( o.O)
(")_(")
it's not the same medicine. the us has standards. if you buy 5mg of xxx in the us; it's 5mg. in mexico it could be 4mg or 6 mg. i bring this up because of a lawsuit against a doctor. the patient died and the family sued. the widow made the mistake of bringing the medication to court and the defence had it analized because it was from mexico. the dosage varried from pill to pill in the same bottle and the doctor was aquitted. the patients heart condition required an exact dosage and the patient didn't follow the doctors prescribed dosage.
what do you think happens to meds that don't meet quality control standards? they get sold to other countries without those strict standards. are you old enough to remember when all those defective condoms were sent to africa. their standards are lower.
also remember that $5.00 in cuba may be a days pay.
i have a med that has to be exact. 32.4 mg to be exact. anymore would kill me (over a few weeks) and less would throw me into seizures again. i'd rather pay for the top quality then play russian roulette buying it in another country.
i beg to differ. it's more participants receiving healthcare. those that can pay in; are already paying in. look at medicare and medicaid. the taxpayers are already paying in and that system is so burdened. imagine another 280 million added to that system. the government would not only have to raise taxes but cut other services.
ps: more participants also means more paperwork and thus more administrative costs.
The taxpayers you speak of are already paying in and paying into private insurance. Under a universal system, they'd only be paying the tax - which would be cheaper overall. Many companies would benefit, too, as they would no longer have to offer insurance as an incentive to their employees.
...are those who've helped us.
Right 'round the corner could be bigger than ourselves.
exactly. Also, I don't want a congress that has practically zero physicians in it making up policy that affects my health, unless the congress listens to those physicians and not to special interests. (that'll be the day)
i can understand your point and it's a good one. but i can't get past the fact that medical costs will remain the same. a nerve conduction test will still cost $8K usd so the amount of additional taxes would have to equal that of private healthcare premiums. the additional healthcare recipients would have to raise the premium costs. i can't see how it wouldn't.
because they're busy treating patients. i want my doctor concentrating on medicine and not lobbying for more money.
the AMA does do some medical lobbying. http://www.ama-assn.org/ama/pub/category/7834.html http://www.ama-assn.org/ama/pub/category/13404.html
http://www.ama-assn.org/ama/pub/category/8659.html
here's something from JAMA
A NEW FOCUS FOR HEALTH CARE REFORM: REALIGNING COMPETITION AROUND PATIENT VALUE
WASHINGTON, D.C.—The health care policy debate is stuck in a place that undermines physicians and the nation’s health. The real problem is not cost, but value, according to an article in the March 14 issue of JAMA, a theme issue on access to care. The only real solution to the national health care problem is to dramatically increase the value of the care delivered for all the money being spent. And that, the authors argue, is an effort that must be market based, medically sound and physician led.
Michael E. Porter, Ph.D., M.B.A., of Harvard University, Cambridge, Mass., and the Harvard Business School, presented the article today at a JAMA media briefing on access to care at the National Press Club.
Dr. Porter and Elizabeth Olmsted Teisberg, Ph.D., M.Engr., M.S., of the University of Virginia, Charlottesville, examined the status of health care today, and propose a strategy for reform.
The authors write that the health sector today has the wrong kind of competition. Each player in the system gains not by increasing value for the patient but by taking value away from someone else. This does not improve health outcomes per dollar spent—in fact, it often does the opposite. Health care competition does not have to be zero sum. The authors make the positive case for realigning competition around patient value, and they call on physicians to lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.
The authors’ proposal highlights three principles that will put competition on the right track: 1) the goal is value for patients, (2) medical practice should be organized around medical conditions and integrated care cycles, and (3) results—risk-adjusted outcomes and costs for each medical condition—must be measured.
The Goal Is Value for Patients
“Improving value for patients is clearly the only valid goal for ethical reasons. It is also the only goal that aligns the interests of patients, physicians, health insurance plans, employers, and government. If physicians improve value for patients, they will be able to credibly engage Medicare and health plans in new contracting and reimbursement practices that reward such value.”
