Health Care Ponzi Scheme

If you want to know if an airline is in bad shape, listen to the flight attendants when they're on break over by the bathroom/kitchen area near the back of the plane.  Better yet, look in the eyes of the counter staff. They know just how bad things are.

In the medical world, you can use the same test, but listening instead to the medical assistants and billing clerks who staff the real front line on the war on health care.

Flying blind,  On "Healthcare Air"

You've all heard them -- with two phone receivers up to their ears,  on endless hold,  trying desperately to get 'pre-approval' of your visit as you wait in the reception area.  They're the ones who know the deep dark secrets that we only can imagine. Health insurers can run friendly ads on TV,  and your doctor can be as warm and pleasant as he wants. The reality is that stacking patients up like planes circling to land in a multi-hour waiting room traffic jam isn't your doctors idea of a good time, either.

Insurers have declared war on their customers, refusing more claims, increasing deductibles, limiting the number and the amount of a particular prescription that can be filled via mail order at one time.  Much as the airlines begin to charge for each bag put under the plane, insurance companies are nickel and diming America to death.

I'm not talking about the big terrible stories of refusing treatment or forcing the desperately ill to beg for coverage.

What I'm talking about are the daily indignities. Endless red tape makes the process of keeping your family in good health fast becoming a full time job.

For example,  my insurance company won't allow you to submit a prescription for a medication that one of family members needs to be on for a chronic condition.  Instead it must be 'renewed'  every 30 days.   Renewal comes in the form of a robot phone call that comes in the middle of the day -- during work,  and can't be responded to without a return phone call to an operator who requires you to hold. What's the purpose of renewing a medication for a chronic condition every 30 days? Not taking it would have a serious adverse medical effect, so this isn't about keeping the patient healthy, it's about making it harder to get the medication and care that we need.

If you ask the folks who manage the billing at your doctor's office they'll tell you the same thing.  More rules.  More red tape.  More waiting on hold.  Explain to me how this is in any way about either improving patient health or reducing waste?  It's not.  It's about making it harder for you -- the paying customer -- to get health care.

You knew this was coming.

I remember the first time I called my insurer's 800 number and it said:  "if you're a patient, press 1, if you're a provider press 2."   Uh oh.  They're not doctor's any more,  they're "Providers" -- and they have to call the same 800 number I do.   What does that mean?  It means that they're no longer experts, professionals, an honored profession about care -  they're simple vendors to the health insurer. This shouldn't have happened.

The Ponzi Scheme. You know that you've 'invested' in the the current plan.  You believe that it will pay off when you need it.  When you hear terrible stories of plans that don't cover patients,  or coverage that seems to get thinner as costs go up, you say, "Boy, glad that isn't me." But of course,  it's happening to everyone.  Change is scary.  But staying the current course is a flight path to disaster.

So, what should happen?

-  Doctors should be back in charge.

-  The government should set up a system to provide Medical Justice

-   Patients should have a free market system with choices and options.

Here's are 3 specific suggestions that could get actual voters and health care consumers excited about changes in health care policy:

Doctors Lead Care:   At the moment,  doctors seem to be the ones who have the least say in the system.  They've got huge risks in insurance claims and their own legal exposure.  At the same time,  they appear to have less and less of a voice in decisions about how they treat their patients and how they can provide proper care.  By requiring insurers to give their primary care physicians more authority,  they would trim paperwork and also limit defensive medicine.

Health Care Court:   Create a court that can mediate and rule on conflicts between patients and insurance companies.   A combination of mediation and objective review that gives patients a 'court of last resort'  when insurers refuse to cover claims that are a medical necessity.   The 'keep them honest'  function here would be that there would be a public record of precedent,  so patients could use prior rulings to drive more expeditious decisions from their insurance companies.

Choices and Options:   While people may be against the 'public' option that sounds like health care provided by the post office or DMV,  the reality is that private options are narrowing, not expanding. Health insurers are consolidating, and the result is a handful of companies are setting policy for reimbursement, patient care, and network configuration. This isn't capitalism - it is essentially a health care monopoly. Doctors are opting out;  taking cash and allowing patients to choose the medical professionals who best serve them. Going forward, there should be insurance that is in place for catastrophic health care,  allowing patients to buy day to day health care a la carte, and at lower costs.  Doctors would happily skip the red tape to get paid in cash.

Three simple solutions.   Doctors leading decision making. Medical justice. And choice.  That's a health care proposal that average American's would get behind, rather than a vague notion of 'reform'  with no clarity around policies or practices.

Follow Steve Rosenbaum on Twitter: www.twitter.com/magnify

Comments

[maxfax]

Wow, how stunning only 9 posters responded to this blog. Guess people still don't get what we're up against. Sad, very sad.

[jmpurser]

Your touching faith in a "market" that spent the last 50 years proving it should have NOTHING to do with health care would be comical if I weren't sure you were quite sincere.

[winner4real]

Claims that our insurance company used to pay on a regular basis for continuing care are now being srutinized with red tape. Their practice now is to ask for doctors' notes on every claim. When the paperwork is sent in and the claim is supposed to be reviewed when you follow up you are told that they didn't recieve the claim so the billing office has to resubmit the paperwork. Talking about stalling. It has really gotten bad this year. Instead of paying the claims maybe they need the money to pay their lobbyists!

[maxfax]

I believe you're underplaying how despicable insurance companies treat sick people.

[jmklein]

How dare they charge customers by expected value! Are we to reduce chance to probability theory?

[standard]

"Health insurers are consolidating, . . . This isn't capitalism - it is essentially a health care monopoly."

That's precisely why every average American needs a strong public option--and the health insurance industry and their Republican Party toadies are fighting against it tooth and nail.

Excellent post.

[ChiProgressive]

The big problem with paying cash for routine care is that the people who desperately need primary, secondary and tertiary preventative care will skip it. You wouldn't want to privatize the fire department or the police, so why have a private intermediary between you and your health care provider? Quality health care is a human right.

I've been a patient and I've worked as a Nurse assistant, medical assistant and I am now a health educator.

Let's have the VA system for all!

[EscalatorMusic]

Hi Chi,

The reason why it is not like a fire department is that they can let you die alone, but they can't let your house continue to burn and endanger surrounding property.

The broker always takes their cut and right now that cut seems huge.

[BarryS]

1.anti-tru­st enforcement: no ins co controls more than 24% of any market. break up companies or automatically put the overage on medicare.

2. delay on phone more than 10 minutes: $1000 fine per minute afterwards. Bet that would get them to hire enough people.

3. refusal of care/payment for no reason: if patient lives, $1,000,000 per dayfine until compliance; if patient dies, 1st degree premeditated murder charge for board of dirctors severally and collectively.

Bet they would beg for a public option then.

[Heleric]

You make a very good point. They actually do whatever they can to make getting health care as difficult as possible. How could anyone defend this kind of business practice. It's an absolute shame that the Insurance companies run the show in this country. This has to stop.