Who says we don’t have Richard Nixon to kick around anymore? This President let HMO’s creep in on his watch. Kaiser Permanente reinvented the health care insurance model and did so with Nixon’s blessing.

When you first look at HMO’s the concept doesn’t sound too abominable. Catch and cure problems before they become big and expensive medical catastrophes. If you join and use in plan Doctors, testing facilities and Hospitals, you pay a minimal amount, if anything out of pocket beyond your periodic insurance fee. You get check-ups to make sure you don’t have any major problems that can be caught and treated early. Medications are cheaper because the HMO plan administrators can bargain with Pharmaceutical Companies to get medications at a much cheaper rate than any individual.

So far, so good except the HMOs found out they could originate a lot more money by not paying for Doctors, Testing Facilities and Hospitals than by just paying less. They therefore, invented the phrases “reasonable and customary”, “elective procedures”, and the plan’s “pharmaceutical list”.

To the HMO reasonable and customary fees means the fees charged decades ago by the least expensive Physicians or Hospitals. My wife recently underwent surgery which resulted in a Hospital bill of $60,000. The HMO paid less than $5,000. So far so worthy since we didn’t have to pay the dissimilarity out of pocket. However, we had to use the Doctors assigned by the Hospital instead of the Doctors we wanted to use. My wife was in the Hospital for 14 days and only saw the Doctor in charge of her case on only 3 occasions. The result was that she put on 30+ pounds of water weight, while eating virtually nothing. If we had a Doctor who showed up they might have noticed this plight developing and given her diuretics to shed the water. Instead they released her and a day later she was readmitted through the ER for Congestive Heart Failure. She could not breath because the water filled her chest cavity causing heart failure and the inability to exercise her lungs which were compressed by the large amount of liquids surrounding and compressing them.

The Hospital floor seemed to be divided into two sections. One for indigents and HMO patients who got minimal Doctor and Nursing care and the other side by people with Major Medical, PPO and self pay patients who received intensive Doctor and Nursing care.

My wife after a total of 18 days in the Hospital was told she would need standard Physical Therapy for patients with congestive heart failure. The HMO idea rejected this as an elective procedure even though the Doctors said it was primary. I was forced to give her IV medications at home even though I never did this before. If I made one mistake it could have been fatal.

Personally, I was taken off of prescribed medications that worked well and forced to use over the counter medications which of could I had to pay for 100% out of pocket and which did not work as well as the prescription they didn’t want to pay for. I got a letter from them with this switch and a coupon for $5 off the price of the first box of the over the counter medication. They have tried to switch other medications I take and I had to appeal their decision and get letters from my primary care Doctor to say that I would not do well with the medication switch.

I also noticed that HMO patients had to wait up to two months for a Specialists appointment. I asked the appointment desk if I was paying cash could I contemplate the Doctor sooner. They said yes.

HMOs seem to reward Notable Care Doctors who give fewer referrals, cheaper medications, and who honest tiring, refuse treatment. My Doctor admitted this to me. Then he switched me to the office Physician’s Assistant rather than spend his precious time with me.

There are some major problems with our current medical system. HMO’s are leading the diagram to poor quality health care in this Country. By the intention, for this insurance my wife and I have to pay a fee of over $500 each month and my Employer has to kick in even more than that.

There are a lot of people that think that welfare recipients are lazy, do not want to work and are taking advantage of the system, however that is not the case. Some people are receiving assistance from the government because they cannot work due to disabilities, an illness, old age, or having to take care of a sick or disabled person. If they have children they can’t afford the babysitter when they work. To procure assistance with babysitting the person has to be put on a waiting list. The waiting period is usually two years. For a person to obtain welfare they must be extremely poor and prove to the government that they actually need assistance. The application for welfare and food stamps is very long and detailed and it asks for the name, address, telephone number of the person requesting assistance. It also asks for utility bills, birth certificates of the parents and children and death corticated or divorce papers if applicable. The documents must be submitted with the application so the government can request child support from the courts for the person taking care of the children. The information requested is very personal and if the documents are not provided the assistance will not be forthcoming. In addition, an investigator comes to the residence to confirm the information provided. The investigator can ask the neighbors for information. The amount of assistance given is not sufficient for the basics such as food, rent, and utilities.

