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Company Overview
Medical Mutual is the oldest and largest health insurance company based in Ohio. The company serves its customers through high-quality, affordable group and personal health insurance plans, and third-party administrative services to self-insured group customers.
More information can be found on the company's award-winning Web site at MedMutual.com [1]
A Pioneer on the Cutting Edge
In 1934, America was in the depths of the Great Depression. But in Ohio, a group of fledgling Clevelanders authorized a loan of $7,500 to start the Cleveland Hospital Service Association (CHSA), a pre-payment hospitalization plan to help people pay for their healthcare needs. It was one of the first plans of its kind in the nation and the first ever multi-hospital payment plan.
Today, as Medical Mutual of Ohio, that same healthcare pioneer has been transformed into a multi-faceted company with health insurance at its core. Through the years, the company's mission has not changed – to finance and manage benefits that improve the health and well-being of its members.
Community Involvement
Medical Mutual's mission – to improve the health and well-being of its members – goes hand-in-hand with its commitment to promote wellness through its involvement with more than 200 charitable organizations.
Flexible Products
Medical Mutual provides cost-effective access to quality healthcare for its members by delivering leading edge health insurance products and related services in a manner that enables it to maintain a strong financial foundation, and also, support the communities it serves.
Group and individual customers have a complete line of comprehensive, flexible benefit designs in which to choose. Medical Mutual's SuperMed family of managed-care products include: Preferred Provider Organization, SuperMed Plus; Point of Service, SuperMed Select; and Health Maintenance Organizations, SuperMed HMO and HMO Health Ohio.
The Highest Quality
Medical Mutual's focus on quality has earned the highest accreditation from the National Committee for Quality Assurance , (NCQA) an independent not-for-profit organization dedicated to improving the quality of America’s healthcare.
NCQA has awarded Medical Mutual the highest levels of accreditation for the Company's PPO, POS and HMO products. In fact, Medical Mutual's SuperMed Plus product was the first PPO in the country to earn this status from NCQA.
To earn these accreditations, Medical Mutual has met rigorous requirements that focus on complaint and appeal processes, customer service, physician credentialing, utilization management and the infrastructure for quality improvement. These areas have been identified by employers, consumers and others as being of special interest.
A Brief Corporate History
In 1934, America was in the depths of the Great Depression. But in Ohio, a group of fledgling health insurance pioneers in Cleveland authorized a loan of $7,500 to start the Cleveland Hospital Service Association (CHSA), a prepayment hospitalization plan to help people pay for their healthcare needs. It was one of the first plans of its kind in the nation and the first ever multi-hospital payment plan.
Today, as Medical Mutual of Ohio, that same healthcare pioneer has been transformed into a multi-faceted company with health insurance at its core. Through the years, the company's mission has not changed – to finance and manage benefits that improve the health and well-being of its members.
It was 1926 when John R. Mannix, who at 24 was the youngest person to ever be appointed to the post of hospital administrator, began experimenting with the idea of hospital pre-payment. His revolutionary idea was to divide the cost of healthcare among all people whether they were hospitalized or not. Unknowingly, he applied the basic principle of insurance, and from it, sprang the beginning of a movement that would evolve into the system that we have today.
Eventually, Mannix led the crusade that led to the formation of the CHSA, which opened for business on June 15, 1934, in room 237 of the 1900 Euclid Building in Downtown Cleveland. Premiums at the time were 60 cents a month for ward service or 75 cents a month for semi-private room service. At that time, the maximum length of hospital stay under contract terms was 21 days. There were no age limits, nor were subscribers called on to take physical examinations to join the plan.
At the time, hospital service associations around the nation became known as Blue Cross Plans. But it wasn't until 1939 when the non-profit prepayment plans officially came together under the Blue Cross identity when it came under the control of the American Hospital Association.
Medical Mutual of Ohio was created from two companies. The first, CHSA, which was formed to provide hospitalization insurance, and Medical Mutual of Cleveland, which was formed in 1945 to provide insurance for the payment of physicians' bills.
