Monday, June 29, 2009
Health Group Health, Poster Child?
Posted by Eli Sanders on Mon, Jun 29, 2009 at 10:54 AM
As Maria Cantwell and the Senate Finance Committee talk up the coop compromise as a politically-doable health care reform strategy (as opposed to the public option, which they say doesn't have the votes), Seattle's Group Health Cooperative is getting a lot of attention.
On KUOW last week, Cantwell used the local coop to make the case for national coops:
I think Group Health has done well in the Pacific Northwest. I think it’s done well in the state of Washington and into Idaho… It’s a tested system and it’s done well.
What say you, Slog mob? Our very own Group Health as a model for the nation? If any of you out there are Group Health members, and have something to say about the coop's new poster-child status in the national health care reform debate, please e-mail me today. I'd love to hear your stories and perhaps use them in a piece I'm working on for the next dead-tree edition.
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1
Yeah, let's see how effective Medicare would be today if it had been created as a bunch of little, quasi-private Medicares. If I were the insurance companies, I'd rather have to compete with local coops than a single, national public provider that has enough bargaining power to set standards and drive down costs. Think of it as "divide and conquer."
If Maria Cantwell wants to maintain that a real, national pubic option doesn't have the votes in the Senate, then maybe she doesn't have the votes here in Washington to get re-elected.
If Maria Cantwell wants to maintain that a real, national pubic option doesn't have the votes in the Senate, then maybe she doesn't have the votes here in Washington to get re-elected.
2
My parents both have Group Health. When I was a dependent I went there for all my primary and emergency care. I had good doctors and got very good treatment. They prescribed generics when they were available, they offered tips about improving my diet and exercise, they had a big online database where I could look up health topics. I was very pleased with it; I wish my current health insurance was as good.
3
The access they offer is good, but I have had some terrible, TERRIBLE experiences with several of the doctors there.
5
I have been a Group Health member for twelve years. GROUP HEALTH SUCKS.
I am currently embroiled in a controversy over an injury I suffered. My doctor appears to just plain not believe it hurts, even though it has hurt every goddamn motherfucking day for ten months. "Naproxen", they say, which helps a little but not much, and occasionally makes me puke.
I have been humiliated on a cold bathroom floor, I have been denied treatment, I have been told to lose weight by grossly obese people who can barely move around -- the ONLY preventative care I've received even a hint of. I have had doctors examine me for three seconds and then immediately start showing me glossy brochures for expensive appliances I don't need but in which the doc has investments. When I asked for a mental health referral I was given the names of a dozen people, NONE of whom are accepting new patients; I never got fuck-all, and ended up going out of insurance for help.
My eye appointments are covered but after the copay and lab fees and so forth, they're as expensive as uninsured appointments at a less chi-chi facility.
Group Health represents everything that is wrong with American health care. Most of their employees aren't health care professionals at all; they're men in suits shuffling paper. They have no shortage of glamorous new capital facilities with exotic hardwoods but almost no primary-care doctors.
For all of this, I pay a goddamn fortune. I HATE GROUP HEALTH.
I am currently embroiled in a controversy over an injury I suffered. My doctor appears to just plain not believe it hurts, even though it has hurt every goddamn motherfucking day for ten months. "Naproxen", they say, which helps a little but not much, and occasionally makes me puke.
I have been humiliated on a cold bathroom floor, I have been denied treatment, I have been told to lose weight by grossly obese people who can barely move around -- the ONLY preventative care I've received even a hint of. I have had doctors examine me for three seconds and then immediately start showing me glossy brochures for expensive appliances I don't need but in which the doc has investments. When I asked for a mental health referral I was given the names of a dozen people, NONE of whom are accepting new patients; I never got fuck-all, and ended up going out of insurance for help.
My eye appointments are covered but after the copay and lab fees and so forth, they're as expensive as uninsured appointments at a less chi-chi facility.
