News

Stanford Hospitals terminate Blue Cross coverage

Negotiations ongoing between Anthem Blue Cross and Stanford Hospitals and Clinics

Patients with Anthem Blue Cross health insurance stopped having coverage at Stanford Hospitals and Clinics on Thursday (Sept. 1) after contract negotiations were not resolved, according to an Anthem document Palo Alto Online received yesterday.

The contract termination means that Stanford University Hospital, Lucile Salter Packard Children's Hospital (LPCH) and Stanford Medical Group might not be in the Anthem insurance-plan network. Authorizations and copay amounts could change for patients with the HMO and PPO plans, Lucile Packard spokesman Robert Dicks said.

The hospitals sent Anthem a letter on Feb. 25 informing the insurance giant of the termination on the contract's Sept. 1 expiration date.

The hospitals and Anthem have been in contract negotiations for several months to try to reach an agreement on reimbursement rates. Negotiations are ongoing, Dicks said. The two sides are close to an agreement, he said.

"The hospitals continue to work diligently with Anthem on negotiating new terms of agreement and are hopeful that a new contract will be signed as soon as possible. In the meantime, patients covered by Anthem Blue Cross HMO or PPO may still receive our world-class care.

"However, during what we hope will be a temporary and interim period, Anthem Blue Cross HMO members should continue to work closely with their primary care medical group for approval and authorization. Anthem Blue Cross PPO customers may have different co-pays and deductibles but should continue to have access to Stanford Hospitals and Clinics and LPCH facilities and physicians," he said.

If their primary-care physician is in one of the Stanford hospitals or the clinic, they might have to change physicians temporarily to receive authorizations from within their network. He said that patients should check with their medical group or with Anthem regarding their coverage.

If someone has Anthem Blue Cross HMO they can still receive care as long as Anthem Blue Cross or the patient's s primary care medical group provides authorization. However, Anthem Blue Cross has the right to redirect HMO patients to other contracted hospitals or physicians, Dicks said.

If a patient has Anthem Blue Cross PPO the patient might have different co-pays and deductibles. Elective procedures requiring pre-authorization, such as many outpatient surgeries, may not be approved by Anthem Blue Cross, he said.

The hospitals are also advising people to contact the Anthem Blue Cross Customer Service phone number listed on the back of their insurance card regarding continuity of care.

In its letter, Anthem said the California Department of Managed Health Care is requiring the insurance company to allow general enrollee access to Stanford medical Group until Sept. 16.

"Although Anthem will not publicly share details of its confidential contract negotiations, discussions with Stanford are ongoing," the company said in its statement.

"Because provider rates are the predominant driver of higher healthcare premiums, Anthem considers it our obligation to seek financial arrangements with network providers that result in competitive premiums for our members and clients.

"We are committed to ensuring that new contract rates remain profitable for Stanford. Nevertheless, given the current climate of health insurance reform, Anthem must maintain a balance between reasonable profits for hospitals and medical groups while providing member value."

California law requires Anthem to prepare for a potential hospital termination. The insurance carrier has submitted a transition-plan filing with the Department of Managed Health Care to ensure that patients have adequate health care after the medical group terminates from the insurance company.

Anthem has filed a transition plan for Stanford Medical Group that has been approved, with some conditions. Transplant patients can continue to receive services and will be reimbursed at in-network levels. Transplant patients at Stanford and Packard hospitals will also continue to receive care.

In-patients at Stanford hospitals will continue to receive uninterrupted care at in-network benefit levels. Doctors can also request continuity of care coverage, although that will be based on a number of factors, according to Anthem.

Emergency services can still be obtained at Stanford and Lucile Packard and do not require pre-authorization, the company said.

Comments

1 person likes this
Posted by Moi
a resident of Another Palo Alto neighborhood
on Sep 2, 2011 at 10:38 am

Medicare for all! Everyone should have basic health care.

Universal single-payer is the only solution.


1 person likes this
Posted by Judith
a resident of Another Palo Alto neighborhood
on Sep 2, 2011 at 10:50 am

I agree completely!


1 person likes this
Posted by dennis
a resident of Downtown North
on Sep 2, 2011 at 11:10 am

Moi and Judith are correct - Medicare For All!, Single Payer! - yea! But today's employment figures would argue against anything that would add to unemployment. The number of people dependent for employment by the devilishly complex private health insurance scheme, is quite substantial. Any move toward a rational healthcare system would reduce this complexity, thus killing jobs while saving lives, increasing the environmental burden inherent in overpopulation.