In 1957, the CHSA merged with the Akron Hospital Service Association to form Blue Cross of Northeast Ohio. Then, in 1984, Blue Cross of Northeast Ohio merged with Medical Mutual of Cleveland to become Blue Cross and Blue Shield of Northern Ohio, combining coverage for hospitalization and physician fees under one roof. In 1986, Blue Cross and Blue Shield of Northern Ohio merged with Blue Cross and Blue Shield of Northwest Ohio to form Blue Cross and Blue Shield of Ohio.
In April 1997, the company re-claimed the name of one of its predecessors, becoming the present day Medical Mutual of Ohio.
The combination of an expensive healthcare market and a legal status that threatened its future forced the company to make a bold move in 1987, not only for survival, but also for the benefit of its policyholders.
The company proposed a change in state law that would enable it to contract with hospitals in a competitive manner. The result was a memorable legislative battle that concluded in victory for all consumers.
In 1993, Medical Mutual was among the fastest-growing healthcare companies with a managed care product known today as SuperMed. SuperMed proved beneficial to the Greater Cleveland Growth Association's Council of Smaller Enterprises (COSE), and later became a national model for insurance among small businesses, chambers and associations.
In 2001, Medical Mutual's SuperMed Plus was recognized as the first Preferred Provider Organization in the United States to earn Full Accreditation from the National Committee for Quality Assurance, an independent not-for-profit organization dedicated to improving the quality of American's healthcare.
In order to keep Medical Mutual financially stable and growing, the company has expanded beyond health insurance. As a way to leverage the company's vast computer systems, Antares Management Solutions was introduced in 1997. Antares offers access to a broad range of technology resources and applications, which encompasses the installation and management of hardware and software for businesses in a variety of industries.
Medical Mutual Services, another company launched to ensure long-term company stability, provides comprehensive third-party administration of healthcare benefit plans to companies nationwide, featuring the most innovative information system applications and technologies.
Despite the fact that the Medical Mutual of today is much more than a health insurance company, it continues to focus on its founding principles that were introduced in that small office on Euclid Ave. in Downtown Cleveland – providing the best service, products quality and value.
The Evolution of Medical Mutual
1934 Cleveland Hospital Service Association formed to provide hospitalization insurance.
1939 Blue Cross Association is formed. Cleveland Hospital Service Association is a member.
1945 Medical Mutual of Cleveland formed to provide insurance for physicians’ bills.
1957 Cleveland Hospital Service Association merges with Akron Hospital Service to form Blue Cross of Northeast Ohio.
1961 Medical Mutual of Cleveland becomes affiliated with the Blue Shield system.
1984 Blue Cross of Northeast Ohio merged with Medical Mutual to form Blue Cross and Blue Shield of Northern Ohio.
1986 Blue Cross and Blue Shield of Northern Ohio merged with Blue Cross of Northwest Ohio to form Blue Cross and Blue Shield of Ohio.
1997 Blue Cross and Blue Shield of Ohio renamed Medical Mutual of Ohio.
The Historic Rose Building, Headquarters of Medical Mutual of Ohio
The Rose Building, corporate headquarters of Medical Mutual of Ohio, is one of Cleveland's first steel-frame buildings and one of the city's many distinctive historical landmarks.
Completed in 1900, standing 10 stories high and covering an acre of land, the 380,000-square-foot facility was the largest and tallest office building in Ohio, and the largest outside of New York City.
Many Clevelanders doubted the building's viability, referring to the building named after Benjamin Rose as "Rose's Folly," because they never thought business would grow as far east as the building's location at the corner of Prospect Avenue and Erie (East Ninth) Street.
Originally, the first five stories of the building were planned for a department store. This intention accounts for the unusually high ceilings on these floors. When a tenant for the floors couldn't be found, Rose operated his own store, Scott-Griggs Company, until his death in 1908. The remaining five floors housed commercial and medical tenants.
Other tenants have included Western Union, the BF Goodrich Chemical Division, and the Forum Cafeteria, which occupied the ground floor for 50 years. These tenants, and others, helped to fund the Benjamin Rose Institute, a well-known facility for elderly care.
