Health Care, HMOs, and Sicko
Even if you are insured by the premier HMOs such as Aetna, Blue Cross/Blue Shield, or Kaiser Permanente, you will be shocked to learn you are not truly covered for medical emergencies and disasters. This is how the HMO system supposedly works in America.
1) You the consumer or your employer pays a certain fee (I believe about $4000 a year for a single, healthy, normal adult) to the HMO to insure you.
2) While "covered", you receive lower prices when you need to visit a doctor or hospital. Instead of paying a $200 copay for a doctor visit, the HMO works it out so you only pay around a $20 copay.
3) When a real emergency strikes, such as a terminal disease like cancer or an serious accident requiring surgery, you shouldn't be as unfortunate as the uninsured person who is charged over $100,000 for the life saving surgery, and obviously can't afford it. Your HMO is supposed to cover you to provide fast, efficient, professional treatment for a far lower price.
Keep in mind the movie Sicko is focused on the 250 million Americans who are insured, not the 50 million uninsured victims. So you are a decent, hard working American, not filthy rich like most people, and properly insured by a top notch HMO. The harsh reality is that item 3 in the list above is where the HMOs will fail you.
An HMO gets their revenue from your fees either you or your employer pays. When the time comes for life saving surgery, the HMO is supposed to refer you to the best hospital and doctor and pay for at least most of the surgery costs. This is where reality sets in, because there is a conflict of interest between the HMOs profits and your health.
When you go to the hospital, the HMO must pay for the costs, thus reducing their profits. When you go for better and more expensive surgery, the costs rise and the HMOs revenues are depleted even more.
Therefore, the HMO will do an extensive background and acting routine to find reasons to DENY you the necessary surgery. As long as the HMOs can find an excuse to prevent you from visiting the hospital, the HMO won't lose their money, although you lose your health and life.
Think it can't happen? It does and it will. As I said before, before very careful who you vote for in the polls, because the Republicans are the primary beneficiaries of HMO contributions, which is also covered in Sicko.
More entries on health care and Sicko are coming. Stay tuned.