Organize Around Medical Conditions and Care Cycles
Dramatic improvements in value will require the restructuring of health care delivery, the authors argue. “Organizing care around medical conditions, rather than specialties or procedures, is key to improving value to patients. A medical condition is a set of interrelated patient medical circumstances that are best addressed in an integrated way. This encompasses conditions as physicians usually define them, such as diabetes, congestive heart failure, arthritis, or breast cancer. But this definition differs by including all needed specialties and the prevalent co-morbidities, such as diabetes combined with vascular problems or hypertension.”
“For virtually every condition, the cycle of care begins with screening and prevention and extends all the way through preparation, treatment, recovery, ongoing monitoring, and active disease management in the case of chronic conditions. Multiple specialties, services and even entities are involved in the cycle of care. Value for patients comes from the overall effect of the entire sequence of activities, not from any individual service.” The authors note that physicians are beginning to organize care around medical conditions and are forming institutes, centers, and other types of integrated structures that bring needed specialties and expertise together and encompass the care cycle.
“Better integration of treatment with prevention, rehabilitation, and disease management will reveal obvious ways to improve the overall outcomes and reduce costs. It will also point the way to how to change the broken reimbursement system.”
Measuring Results
“There is simply no way to achieve large and sustained improvements in value for patient without measuring results: the set of risk-adjusted outcomes of care for each medical condition, together with the costs of achieving those outcomes. Processes of care, the focus of much of today’s quality movement, are not results. Good outcome measures are vital feedback indicating what works and what does not. These measures enable professional insight and the development of expertise.”
“Designing risk-adjusted outcomes measures is not easy, but their practicality has been convincingly demonstrated. In some very complex areas of care, such as intensive care, transplant surgery, cardiac surgery, and long-term care for cystic fibrosis, validated measures have been available for many years. Clinicians can and should develop meaningful measures,” they write. “Results information reveals one of the most crucial insights about health care delivery: truly high-quality care is usually less costly. One of the most important reasons to measure results is that the best way to reduce costs is to improve outcomes.”
How Value-Based Care Delivery Could Change Medicine
The authors write that implementing these reforms will create powerful ripple effects throughout the health care system, including more effective collaborations between physicians and care teams, greater patient involvement in their health care, fewer malpractice suits, more supportive health plans and government payers, new means for reimbursement, and higher performance levels by physicians and care teams and an improvement in overall value of patient care.
“Paying for care cycles and rewarding value is ultimately the only feasible way to change a reimbursement system that everyone knows to be broken. When value rules, the nation will finally get better outcomes for every dollar spent on care. Competition on value, then, must become the nation’s health strategy. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system. In the economy at large, competition on value underlies the wealth of nations. It can transform the health of nations as well,” the authors conclude.
(JAMA. 2007;297:1103-1111. Available to the media at http://www.jamamedia.org)
Editor's Note: The George W. Baker Foundation at Harvard Business School and the New England Healthcare Institute provided financial support for the authors’ research during the time that this article was written. The authors receive royalties for their book Redefining Health Care and honoraria for presentations and discussions related to it. They each own stock in a number of companies that are suppliers to the health care sector.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations@jama-archives.org.
They had this problem in Germany. Their solution, and it's not a bad one, was to continue with a co-pay system. You pay the tax so that there's universal coverage, but you also have to pay when you go to the doctor. Not alot - I believe a standard doctor's visit is around $10, but it helped fund the system and keep people from visiting doctors willy-nilly just because they have an afternoon off.
that would work in theory; but what about those that can't afford the copay? the idea was free healthcare for all.
But, yeah, for some it would be completely free. Theres no getting around that - and it's something we're doing already anyway through our emergency rooms. Nothings perfect. I'm just looking for better.
fair enough.
Single-Payer National Health Insurance
Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.
Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 46 million completely uninsured and millions more inadequately covered.
The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.
Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.
Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.
A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled though negotiated fees, global budgeting and bulk purchasing.
Amen to the last post. Yes that is the answer. Get rid of the bullshit costs, and direct costs to actual practice of medicine.
And guys, doctors are barely making a living now, so a cut in pay..thats a joke. Most doctors depend on reimbursement from insurance companies. IF they keep lowering the fees as they do, then the net overhead continues to exceed the net gross and the shop closes. this is where we are now in america.
Why such a low opinion of America? You don't believe that we could do at least as good a job as Germany if we set our minds to it?