An outstanding attraction of the early Rose Building was its lobby, designed around a circular stairwell 10 stories high. Four open-caged elevators serviced passengers. In 1928, the lobby was remodeled much as it looks today.
The institute sold the Rose Building in March 1984 to Medical Mutual of Cleveland, which is a predecessor company of the present day Medical Mutual of Ohio and a tenant since 1948. Four months later, Medical Mutual of Cleveland merged with Blue Cross of Northern Ohio, which had also been a tenant since 1948.
At the same time Medical Mutual purchased the Rose Building, it also acquired the adjacent Sloan Building, now called the Rose Building Annex.
Built in the 1940s, the Sloan Building was originally an apartment building, and was later converted into office space. It was even once occupied by Chef Boiardi, for whom the line of canned Italian foods is named.
Originally designed by architect George H. Smith, the Rose Building has undergone several changes since 1900. In April 1985, construction began on a five-year total renovation of the building under the direction of The Voinovich Companies, to convert it from a multi-tenant facility to Medical Mutual's corporate headquarters.
The first phase was to restore the building's exterior to its original appearance. Subsequent phases included renovations and repairs to make the building more energy efficient and conducive to telecommunications and computer technology.
Today, the Rose Building has been completely restored to its original exterior. It stands as a source of pride for Medical Mutual employees and Clevelanders alike.
Kent Clapp
Having been with the company since 1976 Kent Clapp became president of Medical Mutual in 1992. In 1997, during a time in which Medical Mutual was in a major financial crisis, Clapp famously staged a coup against his boss to save Medical Mutual, its employees and subscribers from financial loss. During this time Kent was fired by his boss and came back days later, with majority board backing, to fire his boss and become the Chairman and CEO of Medical Mutual. He led the company out of the difficult time and back into a respectable financial situation.
On December 3, 2008, Clapp and his fiancée Tracy Turner died in a small plane crash on the Puerto Rican mountainside.
To fill the positions left empty following Clapps death, Samuel Miller, co-chairman of Forest City Enterprises, and David Young, a retired partner with the law firm Squire, Sanders and Dempsey, were named interim co-chairs.
A management committee was appointed that consists of Young, Miller, James V. Patton, a retired Medical Mutual executive, and Charles A. Bryan, a retired Nationwide Insurance Co. executive. Charles Bryan was also named the acting CEO.
Historic Rose Building Rose Building Today
References
Is Inflation Tamed ? -- Stock Market Analysis (29)
Is Inflation Tamed? Stock Market Analysis (29) If you have a stake in the stock market, you should pay attention to the signs of inflation in the economy. The following are the main factors of inflation: • Demand and supply interaction. • Economic competition and transparency. • Government policies on interest rates, deregulation, taxes, etc. • Market structure, public/private ownership, labor supply, cartels, etc. • Nature of product, scarcity, substitution, technological change, etc. The stock market is most sensitive to interest rates. In general, when interest rates fall, it signals less inflation, more investment, and better economy ahead. Stock prices tend to go up. The reverse is true when interest rates rise. In fact, the fall in interest rates causes more money to flow into the stock market because bank deposits or bonds no longer yield a good return. Remember the high inflation of 1970s? It was brought about by the OPEC oil cutback and commodity shortage. It had a devastating effect on the stock market. That period is described as stagflation where economic stagnation and inflation coexisted. When oil prices began to tumble in the early 1980s, inflation receded and has never come back so fiercely since. The rise of oil prices in 2008 only brought about a milder and temporary inflation being cut short by the financial meltdown and worldwide recession. Has inflation been tamed? Definitely. The reasons are as follows: Due to the rise of the high-tech industry, the world economy now has higher electronic contents, as shown in banking, finance, publishing, retail, autos, telephones, household goods, etc. The electronic parts tend to fall in prices even with better quality and productivity. Overall, the higher the share of electronics in the economy, the greater is the downward pressure on prices. Generally speaking, over 50 per cent of production cost comes from labor. In the electronics industry, labor union is almost non-existent. That means labor cost is most competitive in high-tech, as opposed to auto, health care, or education. The supply of cheap labor worldwide is plentiful. In China and India, millions and millions of unemployed or under-employed are eager to work for low wages, not to mention other countries