Looking for Perspective on Two Issues

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I’m looking for scholarly informational sources, Thom's books included, to educate myself on two topics.

(1) For the sake of perspective and to mitigate the unfounded notion I have that the recent election of “tea bag” mentality congressional representatives is without precedent, I would like to read, in the area of American history, about similar cases and how the country got past these obstacles to progress.

(2) I am utterly dumbfounded when it comes to knowing the historical circumstances and processes that prompted and permitted the insurance industry to insert itself between me and my doctor. What brought this on? Did the insurance industry legitimately find a need and fill it?

Any help would be appreciated.

bryan_stuart's picture
bryan_stuart
Joined:
Jan. 7, 2011 12:09 pm

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Quote bryan_stuart:

(2) I am utterly dumbfounded when it comes to knowing the historical circumstances and processes that prompted and permitted the insurance industry to insert itself between me and my doctor. What brought this on? Did the insurance industry legitimately find a need and fill it?

if you are looking for "scholarly informational sources" on this matter. Read the contract you signed. Should all be in there.

Elbridge's picture
Elbridge
Joined:
Sep. 24, 2010 8:05 am
Quote bryan_stuart:
(2) I am utterly dumbfounded when it comes to knowing the historical circumstances and processes that prompted and permitted the insurance industry to insert itself between me and my doctor. What brought this on? Did the insurance industry legitimately find a need and fill it?
Any help would be appreciated.

I suppose you'd look at the history of insurance law and how insurance became popular as a form of employee compensation. It has been legal for you to pay insurance companies to accept financial liability for your unknown future risks for quite some time. Insurance policies spell out what is covered and excluded. I assume what's excluded is what you are getting at when you say the insurance industry has inserted itself between you and your doctor. But I hope you realize that when you buy a policy (or accept a policy bought by your employer as part of your compensation) you are not limited to only those treatments that the insurance policy covers. If the insurance doesn't cover something you want or need, you can still pay for it yourself.

I believe that its obvious that medical insurance fills a legitimate need. In my case, my need as to be sure that large unknown risks my family might face would be covered. We've paid in $250,000 or so in premiums and claims have amounted to at least $2 million and counting.

I have experienced a bias on the part of providers to limit presented care options to that which is covered by my policy, but I have always insisted that all treatements be presented to us as options whether covered or not so I was the one ultimately making the decision, not the insurance company. There was a time when we had a policy that excluded needed medication so I paid for it until I changed policies to one that did not exclude that coverage. I don't blame the insurance company for the doctor's bias. They have consitently told me that with few exceptions people act as if the covered treatments were the only ones that existed and would not even consider paying directly for that which the insurance company did not cover under their policy; even when they could afford it and it was essential to their health. The assumption that every patient will only want to know about covered options and to therefore withold information about uncovered options is the doctor's.

What I am curious about is when people began to think differently about health insurance versus other forms of insurance. With car insurance people will make a decision to buy a policy that does not cover collision and seek estimates for uncovered repairs and pay for them out of pocket ( or simply live with the damage) without accusing the insurance industry of inserting itself between themselves and the service provider. They recognize and accept the terms of the policy that they chose to buy. In the 60s and 70s, "Major Medical" policies were common and people paid for the day to day stuff as a norm. Now there seems to be this perception that every medical policy must cover every medical service I might want or need regardless of the terms of the policy that was purchased.

If the premise is that the limitations of the coverage your policy has is an unreasonable insertion of control over the heath care provided to you, perhaps you one should look at their employer for what coverage they bought, not the insurance company (industry) that offered it.

stwo's picture
stwo
Joined:
Jul. 31, 2007 4:01 pm
Quote bryan_stuart:

I am utterly dumbfounded when it comes to knowing the historical circumstances and processes that prompted and permitted the insurance industry to insert itself between me and my doctor. What brought this on? Did the insurance industry legitimately find a need and fill it?

I've often wondered the same thing.

The best explanation I've heard dates back to WWII. FDR had instituted wage controls under the pretext of national security. Like many Progressives, FDR mistakenly thought he had some kind of omnipotent power to suppress natural markets.

Of course, there was a shortage of labor, so the price of labor went up. Businesses couldn't offer higher wages to attract workers, so they began to offer fringe benefits, one of them being health insurance. After the war, the US became the industrial engine of the world, and the concept of fringe bennies became rooted in union and non-union wage negotiations.

For decades, this was no big deal, but as medicine advanced, it become more technical and more effective and more expensive. This rapidly improving care was delivered to consumers with little or no out of pocket cost, which almost certainly exacerbated the situation. Health "insurance" - which is supposed to be for catastrophic illnesses - has morphed into the modern concept of "health care", which is someone else is supposed to pay for my lipitor and my office visit.

Anyway, that the story as I understand it and it makes senses to me.

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PeeWee Returns
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Jul. 31, 2007 4:01 pm

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