Wednesday, November 20, 2013

How Bad Must Things Be for the President to Apologize?

I don't do politics, mostly because it makes me crazy, and I don't like me when I'm crazy.  I hate listening to speeches from politicians, because of the massive grain of salt that I have to stomach with it.  If I end up accidentally catching part of one, I just sit there, angry about how transparently manipulative they are, and seem to process nothing but the double-speak that takes place.  I truly despise politics.

Listening to the radio and hearing the President apologize for the healthcare fiasco genuinely frightened me.  My first thought was "...if things are already as bad as we know them to be, how much worse must they actually be for the President to say he's sorry???"  I mean, really, how many times in history has the head of a nation apologized?

Am I qualified to make statements as to how the government should make changes to the healthcare system?  Does anyone seem to be?  I have worked in a medical billing office for almost 8 years, and I do have normal-person insurance, so I do have a perspective that most in the government don't.

Insurance companies are only able to profit from healthy people who don't use the insurance they are paying for.  Naturally, if you require companies to provide plans that will insure anyone, despite how unhealthy they are, it's going to cost boatloads more for that plan.  By covering unhealthy people, they have to be prepared to pay for their extra visits to the doctor.  It's shocking, I know, but these companies are in business to make money. 

The government has now made available sub-standard insurance at high rates.  Yipee.  Doctor's do not want to be paid sub-standardly, as evidenced by the fact that most of them already refuse new Medicare patients.  Why?  They want to make money.  They know that other insurance plans pay better than Medicare, so they have to put a priority on maintaining a balance of their patient caseload that will still make the lines on the profit chart go up.  

Guess what's going to have to happen to make these new plans more affordable?  They will have to pay out less.  There's no two ways about it.  For a product to cost less, the producer must spend less to make the product available.  It's just basic business. People will then have plans they can afford, but still won't be able to afford their healthcare costs, unless the provider is willing to take a reduced rate.  What providers will be willing to do that?  The ones that find ways to provide cheaper service to their patients.  Again, it's just basic business.  The providers still need to make money, so they will be forced to provide sub-standard care, and be paid sub-standard rates in return.  Funny, that sounds just like the system we already have...


Here's What You Should Do:

Plan #1: Socialize It
You want it socialized that badly?  Here you go:

People keep acting like government run healthcare is new in the US, but it's not.  We've had Medicare since 1965.  Is Medicare well-maintained?  No!  And, everybody knows it!  We've heard for years how underfunded it is, and how it may not even be there when I get to the age that I might need it.  When the talks about more government run healthcare were the only thing any of us seemed to care about, I kept saying I needed to record some of the ridiculous phone calls we had with them at the office, and post them all online so people could hear what government run healthcare actually sounds like.  People are undertrained, and frequently (though, not always) downright rude.  One peeve for our office was that for about 6 months, we were required to call a system that could not give us all the information we needed before being allowed to call and speak to someone who could.  It was ridiculous, but despite the employees knowing that the automated system was incomplete, they were required to force us to call it before being allowed to tell us what we needed to know.  And, they were willing to spend as much time arguing with us about the uselessness of the call as it would take to answer our few questions.  Inefficiency drives me crazy.

Is it efficiently run?  No, but how can we fix that when the responsibility for doing so is split up among so many different companies who run it for the government?  Last year, a company based in New England took the Medicare reigns for our region of the country.  We spent months trying to sort out the various irritating changes that this brought.  Now, their company (which was in the middle of a buyout when they took over) will be transferring control to their new parent company within the next year, and I'm sure we will all have to deal with more unnecessary changes.

When they feel the need to check our paperwork, is it done quickly?  Heck, no.  We had to go through a chart review several years ago, and it took over a year and a half to be completed.  They had us send them charts from 3 years before the request, for them to check over.  By the time the whole ordeal was over, it had been 5 years since the patients had actually been to our office.  How can a system that has so much money tied into it be run so inefficiently?

You really want to provide government run healthcare to a nation?  Show that the insurance you already provide works.  If Medicare works, allow people who aren't yet of age to opt into it by paying for coverage. If it gets working great, and people really decide they want socialized healthcare, start making it apply to more people.  

HWYSD:
1. Fix Medicare
2. After 1 year, make it apply to citizens under 20.
2. For the following 9 years, every year make the age for Medicare eligibility lower by 5 years.
3. By the time 10 years is up, everyone would be eligible, and be part of a system that had been repaired and shown to be functional.

The gradual change would make it something everyone could actually keep up with, instead of having a ridiculous system shoved down the throats of the entire country all at once.


Plan #2: Fix It
The healthcare industry is just that, an industry.  An industry is designed to make money.  The problem with this one is the same problem we have with any other industry in America: we all want to find ways to make more money by doing less work.  (Don't get me started on how we have completely reversed the American Dream)  In any case, costs are out of control.  Equipment for medical offices costs a ridiculous amount of money, which makes doctors charge more, which makes insurance companies pay more, which makes their customers pay more.  Why?  Because the system allows it, and continuously feeds upon itself.

We took our son in to get tubes in his ears last year.  The procedure takes about 10 minutes.  They knock him out, hook the tubes in, wake him up, observe him for a couple of hours, and you're out the door.  It was great (for both our kids, actually) since they had very frequent ear infections.  Our insurance knocked the total billable amount down to around $2,000.  I wish I made that every 10 minutes.  The money, of course, gets split among the hospital for the facility, the anesthesiologist, the doctor who performed the surgery, etc.  Once it's all boiled down, it's a pretty fair rate (which is the whole point of the "fee schedule" that the insurance company made the doctors agree to).  The odd part is that the total charges submitted (before being discounted to the fee schedule amount) were over $12,000.  Holy crap.  You could buy our cars 3 times for that.

Now, for those who aren't familiar with fee schedules: the hospital can bill as high a number as they want, but if they are a member of an insurance network, they must take the discount down to what that company has decided is a fair rate for the service.  If they are out of network, they take no fee schedule reduction, but the patient's deductible will usually be several thousand dollars, so the high rate would offset that, ensuring that the hospital still made some money without having to squeeze every dime out of the patient all at the time of service.

HWYSD:
So, what do we do to fix this?  Limits.  If we want to fix the current system, somebody needs to make all parties involved meet on some middle ground.  My thought?  Use a fee schedule.  No more in-or-out of network mumbo jumbo.  Set a nation-wide base rate of pay for every medical service, then based on the provider's location, place a positive or negative percentage adjustment on that fee schedule to take the regional economics into account.  Boom.  Doctors know what they will be paid, insurance companies know what they have to pay, and patients can decide if they really need insurance or not.




Hey, these are just ideas.  Like them?  Share them.  Want to steal them and write a bill based on them?  Go nuts.

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