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Posted by Donna Pimm
a resident of Menlo Park
on Sep 2, 2011 at 11:15 am

I was very very unhappy with the treatment and care at Stanford, they also charged my in Insurance Company way too much and took advantage of my Medicare.


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Posted by Arch Conservative
a resident of Menlo Park
on Sep 2, 2011 at 11:28 am

I agree with Donna Pimm. I spent 12 dsys there couple of years ago. Terrible food and nurses could barely speak English. Charged the insurance company for medicine and pills I never got, 20 PTs and OTs at $200 per pop, that were never done, ""admittance fees" and a host of other items. When I asked for an explanation, the business office said in effect " Well, we just do that with all patients and no one complains". Looks like someone finally did and got heard.

Had a couple of hospital stays since then, but was very firm in telling my doctor that I would never go back to the Stanford Hospital. And I never will.


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Posted by David Pepperdine
a resident of Another Palo Alto neighborhood
on Sep 2, 2011 at 11:49 am

The US has by far the most ineffective system of healthcare of all industrialized countries. Most of it is due to bickering about money. The AMA does not want more doctors -- they limit residency positions by not recognizing more teaching hospitals. They use scare tactics about foreign medical graduates (much like Detroit did about Japanese cars in the 1970s and 1980s). Today, there are under 100 cardiologists graduated per year for a population of 350 million people!

Insurance companies limit the number of doctors in their plans in a given geography as one (coarse but effective) way to limit costs, thereby delaying (if not denying) access.

As a new patient, when you call a doctor's office, they always ask who your insurance is with before telling you when you can be seen. This is so they can make priority decisions based on payment. If your insurance puts them on a "capitation" plan, where they get a fixed payment from the insurance company (with a small uplift depending on how many patients they see), then it's in their interest to send you to the back of the line hoping you'll go away and see someone else instead. If you have "plum" insurance, you get whisked to the front of the line.

IMHO, the best way to eliminate this is to open up the system to market forces -- supply and demand:

a) Allow foreign doctors to set up shop here provided they pass the same exams that US graduates do. The qualification procedure should be blind to where they got their degrees (which the AMA circumvents today by administering oral exams).

b) Don't limit the number of doctors -- in any specialty. We don't do that for airline pilots, engineers, or firefighters. We shouldn't for doctors either.

b) Remove the artificial AMA-engendered limit on residency positions.

c) Have people pay for their routine treatment out of pocket, in much the same way they pay for car repairs, without the bloat of an insurance bureaucracy.

d) Have health insurance for high expense situations only (say, over $20K in a year, or use a sliding scale depending on income).

e) Maintain the county-provided safety net for those with a demonstrated financial need.

The focus needs to shift from Wealth Care to Health Care!

My 2 cents.


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Posted by Moi
a resident of Another Palo Alto neighborhood
on Sep 2, 2011 at 12:03 pm

dennis --

You are too funny.
Somehow I doubt that your remarks will be appreciated by most readers.


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Posted by everyone needs access to health care
a resident of Adobe-Meadow
on Sep 2, 2011 at 12:11 pm

Shame on both Stanford and Blue Cross for screwing their customers. This is why we need a Federal program to provide health care access to everyone. Quit stalling and get it done.

Saying that cancelling people's health insurance will the employment picture is a bogus argument.


1 person likes this
Posted by Dan
a resident of Southgate
on Sep 2, 2011 at 1:50 pm

I'm sure the impasse is due to $$$: negotiated rates. Large insurers use their size to arm-twist doctors and hospitals into giving them lower rates. Results:
1. A small, start-up health insurance company has no chance.
2. Hospitals must cut costs to live with the low prices paid by insurers, like mandating doctors spend no more than 10 minutes with a patient.
3. Doctors/hospitals raise rates for patients not part insurance plans with negotiated rates.

This country spends way too much of our health care dollars trying to push costs onto someone else. All that effort cost a lot but doesn't save a single life. Health Care debate needs to be not about who pays (federal, state, insurance, individual, company), but about how to reduce overall costs.


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Posted by Publius
a resident of Portola Valley
on Sep 3, 2011 at 11:59 am

Thank you David for your comments. I think they are well thought out, and I agree with the bulk of your thoughts, except your initial statement. Discussions are generally much too broad about healthcare, in my humble opinion, and should separate the money side of the equation and patient care, when making broad generalizations about how effectual our healthcare system is. In general, patient care, especially the speed of patient care, is very high in the US, if not the highest. Our financial system of procuring healthcare and healthcare coverage is definitely a mess. A government-run universal healthcare system, financed through an already bankrupt government, further separating people from any realization of the cost of healthcare, makes no sense at all.


