Sunday, August 30, 2009

The Health Care Debate Continues

As time moves on, the health care debate does too. And all we see is the passionate debate for or against it, with no real discussion of what's broke about the system and what specific aspects that need fixing. It seems that there are 2 schools of thought; Government run health care or increase insurance competition without the government entering the business. HR 3400 is the Republican solution to health care which simply put, has tax credit provisions for maintaining health insurance, and allows for small businesses to pool into groups to purchase insurance for their employees at large group rates, and more blah blah blah about fraud waste and abuse and so on.

Let me tell you something, when you have a middle man administrating the care whether it's the government, in the case of Medicare and Medicaid, or the private sector in the case of all other insurance, rates are predetermined/negotiated. Which means the insurance company or the government tells the provider how much they will pay them for a certain service or procedure regardless of cost. A set up like this encourages fraud waste and abuse on so many levels. Meaning a doctor sees a patient and takes the opportunity to run all sorts of tests and procedures, ordinarily unnecessary but particularly if it is of no harm to the patient in order to increase their reimbursement. All they have to do is justify it medically, and when you are an expert in the game you can justify anything. This is especially easy to do and difficult to prove on older patients or if the patient makes any comment that could be construed to justify ordering this or that, which is another billable item.

What I am trying to say is that as long as there is a intermediary that must employ doctors, nurses and administrative personnel to administer payment on behalf of the patient, fraud waste and abuse will continue. Do you not find it fraudulent that insurance companies can deny coverage on the basis of a preexisting condition? But they can. This is the issue I think Americans can agree on and where we ought to start. That doesn't mean these patients might not have to pay higher premiums or higher deductibles or co-insurance.

Let's be honest, the fact that we pay premiums just means that insurance is just a payment plan for our routine medical care that is expected to even out over time. How else is an insurance company going to make money? For example. My parents were without health insurance when they first got married, by choice. They could have paid for it, but money was tight and it was a risk they chose to take since they are both very healthy. About a year later, dad went to the ER for kidney stones. They paid the discount they were offered to pay in full at the time of service. (All facilities offer this probably doctors too, some just make you ask for it) Calculated out, it cost about what insurance premiums and a deductible would have cost them for the time period of being uninsured. Had they put that money in savings every month, they would have had that money at the time of service instead of having to put it on a credit card.

I will say it again, if doctors and patients ban together to cut out the middle man, whether the government or insurance companies and take back personal responsibility for our health care, (dare I say live healthy lives?) I bet the cost of care would drop dramatically because doctors wouldn't have to employ staff or pay agencies to bill and collect from insurance companies. They could just collect the full amount up front at the time of service and I bet it would be lower than the "negotiated rates" they get from insurance companies or Medicare because Doctors and facilities would truly have to compete for your business. See my previous post about this issue on July 12. But I know 90% or you or more will likely disagree with me on this issue just like 90% of America is going to disagree with me about privatizing social security.

My point of this post is rather than each side insisting on their solution and their solution only, both of which only treats the symptoms, how about we think outside the box and treat the problem. At the very least, let's focus on 1 part of the system that we can all likely agree on (preexisting denial, or perhaps something else) and start there if the majority don't really want to treat the problem. As it is it just seems like a political power grab taking freedom from you and me the consumers.

3 comments:

Amlicar said...

Hey Lola/s Master, Your attempt at compromise is a gallant attempt from a rationalise American hoping rational Congressmen are listening.

But you are not paying hundreds of millions , to represent you. The Insurance Companies are doing that to our Congressmen.

President FDR called them "Organised Money" behaving like "Organised Criminals".when he was trying to improve our social services and met the same name calling and attacks.

So they all understand the problem....the corrupt Congressmen and white supremacists supporters in Congress.....want the situation to remain unchanged.

Yes its a power grab.....its always a power grab, this is a class society. The Rich will bleed the the country dry to ensure profit margins are realized. The Middle and working classes have to battle to save the country from going broke , time and time again.

Which power grab best serves you? who do you want to win ?..The people..represented by the President Obama and his Administration, or "Organized Money" operating like Organized Crime...."?

Take Care..Don't be pessimistic...be positive, THINK PROGRESSIVE !!!

Jay said...

psssst....Obama and his administration and "organized money" are one in the same.

The game is rigged and, we not only are going to lose, we are not even allowed to play.

Elizabeth said...

What good ideas you have! If only the government would l.isten . . .

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