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07.07.2009 5:54 pm

Why is an insurance clerk better than a government bureaucrat?

St. Louis Post-Dispatch
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Alan Renner of Ballwin asked “What government agency or program is run as efficiently as a private for-profit company?” (”Unfair competition” 7/5)  The answer is Medicare which runs with overhead costs as low as 2.5% while private health insurance companies waste 15 to 20 % of the money they take in on things like enormous CEO salaries, advertising, free lunches for prospective customers, staff salaries to pay people to find reasons NOT to pay claims, and those endless pieces of junk mail trying to sell us their crappy products.  Medicare doesn’t have to advertise.  All a person has to do to join is turn 65 years of age.  It’s as simple as that.  I’ll take the “faceless bureaucrat” processing my claim any day over a “faceless” clerk at a private insurance company who is paid to say NO.
 
Susan Cunningham
Pacific

37 comments

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This is almost 20 years ago so I am not sure what it is like today, though I doubt it would change.

I would wake up in the middle of the night in pain in my back. It was not every night and could go weeks between attacks. The first few times I wrote it off as muscle strain, it would ease after and hour or so.

Then one night it was extreme. I went to the emergency room and was treated for a possible heart attack. Turned out not to be a heart attack. I was released and given the name of a doctor. The doctor started treating me for an ulcer, putting me on medicine for a month.

The following week I had the pain again, always 2 or 3 in the morning. I again went to the emergency room. They ran some tests and found nothing. The doctor warned me that he knew my insurance company and they would cancel me if I did not stop coming to the emergency room. He had no explanation what I should do when I was in pain in the middle of the night.

A side note: a few years ago I broke my ankle. It eventually needed 4 screws to hold everything together. I walked into the emergency room, Waited my turn and eventually was taken to the examination room. I joked with the nurse the whole time. She told me that my pain threshold was very high, I am not sure about that, she said I should have been in agony. The point is if she was correct then my pain in my back had to be severe.

The third time I went to the emergency room for the pain I first called my on-call doctor who told me to go. They eventually found that the problem was a blockage between the gall bladder and the rest of my system,I am unsure where the gall bladder leads.

The insurance company disputed and did not want to pay some of the emergency room bills, saying I should have waited for normal hours.

The point being, everyone worries about the government clerk controlling your health care. While my doctor was worried that my insurance company clerk would cancel my insurance and the insurance company clerk thought I should have just sucked it up and deal with the pain for 6 more hours before seeking help.

So either way you have a clerk and not a medical professional making health care decisions for you. So there are other issues to debate, but either way you are getting a clerk as your first line of insurance. The insurance company clerk is also worried about making a profit.

— Bob
6:16 pm July 7th, 2009

Susan Cunningham:

“Medicare doesn’t have to advertise. All a person has to do to join is turn 65 years of age. It’s as simple as that. I’ll take the “faceless bureaucrat” processing my claim any day over a “faceless” clerk at a private insurance company who is paid to say NO.”

If you think dealing with the government is as simple as that, you’re a damned fool. My father took my mother to apply for Social Security in 1968 and he waited in his car on the parking lot. She was given $255, his death benefits despite her protests that he was waiting for her on the parking lot and to the best of her knowledge, alive and well.

I applied for Social Security in October 1999, two months in advance of my 62nd birthday, hopefully with enough time for clerical processing of my first check in December. I got that check in March the next hear with no back pay, no explanation and minimal satisfaction with the performance of our government.

I had been tested and treated for Diabetes more than a year prior to signing up for Medicare 3 years later. Medicare paid for my first office visit to my doctor but refused to pay for the blood tests checking the progress of my Diabetes. I was told that Medicare didn’t pay for the original diagnosis of the disease and spent the better part of a year trying to get them to understand the proof I sent them 3 times proving that my private insurance carrier had paid for the original diagnosis and more than a year of treatment. They never accepted the charge, I had to pay.

Is this what everybody can expect for 2.5 percent overhead?

— Iconoclastic Sage
7:09 pm July 7th, 2009

Icon…

I have no explanation for your problem. My dad is almost 85. When he applied to Social Security they started everything right on time. They even caught an error, my mother died before that. As a result my Dad was entitled to some social security payout for my mother. My Dad was not aware of that but the social security clerk caught the mistake that he made and corrected it for him.

He has had a blood disorder his entire time on MediCare and recently a cancerous kidney. All bills were paid on time, with no hassle.

So I am unsure what went wrong in your case, but my Dad had the complete opposite of your experience.

— Bob
7:30 pm July 7th, 2009

Medicare screws doctors by underpaying them. Lawyers drive up costs with frivolous lawsuits. These actions reduce the supply of health care providers and further drive up costs. Medicare has 2.5% overhead and enormous fraud. Private insurance companies have more overhead in order to control fraud. Pick your poison. Also, funny how you forgot to mention that Medicare is GOING BROKE. Free market solutions are the answer, not big government.

— Shtaven
8:43 pm July 7th, 2009

I deal with a lot of elderly people while doing my charity work. I have NEVER met an elderly person who doesn”t like medicare. Icon..if your not happy with your medicare coverage(socialized medicine)why not drop it and get yourself a private health insurance policy??

— allisok
9:35 pm July 7th, 2009

Susan,

Medicare doesn’t control costs, that’s why it’s going broke. Medicare dictates to doctors and hospitals what they must accept for their services, and even forces them to provide emergency/obstetrical services to those who cannot pay. The physicians and the institutions are going to make that loss up somewhere, so the cost is shifted to private insurers and patients.

As we get farther down the line and more and more baby boomers start joining Medicare, costs will skyrocket since older people typically have more medical costs. Those government bureaucrats you are so enamored of will have to do something to slow down runaway costs because the private sector will be tapped out (or run out of business since they can’t print money like Uncle Sam). The only choice then is to raise taxes or ration care. Your “faceless bureaucrat” will be handing out the same “No” you claim to hear now from private insurers.

— Merc Man
9:55 pm July 7th, 2009

allisok:

Your failure to understand my comments is becoming boorish. I responded to Susan Cunningham who thinks government workers are God’s gift to us with my unfavorable experiences and you think I should be penalized with further insurance problems. I have supplemental private insurance and to my knowledge, when a person becomes eligible for Medicare, it is always considered their primary insurer. The elderly people you deal with are being shortchanged even if your work is voluntary.

— Iconoclastic Sage
9:57 pm July 7th, 2009

I have a question for all of the Medicare haters. Do you realize that very few, if ANY, persons over 65 years of age would be able to buy health insurance in the private market? I have a 40-something friend who was denied health insurance because she had *tests* done on her heart — even though the tests found *nothing* wrong. She is perfectly healthy, but can’t buy health insurance. Does anyone really think an over 65 year old with diabetes would be able to buy health insurance? Seriously?

So here is my question. If your DREAM comes true, and Medicare goes *bye-bye*, are you really OK with you, or your parents, or your grandparents becoming uninsured at age 65, or even earlier? Seriously?

— Lisa12
11:26 pm July 7th, 2009

The solution is simple: work at a company that provides health insurance until you drop dead on the clock. No need for medicare then. If you can’t work for your health insurance, then that is alright too because you will just die sooner and won’t be a burden on society.
Got to love the new Neocon party: no compassion for anyone’s life situation. Where is the old Republican party?

— Bill
12:51 am July 8th, 2009

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