in Asia, South America, and Africa. The temptation is great for Western companies to relocate their production overseas, especially in labor-intensive industries. The overall picture is that workers are losing their bargaining power. This has a dampening effect on wages, hence on costs, prices, and inflation. The explosion of Internet commerce adds to the downward pressure on prices because people shop and compare online. Companies also advertise and compete fiercely online. This increases transparency and competition in the marketplace. Globalization acts as an inflation damper, too. More and more firms now compete worldwide rather than in a protected region, Employers go around the world seeking new markets and lower labor costs. All of these contribute to more intense competition and higher productivity that in turn will lead to lower inflation. On the other hand, the causes of high inflation are still with us. Nowadays, they mostly originate from commodity or material scarcity, because the earth has limited natural resources. Oil is a good example. Fresh water, food, and some metals are next in line. However, as alternative energy sources are developed, oil scarcity will become a less disruptive force. In addition, the new technology of material science is producing new alloys or composite materials, thereby substituting or reducing the need for scarce metals. Another source of inflation is health care services. Health care is a unique industry dependent on medical technology, a specialized labor force, peoples lifestyle, and cultural values about life and health. All these tend to exert upward pressure on prices. It is very difficult to contain health care costs as described in my previous videos #27 and 28. Finally, there exists a wild card affecting future inflation. It is the effects of climate change due to global warming. If more droughts, floods, hurricanes occur as predicted, the production of food will be disrupted leading to higher prices that will have widespread consequences for the global economy. In addition, water supply to agricultural areas and major cities will be curtailed if a drought persists for a long time. For further information, please email to stockfessor@comcast.net
Author: stockfessor
Keywords: stock market share mutual fund industry retire invest
Added: January 6, 2009
Queen Noor of Jordan speaks of Humanitarian Catastrophe in Gaza
CNN's Wolf Blitzer speaks with Queen Noor of Jordan about the Israeli incursion into Gaza. Queen Noor of Jordan is an international humanitarian activist and an outspoken voice on issues of world peace and justice. She was born Lisa Najeeb Halaby to an Arab-American family distinguished for its public service. After receiving a B.A. in Architecture and Urban Planning from Princeton University in 1974, Queen Noor worked on international urban planning and design projects in Australia, Iran, the United States, and Jordan. She married His Majesty King Hussein bin Talal of Jordan in 1978. Queen Noor plays a major role in promoting international exchange and understanding of Arab and Muslim culture and politics, Arab-Western relations, and conflict prevention and recovery issues such as refugees, missing persons, poverty and disarmament. She has also helped found media programs to highlight these issues. Her conflict recovery and peacebuilding work over the past decade has focused on the Middle East, the Balkans, Central and Southeast Asia, Latin America and Africa. Queen Noors work in Jordan since 1978 has focused on national development needs in the areas of education, sustainable development, human rights and cross-cultural understanding. She is also actively involved with international and UN organizations that address global challenges in these fields. The initiatives of the Noor Al Hussein Foundation (NHF) which she chairs have transformed development thinking in Jordan through pioneering programs in the areas of poverty eradication, health, womens empowerment, microfinance, and arts as a medium for social development and cross-cultural exchange, many of which are internationally acclaimed models for the Middle East and the developing world. The NHF manages one of the largest portfolios of economic empowerment development programs in Jordan, including several semi-independent institutions. Among them, Jordan Micro Credit Company, NHF's microfinance institution (MFI), is one of the largest micro-credit companies in the region, and is rated as the tenth best performing MFI worldwide for 2007. The Institute for Family Health, which provides comprehensive health care services to Jordanians, since 2006 has provided medical assessments and services with local partners to over 90,000 displaced Iraqis living in Jordan, including psychological counseling and rehabilitation. On a regional level, NHFs Village Business Incubator for women, which promotes womens active role in the labor market through business training and linkages with marketing and lending institutions, is being replicated in Syria. Queen Noor also chairs the King Hussein Foundation (KHF) and the King Hussein Foundation