Comments on: Shrinks Opting Out of HMO Plans

By: Reader

Reader — Wed, 21 Jun 2006 01:52:08 +0000

I guess having worked in the healthcare system, there is not much difference between how an insurance co. runs a care facility and how a health system like Fairview runs one. There are the same limits and layers that the caregivers have to deal with to try to do their job and help people.

Maybe I did not interpret the debate as literally as I should have. Forgive.

By: Mr. Mustard

Mr. Mustard — Tue, 20 Jun 2006 23:41:33 +0000

I know that arguments and put-downs are par for the course on the Internet, but I’m confused about what’s being disputed here. Is it your contention that Fairview is the same as a health insurance plan? Or that health plans actually do control health systems in Minnesota? I don’t believe I’ve suggested that health plans have no influence at all on the practice of medicine. But the term “take over” certainly seems to suggest ownership and/or control.
So what is it you’re saying, exactly?

By: Reader

Reader — Tue, 20 Jun 2006 23:01:29 +0000

It is clear that you don’t work in health care, Mr. Mustard.

By: Mr. Mustard

Mr. Mustard — Tue, 20 Jun 2006 22:45:01 +0000

“Health System” is different than “Health Plan.” And we were talking about Health Plans. HealthPartners/Regions is pretty much the last insurer/provider model in Minnesota. Allina and Medica split. Mayo decided not to run an HMO. North Memorial is indeed independant, but only in the sense it’s not part of a larger health system. With the Maple Grove hospital, it will be on the same level, or close, as some of the other systems mentioned. All of these systems, or provider groups, negotiate with health plans for contracts. They are not “run by” health plans.

By: Reader

Reader — Tue, 20 Jun 2006 21:57:37 +0000

There are very few major hospitals in the Twin Cities that are not “run” by a health insurance or a “health service” group. North Memorial is one example of a independent hospital.

Some groups running hospitals and clinics and sometimes insurance too in the Twin Cities are Health Partners(Regions), Health East (St. Joes & St. Johns) , Fairview(Southdale, Ridge, & University of Minnesota), Park Nicollet (Methodist), Allina (Abbott NW, United, Unity & Mercy and Mayo (Mayo Clinic & most of southern MN).

By: TBartel

TBartel — Tue, 20 Jun 2006 21:16:48 +0000

More overall, but what will happen if Hatch loses the governor’s race and we have someone who can’t make political hay on the backs of the HMOs?

By: Mr. Mustard

Mr. Mustard — Tue, 20 Jun 2006 20:45:00 +0000

I’m pretty familiar with the Dr./Insurer relationship. Are you speaking of the U.S. health care system overall or just in this state? I’m not aware of health plans taking over hospitals in Minn (not in recent years at least). Physicians groups are a slightly different ball of tea, but even there I’m not hearing of health plans “taking over.” Our Attorney General has frowned on that, as I recall. Any examples?

By: TBartel

TBartel — Tue, 20 Jun 2006 20:41:03 +0000

Mustard, ever asked a doctor what it takes to get paid by insurance companies? Many (most?) have to employ people just to file claims for reimbursement, and then argue that their claims are legit. Another layer of health care workers who have nothing to do with health care. Also, ever notice that the insurers are actually taking over the hospitals, and the doctor groups, and so are getting paid coming and going and the doctors often end up being their employees and making a lot less?

By: Mr. Mustard

Mr. Mustard — Tue, 20 Jun 2006 19:29:15 +0000

“Increasingly controlled” is debatable. Physicians have actually gained back some of the bargaining power they lost in past years. Blue Cross recently announced plans to increase reimbursements to psychiatrists. The imbalance may still exist, but I’m not sure it’s getting worse in every case.

The real point here is what is the proper response to the imbalance? Is it to opt out of the system and ask your patients to pay upfront in cash? The psychiatrists in the story may have compelling arguments, but this approach surely won’t work on a large scale. Wouldn’t it be better if the provider community worked to address these issues in the political arena? Unfortunately, most physicians seem allergic to politics.

By: TBartel

TBartel — Tue, 20 Jun 2006 17:50:06 +0000

I think the question here is that the doctors are beginning to realize that the patient-doctor relationship is being increasingly controlled by the insurance companies who are getting incredibly wealthy while screwing the doctors and the patients with ever lower fees and higher premiums, respectively. Drug companies seem to be doing fine, though, too.