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Posted by Bob
a resident of Community Center
on Sep 4, 2011 at 10:10 am

and then........ Stanford UNIVERSITY recently announced that next Jan. 1st Stanford EMPLOYEES will be dumped out of the popular Health Net and Pacific Care HMO's and forced into Kaiser or a new plan run by BLUE CROSS ANTHEM. Go figure. Don't those two institutions talk to each other?


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Posted by How about better, smarter, cheaper
a resident of Another Palo Alto neighborhood
on Sep 5, 2011 at 1:36 am

Many above posters make good points. I'd like to expand on many previous points:

It's true, we have the most ineffective system in the advanced world. In 2006, healthcare bureaucracy cost all of us $450 billion (with a "b"), mostly because of private insurers. That same year, the entire Medicare program, all the healthcare for retirees, cost net about $326 billion (and a quarter of that is bureaucracy costs from private insurance that permeate the system).

Put in perspective, that's on the order of what we spend for the entire DOD in a non-war year. With half of all healthcare outlays in some way coming from government, its a huge untapped costcutting opportunity. And an opportunity to provide better healthcare at the same time.

According to T.R. Reid's book, "The Healing of America", the U.S. is the only advanced nation that still allows insurance companies to profit from healthcare financing.

This is not to be confused with government systems. Many other nations have more highly privatized systems than ours. Providers, hospitals, labs, all can profit. Just insurance companies can't profit for healthcare. We are the only advanced nation still allowing that.

The U.S. is also the only advanced nation that does not provide universal healthcare, a notable competitive disadvantage. We also spend far more per capita without getting the best results or the best service. Imagine you have surgery and your insurance pays to send you to a spa in Marin to recover for 6 weeks, a spa where the minimum wage is $30/hr. That sort of thing has been available for people in Switzerland (where wages are far higher) for decades. And they still pay far less per capita than we do and cover everyone. The Swiss, according to Reid, tried letting insurance companies profit for healthcare, but costs went through the roof and people went bankrupt, so they held a referendum and stopped it, which solved that problem.

I think people who want universal single payer instinctively could see that it was the only option removing the profiteering from healthcare financing (insurance). But I hope they will consider that removing the profiteering from healthcare financing could give us universal coverage without it needing to be government single payer.

I want to note once again that removing the profit from just healthcare financing leaves our healthcare DELIVERY system largely untouched. It does not have to in any way change things to government run. It just removes a perverse incentive that can never align to the benefit of patients. As Reid points out, there is a fundamental conflict between paying investors and paying for people's healthcare.

One of the biggest barriers to solving our problems is the myth that insurance companies save money. In limited contexts, for themselves, they save money. But they don't save money for our system, they have no responsibility or incentive to do that. They are a middleman that profits from the size of the healthcare economy. They benefit if that economy is as large as everyone can bear, and not surprisingly, it always is.

Their need to save costs in limited contexts to benefit themselves comes from their need to control the system to derive their maximum profits from it, which is their responsibility to investors. Their need for CONTROL results in the huge bureaucratic burdens and the denials.

We could be saving hundreds of billions of dollars every year, providing better healthcare, and supporting a system that works toward serving people better (and ultimately sees cost savings from solving problems better and keeping people healthy and productive), rather than serving insurance companies interests first and foremost.

We're not talking about doing anything strange. The model would be like consumer-owned credit unions rather than investor-owned banks.

It wouldn't be that difficult to make this one change. Jobs could be shifted from pushing paper/avoiding giving people healthcare, to adding healthcare training and jobs/actually providing it. For the same or less money.

We should be covering all necessary healthcare, even so-called experimental care. experimental care is after all mostly defined by insurance companies in order to control what they pay -- they don't like anything unpredictable. But this stifles innovation and problem solving. Imagine paying for all reasonable care so long as physicians are willing to document the case in a national database (without names). Universal heatlhcare becomes at the same time like underwriting a giant research study that includes virtually everyone with an unsolved medical problem. Suddenly we'll have real advancement in medicine again, and save money at the same time.

As for OVERuse, that's not as much of a concern if patient judgement of results is included in the remuneration and performance equation. Patients want to spend as little time in healthcare settings and getting care as possible, not more. Giving out free healthcare is not the same as giving out cash. If you could wave a wand and take care of all ills for free, there's not a single person who would choose endless surgery, uncomfortable and risky tests, or pills over that. Patients want to be well to live their lives, not spend their time in medical care that takes them from it. If doctors and patients are given the autonomy to do what makes people well and not overcontrolled as in our convoluted system at present, our system will work better and be cheaper, and the entire rest of the advanced world has realized.

