Where Has All the Health Insurance Gone?


I want to start going to a fitness center, and since I broached the subject in front of some family members, they helpfully offered the advice that I should double-check what my health insurance offers. It makes some sense, since their point was to prevent me from paying membership fees if they were already included in my policy. Unfortunately, this has become a normal conversation in America, because we have – as a nation – completely lost the true meaning of the phrase “health insurance.” I can’t blame anyone for that, because the language we use to talk about insurance has changed radically over the years.

In spite of being eligible for AARP (by merit of marriage), I’m not yet 50. But, I’m old enough to remember the evolution of how Americans have paid for medical services since the 1970’s, and the terms we’ve used for that.

Medical Insurance – This one is simple, mostly straightforward, and is what we called policies that would usually just cover hospital visits, and emergent care. Some policies would take a small bite out of the costs of routine doctor visits from the start, but most wouldn’t start paying for those regular visits until we had paid a generally high deductible out-of-pocket. My parents would usually eat right through that, since I was a sickly child. “Finally! The insurance kicked in!” was a common statement from my mother by around May or June of each year, when the receptionist in my doctor’s office would tell her those happy words, “No charge for today!” The bottom line for these policies was that people paid premiums to cover primarily extremely expensive services that they couldn’t afford otherwise, and routine care was paid primarily out-of-pocket. Those expensive services were mostly for grave illnesses or injuries.

Health Management/Maintenance Organization (HMO) – Arriving in the early 1980’s at least in our region, the HMO was a godsend in my mother’s eyes – at first. Sure, the paychecks went down more than with the old insurance, since the premiums were so much higher. But, all doctor visits were blessedly low cost! No more writing checks over $50 for just a routine check-up. Before my mother could absolutely declare it paradise, she ended up seeing a pediatrician to remove an in-grown toenail. You didn’t misread that. This was when my mother learned what the “management” part of that acronym really meant – patients will see whoever is cheapest for the organization, so that means the correct specialists might not fit that description. My mother ended up with blood poisoning, a hospital stay to receive IV antibiotics, and a lot of follow-up visits to other (not necessarily correct specialty) doctors to make sure there was no lasting damage to her foot or leg. Needless to say, this was the beginning of the end of people relying entirely on the advice of physicians. It’s great that people have become advocates for their own health, and learn about their medical problems. But, it would have been much better if it hadn’t started out of necessity, because many people were just like my mother – being given the cheapest care their HMO’s could throw at them. The bottom line for HMO’s is to have customers pre-pay for care through high premiums, out-of-pocket expenses are relatively low, but these organizations are focused on saving as much money as possible. They have fallen out of favor because they got a reputation for pushing questionable care – like my mother received – at the expense of patients’ health.

Preferred Provider Organization (PPO) – This is something that started sometime in the 1990’s in Western Pennsylvania at least, and is essentially still an HMO in how it operates. The primary difference is that instead of telling patients who to see, there is a list of providers to choose from within the region. The companies offering these policies negotiate contracts with hospitals, pharmacies, provider groups, and occasionally with health clubs – which is what I theoretically should be checking. Calling PPO’s “Preferred Provider Organizations” is a misnomer, and if there was truth in advertising, they would be called “Pre Paid Office-visits”. The bottom line for PPO’s is again forcing customers to pre-pay for care, which means that the majority of people do not get anything close to their investments back in these programs. Instead of the problems of questionable care seen in HMO’s there are issues with “in-network” versus “out-of-network” providers. Some regions like my own are ruled by medical monopolies, which means that depending on which insurance company is underwriting a PPO policy, customers could be restricted from using certain hospital and health networks entirely. This has become an issue since insurance companies are increasingly becoming directly involved in providing medical care, and hospital systems are starting their own insurance companies.

Right now, there’s yet another “health care” bill being considered, but because it’s not going to change the status quo of the insurance market that is essentially limited to high-premium pre-paid care policies, it’s no better than its predecessors. I understand, it’s been around 40 years since we had “real” health insurance in America, and that many people don’t remember it clearly at all. But, people really do need to think about this, and reconsider how we’re doing things. We don’t have real choices anymore when it comes to health insurance – the differences are just in costs, not in what they really offer. The primary reasons why traditional health insurance of the 1970’s and before fell out of favor was because of restrictions on Health Savings Accounts (HSA’s), and now that we’re finally easing those, perhaps it’s time to demand that government get out of the insurance business. Let the people demand what they really want from insurance companies. I sincerely doubt that I’m the only person in America who would love to return to a system where I have a policy to cover major medical problems, deductibles on routine care, and real pricing on health care – instead of the imaginary pricing created by government and insurance companies.

For now, it’s time to for me to find out if I can get a health club membership discount thanks to my current insurance – not because I “like” the idea, but because I’ve already paid for it!

Image: ccPixs.com


Source: Subculture

Where Has All the Health Insurance Gone?

U2 Still Surprising LA with Live Performances


Almost thirty years ago, U2 took to a roof in LA, at Seventh and Main. Radio hosts pointed out it wasn’t in a great neighborhood, but people might want to drop by to listen, since the concerts were all sold out. Many people did, which lead to the LAPD shutting down the performance. That was in 1987, when MTV still played music videos, and the band was filming for that and the promotion of their new album, “Joshua Tree.”

That was five years before the LA Riots – the U2 rooftop performance didn’t result in any arrests (or at least there is no mention of them in any accounts of the day on the web now.)

Now, the band is on tour for the first time with just the “Joshua Tree” album on the playlist for their performances. Maybe they thought it would be a good idea to do a smaller scale reprise of the LA live performance that resulted in the music video for “Where the Streets Have No Name.” This time, they just took over Jimmy Kimmel’s stage:

While it might be interesting to see how they would do it, it’s doubtful that U2 is getting as much “help” as they did in that version of “I Still Haven’t Found What I’m Looking For” on the road.