Food stamps that are given are not sufficient for a family to have nutritious meals. The family has to attempt to procure food banks to supplement the food purchased with food stamps. Medical assistance for the poor is not good because many doctors do not accept Medical, Medicaid or Medicare; so the poor have problems obtaining appropriate health and dental care. Housing for the poor is difficult to obtain and there is always a waiting list. The little money that is given to a family on welfare is not sufficient to purchase new clothes for the children. The family has to go to thrift shops and second hand stores for clothes and shoes. All necessary items for the residence are usually purchased from thrift shops, and garage sales. Very rarely can a family on welfare recall new items. Previously families could purchase items at department stores on layaway but now it is rare the store that has layaways. Sometimes if the family qualifies the parents can obtain assistance with utilities.

The ones that suffer the most are the children as they are not given the proper nutrients at home to develop strong and healthy bodies. By the time they enter school they are lacking in basic vitamins and minerals and sometimes come to the attention of school personnel. School personnel usually inform the parents that they can fetch free breakfast and lunch at school upon qualifying. Many children start developing poor self esteem when they realize they are poor others do not . Sometimes the result of unpleasant nutrition makes a child sickly and this leads to learning problems in school. This is all due to poverty which exists in the United States of American even though it is a wealthy nation. The welfare system does not allow people to take advantage of it and when a person commits fraud to obtain welfare they are usually caught as neighbors and strangers will complain to the proper authorities.

When a family is on welfare and receiving food stamps people discriminate against them. The family does not have what the majority of people have and this leads to problems within the nucleus of the family. The grown ups fight over money and the children suffer unnecessarily. Being on welfare many times provides the impetus for the family to educate and motivate their children so their children will grow up with goals to better themselves and not depend on the government for substance.

Managed Care evolved as a means for controlling the skyrocketing healthcare costs under the traditional Fee-for-Service system. It is a health care system that is expressly designed to manage the delivery of health services in an efficient, cost-effective manner. Today, well over half of all Americans with health insurance coverage have a managed care health policy. It is also the most well-liked health plan offered by employers.

The two leading Managed Care Organizations (MCOs are the Health Maintenance Organizations (HMOs) and the Preferred Provider Organizations (PPOs).

Health Maintenance Organizations (HMOs)
The term “health maintenance†derives from HMOs’ emphasis on preventive care, which is based on the idea that keeping its members healthy, it will avoid more the costly medical expenses of a preventable condition. To this end, HMOs provide preventive care such as well-baby visits, mammograms, immunizations and physicals.

The HMO is both the insurer and the healthcare provider, with its beget network of healthcare personnel and facilities. The HMO has its own hospitals and clinics, and either employs its own health care personnel, or contracts with a network of individual doctors and medical practices to deliver services

The HMOs are the most restrictive of the managed care plans, as they strictly limit your choices of benefits, procedures and healthcare providers. Your choice of doctors and hospitals, for example, is limited to its network of healthcare providers. If the required care requires a provider outside the network, express authorization from your primary care physician must be obtained prior to getting this service. Exceptions are made for emergency care.

HMOs typically require you to select a primary care physician from the doctors within its network. This doctor manages every aspect of your medical care. If the services of a specialist are required, your critical physician must provide and authorize a referral for this care. Any additional services such as lab tests or x-rays also require his/her pre-authorization. In this sense, your primary care physician acts as a gatekeeper fro the HMO, helping minimize costs by eliminating the spend of services that are not medically necessary.

A co-payment is required for each doctor visit or emergency care. Unlike the Fee-for-Service plans, however, where claim forms are required for doctor visits, a member card is all that is required if you have HMO coverage.

Whereas the Fee-for-Service plans, require claim forms for doctor visits, under the HMO, all you need is a member card. The doctor’s office uses this to verify coverage and to coordinate billing for your care with the HMO. A co-payment must be made at each doctor visit as well.