Are we innovate and smart enough to this? Or will we continue to be dragged down until we are no longer able to compete in the world? The big question is: Do we love our families and lives more than paying obscene amounts of money to insurance companies to impose nonsensical inefficiencies and backbreaking costs on our system for their own benefit?



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Posted by Ats
a resident of Midtown
on Sep 5, 2011 at 8:50 pm

Many suggest Medicare for all is the answer. Nothing could be furthr from the truth. Patients must realize that all insurance companies would like to pay to medical providers the same reimbursement that medicare pays. Bottom line if it weren't for the private insurance carriers who pay considerable more than medicare for the same service provided Medicare would be in more severve negative financial condition than it is currently and the providers of medical care could not survive.


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Posted by George
a resident of another community
on Sep 6, 2011 at 5:16 am

When buying health care, you can think of three desirable parameters: low cost, high quality, access. Generally, you will never be able to get all three no matter what. "Medicare for all" provides low cost and theoretical access, but what do you think will happen when everyone decides they need to see the highest quality providers, and have equal buying power? Long waiting lists, so access suffers. You'll be able to get in to see the lower quality providers and institutions, however. What Anthem Blue Cross is doing is choosing cost at the expense of quality.


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Posted by How about better, smarter, cheaper
a resident of Another Palo Alto neighborhood
on Sep 6, 2011 at 2:09 pm

Read my post above. We can do better because the rest of the advanced world has figured it out, and we are smart enough to, too.


George,
That depends on how you define those parameters. Do you mean lower cost than we have here, higher quality than we have here and better access? If so, you can find that in quite a few places around the world, like Switzerland, because we can't seem to get out of this box of thinking we have to pay profits in healthcare financing, no matter how bad and expensive the system gets.

You forget that the Blues came into being during an era of high quality, relatively reasonably priced medicine in this country. They were then all non-profit organizations, too.

Ats, I wish everyone could get out of this box of thinking the choice is government insurance or government healthcare versus what we have. Please read my original post above. If we just learn an important lesson from every other advanced nation in the world, we can in fact provide better care for less than we are paying now. I think we are smart enough to learn that lesson. But it takes not falling into old ruts of thinking, because if the answer were there, we'd have found it.

ALL healthcare costs about 25-30% more because of the cost of healthcare bureaucracy imposed on our system because of private insurers. That's just a fact. If Medicare could pay 30% less than private insurers, they would only be getting the bureaucracy cost that permeates the system out, a bureaucracy cost that comes about almost entirely because of private insurers (read my post).

There is something that doesn't add up here for me when I hear people claiming insurance companies pick up anyone else's slack, too. Anyone who has ever had an insurance co ampany deem something unnecessary or otherwise not covered knows that the charge could be five, ten, twenty times what the insurance company pays for the same service. That adds up when multiplied by a lot of people, in fact didn't Sutter lose some kind of RICO suit for so aggressively charging the "uninsured"? Even people who don't have coverage -- they'll be aggressively collected against, they are not all people who don't eventually pay -- maybe it's not even most. What about when those people pay two, three, four times what the insurer would, but most of their charge is stlll written of as "uninsured" because they're charged so much more? How do the statistics deal with that?

When the statistics of "uninsured" care are gathered, do they differentiate? Do they lump in the care insurance companies managed to weasel of, do they count people who have no policy but who have to pay outrageously inflated amounts for the same care and may eventually default, or do they really just count care to people who don't have any coverage at all and who could never pay anything? I can guarantee you it's not the latter.


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Posted by George
a resident of another community
on Sep 6, 2011 at 4:53 pm

Not arguing that our system isn't broken - it is. I actually agree with you in believing that a single payer system is the only solution that avoids a starkly two-tier system of healthcare. However, don't hold your breath waiting for a single payer system in this country. Congress cannot do even the simplest things right now. You have to deal with what is going on now, not what you wish would happen. With doctor shortages (present and projected to increase dramatically) the idea that "market forces" will somehow decrease the cost of health care makes no sense. If we are really dealing with a market, prices will rise rapidly in the face of shortage. Some are protected against this - Medi-Cal patients who show up in ERs, for example. However, this is the predictable effect of the Republican party's insistence on treating medical care as a market commodity. Blue Cross wants to pay less for health care for their subscribers, fine, they won't have access to Stanford. That's the current market discipline. If Stanford has trouble filing their beds, they'll decrease the price, otherwise, not so much.


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Posted by Toady
a resident of Old Palo Alto
on Sep 6, 2011 at 8:34 pm

As long as the demand for healthcare is separated the cost, we will continue to have problems. Simple economics behavior.