For those of you who want to do a direct comparison, here’s when the band walked the strip in Las Vegas to do the original music video:


Source: Subculture

U2 Still Surprising LA with Live Performances

It’s a Soap Ad – Not the End of the World!


In case you weren’t aware of it, many women are very particular about the products that they use to take care of their own skin (and the skin of their babies.) The makers of Dove products have made a cozy home for themselves on the market for women with sensitive skin. In case you’re wondering what that means, when you go into a store with entire aisles of soaps and shampoos, the people with sensitive skin can buy maybe a handful of products on the shelves without fear of adverse reactions.

That means burning, stinging, rashes, break outs, and all manner of other nasty things.

There’s another little problem for many women when it comes to products they like. Manufacturers have a horrible habit of taking some off the market entirely, without bothering to even attempt to replace them.

(My aunt used to say, “Never say you love something, because someone in the factory will hear you, and they won’t make it anymore!”)

Dove is guilty of removing some products, but they’re really good about coming up with a “new and improved” option that often really is at least as good as what it’s replacing. Sometimes, it really is much better.

That said, when I came across people talking about boycotting Dove, I rolled my eyes.

Nope. Not happening in my household.

When I heard why, it was all I could do to keep from spewing coffee everywhere.

Seriously? People are upset about an advertisement about mothers that happens to include a transsexual?

I believe the argument was that Dove was somehow endorsing LGBT lifestyles by just having “those people” in the commercial.

Well, not exactly.

If you watched it, great. If not, just take my word for it on this one.

No, they were not “endorsing” anyone in their commercial.

Yes, they were saying that every mother is entitled to being able to make her own decisions about how she raises her own children. (It’s safe to assume that they aren’t suggesting that can include mistreating or abusing any precious children.)

If you really want to push it to the political end, this commercial was promoting the individual liberty of mothers everywhere, period, full stop.

Dove wasn’t telling anyone how to be a parent.

Dove wasn’t saying any parent is better than another.

Dove was saying all parents (especially mothers) are created equal, and are endowed with the right to raise their children how they see fit.

Oh no!

That’s terrible!

Let’s boycott them right now, for making the radical suggestion that everyone (from government down to in-laws) should stay out of the business of mothers!

Needless to say, this is just another case of people looking for a reason to be outraged.


Source: Subculture

It’s a Soap Ad – Not the End of the World!

Texas Failing at Replacing Planned Parenthood


First, as usual when getting into the mess that is the abortion debate, I want to point out that my views on this issue are split – personal and public. My personal views are, well, personal and do not make it to the page. Don’t ask. All you will do is make me annoyed with you. My public view is simple – I’m not prepared to tell anyone else what to do with her body. I’m not living her life, so it’s none of my damn business.

Now, on to dealing with the folks who can’t just leave other people’s business alone. Oh, Texas! You’re just so precious! Your lawmakers thought it would be a good idea to try and make a replacement health care network to replace Planned Parenthood. And, to make it even better, you thought that sending women to clinics that probably would come off as at least a little judgmental to many women would be a great option. Of course, that isn’t the really big problem with your little venture here, is it?

In the effort to kill the hated Planned Parenthood in your state, yes you did spend a whopping $1.6 million – for NOTHING! Well, you gave it to your darling, Carol Everett, and her anti-choice organization The Heidi Group. They were supposed to get women to go to a group of clinics that you claim are better than those other ones you hate so much. Of course, that might be a little difficult for them to manage, right? They’ve been busy…. doing…. well….

No one seems to know what they’re doing.

Dropping by their website today, it was noted that they’ve been real busy doing nothing…

No site updates since September of last year! Wow!

What could possibly be the problem?

Well, it seems Everett isn’t happy with just $1.6 million. Her good work is stalled as she’s waiting for the taxpayers of Texas to shovel over another $5.1 million to her!

But, life is priceless, right?

Seriously, I think it’s time for Texans to think a little bit about this whole war on Planned Parenthood deal. It’s expensive, for one thing. Also, it’s not really addressing the underlying problems. Yes, we all know you want to stop abortions from happening. You won’t. That’s a fact. So, once you accept that there will always be abortions one way or another, maybe you need to think more about how to prevent them. How about campaigning for at least some of the birth control pills out there to end up over-the-counter? While you’re at it, just stop saying that there are piles of women who use abortion as birth control. It isn’t true, and it just makes people who are fence-pole sitting hate you – or at least back away from you because you might be crazy. Then there are the alternatives to abortion itself. While there are small pockets of activists who talk about improving the adoption system, there aren’t enough of them. Seriously, if you want to stop abortions, stop talking about just saving babies in the womb, and start fighting to make adoption easier. Also, please stop jumping on the “end all entitlement programs” bandwagon, not because I think we should have lots of them myself. You want to force women in low income brackets to have children, then you can’t turn around and tell them “too damn bad! I’m going to campaign to stop government programs that can keep you from being homeless!” Sorry, but you can’t have it both ways.

In case anyone is wondering why this experiment to replace Planned Parenthood isn’t working, beyond the possibility that the state of Texas was just scammed, women who go to those clinics know that those other clinics are all about forcing their beliefs on patients. Whether that’s true or not doesn’t matter – perception is everything, and the fact is that women who go to Planned Parenthood aren’t interested in being lectured to at all. That’s why they go there.

Lesson for the day? Back to the drawing board, anti-choice folks!

Feature Image: “I Stand With Planned Parenthood” by Women's eNews is licensed under CC BY 2.0


Source: Subculture

Texas Failing at Replacing Planned Parenthood