State of the Union

President Obama said “There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

Since this is where I make my comments here we go.  First of all the reason that many doctors, nurses, and health care experts consider the approach in question to be a vast improvement is that anything would be a vast improvement.  Health insurance companies have taken over health care.  They deny coverage for people who are sick, charge unreasonable amounts for premiums, and then deny payments to the medical professionals who are actually treating the sick.  I submit that the health insurance companies themselves are the problem.  If you want to hear that from someone smarter than me I’ll refer you to Dr. Steffie Wollhandler.  I don’t happen to agree with her about the “Medicare for all” idea, but that’s simply because Medicare is insurance as well.  However, the “Medicare for all” plan would be a better approach that would meet your criteria above.

A more reasonable approach would be to hire the medical professionals on a salary basis to treat all the sick and injured.  You could give them more than they are making now, pay off their college loans and still save money since you are bypassing the health insurance company middle man.  This would cost less than the “Medicare for all” plan, and when it would cost less for the American people when you consider the increase in taxes would be offset by not having to pay an insurance premium.

I know that you aren’t going to do either of these because the health insurance lobby is too powerful.  You have explained that.  There have been times over the last year that it wasn’t clear what you wanted aside from health care reform that doesn't hurt the insurance companies.  Perhaps this will meet your criteria. 

• End the practice of denying coverage to people with pre-existing conditions.  This will enable people to get insurance. 
• Define health insurance packages.  I’ve seen negotiations for health insurance for a small business.  When you shop around you have to be really careful that the coverage is the same.  One company might sound good, but then somewhere in the policy you end up finding out about some piece of coverage that does not match.  The idea here is to have a few standardized labels so that anyone can compare prices apples to apples.  This will drive down premiums. 
• Make sure that the health insurance packages can not preclude supplemental insurance.  Maybe it’s just me but I would rather pay a premium for supplemental insurance that I know is coming than pay a deductable (or a bunch of co-pays) as a surprise.  On the face of it you might think that this would increase costs.  Over the longer term I would suspect that it would encourage people to get things looked at sooner which usually translates into cheaper.  The reason it works out the other way for insurance companies now is that they are considering the term of the policy.  If they were actually concerned with their customers well being the co-pays and deductibles would be lower.  Another way to handle this would be to drop co-pays across the board.  
• Define coverage criteria for everything across the board.  For each procedure that a provider performs there could be as many different forms, or steps to get paid as there are different plans.  Since one insurance company can have a multitude of plans it can get confusing really quick.  Set the coverage criteria for each procedure in law and make them as objective as possible.  I would suggest a group of providers and insurance company representatives get together and hammer this out.  This protects the American people from getting health insurance that isn’t worth anything.  If done well it will cut costs for both the provider and the insurance company since everybody would know the rules. Note: If the insurance companies object to this on the grounds that having to pay more claims will mean higher premiums (which they will) make sure to get a list of exactly who is objecting because they are basically saying that they had no intention of paying legitimate claims which might be grounds for criminal charges.
• Require everyone who can afford it to buy health insurance. This is mainly to placate the insurance lobby, but it could actually help providers as well.  Knowing that someone has health insurance and knowing the coverage criteria makes it a lot easier to get paid.  You then just have to find out who to send the bill to.  

So far this approach should reduce premiums, reduce cost, and cost very little to the government.  In fact it might come out as a gain for the government since the coverage criteria thing might best be enforced with fines. The following things might also save some money.

• Drop Medicaid and instead create a system of clinics and hospitals that uninsured people can use.   I'm sure that this would save money overall.  I'm not sure that it would save money for the federal government.  
• Set up a national health records database.  This will help with enforcing the uniform coverage criteria above.  This will help with diagnosing problems quickly.  The technology to do this is established.  I understand the privacy concerns, but this type of technology could save a life.  Privacy concerns should always be less important than saving a life.

This part will cost some money, but we just saved money while covering the uninsured.

• Expand Health Savings Accounts by allowing people to have them regardless of the type of insurance they carry.  
• Increase finding to Medicare.

I don't really think that this will get done.  I just thought I would let you know how.

 

Medicare fraud

I saw this article the other day.  I am against true Medicare fraud.  I don’t like any type of fraud.  The problem is that Medicare lumps something called “Medical Necessity” in with fraud.  This inflates the dollar amount involved by an unknown quantity. 

“Medical Necessity” is exactly what it sounds like.  Someone at Medicare decided that the patient did not need the treatment or item provided.  The real problem with this is that the people at Medicare haven’t seen the patient, and have no idea what the patient really needs.  It has been my experience that Medicare is wrong, but you have to appeal these cases to a very high level to prove it.  Based on that, I would consider these cases of Medicare committing fraud (or theft of services) against providers.

So in summary no one should be getting away with fraud.  This includes Medicare.  That’s the way I see it. 

Medicare For All

I saw this article on Google news this morning.  My initial reaction was that these people simply didn’t contribute enough to Pelosi’s last campaign.  While that’s true I also noticed that you don’t see much about the Medicare for all proposal in the news so I decided to comment on that.