International (KHFI), founded in 1999 to build on King Husseins humanitarian vision and legacy in Jordan and abroad through national, regional and international programs that promote education and leadership, economic empowerment, tolerance, and cross-cultural dialogue, as well as media that enhances mutual understanding and respect among different cultures and across conflict lines. Through KHFI, headquartered in the United States, Queen Noor awards the King Hussein Leadership Prize to individuals, groups or institutions that demonstrate inspiring and courageous leadership in their efforts to promote sustainable development, human rights, tolerance, equity and peace. The KHLP is awarded at an annual dinner and cross cultural dialogue that serves as a platform for next generation peace-builders and world leaders such as President Bill Clinton and Kofi Annan. She has assumed an advocacy role in the International Campaign to Ban Landmines, and has traveled to Central and Southeast Asia, the Balkans, the Middle East, Africa and Latin America to advocate with governments, support NGOs, and visit with landmine survivors struggling to recover and reclaim their lives. She has testified before the U.S. Congressional Human Rights Caucus appealing for humanitarian assistance and justice for hundreds of thousands of landmine victims worldwide. Her Majesty is a board member of Refugees International and an outspoken voice for the plight of refugees, displaced persons and other dispossessed people around the world. She has visited Pakistan to assess the Afghan refugee situation, and is advocating for international support for the nearly 5 million Iraqis displaced in Iraq and in Jordan, Syria and other countries after the 2003 Iraq conflict. In 2004 and 2005, as an expert advisor to the United Nations, Queen Noor traveled to Central Asia to advocate for adoption and implementation of the Ottawa Treaty throughout the region and for multi-sectoral commitment to the Millennium Development Goals in Tajikistan, one of the worlds poorest countries.
Author: ArchivesAlgeriennes
Keywords: queen noor of jordan king abdullah II hussein Women Rights KINGDOM prince army jihad CNN air strike missile obama us germany war america Gaza invasion israelf-16 bush malaysia england IDF Palestine al jazeera usa Hamas 2009 algerie australia algeria France china russia japan pakistan egypt الجزائر فلسطين غزة إسرائيل حماس إسلام جهاد العراق مصر الجزيرة السعودية المرأة النساء الأردن
Added: January 4, 2009
Global Report - 02-January-2009
http://www.instablogs.com/ Israel attacks Gaza Nearly 20 Palestinians died in the first few hours of the New Year while another 30-40 were injured by early Thursday evening. According to the Director of Ambulance and Medical Services in Gaza there are about 417 dead and 2000 injured 260 of them seriously. An important event took place today; Israel had assassinated one of Hamas big leader in Gaza who is Nisar Rayyan. The leader was attacked by Israeli airstrike on his house after his refusal of leaving the house following a warning call from the Israeli army telling him to leave the house. The result of this strike was 10 died, tens of injuries and large destruction of the houses nearby. Pak afghan Trade Freedom in trade and travel is expected to bring a number of benefits for both Pakistan and Afghanistan. It can also promote mutual trust between the two nations with common culture. However the Pak-Afghan border has been infamous for illegal trafficking for several decades. In the context of the prevailing terrorist violence in both the countries trade related mobility is as prone to be misused or victimized at the hands of the organized terrorists occupying the areas close to the Pak-Afghan border. It is therefore crucial for both the governments to take strict security measures for all the trade transactions that cross the border. Moroccan New Year Eve Unlike all the capital cities of the world that celebrate the coming of the New Year. There is no such public celebration in Morocco because of cultural and economic reasons. Moroccans only celebrate some religious and national festivities and also because the majority of Moroccans are poor the last thing they think about is such celebration, they have much more interesting things to think about. However, there are some people who celebrate the coming of the New Year for e.g. Some families make family reunions and have dinner together and exchange gifts whereas others go to the night clubs to dance and drink of the whole night. Then there is another section of Moroccan society that is rich people with European life styles and celebrated just like Europeans in case they celebrated in Morocco and didnt travel to Paris or London or any other famous city. Generally, most of the Moroccans do not celebrate New Year and according to them the best about this is the holiday. They think its a good chance to relax and take rest before they begin to spend another long New Year in their lives. Jordanian New Year Eve With every New Years Eve Jordanians make plans on how to spend their special evening. Choices however are not too many since Jordan is an Islamic country that holds no public celebration for the end of Gregorian years. So just like every year there are those who can afford to celebrate it in hotels and other expensive places while others prefer to celebrate it by merely cruising down the streets in their cars to watch whether there are any pedestrian activities or gather in houses with families and friends. However this year might be different as the general population might not be in any mood to celebrate knowing that their brothers in Gaza are getting brutally not forgetting the fact that more than 40% of the Jordanian citizens are of Palestinian origin. http://www.instablogs.com/
