Damned If You Do, Damned If You Don’t

Squeezed May 10, 2005

It’s not easy working for a health insurance company these days. And with what’s going on in the news, both nationally and here in Hawaii, it is downright difficult working for the largest insurer in the state, as I do.

Here in Hawaii, if HMSA so much as coughs, it makes front page news. And if it even thinks about how much it will take to cover ever-rising healthcare costs, it gets hit on all sides.

HMSA made a profit? What are they asking for another rate increase?

HMSA lost money? What are they doing with our insurance premiums?

Talk about damned if you do, damned if you don’t.

HMSA has to please individuals, companies, and the state government, which has to sign off on rate increases. And it’s anything but a rubber stamp.

But recently, I read in the Advertiser about rising costs to practice medicine in Hawaii, especially in the fields of OB/GYN and orthopedics. Mostly it’s malpractice insurance, but the article says:

One reason doctors’ pay is dropping is because health insurance companies are cutting the amount they reimburse doctors for certain procedures.

And then, the next day, they run an editorial written by a doctor who essentially says, in effect, “don’t visit the Big Island,” because they can’t guarantee that they’ll be someone there to set a broken bone if you get one. He talks about the long hours, but then, it gets to the real heart of the matter…after bemoaning Medicare’s reimbursement policies…

And other insurance companies have taken the same perspective, even though Medicare was created to care for our nation’s seniors and disabled, a population we are all supposed to honor and assist. These other companies, like HMSA, are now paying physicians even less than Medicare.

Again, what insurer was mentioned by name? Yep. HMSA.

And on top of that, there are those who figure that the whole system is broken anyway, and that we should scrap the whole thing and go to a universal single-payer system.


People get sick. There’s no denying that. And there are people who are born sick, or suffer life-threatening illnesses or conditions, and their conditions need to be managed. But there are three realities about health care, regardless of whether it’s private business, government, or individuals who foot the bill:

  1. It’s not cheap.
  2. Someone has to pay for it.
  3. Unless something is done, costs will spiral out of control.

Until the average health care consumer realizes that he or she has the power to influence health care costs for the better, we are going to continue to see large increases in healthcare costs year after year, which will be reflected in insurance rates. Or taxes. Or budget deficits. Or benefit cuts. Or eligibility cuts. You get the picture. Not pretty.

Fortunately, there are many things we can do. Lose weight. Stop smoking. Get plenty of exercise. Get generic drugs at the pharmacy. The healthier we as a society are, the less we spend on healthcare, the more affordable it becomes, and the more resources are available when we really need it.

Like I said, I’m sick and tired of seeing health insurers and government programs being made to be the bad guys in all of this. Don’t get me wrong, the system is not perfect, and people will have legitimate grievances. But improving our healthcare system is a team effort, and I still have faith in the system we have. We as consumers need to do our part.

Disclaimer: these are my own opinions, not necessarily those of my employer.

4 Responses to “Damned If You Do, Damned If You Don’t”

  1. Linkmeister Says:

    As a society which used to aspire to being fair, how can we justify 45M uninsured people? I don’t see the employers stepping up to the plate (they’re running away from it), and it was a weird way to create health coverage in the first place. Why should one’s health care be tied to one’s employment?

    I’m not picking on HMSA (or Kaiser, or HMAA, or whoever else is out there) in particular, but something has got to change in order to make healthcare more affordable (and cheaper to run, too).

  2. Keith Says:

    And I agree. Something has to be done. You’re right, we have far too many uninsured. Of course, we in Hawaii have it better than other places with the Prepaid Health Care law, but of course that still leaves self-employed people and part-time workers out of the loop. And the QUEST program can only go so far as well, admittedly.

    Now, we agree that something has to change to make healthcare more affordable. But the question is, affordable for whom? Let me reiterate, someone has to pay for what we use; if not us directly, then our employers, health insurers, and the government.

    The best way to keep healthcare affordable for everyone involved is to keep demand under control, and that’s the responsibility of all of us. Too often we’re lulled into the notion that healthcare is manna from heaven. I thought that way too, until I took this job.

    And as you can tell, I’m a little skeptical when it comes to government running healthcare. I’ve watched the debate and rancor that surrounded the drug benefit for Medicare, and the result was a complicated mix of deductibles and co-pays. With most healthplans with drug benefits, it’s a bit simpler…X number of dollars, each time.

    Imagine if the question were a national health care plan. Yikes…

    Thanks for your thoughts, though.

  3. Linkmeister Says:

    I have no objection to paying slightly more in taxes if it means I get health care without worrying about whether I can afford the 50% co-pay on a $2,000 MRI.

    Ezra Klein did an interesting analysis of various countries’ health systems here, if you’re interested (and have time).


  4. Lynn Vasquez Says:

    aloha, i’m a kaiser member and i hate the way they do things there. i love my doctor and social worker. if i ever need to go into the hospital again…i would go to either kuakini or queens. i have my reasons why not kaiser and st. francis.

    my eighty yr. old mom has been a member of hmsa for ages. two months ago, hmsa sends her a survey to fill in regarding her kidney doctor. she didn’t do it cause the doctor died. someone called from hmsa and still took the information. earlier this month, another survey. now that’s excellent service!

    even the telephone operators sound nicer and with more aloha than the ones from kaiser. especially, at the honolulu clinic. talk about rude and grouchy. they sound all as if they going through menopause!hehehehe

    Auntie Lynn aka Auntie Pupule

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