Tell me how single payer solves that problem without rationing healthcare.


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Posted by How about better, smarter, cheaper
a resident of Another Palo Alto neighborhood
on Sep 7, 2011 at 12:59 am

I wasn't advocating single payer -- think out of the box, people!

I was saying that people who favor single payer instinctively understood that it was the only option on the table that did away with the big, ugly, unnecessary $450 billion annual bureaucratic elephant in the room. However, if you read on, I say we don't need a government system or single payer to do that.

I am not in favor of government run single payer insurance, I have a lot of problems with that. I think we can do better. (I do think it would be better than what we have, but that's more a reflection of how bad things are than thinking it is the best option.)

There are many advanced nations around the world today where hospitals, doctors, labs, providers of all kinds can profit and the insurance companies are all PRIVATE, not government. In fact, their health systems are more privatized than ours with our Medicare, the VA, etc. The big difference? They cover everyone, get better results overall, for way less money. AND for all of them, every last one of them, all health insurance -- healthcare FINANCING, not healthCARE -- is all non-profit. This does not mean government. This does not mean single-payer. This is like consumer-owned credit unions, it could be many credit unions, the insurance companies exist to do the best job for the consumers possible, not for investors.

We are the only advanced nation on the planet now that still allows profit in healthcare FINANCING. We are also the only advanced nation without universal coverage, the only one paying nearly so much per capita, without getting the best results overall and without covering everyone.

You don't have to disrupt the whole system to solve this. And private companies could initiate it. Read my first post again. Then read T.R. Reid's book, The Healing of America.

Removing profiteering from just insurance as the rest of the advanced world has done, would give us better, cheaper, smarter, and give more care, give care to everyone, as the rest of the world has realized. Take a look around the world where things are cheaper, better. Reid's book does this. I doesn't have to be accomplished by government fiat, either.

Do you know in Japan, they use private (all non-profit, of course) health insurance, private providers, and people use healthcare far more than here -- six times more visits to the doctor per capita, two to three times more MRI's per capita than here, yet their MRI's are much cheaper than here, their healthcare costs less.

All over the advanced world, there are systems where people utilize services more, or smoke more and eat just as badly, and they all provide healthcare to everyone for far more reasonable prices and in some cases, like in Switzerland, they provide benefits people here can't even imagine, yet their healthcare costs less and everyone is covered. They do not have a single payer system. The big difference, as I noted above, is that their insurance companies cannot profit for healthcare financing. For-profit companies run health insurance there like charities almost, using their performance to advertise their other for-profit insurance products. They tried allowing companies to profit for healthinsurance and it backfired big time and they stopped it. It was a clear demonstration that it doesn't work. In fact, I don't think it gets much clearer than that for a topic like this.


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Posted by How about better, smarter, cheaper
a resident of Another Palo Alto neighborhood
on Sep 7, 2011 at 1:06 am

I mean, come on folks, what part of saving most of $450 billion every year, money that goes to make the system serve insurance interests rather than patient and doctor interests, don't we understand? I thought we had reached the place where we couldn't afford such foolish "luxuries" or at least where we cared more about people than unnecessary, wasteful, and unimaginably expensive paperwork.


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Posted by Sigh..same ol' malarkey
a resident of Meadow Park
on Sep 7, 2011 at 5:29 am

Every time this happens, the same ol' folks who want equally crappy health care for all ( never forget, Cuba has Universal Health Care and Economic Justice).

If you think it is horrible that Stanford and Anthem couldn't agree on rates, so Stanford shut their doors to Anthem customers...wait until we get the "universal, efficient" health care that Moi, Judtith and David, think will fix it.

Hee hee hee hee heee.Can't wait to see their faces when they realize half of the doctors/hospitals/therapists/nurses/pharmacies/etc have shut down since it simply isn't worth it to keep open any longer, if they get their way.

Oh..wait!!! Then we would ALL have less medical coverage, but it would be "fair" because it is "universally less"!!

These folks truly have no clue how to connect the dots from their wishes to the reality.

I suggest reading anything by Sally Pipes to begin to understand what is great, and how to keep it.

In the meantime, how about doing just a few simple things to help us all afford health insurance?

1) Let us buy insurance only against what we want to insure..don't force me to pay monthly premiums for everything from language translation to chiropractic insurance. I just want catastrophic insurance.