Author: instablogs
Keywords: "Israel attacks Gaza" "Nisar Rayyan" Hamas "Gaza Strip" Palestine Instablogs "Pak Afghan trade" terrorism "illegal trafficking" "law and order" Afghanistan Pakistan "New Year Celebration" travel gift Paris London Morocco hotels Gaza
Added: January 2, 2009
Fixing US Health Care Inflation -- Industry Analysis (28)
Fixing US Health Care Inflation Industry Analysis (28) The US health care crisis was discussed in my previous video (#27). This video is about fixing the health care runaway inflation, which is in fact the heart of the problem. The following shows how to address the different causes of the inflation. New Technology Unlike the hi-tech industry where a new technology always brings down the price, the opposite is true when a company invents a new drug or testing equipment. The obvious reason is the five-year patent, which allows the company to charge a high price necessary for recovering the development costs. When the patent period expires and the generic products start to compete, the price may not come down because the company continues to market or hype its new brand for saving your life. The consumers do not have the expertise to question them and tend to accept what they say. An easy solution is to mandate all health care companies to publish their prices online to let the consumers compare. This will inject competition into the market. When a big price difference is shown to the public, the company charging a high price will try to mark down in order to compete. The key is transparency that will make the health care industry more competitive. Powerful Lobby Many legislators do not have the backbones to face the powerful lobbyists. They pass laws that favor the drug companies and other special interest groups. A concerted effort is required for the public, supported by employer, labor and other associations to counter the lobbyists. Remember the public has the votes to kick out any legislator who kowtows to special interests. Aggressive Lawyers and Defensive Doctors Trial lawyers like the present situation to continue because there is no limit to compensation awarded due to medical malpractice or drugs that do permanent damage. This results in an uncertain business environment where the malpractice insurance for doctors skyrockets, thus contributing to the cost inflation. A law must be passed to limit the damage compensation to a reasonable amount so that doctors can operate without constant fear of being sued for exorbitant sums. This fear makes doctors extra defensive causing them to order unnecessary lab tests for the patient to guard against a lawsuit. Health Insurance The purpose of insurance is to cover for accidents or major events that do not occur everyday so that the insured are protected and the insurance companies can stay in business. Health care does not fit exactly into the regular insurance model, except for infrequent or catastrophic events such as pregnancy, cancer, heart attack, or traffic accidents. In these cases, health insurance can be less expensive and more affordable because of low occurrence of such events. However, another aspect of health care involves personal responsibility. What do you do when someone follows an unhealthy lifestyle that leads to frequent medical treatments? What do you do when someone often sees a doctor for the slightest body discomfort? If those people are required to pay for their own expenses each time, it will teach them a good lesson not to put extra strains on the entire health care system and push up its costs. Health insurance companies are no good in handling these two situations as described above. The result is higher premium for everybody, insuring only the healthier ones, complicated procedures, and refusal to pay without a valid reason. Even if the government takes over the insurance business, the problems will not go away. The key to solving this problem is more difficult including public education, personal responsibility, and disease prevention. Bureaucracy The streamlining of paperwork and bureaucracy in a huge industry like health care can always save billions of dollars. This is especially true if medical records are digitalized and centralized in secure databases. Fraud and Corruption Every year, the government has uncovered large sums of money wasted due to fraud or corruption. Tighter enforcement will further cut down this waste. Individual Health Accounts Many experts advocate individual saving accounts for health care. This has little effect on the runaway cost inflation. It merely opens doors for financial companies to tap into consumer savings. Remember the billions of dollars lost in 401k retirement plans in the 2008 financial meltdown? Consumers should beware of getting swindled for a second time. For further information, please email to stockfessor@comcast.net
