Archived Story

Privatization hampers Medicare

Published 12:31pm Wednesday, July 24, 2013

I almost didn’t write this column. I don’t want to seem ungrateful or critical of the nurses and doctors who have provided health care for me and my family through a variety of illnesses.

But after another recent bizarre incident with one of the private companies that administers the drug program for the teachers retirement system and Medicare, there’s a story here that needs to be told. Put simply, for all the nonsense we hear about business being more efficient than government, it just isn’t so.

I got a letter from — we’ll call it “Hurry Scripts,” the company in question. It said, “Please contact our Member Services Department as soon as possible.”

So I called and, after punching the requisite buttons in response to the standard computer voice, talked to “Lenore.” She was puzzled, and said she couldn’t find what prompted the letter. She said she’d get the supervisor, put me on hold, and I listened to the happy, motivational computer music that was sputtering in and out.

“Ellen,” the supervisor, too was baffled, said she’d have to research the matter, and put me back on hold. Finally, she came back and said, “I can’t figure out why you received this letter.” I thanked her and hung up.

This is only one, small illustrative incident in a long string of, frankly crazy fumbles, puzzles, and dead end conversations since I’d gone on this privately managed Medicare system in June.

The first weird letter arrived saying “Hurry Scripts” had filled one of my prescriptions but didn’t know where to mail it!

So I called them, and after going through the computer rigmarole, told a lady in Las Vegas, where most of their operators are, they could mail the prescription to the same place they had mailed the letter. It was also the same address they had been sending my prescriptions for years, servicing my previous insurance.

My wife, with the same insurance and “Hurry Scripts,” went to the local drugstore where we’d gotten prescriptions filled and were told they had no agreement with our insurance company — we’ll call it “Nyetna,” so she had to pay the full price for a medicine she needed.

Next day we received “Nyetna’s” brochure listing the drugstores where we should shop, and yep, it included the very one who’d said they had no agreement.

On one occasion I received a phone recording which said “Hurry Scripts” could not fill my prescription for Crestor, the cholesterol-lowering medicine my cardiologist had prescribed. When I called back and asked “Mary,” at “Nyetna” why it couldn’t be filled, she said it wasn’t “Nyetna” that wouldn’t fill it, but “Hurry Scripts.” But, I pointed out, they’ve been sending it to me for months under my old insurance.

So, we conferenced with “Chuck,” who seemed to be in India, but got nowhere, leaving the matter still unresolved. I have several months’ supply, so I’ll let the cardiologist argue with the drug company about what pill to pay for — but what a waste of his time.

Anyway, I’ve got all my medications so far, but the large amount of confusion and duplication costs all of us lots of money. This complicated, for-profit health care system is by far the most inefficient in the world.

Doctors and nurses in England, especially, never have to spend their time figuring out what to charge a patient, who’s going to pay, or how they’ll collect it.

It’s a public, single-payer, system, paid for by citizens’ taxes. The medical profession, the patients, and the politicians left and right there are generally quite satisfied with it.

Maybe we should take another look at our privatized health care system. Let’s think again, when we hear about the virtues of the business world and how we should run hospitals or schools like a business.

The goal of a doctor, hospital, or school is service. The goal of a corporation is to wring all the profit it can out of its customers, no matter how many corners — or wages — it has to cut. And for-profit health care has to cost us more because it has to include in every transaction what non-profits and government agencies do not — profit.

 

Jack Burgess is a retired teacher of American and Global Studies. He’s a native of Southern Ohio who served on the Ohio Governor’s Commission on Health Care Cost Containment.

 

 

 

  • keta

    Every other industrialized country has some form of universal health care. Using the 16 bottom line public health statistics, every one of those countries provide better care than we do, at a fraction of the cost. The reason we’re in this ditch and can’t get out is because our representatives represent insurance companies and pharmaceutical companies, not us. End of story. Trying to lower the cost of health care AND protect these corporate empires is futile. But; the Affordable Care Act provides some incremental steps toward universal care, so it’s a million times better than anything that’s come before. Baby steps are better than no steps.

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  • mikehaney

    As far as getting billed and insurance not paying, too many times provider messed up the billing for I and family members, young and old. First thing is call provider who probably messed up the billing. Also, first thing to ask is, am I covered with my insurance.
    For routine tests and prescription drugs. Have been known(once) to pay only 1/3 of dr visit charge, and I did ask ahead of visit as far as coverage. You might get a phone call from collection(which you can legally tell them not to call back). The letters you just file away. I believe that group is being charged with over billing the government presently. Just because you get a bill, doesn’t mean it is correct and you “have” to pay that amount.

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  • mikehaney

    Public insurance
    Emergency vehicle in Hannover

    All salaried employees must have public health insurance. Only public officers, self-employed people and employees with a large income, above c. €50,000.00 (adjusted yearly), may join the private system.

    In the Public system the premium

    is set by the Federal Ministry of Health based on a fixed set of covered services as described in the German Social Law (Sozialgesetzbuch – SGB), which limits those services to “economically viable, sufficient, necessary and meaningful services”
    is not dependent on an individual’s health condition, but a percentage (currently 15.5%) of salaried income.
    includes family members of any family members, or “registered member” ( Familienversicherung – i.e., husband/wife and children are free)
    is a “pay as you go” system – there is no saving for an individual’s higher health costs with rising age or existing conditions.

    With an aging population, there is an intrinsic risk that, in the long run, the burden to be carried by the young and working generations for the higher share of elderly will run the public system into a huge deficit or result in high premiums.
    ——————————
    Germany has been working on public health care since the 1800′s. Statistically their health care is better and my guess is mainly due to the total population has regular check ups by health care providers.
    Jack’s problem with his insurance would prompt me to make a call to State of Ohio, probably Columbus.
    Still say that Obamacare is a train wreck, not sure how bad yet. We’ll find out.

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  • Geronimo

    Well said . bklibrary!

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  • bklibrary

    Mr. Burgess and excellent article. For the last thirty-five years I have argued about this same Corrupt Healthcare System that is eroding every middleclass and poor working class American’s pay day. I think Obama care would have worked if it had came sooner but the right winger and the rogue profiteers have just about destroyed the class system. America is so divided now over problems that it will take many generations if they make it to overcome this crime of HIGH PRICED Healthcare and Insurance rogues. Free enterprise could still work if there were not so many filthy rich that want nothing else but more wealth. George Carlin was right with some of his assertions about this nation it leaders and how some people use religion as a token to get elected to office. It really stinks!

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  • mickakers

    Jack Burgess; An excellent article describing the complications, failures and incompetence of our Medical and Prescription services. We most definitely need a one payer plan. Your closing paragraph says it all; “The goal of a doctor, hospital, or school is service. The goal of a corporation is to wring all the profit it can out of its customers, no matter how many corners–or wages–it has to cut. And for-profit health care has to cost us more because it has to include in every transaction what non-profits and government agencies do not — profit.”

    (Report comment)

  • mikehaney

    I’ll take the free enterprise system anyday over anything run by the government, except collecting taxes of course.

    (Report comment)

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