2) Let me buy my insurance at 18 or 21 years old..and keep it, privately, the rest of my life, no matter where I go..no special favors to companies for insuring me, equalizing the field for buying insurance between companies and me. Companies will no longer provide insurance, all of us are free to buy and carry from job to job, the companies no longer provide insurance, trapping us into their jobs and setting us up for pre-existing conditions tied to their insurance, their jobs. And, they can compete by salary better, not by health insurance.I am free to go where I wish and work for whom I wish without being "stuck".


Those 2 alone will lower the insurance rates to 1/2 of what they are now, and stop the "preexistings" that happen while "on the job", trapping you into a job or trapping you into being uninsurable if the company goes under or you want to leave. Get it when you are 18 or 21, switch if you wish as you age and make more money, and decide you want cadillac insurance, but never stop paying the premiums, which are half, and never have a 'preexisting".

Freedom, at last. And we all can afford something..from bike level to Tesla level.


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Posted by How about better, smarter, cheaper
a resident of Another Palo Alto neighborhood
on Sep 7, 2011 at 8:49 am

This reminds me of that scene in The Last Battle by C.S. Lewis, where the dwarves are thrown into the stable, which actually leads to another world, in the outdoors, but no matter what the Pevensie children do to show them they are outdoors with a feast in front of them, they continue to argue and fight as if they are still inside a dark stable with scraps.

@Sigh -- you are the one who seems to want crappy healthcare and crappy, expensive insurance, because that's what your suggestions would get us. Can you please tell me where in the world your suggestions have been implemented, and work? You are making hopelessly naive assumptions about the way insurance companies work.

Cuba has universal healthcare, yes. So also does Japan, Sweden, Germany, Switzerland, Denmark -- oh, wait, every advanced nation EXCEPT US! "Universal healthcare" just means everyone gets healthcare, everyone gets coverage. Of that list I just gave you? ALL of them use private insurance companies.

In Switzerland, they pay considerably less per capita for healthcare, cover everyone for better care than we get now, with perks you can't even imagine. Again, imagine your insurance covered you to go to a spa for six weeks to recover after your surgery, and cost half of what your insurance that makes you spend that six weeks buried in paperwork for coverage you may never get.

Connect the dots from wishes to reality by getting out of your ideological box and look at real examples in the real world. Wake up and look around you at the feast everyone else is enjoying while you would relegate us to scraps because you believe, even in the best you can imagine, that that's all there is.

Read my first post on this topic. Read T.R. Reid's The Healing of America (He went around the world and examined other systems and reported on that)


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Posted by Sigh
a resident of Meadow Park
on Sep 7, 2011 at 9:03 am

Dear HBSC: Where have they been implemented and worked? Here, before the Fed and State regulators took over and destroyed our choices. 30 years ago, health insurance was affordable for all..then the regulators took over and mandated impossible to pay for coverages. Made those of us who wanted truly portable health insurance that we bought and paid for ourselves pay ever more, as well as our employers pay ever more and thus pay us less or make us pay more of the costs.

Nowhere else has it been tried to go back to fewer mandates, more freedom, in health care choices... which is the point. We have lots of examples of mandated, centralized health care here and around the world, from Oregon and Massachussetts, to models throughout Europe and, of course, the old stand bys behind the former Iron Curtain, just across the Florida waters, and south of our border.

They have all failed. I like to look at the real models that have tried and failed, or are in process of collapsing from bankruptcy.

Let's try something American..? Let's each be mature adults and make wise choices..I trust myself a heck of a lot more than ANYONE else to care for me or my family.

Or do people like you REALLY think that somehow we Americans are so much smarter than every other people in the world, and WE can trust our govt to do a better job of managing our health care than any other govt?


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Posted by Sigh
a resident of Greenmeadow
on Sep 7, 2011 at 9:05 am

HBSC: Have you read anything by Pipes, Sally? Try it.

BTW, I HAVE tried to read the "Healing"..yikes. Not a book for scientifically and statistically oriented minds. Definitely a book for emotion driven. I prefer to live in real-world. I keep my fantasy and propoganda for laughs. Reminded me far too much of Moore's "Sicko" malarkey.


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Posted by free service,free service,free service
a resident of Palo Verde
on Sep 7, 2011 at 9:43 am

Free,free,free,for everyone.


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Posted by How??
a resident of Old Palo Alto
on Sep 7, 2011 at 11:03 am

free service,

How do you propose to pay for "free, free, free, for everyone"?


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Posted by Pearl - fiscal conservative
a resident of Duveneck/St. Francis
on Sep 7, 2011 at 11:15 am

"the U.S. is the only advanced nation that still allows insurance companies to profit from healthcare financing. "

Shameful.