PROS
§ These are the least expensive of all health care plans.
§ It provides comprehensive health care which includes preventive and emergency care
§ Aside from your monthly premium, there are little or no out-of-pocket expenses
§ HMOs place large emphasis on preventive care, and provide coverage for it.
§ There is far less paperwork keen under an HMO health plan

CONS
§ If your primary care physician is not portion of the network, you will have to switch doctors or else pay for the care out-of-pocket.
§ Though they are the least expensive plans, HMO health plans often limit coverage or access to benefits in their bid to cleave costs.
§ There is a longer waiting period for doctor and specialist appointments than there are under the Fee-for-Service and PPO health plans.

Preferred Provider Organization (PPO’s)
The PPO is a cross between the Fee-for-Service and HMO. Like the HMO, PPOs contract with a number of hospitals, doctors and other health care professionals to deliver health services at discounted fees. Under a PPO health conception, however, you can visit any of the health providers within this network, and pay the same agreed-upon discounted fee. This effect of managed care been described as the equivalent of a discount buying club for healthcare.

Other similarities to the HMO include:
*A copay for your doctor visits
*An emphasis on preventive care
*No claim forms are required to salvage coverage for medical care
*A requirement to select a primary care physician to manage your medical care

Just like the Fee-for-Service plans, you may choose to catch medical care from a non-network provider. However, you may only be eligible for limited coverage for that service, and it will generally cost you more out-of-pocket. In some cases, coverage may even be denied.

PROS
*PPO plans give you more flexibility and control in making decisions over your absorb healthcare.
*You can see any doctor within the PPO network, rather than one primary care physician
You do not need a referral to get to examine a specialist
*Like the HMO, PPOs provides comprehensive health care including preventive and emergency care

CONS
*PPO plans are more expensive than HMOs in monthly premium
*Out of pocket expenses such as deductibles and co-insurance add to the costs of your health insurance.

Texan is a cultural hot area due to the diverse population as gifted due to its proximity to the country of Mexico, commands a population of 23 million, one of the highest population find in the United States. A mix of culture, language and the life style has made it an ideal marketplace for a number of industries, including the insurance business. So, the insurance companies are entering into the Texas market and have made great progress. The presence of insurance giants like Blue Cross Blue Shield, United Healthcare, Aetna, Kaiser Permanente, Humana, etc. have made the race for success within insurance companies increase. In fact, to break the language barrier and expand their reach Spanish language is largely inspired in the corporate circle of these insurance companies in addition to English. This becomes very noble to target the customers who are not fluent in English.

The availability of number insurance providers has increased the number of Texans who apply for different insurance plans. The availability of different plans that can be customized to suit a number of different situations helps to ensure the needs of community are met, while detached providing a financial gain for insurance providers.

So, instead of so many advantages and flexibility that the insurance companies provide to their potential customers, there are still a large number of uninsured Texans. Of course, there may be genuine reasons, but always getting insurance pro-actively helps at the time of need. The reasons may be anything including loss of insurance coverage for the family due to job termination, youths coming of age and getting losing insurance coverage that may have been provided by a parent or caregiver, or carelessness by the employer not taking part in covering their employees with and adequate insurance plan.

So, suitable now, if you feel that the insurance policies out there are unaffordable, then TexCare is an insurance provider worth investigating. This is a really good deal and affordable enough if you have one working member of your family. This company calculates your premium based on your salary and family size as the primary criteria.

While these elegant premiums may not provide optimum coverage for everyone, it is a perfect solution to the ever increasing problem of uninsured women having children without health care options. These children will be provided with adequate coverage that may not have been afforded elsewhere. Residents of the state of Texas can be assured that they have a new option when it comes to obtaining affordable health insurance thanks to TexCare.

References: http://www.chipmedicaid.org/english/cover.htm

I want to go a few different directions with this article. First, a few things about me. I am 24 years veteran and I have my B.A. in History. I currently work as an assistant in a school district and I am working on my Master’s in Special Education. I consider myself a somewhat moderate republican. With that being said I am a very strong conservative. I give my bio because it will be relevant later.

