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Insurance Companies Push for Universal Health

By On · Add Comment · In baby boomers, health care reform, individual mandate, insurance companies, private insurers, universal health care

I wrote in my last blog post that insurance companies have a vested interest in universal health care. This might be a surprise to some, since it might not be obvious how private insurers will profit from health care reform. A Los Angeles Times piece hot off the press explains just how–through mandated individual coverage.

“Individual mandate” is the provision private insurers are hoping for; without it, they might as well pack it in, because reforms are sure to destroy the industry. Why else would insurance companies back a plan to restructure the health care system that they’ve fought to block for sixty years plus? The individual mandate would require everyone to buy medical insurance, which insurers hope will be sweetened by taxpayer-funded subsidies for customers who can’t afford it, and enforced with fines.

If the individual mandate provision goes through, then insurers stand to gain millions of customers over night; and it will probably save the sinking ship as the insurance industry has been hurting for some time now. Since 2000, business has waned for private insurers as rising premiums pushed scores of people out of the market. The current recession has only heightened the problem. As baby boomers age, things will get worse: 79 million boomers will turn 65 in 2011 and move away from private insurance coverage to Medicare. And an estimated 170 million people will be making that shift over the next two decades. So, basically, health insurers need this mandate.

The scenario which the private health sector can least afford would be the one where the single-payer plan is adopted. In this scheme the government pays all bills, rendering private insurance obsolete. Clearly, for the health insurance industry, this can’t happen.

So that’s why you are now hearing insurance companies getting into the universal health care act. Playing their cards right can lead to huge profits; but playing the wrong hand can lead to a bust. Just pointing it all out so you understand the economics and politics behind this movement. I’m not against it, as long as the powers that be (or as it will probably turn out, the new powers that be) don’t start messing around with fee schedules. If it prevents waste and crookery and medical mistakes without making hard-working health professionals go belly under, then wonderful; erect the statues today. But I can’t see how all this is going to be funded without taxing the lot of us (bye-bye, small businesses), or slapping health care with mandated lower reimbursements. If it is the latter, expect the quality of health care to suffer big time.

Uninsured Raise Health Care Costs for All – Really?

By On · Add Comment · In Families USA, health care reform, insurance companies, medical care, reasonable and customary
What our federal government wants to do is reform the health care system–that is, make sure medical care is available to everybody. Universal health care, the belief goes, will lower costs and make people healthier (I’m guessing, because I don’t really get the ultimate goal of all this reform stuff).

Healthier? Really. And lower costs? Hmm. A recent report from the sham organization, Families USA, has suggested that uninsured people increase health cost for everybody. They claim that as medical bills go unpaid, the costs are shifted to the insured through higher premiums. Unfortunately, but not surprisingly, Families USA provides no rational argument–no facts, whatsoever. I’ve read their sorry report, and it’s obvious to me that it is just fodder for the politicos trying to push the health reform agenda. Most people, especially those that favor reform without question, won’t bother to read the report; and many more won’t understand it. In fact many doctors won’t understand it because they don’t do the billing in their office. But every billing manager in health care will know my words ring true. Listen.

Families USA claims that doctors and hospitals charge more for their services when uninsured patients don’t pay their bills; they claim that providers primarily pass these increases on to insurance companies. Nonsense! That’s illegal. All medical procedures have reasonable and customary (R & C) rates that are determined by discipline (medical doctor, chiropractor, physical therapist, etc.), procedure (examination, office visit, debridement, x-ray, etc.), and zip code (Beverly Hills, Bakersfield, Omaha, etc.). Charging more than this R & C rate 1) won’t get paid by the insurer and 2) is illegal. A provider also can’t raise the bill to insurers by upcoding either–that is, charging for a higher level of service to pad the bill. Illegal!

So the claims by Families USA are pure BS, plain and simple. And to the undiscerning reader it may seem like cold, hard facts; a good reason to support universal health care. But it’s a lie. Understand this, universal health care is being embraced by political groups, ideologues, and insurance companies alike. That’s right, insurance companies*. Because they smell the money-making opportunity in this horse turd. More insured means more premiums for the insurance companies–believe that. And they love it! They have a vested interest in perpetuating the complete falsity of passing costs onto the insured. Bull! Insurance companies raise premiums for one reason and one reason only; the same reason they withhold reimbursing health care providers for as long as they can–PROFITS. And profit from this political mumbo jumbo they will.

*“Reasonable and customary charges” are the allowable charges that Aetna will pay for medical services by contract with providers in its network. Rates are consistent with those normally charged by the provider for the same services or supplies and within the general range of rates charged by other providers in the same area for the same services or supplies. When you use a network provider, you pay only the coinsurance on the allowable charges. When you use an out-of-network provider, Aetna pays the allowable charges it would pay a network provider, and you pay the difference. You decide.

Medical Shortage

By On · Add Comment · In insurance companies, medical costs, medical doctors, medicine, primary care physicians, universal health care

Looks like medical doctors don’t care for this federal health care stuff. According to a recent survey, many primary care physicians plan to quit or drastically cut down their hours seeing patients because they are feeling “overworked.” 7,200 physicians surveyed said they would NOT recommend medicine as a career. Wow! Neither would I.

The doctors surveyed stated that they’re simply bogged down by paperwork; and this paper-pushing leads them to give less time to patients. For any doctor who is in the game to help people, I can attest, this is a frustrating situation. And it isn’t going to get any better with a universal health system, that’s for sure.

The paperwork attached to the federal health programs like Medicare, Medicaid, and other federal and state insurance plans is oppressive. Yes, yes, yes, there is some fraud going on, and the government doesn’t like being cheated. But the strain caused by the paper-pushing rigmarole is just too much. Geez. The feds think it curbs costs, but in fact, it reduces quality of care. And worse yet, our skilled and hard-working primary care physicians are ready to walk away. The only worthwhile career in medicine today is in specialization–surgeons, oncologists, anesthesiologists, and the like. Who wants to see 100 people in a day, and then stay in the office all night doing paperwork? Sure makes research sound good.

I have to sympathize with the doctors here. I understand why all this paperwork craziness is happening. Medical costs are spiraling out of control, and part of the problem is fraudulent billing–from doctors and hospitals. Understandably, insurance companies don’t want to pay for anything that hasn’t actually taken place–you know, double paying for surgeries, paying for patients who weren’t really in the hospital, and so on. But to overburden doctors with safeguards, in the form of government forms, and so much that patients end up losing quality of medical care just doesn’t make sense. Insurance companies just have too much damn power, and it’s time they stop being placed on the top of the priority list. Let them police their own damn suspicions, and if they catch a fraudulent doctor or hospital–then great, throw the book at them. But to have the support of the federal government in this documentation madness is just that–mad!

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