We are America. We can, without inventing some newfangled system that will never make it out of the gate, immediately shift over to single payer or Medicare for all and cut national costs by the 20-40% markup that the for-profit-bloodsucking-insurance companies add to everyone's cost. (bravo to Dennis for the farcical "insurance companies employ lots of people" post!)

Compare to Cuba? Why don't you believe we can do better than Cuba - do you think that little of our great country? Besides, Cuba trains more doctors than the US (per capita) and has better outcomes (despite having far less technology available because they are so poor.)

Look up Cuba's infant mortality and lifespan - and compare their medical expenditures to the US per capita.

No, I believe America can build a better system than the rest of the world.

Just lose the bloodsuckers first.


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Posted by You're a bunch of socialists
a resident of Menlo Park
on Sep 7, 2011 at 1:16 pm

To Pearl,

Please get sick in Cuba.....PLEASE!!!


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Posted by What about better, smarter, cheaper
a resident of Another Palo Alto neighborhood
on Sep 7, 2011 at 8:27 pm

Pearl,
Please read my first post on this discussion thread. Are you asking me about Cuba? Why aim for Cuba? Why not aim for something like Switzerland where the minimum wage is something like $30 an hour and they can still afford to offer everyone healthcare, in a private delivery system, with private insurers (who profit for other avenues of insurance, but cannot make a profit for health insurance, because they tried that and it caused the problems we are trying to solve).

The model I am trying to describe here -- for just insurance, no need to monkey with healthcare delivery to get hundreds of billions in savings every year -- would be more akin to consumer-owned businesses like credit unions rather than investor-owned banks. We do not have to push for politically impossible (and probably not optimal) changes like single payer or a government program in order to get the benefit the rest of the world has found and dramatically cut costs while improving service.

Our country once had a thriving multi-billion dollar medical tourism industry, people came from all over the world to get advanced procedures here. Some still do, but the industry has been decimated, mostly lost to countries like Singapore and Switzerland, even Thailand, that offer the same advanced care for a fraction of the cost. Now medical tourism means Americans going overseas to get care they can afford.

I'm asking people on both sides of a tired argument to please consider that there is a different way they haven't considered -- all of you -- and please actually read my first and second posts on this thread before just going back to arguing over the same scraps in the dark...

As for Sigh -- you're hopeless. You haven't read The Healing of America, admit it. It's by a seasoned news reporter, is highly fact-based, objective, well-written and researched, and the opposite of what you claim.

Again I ask, are all of you so in love with your well-honed ruts that you would rather wear them further than have better healthcare and coverage for your families for a fraction of the cost? That you would ignore the opportunity for our nation to save hundreds of billions of dollars every year while freeing our doctors to practice medicine again, and our system to actually work as we intended?

Sigh, the era you are so wistful about was when the Blues were all non-profits. They built their empires with all kinds of tax and other advantages as non-profits. Eventually, they began running as for-profit entities, even before the conversions to for-profits. That happened to coincide with when all the problems you describe began. Also, have you forgotten that the big change you describe then wasn't regulation, it was actually a huge deregulation of the insurance industry, which used to be regulated at the federal level at the time you are so rosy about.

Otherwise, you're doing an awful lot of emotionally-driven handwaving. And you are hopelessly naive about the workings of the insurance industry -- and what is going on around the world.

I'll state again: we spend far more per capita than any other advanced nation. We are the only advanced nation that doesn't cover everyone. Many of those advanced nations, some of which I mentioned above, HAVE A MORE PRIVATIZED HEALTHCARE SYSTEM THAN WE HAVE. And they are getting better results overall. (In some cases, perks you could only dream of here.) Their doctors and patients now have more freedom than ours have. These are successful models, and the one thing they share is that none of them allow insurance companies to profit for healthcare. Period. Doctors, hospitals, labs, other providers can profit, just insurance has to be non-profit (can be private non-profit, though, as the Blues were). That is the only common thread among all of those different systems.

We do not have to accomplish this with a government program or single payer, in fact it would be politically and logistically far easier, as other countries have done -- as our country did when you thought it was so great -- to finance healthcare through non-profit insurance only.

So I ask you again, Sigh, where else in the world have your suggestions been tried and worked? You didn't answer my question, you evaded. The tragedy is that you seem to want what I am offering, but you're stuck in that old rut.


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Posted by momofagirl
a resident of another community
on Sep 8, 2011 at 12:00 pm

I brought my kid to the LPCH lab for a blood test on 9/3. The stuff checked our insurance information when she was admitting us. I thought i was still visiting a network lab. (and even today my insurance's website still listed LPCH as network provider.)

Now I found that I went to out-of-network lab. My insurance is blue shield of california EPO.