Group Health represents everything that is wrong with American health care. Most of their employees aren't health care professionals at all; they're men in suits shuffling paper. They have no shortage of glamorous new capital facilities with exotic hardwoods but almost no primary-care doctors.
For all of this, I pay a goddamn fortune. I HATE GROUP HEALTH.
6
I don't see that big a difference between a fully public option and a federally chartered coop; in practical terms a coop would essentially be a public option. A coop would be nonprofit, federally subsidized so that every American had access to insurance they can actually pay for, and subject to public scrutiny in a way that private insurers are not.
In Germany, which is a similar model, really, public health insurance is required for people making less than a threshold monthly amount (I think around $3,000 per month), and the premiums are on a sliding scale based on income and set by the government. College kids and self-employed people fall into that category, too. Other people then generally pay into the private insurance system, where employers pay half and employees pay half. There is a statutory limit on the employee premium, however, set as a percentage of income, i.e. I think you can't pay more than about 12% of your income for health insurance. Everyone also has access to optional private supplemental insurance. For instance, if your employer-subsidized plan doesn't cover everything you'd like, you can buy extra policies.
The current American health care system could be adapted pretty easily to a universal insurance system following a German model, but using regional or national coops so long as the coops are subsidized to insure people who can't afford insurance otherwise and so long as people have portability of insurance from job to job (and for when you're self-employed).
I think that is kind of where the nervous Nellies in the Senate, including Cantwell, are heading. It's not bad so long as they implement the coops properly.
In Germany, which is a similar model, really, public health insurance is required for people making less than a threshold monthly amount (I think around $3,000 per month), and the premiums are on a sliding scale based on income and set by the government. College kids and self-employed people fall into that category, too. Other people then generally pay into the private insurance system, where employers pay half and employees pay half. There is a statutory limit on the employee premium, however, set as a percentage of income, i.e. I think you can't pay more than about 12% of your income for health insurance. Everyone also has access to optional private supplemental insurance. For instance, if your employer-subsidized plan doesn't cover everything you'd like, you can buy extra policies.
The current American health care system could be adapted pretty easily to a universal insurance system following a German model, but using regional or national coops so long as the coops are subsidized to insure people who can't afford insurance otherwise and so long as people have portability of insurance from job to job (and for when you're self-employed).
I think that is kind of where the nervous Nellies in the Senate, including Cantwell, are heading. It's not bad so long as they implement the coops properly.
7
I've been a Group Health member for about a decade, and I've received excellent care and quality service at GH.
HOWEVER!
I'm young and in very good health, and I've never needed help with anything other than routine bouts with coughs and colds and so forth. What's scary to me are the potential limits and costs in my coverage. The only reason I can afford my policy is because it's one of the high-deductible ones. Will I still go bankrupt if I get a serious illness, like cancer, even though I'm fully insured?
Also, they don't even offer the kind of individual policy that I have anymore because it's too generous (it's an 80/20, meaning they'd pay 80% of the bills and I'm responsible for 20%). It's my understanding that the new individual policies are 60/40. Ugh. Who the hell could afford that?
HOWEVER!
I'm young and in very good health, and I've never needed help with anything other than routine bouts with coughs and colds and so forth. What's scary to me are the potential limits and costs in my coverage. The only reason I can afford my policy is because it's one of the high-deductible ones. Will I still go bankrupt if I get a serious illness, like cancer, even though I'm fully insured?
Also, they don't even offer the kind of individual policy that I have anymore because it's too generous (it's an 80/20, meaning they'd pay 80% of the bills and I'm responsible for 20%). It's my understanding that the new individual policies are 60/40. Ugh. Who the hell could afford that?
8
My wife and I have had excellent care at Group Health over many years and are now on Medicare with Group Health. We wouldn't want to change. That said, we still need a public option for the 40-50 million uninsured Americans, and the Group Health model would not fill that need. Group Health is now more of a non-profit insurance company with salaried doctors than a co-op, which it was originally. I have been writing to Cantwell about once a week in support of a public option. Her response to me last week indicated that she supports a public option, but I'm not sure I believe her because of her conflicting statements. Not to mention that every member of the Senate Finance Committee, of which she is one, is snake and on the take.