First of all, I’m not as big a fan of HR 676 as you might think.  Medicare is a health insurance program.  To me it makes no sense for the government to run health care in that manner.  Here’s why;

§         You and I purchase health insurance because we don’t have the funds to hire the medical staff and purchase the equipment needed to treat our eventual medical problems.  This is not the case with a government.

§         If a healthcare provider’s primary motivation is money they are better off making the patient feel better without actually curing their problem.  This keeps the patient coming back.  Every business in the world loves repeat business.  Medicare for all would do nothing about this.

§         Over a lifetime there is no risk that you will get sick, injured, or both.  It’s a certainty.  You aren’t really insuring anything.  You are just pooling your money to pay for the eventual care that everyone will need.

§         Having healthcare structured in this way creates a claims billing and payment structure which really does nothing to treat the patient.  Yes, I’m saying that the entire health insurance industry is doing nothing to treat patients.  President Obama mentioned in one of his speeches that it’s 6% of the economy and indicated that he’s just not going to go to a single payor system.  I think that when you consider the people doing the billing it’s at least twice that.  So the current system and the “Medicare for all” system would have roughly 12% of the economy involved in nothing more than producing and paying claims.  I think I know why our health care is the most expensive in the world.

Don’t get me wrong on this.  I think healthcare is part of the government’s job for moral and practical reasons.  For the moral reasons I turn to the Bible.  If you look at Leviticus you will see that when people had problems they were to go to the priests.  In that time the priests were both the church and the government.  The argument can be made for either one being responsible for healthcare, but it can’t be made that healthcare should be a private venture.

Also, from a practical point the government should be doing healthcare for the same reasons that the government should be doing military, police, and fire. 

§         All of these require special training.  This training is expensive. 

§         There is a large portion of the time when you don’t need these services. 

§         When needed these services could save lives. 

§         Market forces combined with the above points will lead to infinite cost.  Don’t believe me?  Ok, how much would you pay for?

o       Someone to go into a burning building and rescue your family.

o       Someone to take murders, thieves, etc. to jail.

o       Someone to defend this country from all enemies foreign and domestic.

o       Someone to keep you alive.

Given all of that I still think that HR 676 would be better than any of the other things I have seen. 

Some ideas about healthcare

Previously, I mentioned that I don’t think that the government is going to take over health insurance. In other words it is FUD. I also mentioned that I’m concerned that without regulations that define coverage criteria we will have insurance companies making up reasons not to pay claims. What you will end up with is people with insurance going bankrupt like they are now.



Thinking about it further I can see how taking over the entire health insurance market would result in a situation where it make sense for them to provide health care instead. Paying the medical providers directly in the form of a salary would certainly make more sense than funding some insurance middle man to turn around and pay the providers. Taking out the middle man removes the cost. Of course, like I said before it’s not going to happen.



Since that isn’t going to happen I would like to see a generous benefits package outlined that would be a minimum of what is covered by anyone claiming to sell health insurance. Standardizing a benefits package helps create competition. I’ve seen negotiations for insurance coverage. When the employer talks about lowering the price the insurance company talks about lowering coverage. If you try to go to a different insurance company they give you a different plan that you have to figure out. It’s really hard to get to an apples to apples comparison of plans.



Similarly, I would like for the benefits to just have a coverage percentage, deductable and maximum. Along with this I would like to see language that would allow me to have a supplemental policy to cover all the out of pocket expenses that my current coverage dose not cover.



For all the benefits mentioned above I would like to see a group of people from the health care and health insurance industries come up with standardized coverage criteria for the whole benefits package. I would like the providers of care and health insurance companies to have equal say in the coverage criteria so that you end up with criteria that are reasonable.



I like that it looks like the plans will abolish pre-existing conditions.



I would like for all of my medical records to be available to anyone treating me for anything. If this is handled through some smart chip technology, the internet, or a hybrid of the two doesn’t matter to me. We are no longer in the 1950s. We shouldn’t have a condition where one doctor doesn’t know what the other doctor has done to treat the patient.



That’s the way I see it today.

Some ideas about healthcare.

The headlines today are all about the public option. Some of our politicians are worried about the public option being a stepping stone to the government taking over healthcare. As I mentioned in my previous post I was in the Army. I have seen government run healthcare and I liked it. Unfortunately, that’s not what the stepping stone leads to. It’s not even close.


What they are really talking about is a government takeover of health insurance. This is not likely to happen either. In the article linked below professor Carroll notes several states where similar ideas have been tried. I don’t know of any of these states where the public option has lead to a government takeover of health insurance



Huffington Post – Meet the New Health Care Reform, Same as the Old Health Care Reform

I am a bit concerned about the proposed legislation for another reason. I’ve billed insurance companies before and I know that having insurance does not mean that they will pay. I also know that it’s worse to have insurance that does not pay than to have no insurance at all.


The problem when billing is that different plans within different insurance companies can come up with a different set of hoops that the provider has to jump through to get paid. As long as insurance companies get to make up these rules they will find ways to deny claims. When claims get denied the patient ends up with the bill. So the patient is out the premiums that they paid plus the amount of the medical procedure.