There's a huge difference between paying 15% of provider price and 100% nonprovider price.

Any one here can give me some advice? Shouldn't customer be notified for a termination?
Thanks


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Posted by How about better...
a resident of Another Palo Alto neighborhood
on Sep 8, 2011 at 5:02 pm

mom,
In support of what you are saying --

If people are going to be financially on the hook for their healthcare, providers and insurers should be required to give an accurate and rapid quote for the cost of that care before it is incurred, or it should be free.

Imagine what would happen to commerce in this country if, anytime you bought anything, you were only allowed to know the cost (within three figures) after the fact, and couldn't return it. Imagine buying a car and the dealership having the ability to bill you whatever they wanted after you drove it home.

Yet we pretend we have a marketplace in healthcare, even though patients have no rights when it comes to cost information and billing. In any other commercial arena, it would be criminal to shake you down for hundreds or thousands of dollars after representing that you wouldn't be charged anything.


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Posted by Speak Sense
a resident of Palo Alto Hills
on Sep 9, 2011 at 1:37 am

Dear How about.....

You talk too much. Please calm down. It isnot good for your health.

Thank you!


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Posted by Peace over happiness
a resident of Fairmeadow
on Sep 9, 2011 at 1:39 am

I agree with Speak Sense above. LOL. How about better etc etc - calm down.


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Posted by How about better, smarter, cheaper
a resident of Another Palo Alto neighborhood
on Sep 9, 2011 at 7:31 pm

@Speak Sense -- You should take the advice of your moniker and actually... speak sense. Clearly, this discussion is emotional for you, but to me, it's cold, hard, facts, and they speak for themselves (if you bother to read them).

What's your agenda that it bothers you for someone to point out that we could easily be saving hundreds of billions of dollars a year? Money on the same order of magnitude as what we spend on the entire department of defense? I thought we were in a financial crisis. This is low-hanging fruit.

We spend more money on insurance bureaucracy annually -- largely due to private for-profit insurance -- than is spent net on the entire Medicare program to provide actual healthCARE.

We are the only advanced nation still doing this. We can get these savings using private non-profit companies -- it doesn't have to be a government program -- as numerous other nations are already doing, getting far better healthcare for less money.

Providing healthcare for our nation is a competitive advantage. In addition to hurting worker productivity and the financial security of families, our current system is so burdened by this insurance control, it stifles medical practice, problem solving and innovation.

A defining difference today between the first and third worlds is universal public sanitation. Universal public sanitation came before 20th century prosperity, not the other way around. It is simply too difficult for people to be as productive when they are caught in the daily quest for clean water (and disease avoidance). That is how universal public sanitation came about -- governments and industry wanting healthy workers for the industrial revolution. (Fortunately, i wasn't stopped here on the argument that poor people didn't deserve it if they couldn't pay as much.) Universal healthcare is the universal public sanitation of the next century. We must if we want to remain competitive.

And we can do it with private companies, without changing our healthcare delivery significantly, saving hundreds of billions of dollars annually.

People's lives are at stake, and I want our nation to remain competitive. Read my initial posts on this thread for details. (@Senseless -- I'm happy to repeat if the best you can do is follow with more nonsense.)


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Posted by toulouse
a resident of Meadow Park
on Sep 10, 2011 at 4:30 pm

did any of you wonder why there have been no television, radio, or NY TIMES coverage of a major issue like this---stanford dropping anthem?

Instead they focused on the blunder that caused 20,000 people to lose their privacy....call your local reporter


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Posted by local
a resident of Another Palo Alto neighborhood
on Sep 11, 2011 at 11:54 pm

Probably because this isn't the first time this has happened between Blue Cross and local medical centers, I'm not even sure it's the first time it's happened with Stanford. It's leverage. If it continues, then it would be news.


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Posted by Matt
a resident of Meadow Park
on Sep 12, 2011 at 11:24 am

You're a bunch of socialists, a resident of Menlo Park, on Sep 7, 2011 at 1:16 pm said:

"To Pearl, Please get sick in Cuba.....PLEASE!!!"

Wow. Such intellectual debate. Are you offended at America not having much better outcomes than Cuba (infant mortality, life expectancy) or more offended at Pearl for making you read about it?

Do facts make your head hurt?

Personally, I'd love to vacation in Cuba - it's beautiful. Maybe Pearl will join me when it's legal.

I can't wait to hear "socialists" tell me I'm a commie sympathizer, while he wears clothing from Vietnam or China.

Quit talking, "socialists" and walk the walk!


Sorry, but further commenting on this topic has been closed.

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