I have always enjoyed listening to and watching conservative news channels (Fox News). One of the only talk radio stations where I live is basically the Fox News channel. I bag my fill of Sean Hannity every afternoon because he is on when I get off work and I am doing most of my driving. I normally agree with Hannity on most issues but I have got to win convey with him on this. For the past month he has blasted Obama’s health care proposal. There is nothing wrong with that except for the fact that I cannot trust him anymore. He continues to talk about how dreadful the economy is when ever body who is anybody as it relates to the economy has come out and said that things are getting better. I mean everybody and their mom have agreed that there are positive signs in the economy. Do we still have a struggle ahead of us? Yes. Does anybody with a brain understand that things are at the least slightly better? Yes, except for Hannity. I have never heard him mention anything positive about the economy. Because of this fact I cannot believe what he says about Obama’s health care proposal. If you cannot even admit that there are sure signs in the economy than I cannot believe a word you say about this health care proposal. I will have more on this issue as it relates to Sean Hannity in an upcoming article.

I have a great job working in a school district but as an aide I do not make very great money. My employer offers health insurance but with my salary I was not able to afford it. For the past year my wife and I have had a policy through Aetna (a very good experience if I must say). Despite my meager salary we have always made health insurance a priority. My wife and I are basically living below the poverty level and because of the way we handle our money we have a pretty good life and health insurance (by the way we are both currently in graduate school). With all of that being said you can understand why my wife and I would most likely benefit from Obama’s health care proposal. Despite the fact that things could be easier on me with the passage of this bill I am still against it. I work hard everyday and watch what I spend so we can have health insurance. People living on fast food wages or minimum wage make around what I do and I do not feel sorry for them if they cannot afford health insurance because I know that it is possible to afford health insurance when you perform a very low salary. We already provide health insurance for the poorest people in our country and I even acquire that this program is not merited. There is no telling how many people on Medicaid could pick themselves up off the ground and improve their lives if they truly wanted too. The hard working people of America should not be forced to continue to carry the burden of lazy Americans. Medicaid was enough and this health care proposal only shows people that there are no consequences in life. Spend your money on whatever you want and then ask Uncle Obama to bail you out. If you ask me Obama is setting a dangerous precedent that will only get worse with time. If you provide health insurance to the lowest 10% of Americans in the social ladder and then extend it to the next 5%, before long our country will be providing health insurance to the lowest 35% of people on the social ladder. If you are wondering where I got my numbers, I got my 5% number of people from Obama’s speech to Congress. He stated that probably only 5% of Americans would enroll in Obama Care and I am assuming that a large portion of this 5% will probably be the next step up on the social ladder of those people who are not currently enrolled in Medicaid.

My third and final point is that there have been lies and malicious words from both sides of the aisle. Have some conservatives probably slanted the coverage a little bit when it comes to Obama Care? I would say definitely. I have kind of already covered this in my paragraph about Hannity but I wanted to hit on it briefly again. On the other hand you have had democrats and liberals call certain people who are against this bill horrible things. It is one of the biggest hypocrisies of our time. You had so many liberals and democrats call President Bush horrible things regarding the War in Iraq. The liberal media never once condemned these attacks against Bust and at times they even glorified these attacks. The same liberal media has resorted to all out warfare against the sometimes crazy townhallers that we have seen over the past few weeks. If the roles were reversed there is no doubt in my mind that the same liberal media would be glorifying the crazy townhallers if they were democrats protesting a bill against a Republican congress and president. The hypocrisy is through the roof on this issue.

To sum it up, both sides have acted immature and dishonorable at times. The next month is going to provide numerous quotes and stories from both parties and sides. We may glance wait on at this in a few months and say that Joe Wilson’s “You Lie” comment was just a minor piece in the bigger story. Right now the liberal media has basically made it the most important thing since; please forgive me, sliced bread. It will be interesting to sight how conservatives/republicans/those against Obama Care act if this bill does find passed with a public option. Will they simply lie down and accept it or will they try to execute their occupy country? One thing is for clear, the next few months will be very challenging.