Stefanie Krantz, if you're still checking this story, you said the government runs 3 efficient health care delivery systems. Can you be more specific? I could think of only two government- run providers: the VA hospitals and the military base hospitals. I seem to recall a bunch of stories in the last few years about sub-standard care bordering on the abysmal in both of those systems.

Let me be direct, you were way to easy on the insurance companies - where is your fact checking - MRI's don't cost the insurance companies $500 to $1000 - they pay less than $100 for an MRI - please don't be a mouth piece for insurance companies - you need to dig deeper - when they comment, you need to fact check. Health care in this country has been run by insurance companies for decades - it's clearly not working - 50 million un-insured - the highest per-capita expendures on health care in the world and yet we're ranked in the mid-30's in terms of medical performance. I say through the insurance companies out, they have had their change and haven't performed. As we've seen with banking, we're seeing with insurance - the free market is a mith it's all about greed and taking advantage of the american public.

I'm a small business owner who is sick of seeing my employee medical isurance premiums rise year in and year out at a much faster rate than inflation - when will it stop?

Ken

Yes, our system is weighed down by the inefficiencies of the free-for-all of the fragmented private insurance system. The burden of all those billing people is also matched by the unmeasured burden on patients and families trying to manage payment for their claims.

However... and this is a big 'however'... even if we magically erased the 20% administrative cost... well, that's what my premiums rose just this spring. [As a small business owner I pay 100% of our family's health care premiums and other costs.] And I expect a similar jump next year, just like last year.

Streamlining administration is necessary... but it's a one-time saving. Unless we change how we develop and deploy health care itself, the upward arc will continue.

There are more reasons we need healthcare reform than just coverage for those who do not have insurance. There must be regulations and standards put into place to keep a health insurance carrier from killing a patient either by denial of benefits or using treatments that are economical rather than effective in an effort to make money. These things really happen, the killing, I mean, and they are more likely when your insurance carrier and your care provider are the same person (or people). I have a million horror stories, and I got them all when I worked as a utilization/care manager/discharge planner/geriatric case nurse for a Medicare-risk company (now called a Senior Advantage company), until I no longer could stand being part of a system so corrupt and homicidal. When I heard the opponents of healthcare reform shrieking that reform will dictate euthanasia, I decided I had to tell at least one of my stories because no one seemed to know that the big insurance companies and HMOs have been practicing euthanasia for at least 15 or 20 years already, right under their noses, and probably with their implied approval. (It might not be euthanasia; it might be homicide.) When I was working for an HMO that administered care for many, many "lives" in California, an elderly man was admitted from a skilled nursing facility to the acute care hospital for a urinary tract infection. Yes, he was really old, mid-eighties, and yes, he was demented, but those seemed to be his only diagnoses, neither of which should have been fatal. He was brought in by ambulance,and we put him to bed. His diagnosis was pretty straightforward, and he was put on IV antibiotics. He already had a catheter in place. We called his wife, and she came in with her sons. The doctor, The Hospitalist, whose job it was to get him out of the hospital as soon as possible, preferably prior to the time limit contracted between the hospital and the HMO that would be covered by a flat rate for everything done. It was partly my problem to get him discharged to a place where he would'nt cost any more money for the HMO/administrator. So, the Hospitalist was ordered to talk to the wife to persuade her she wouldn't want her husband to have any pain, so IV morphine could be administered, lots of morphine. Well, the Hospitalist was a young, pretty conscientious man, who had recently completed his residency, and he got really uncomfortable going in to convince the wife of a patient who happened not to be in any pain, to have IV MS. He refused to do it. So, his boss, the medical director of the HMO-Medicare Administrator came in and sat the wife down for a little chat. In only a few minutes he had her declaring she didn't want her husband to suffer (who would?). She agreed with his plan to administer morphine IV at a pretty good rate. It wasn't long before this little old guy's respiration center was depressed and his respirations rate slowed steadily down to nothing. He died in about 3 days, well within his allotted, capitated admission time. Plus, he didn't have to be discharged to a skilled nursing facility which would have been covered as a skilled need under Medicare--and thus would have been an expense to the HMO. During the admission, a surgical consult was accomplished. The surgeon, early in the admission, examined the elderly patient and determined he was not a surgery candidate. When he returned to re-examine him in a little follow-up visit, he saw the patient and his IV morphine and came flying out of the room, screaming at me that this was clearly euthanasia. He threatened all sorts of things, the last of which was an immediate trip down to hospital administration to complain. I wished him well, honestly. He returned to the floor not so long afterward, very subdued and apparently contented with the narcotic analgesia for the man whose only problems were a UTI, old age, Alzheimer's, oh, and an overdose of morphine. I guess the hospital administrator convinced the surgeon of how it is with this particular Medicare organization. The healthcare opponents are so incredibly misinformed about everything involved in this matter, but their accusations of a conspiracy to commit euthanasia are so stunningly ignorant I couldn't restrain myself from telling just this one story. After this horrible experience that, to me, represented the complete downfall of American health care (it was 1995)I had to get out of nursing for awhile, after a pretty wonderful 30-year career, but there are plenty more nurses who do just this same stuff for Medicare-risk companies and Senior Advantage companies (Kaiser, Secure Horizons, Humana, etc.). They get big bonuses when the HMO's hospital census is way down (when they are working the least, they make the most money). The doctors the same thing. Think of it this way, if at the first of the month Medicare gives you a million dollars to provide all the care your members need for that month following, wouldn't you want to keep as much of the Medicare money that's already in your pocket? And how would you do that? By denying or delaying as many procedures as you can get away with. Especially, when hospital costs are 75-80% of your expenditures, wouldn't you want to keep as many members out of the hospital as possible? And if you couldn't keep them out, wouldn't you want to get them out as soon as you could? Wouldn't you load your utilization committee with members all of whom benefit financially from the denial and delay of services? The hospitals and health care providers and insurance carriers are doing the same stuff Enron did only medicine seems nicer than public utilities. I even worked for an insurance company/HMO/provider that did amputations on patients to save money on chronic extremity care. Somebody has to listen to this. Certain HMOs, administrators, and Kaiser-like companies actually kill people.