9
group health is bad to their workers, the nurses went on strike a few years ago because even though the company made a $15 million profit they were wanting to cut the nurses' pay. you should contact SEIU 1199 about this, I'm sure they will be happy to talk shit about group death (ps everyone who works in healthcare, like myself, calls it that for a reason)
10
I love Group Health, and used to work there, but ...
This is not the plan for the 100 million uninsured Americans that have none.
Single-payer national health care - it's the ONLY choice.
This is not the plan for the 100 million uninsured Americans that have none.
Single-payer national health care - it's the ONLY choice.
11
Group Health is no longer a true co-op, for one. It used to be, but it's long since changed its operation structure, but kept the name.
I've looked into their policies several times over the last couple of years, for my wife and I, young, healthy slightly below middle class people. And yet, the premiums are much, much too high. The only affordable option they have is a basic catastrophic plan; and even with that we'd get screwed if something really bad happens. We're rolling the dice right now!
I've looked into their policies several times over the last couple of years, for my wife and I, young, healthy slightly below middle class people. And yet, the premiums are much, much too high. The only affordable option they have is a basic catastrophic plan; and even with that we'd get screwed if something really bad happens. We're rolling the dice right now!
12
Blech, I hate Group Death, as my mental health therapist I was seeing referred to it as. You know there is an issue if your therapist is talking this way during your session. The wait is always very long, I never got to see the same doctor twice, and I felt like a number, not a patient with unique needs. The staff always seemed harried, and I felt like I was intruding to ask them for anything but exactly what I was there for. I have been a member of Group Health off and on for over 30 years all over the state, and my mother was employed by them before that. I far prefer being able to choose from a pool of approved doctors and clinics, as my current insurance does (I am lucky, being a teacher and having excellent health benefits).
13
Not one good experience with Group Health. They are far and away the least engaged medical staff I have dealt with.
Yuck. No.
Yuck. No.
14
I used to work at a naturopathic clinic. Group Health is required by law to offer some naturopathic services. Rather than hire their own, they allow a few NDs outside the system to contract with them.
From my experience dealing with them on the provider side, Group Health isn't the worst provider out there, but it comes close. Pacific Health is the worst, United is second, GHC is third. They have an incredible level of bureaucracy considering that everything is handled within their own system. You would think a co-op would be more streamlined, but you would be mistaken.
It's also ridiculously expensive. When I shopped around for my own insurance, GHC's premiums were astronomical, especially considering their high deductibles and their much more limited selection of providers.
From my experience dealing with them on the provider side, Group Health isn't the worst provider out there, but it comes close. Pacific Health is the worst, United is second, GHC is third. They have an incredible level of bureaucracy considering that everything is handled within their own system. You would think a co-op would be more streamlined, but you would be mistaken.
It's also ridiculously expensive. When I shopped around for my own insurance, GHC's premiums were astronomical, especially considering their high deductibles and their much more limited selection of providers.
15
My mom is disabled, and she and my step-father are at Group Health. My sense from her history of care is that Group Health is decent if you're a healthy person and don't have any complicated health issues. But, as soon as you need help from two different doctors to resolve an issue...you're fucked.
I don't know how my mom and step-father do it, but most of her care is now through Swedish Hospital and an outpatient clinic downtown with doctors from Harborview and UW. I can't say she's any healthier, but at least her docs all now seem to be on the same page.
I don't know how my mom and step-father do it, but most of her care is now through Swedish Hospital and an outpatient clinic downtown with doctors from Harborview and UW. I can't say she's any healthier, but at least her docs all now seem to be on the same page.
16
You know who provides excellent health care at reasonable prices with good service and a friendly, open minded attitude toward everyone? Country Doctor!
