Accountable Care Organizations: A Brief Explanation
Monsters have one thing in common. They are driven by a selfish greed to feed: on blood, on souls, on your bank account. Insurance and drug companies are in the business to make money. Some may say that makes them monsters. Making money at the expense of patients. Money makes investors happy.
Happy investors are really fucking important.
I’m in a business. It’s a weird business. Sick people pay me money to make them better. They didn’t want to be sick, but now they are. It’s not their fault, but it’s not mine either. They are sick, I can help, so I charge them money. You don’t have any money? That’s too bad for you.
Except, I have a conscience. I still help. That’s really stupid business.
If you are lucky, you have insurance. You pay a premium every month. You may also have a deductible. Say it’s $2000. Typically you have to pay all of your medical expenses up to and including $2000 until your insurance company starts to pay. This occurs for one year. After that year, the deductible starts over. The insurance company pays me, the doctor. Most of the time and not always what I’m worth. They kind of decide. I have a contract with them that spells out what I get paid. They can argue it a little or give me a hard time about what I want to do for the patient. Maybe I want to get a CT scan, but they tell me no. That’s not nice. I know what I’m doing.
Insurance companies want to make a profit. In order to make a profit, they have to charge the consumer (the patient) more for their product (the insurance) than they spend (for healthcare). That’s good business. United Healthcare Group, the largest healthcare insurance supplier in the US, posted $10.3 billion in profits in 2014 and that’s up by 7% from the year before. That makes for very happy investors.
Maybe my patient didn’t get that CT scan because her insurance wouldn’t pay for it. I order an ultrasound. Maybe they said no again, but I could get an X-ray. It was normal. Maybe 2 weeks later, her symptoms had progressed and they still say no CT scan. They pay for a screening colonoscopy (thanks Obama), but it’s normal, too. She’s getting worse. How many of you assholes do I have to berate to get the test I want? Finally, a CT scan. Oops. She has cancer and it’s spread.
I hope your investors are happy.
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