On Sun, 30 Aug 2009 11:55:05 -0400, Jim Charter wrote:

> I would be interested in
> what you believe is the exact mechanism whereby the Health Insurance
> Industry contributes to skyrocketing health care costs.

IMO a big part of it is denial of preventative care because the doctor is/
was "out of network" or some other bizzare reason.  So rather than 
prevent us from getting sick, they'd rather things get bad enough that we 
have to go for a major visit.

On a smaller scale, I went to get my teeth and gums cleaned.  The dentist 
said that my gums were bad enough that he wanted me to see a periodontist 
for my cleanings for the next year.

But my insurance company doesn't cover *preventative* periodontal care; 
it's only covered if I've had periodontal surgery, which means I hadn't 
let things get *bad enough*.  So the incentive is to let things get worse 
so I need surgery, then I can get my teeth cleaned.

And of course my dentist didn't know this about my plan (how could he 
keep track of everyone's plan's limitations?), and my read of the plan 
was that it as covered.

Now, it was important enough to me that I paid the whole cost of these 
visits out of pocket, but I can afford to.  Those who couldn't afford to 
would've had to let things get worse in order for them to get better.

And when they get worse, that drives the costs up.  I'm know the 
insurance company saved about $500 by not paying out on my claim, but if 
I'd let it get to the point where I needed surgery, it sure as hell 
would've cost them more than $500.

This is what pisses me off when people who aren't in favour of universal 
health care say "we don't want a bureaucrat dictating what we can and 
cannot have" - because we already *have* that.

(Yeah, slightly offtopic there, but I think I answered your question 
above)

Jim

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