Model health care on them, they are doing a great job.
Model health care on them, they are doing a great job.
18
I had coverage through GHC off and on for about 5 of the past 10 years and my care was always efficient and thorough. Like some of you above, I'm young and generally healthy, but I have definitely had to use their specialist departments a few times and found those to be no exception. The only two problems I can remember having were related to doctors I found to be rude and the solution was simple: I didn't schedule appointments with those providers again.
That said, I think what we really need is a single-payer solution.
That said, I think what we really need is a single-payer solution.
20
If you go to the Medicare website and look at the options for Medicare Part B (which covers clinic and office visits - Part A is hospital coverage) for King County, you'll see that the Group Health option is one of the highest priced options listed. That may be because Group Health offers more services or doesn't require a co-pay. But GHC wants $200-$300 a month on top of the $96 dollars Social Security withholds for Part B. What's affordable about that?
I can't speak to the efficacy or value of Group Health as I've never been a member. I was fairly happy with Kaiser Permanente (a similar system) while living in southern California - which, by the way, cost me only the $96 a month Social Security withheld.
I think we're going to have to get over the notion of kindly ol' Doc Welby coddling us until we're well again. Them days is gone. I think we're going to have to become accustomed to getting only the health care we absolutely must have and no more. That's not to say that we should accept being treated like shit-on-a-stick, but some people - let's face it - are pretty fucking spoiled, maybe neurotic, all the while refusing to pay for the Cadillac care they insist upon.
Here's all I ask from health care: See me at my appointed time. Listen to me for about 5-10 minutes and then tell me what we need to do to fix it. Then let's fix it as soon as possible.
So, Maria, I know $300 or $400 a month is nothing to you. I know you probably spend that much for lunch sometimes, but it's beyond my means and I'm not alone. So tell me, do you really think a public option can't beat $300-$400 a moth?
I can't speak to the efficacy or value of Group Health as I've never been a member. I was fairly happy with Kaiser Permanente (a similar system) while living in southern California - which, by the way, cost me only the $96 a month Social Security withheld.
I think we're going to have to get over the notion of kindly ol' Doc Welby coddling us until we're well again. Them days is gone. I think we're going to have to become accustomed to getting only the health care we absolutely must have and no more. That's not to say that we should accept being treated like shit-on-a-stick, but some people - let's face it - are pretty fucking spoiled, maybe neurotic, all the while refusing to pay for the Cadillac care they insist upon.
Here's all I ask from health care: See me at my appointed time. Listen to me for about 5-10 minutes and then tell me what we need to do to fix it. Then let's fix it as soon as possible.
So, Maria, I know $300 or $400 a month is nothing to you. I know you probably spend that much for lunch sometimes, but it's beyond my means and I'm not alone. So tell me, do you really think a public option can't beat $300-$400 a moth?
21
Bauhaus, you need to wake up to reality.$300-400 a month is CHEAP. That's probably national average or a little below. A lot of people pay as much as $600, if you include their employer's contribution, for a shitty plan (low ceiling, high deductible). It'll be over $1,000 soon, at the rate things increase. Now, imagine you're a family, times three or four.
And of course if you actually get sick, they kick you off anyways.
National health insurance is only part of the problem here. It doesn't address spiraling costs.
And of course if you actually get sick, they kick you off anyways.
National health insurance is only part of the problem here. It doesn't address spiraling costs.
22
I've had Group Health for 6+ years, and if that is a picture of what our future health care plan looks like, we could do a lot worse. I really love my doctor. She works on salary, rather than fee/visit, so she doesn't mind having (sometimes long) email or phone exchanges as an alternative to coming in for a visit. She takes plenty of time to talk to me when I do visit, and makes sure to answer all my questions. My wife and I are swingers, and when my wife and I were just beginning I wanted to discuss risks and STDs, and brought it up with my doc with some trepidation. She was totally cool, asked me detailed questions, and declared the risk of catching a serious STD as low.