Author: stockfessor
Keywords: stock market shares invest mutual fund retire industry analysis
Added: December 26, 2008
US Health Care Crisis -- Industry Analysis (27)
US Health Care Crisis -- Industry Analysis (27) Among all the industrialized countries, the US spends the largest percentage of its GDP on health care. Yet, its citizens are not the healthiest and there exist some 46 million people uninsured. The problem is basically health care inflation that is pricing out the middle class. What causes this inflation? It is essentially a structural man-made problem as explained below: Philosophy Many Americans, especially the Republican Party, believe that the free market, if left alone, will solve all problems of society. However, the market for health care is not really free like that for cell phones and consumer services. The reasons are: lack of competition, lack of information, and the political power of special interest groups. The following illustrates: Drug and other medical technology companies This group is the most powerful due to the resources they possess. For each new product developed, they are awarded with a five-year patent where they can charge a high price. When that period expires, competitors may only come in with similar generic products at low prices. Drug companies are probably the most profitable as shown by the huge dividends paid to their shareholders every year. Flushed with cash, they are able to influence legislation in their favor. This is evidenced by the Senior Prescription Drugs legislation introduced by the Bush team. This law forbids the government to negotiate lower prices for drugs it purchases. Can you imagine the government passes a law to restrict its own right to negotiate for lower prices? A conspiracy must exist to rob the taxpayers money. Insurance companies Health insurers are perhaps the most powerful middlemen. They cherry-pick the healthiest consumers, collect premiums every month, but can still deny payment when the treatment seems too costly or for inexplicable reasons. The middleman role of the insurer destroys the traditional relationship between consumer and doctor. During a doctor visit, the consumer fills out an insurance form. Being medically insured, the consumer naturally wants to get the most service, even unnecessary ones. The doctor wants to offer what the consumer wants, even more, at the highest possible prices. There is no responsibility anymore when a third party foots the bill. Hospitals Most hospitals operate on a profit basis. To boost revenues, hospitals have a tendency to charge high prices and encourage its doctors to prescribe more lab tests, more drugs, and expensive procedures. The consumer has no reason to question as long as the doctor recommends and the insurer pays. Some hospitals offer the so-called managed care plans where they are also insurers themselves. These hospitals have the profit motive of keeping the consumers out the door by inventing complicated appointment procedures. While the premiums paid by consumers are guaranteed, each empty hospital bed and each patient being kept out or delayed represent more profits made. Doctors and specialists Most doctors cannot afford private practice because of the huge overhead costs. Working in the hospital, especially those with managed care plans, the doctors are hampered and frustrated by interventions from hospital managers whose jobs are to cut costs by any means in order to safeguard profits. Lawyers A powerful group of trial lawyers recognize the huge profits to be made from lawsuits against deep pockets like drug companies and hospitals. They will locate victims of drugs or malpractices to help them sue the deep pockets for millions of dollars. The trial lawyers appear to be working for consumer interest. However, they will get the biggest slice of compensation if they win a case for the consumer victim. Government The US government operates four different health care plans: Medicare for lower-income seniors, health care for military personnel/veterans, health care for federal employees, and Medicaid to subsidize state governments own health plans for the poor. It looks very complicated indeed. Conclusion The consumer and government wind up being losers in the US health care system. The interplay of all the major forces described above contributes to the cost inflation that is running out of control. Unless this cost spiral is broken, it will be impossible to fix the health care crisis in the US. For further information, please email to stockfessor@comcast.net
Author: stockfessor
Keywords: stock market shares invest mutual funds retire industry analysis
Added: December 22, 2008