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You may find my manifesto on healthcare in America hostile and I don’t give a damn or crap for I am telling the truth. Healthcare in America is a multi-billion dollar industry for profit because it does not matter if the company is a non- profit organization or for a profit company for United States of America is the most capitalist country in the world, get it? My fellow Americans, we are wired to think or see that having a capitalist economy is essential for democracy. Or most likely, what you call the American Dream, dream of material success and better life, like owning successful, profitable businesses or having highly professional roles with high salaries, focusing on the profit for the company. Healthcare is consists of hospitals, insurance companies or organizations, other healthcare providers, like physicians, specialists, treatment centers, pharmacies that provide medical services, such as treatment, care, prescriptions, medical equipment for health issues, physical and mental. Therefore, healthcare is crucial to our overall well-being. However, the US healthcare is focused on profit, profit that compromises quality of care or impacts treatments. Commercial health insurance is sold and administered by insurance companies or carriers for profit and the health coverage could either be PPO, Preferred Provider Organizations or HMO, Health Maintenance Organizations. Commercial health insurance is usually group coverage, offered by the employer to their employees, but in some cases an employer may give employees medical allowances for healthcare coverage by direct purchase of individual policies, just like how the rest of us, buying or obtaining the coverage through agents of the insurance companies. The insurers provide the insureds or consumers a health policy or a health plan laying out what are covered and what are not covered and the services are either approved or denied according to the provisions of the policy or plan. The limitations and exclusions are provisions that could cut the cost down of services compromising care and treatment. The insurers employ analysts to evaluate and resolve the claims, either by approval or denial based on the guidelines and provisions of the policy, like denying experimental treatments or prescriptions, as an exclusion of the policy They are excluded and not covered because they are not approved by the US Food and Drug Administration. However, these so called experimental procedures or prescriptions are widely administered in other countries. The insurers employ group of medical professionals to review medical records in denying treatments based on being found “not medically necessary” and explaining why and suggesting alternative less expensive treatments. The insurers have weekly meetings discussing the bottom line, the targeted projected revenue to attain net income or net profit for the quarter. Sometimes, weekly meetings can turn to daily meetings, if the projected revenue is off. The officers and upper management with high salaries are rewarded with quarterly bonuses and other company perks. Hospitals, medical groups and other medical institutions operate in the same way, to meet the targeted revenue or net profit and take care of their employees, not the consumers or patients, but there are some physicians who care about their patients, the physicians who work beyond their schedules, who put in overtime without pay. Keep in mind that one of the cost cutting techniques of these institutions is to allot the physicians limited time to treat each patient and do the necessary paper work. Another one is to limit the patient’s hospital stay and transfer them to rehabilitation centers or discharge them early to minimize expenses to ensure the targeted profit. The insurance industry is regulated by many entities: federal, state, organizations; whereby each entity is not aware of what the other entities are doing, creating major inefficiencies and frustrations in the healthcare system. Whatever, the US government is doing is very minimal for the people of America, which is ridiculous and sad. That is why surgeries and some procedures are more or less expensive in some hospitals and medical groups because they could charge whatever they want for the government is not regulating the pricing issue, as well as not policing Medicare and Medicaid health programs to combat persistent fraud and abuse of some providers.

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Manifesto

You may find my manifesto on healthcare in America hostile and I don’t give a damn or crap for I am telling the truth. Healthcare in America is a multi-billion dollar industry for profit because it does not matter if the company is a non- profit organization or for a profit company for United States of America is the most capitalist country in the world, get it? My fellow Americans, we are wired to think or see that having a capitalist economy is essential for democracy. Or most likely, what you call the American Dream, dream of material success and better life, like owning successful, profitable businesses or having highly professional roles with high salaries, focusing on the profit for the company. Healthcare is consists of hospitals, insurance companies or organizations, other healthcare providers, like physicians, specialists, treatment centers, pharmacies that provide medical services, such as treatment, care, prescriptions, medical equipment for health issues, physical and mental. Therefore, healthcare is crucial to our overall well-being. However, the US healthcare is focused on profit, profit that compromises quality of care or impacts treatments. Commercial health insurance is sold and administered by insurance companies or carriers for profit and the health coverage could either be PPO, Preferred Provider Organizations or HMO, Health Maintenance Organizations. Commercial health insurance is usually group coverage, offered by the employer to their employees, but in some cases an employer may give employees medical allowances for healthcare coverage by direct purchase of individual policies, just like how the rest of us, buying or obtaining the coverage through agents of the insurance companies. The insurers provide the insureds or consumers a health policy or a health plan laying out what are covered and what are not covered and the services are either approved or denied according to the provisions of the policy or plan. The limitations and exclusions are provisions that could cut the cost down of services compromising care and treatment. The insurers employ analysts to evaluate and resolve the claims, either by approval or denial based on the guidelines and provisions of the policy, like denying experimental treatments or prescriptions, as an exclusion of the policy They are excluded and not covered because they are not approved by the US Food and Drug Administration. However, these so called experimental procedures or prescriptions are widely administered in other countries. The insurers employ group of medical professionals to review medical records in denying treatments based on being found “not medically necessary” and explaining why and suggesting alternative less expensive treatments. The insurers have weekly meetings discussing the bottom line, the targeted projected revenue to attain net income or net profit for the quarter. Sometimes, weekly meetings can turn to daily meetings, if the projected revenue is off. The officers and upper management with high salaries are rewarded with quarterly bonuses and other company perks. Hospitals, medical groups and other medical institutions operate in the same way, to meet the targeted revenue or net profit and take care of their employees, not the consumers or patients, but there are some physicians who care about their patients, the physicians who work beyond their schedules, who put in overtime without pay. Keep in mind that one of the cost cutting techniques of these institutions is to allot the physicians limited time to treat each patient and do the necessary paper work. Another one is to limit the patient’s hospital stay and transfer them to rehabilitation centers or discharge them early to minimize expenses to ensure the targeted profit. The insurance industry is regulated by many entities: federal, state, organizations; whereby each entity is not aware of what the other entities are doing, creating major inefficiencies and frustrations in the healthcare system. Whatever, the US government is doing is very minimal for the people of America, which is ridiculous and sad. That is why surgeries and some procedures are more or less expensive in some hospitals and medical groups because they could charge whatever they want for the government is not regulating the pricing issue, as well as not policing Medicare and Medicaid health programs to combat persistent fraud and abuse of some providers.

Book: Reflection on the Important Things