Re: Med Insurance
From: art fougner, md (evsono@pipeline.com)
Thu May 11 05:46:28 2006
Medicine can never be truly cost-effective since nothing we do can
prevent the ultimate outcome.
Art
At Wed, 10 May 2006, Joanne Bulley, MD wrote:
>
>Insurance: you can't live with it and you can't live without it. As it
>is all FOR profit - the entire motive of the company is to cut their
>"losses" - that is to pay as little as possible for care so as to
>maximize the profit to the shareholders. To anyone who wants to defend
>the for-profit-motive in the insurance industry ... go right ahead -
>might be interesting to read.
>
>Anyhow - in the most recent issue of "Analog: Science Fiction and Fact"
>(July/August 2006) there is an absolutely great and hilarious story:
>"Total Loss" by James Hosek.
>
>The basic story is the main character (Gary) is in a car accident.
>Just before going to surgery for the repair of his bilateral leg
>fractures, an insurance agent comes in. The agent (Crawford) begins
>talking about "total loss" - and Gary understands that to mean the car.
>Well .. it means the PATIENT - and there is a clause in the HEALTH
>insurance policy that if the COST (direct quote from story) "to sustain
>a patient's condition or to repair dambage exceeds the patients
>intrinsic value" ... the "insurer may decline paying further medical
>costs and attempt to recover costs as obtainable from the removal and
>distribution of body parts from the corpse" ... and so they decline to
>cover and treatment for Gary's condition - and plan to wait for the
>complications to kill him and then harvest the organs. The value of the
>organs being decreased because Gary had smoked (but quit years earlier)
>and had not been a teetotaler. Gary and his wife manage to pore through
>the legalese and find a some loopholes. They do find some loopholes and
>it is a great story.
>
>Now, living & working in the medical field - I could see an insurance
>company writing this and getting away with it .... (cynic that I am)
>
>It is a GREAT short story and gave me quite the laugh when Gary had the
>final word with the Agent. If you have access and can get a copy - you
>should read it.
>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
>At Tue, 9 May 2006, Jamie wrote:
>>
>>Changing jobs is not always optional, and for the vast majority of
>>people paying out of pocket for medical care is most definitely not an
>>option. However much one values a particular physician's care, if one
>>does not have the $65-$100 for an urgent visit, one is not likely to be
>>treated. People without medical insurance end up in the ER for
>>nonemergent care rather than paying out of pocket for primary care.
>>
>--
>"Love is indescribable and unconditional.
>I could tell you a thousand things that it is not, but not one that it is."
>— Duke Ellington, American jazz artist (1899-1974).
>
--
art fougner, md
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