I really like the all-included organization too. I hate with other insurers getting the bill from the doctor, maybe a bill from the hospital, then the "explanation" from the insurance company, then the inevitable billing fuckup where each blames the other. With group health, you pay your $10 co-pay when you check in, and that is that.
I love the way they really have a useful website. Online there is secure email with my doctors, and I can order medication online, hey arrive on my door, free shipping, in just a couple of days.
They even came through for me when I had to have more serious things done. I had to have an emergency appendectomy, which ended up being at Swedish, and my portion of the $14,000 bill was $500, which was pretty reasonable. I also had to have another non-emergency surgery, which since could be planned ahead, didn't even have the $500 charge.
I liked it so well that my wife left her plan that she gets from her employer (amazon), and joined my plan, and now we have the same doctor.
I recognize that if I didn't like my doctor so much, I might have a different opinion of group health, but I've liked most of other docs/nurses that I've interacted with.
Fly in the ointment? I think my employer (UW) pays nearly $500/month for my health plan! Yikes. That is why we need a public alternative. I believe the competition from the government will lower costs for everyone (the free-market people must be spinning).
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I really like the all-included organization too. I hate with other insurers getting the bill from the doctor, maybe a bill from the hospital, then the "explanation" from the insurance company, then the inevitable billing fuckup where each blames the other. With group health, you pay your $10 co-pay when you check in, and that is that.
I love the way they really have a useful website. Online there is secure email with my doctors, and I can order medication online, hey arrive on my door, free shipping, in just a couple of days.
They even came through for me when I had to have more serious things done. I had to have an emergency appendectomy, which ended up being at Swedish, and my portion of the $14,000 bill was $500, which was pretty reasonable. I also had to have another non-emergency surgery, which since could be planned ahead, didn't even have the $500 charge.
I liked it so well that my wife left her plan that she gets from her employer (amazon), and joined my plan, and now we have the same doctor.
I recognize that if I didn't like my doctor so much, I might have a different opinion of group health, but I've liked most of other docs/nurses that I've interacted with.
Fly in the ointment? I think my employer (UW) pays nearly $500/month for my health plan! Yikes. That is why we need a public alternative. I believe the competition from the government will lower costs for everyone (the free-market people must be spinning).
23
I work at Group Health, so my premiums are low. I wouldn't choose them if I had to pay more than I do. I have seen what they charge for independent plans, and even employer plans. I don't think that the five seconds the doc spends with you when you are sick is worth the $300 + a month premiums some people have to pay. I have never had good experinces at teh Federal Way clinic. I tried to contest some "quality of care" issues and they told me that since the DR. prescibed me anitbiotics for an infection I STILL have since 2006 that I had no case. Yea, to bad the DR. never told me about the prescription. So 5 $20 copays later its still not fixed and I ahve to pannel with a new DR. Plus my first DR I saw over it was two hours behind!!! Nurse told me he went to go get coffee after I had already waited in room for over an hour. What a crock of crap. Plus they treat their employees like crap... I'm not a mule. Plus we have a program for teh under privilege or "poor workers" its called Medicaid people!
24
ohtherees I work for GHC billing, believe me we hae a good share of F' ups. Every year we go more automated and less actually bodies reviewing your claims. Customer Service is a pretty big department now. They do have the online stuff, which I admit is pretty convienent/cool.
25
Group Health is fine. Any large solution (single-payer, goverment run, or regionalized co-ops) is going to have endemic problems stemming from beuracratic overhead. Group Health has the right idea: a non-profit model with physicians on a fixed salary (not pay-per-service like most doctors). Their heathcare quality scores are among the best in the region. They rank about 97th nationally (google HEDIS). They still need to drive down their costs and improve the quality further, especially if they're going to be a model for national reform, but they're on the right track. Lastly, they are among the few providers nationally who have a comprehensive electronic medical record, you can view it online, see test results, email your doctor, and make appointments. That's pretty cool, if you ask me.
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