“Conceptually, insurance means normal people should not go bankrupt from serious medical conditions.”–Len Nichols, a health economist for the New America Foundation
Unfortunately the reality is that insurance does not work that way, as is discussed in this article in The New York Times.
Once again, “our” national legislature is throwing around named programs like “single payor” which sounds good, but turns out to be putting the DMV in charge of healthcare. Each suggested healthcare plan focuses on who makes the decision as to health care. What everyone wants, and no one suggests, is that the DOCTOR should make this decision, not a insurance company adjuster and certainly not a program like the DMV single payor.
But all is not lost. The simple solution is what I would call a single payor system. Essentially, make insurance companies actually insure the risks that policies are purchased to protect against. Simply put, if citizen A requires healthcare, than insurance company A pays for that care. No objections, no finger pointing, insurance company A simply pay the bills. Removing the in-fighting between the insurance companies will so substantially reduce the costs of the system that the money can actually go towards medical care.
An example of an ordinary insurance claim demonstrates my point. Suppose a tree falls on citizen B’s car while parked in citizen B’s driveway. Citizen B is supposedly well protected, carrying both homeowner’s insurance and automobile insurance. However, when B puts in an auto claim, he will be told that the accident did not arise out of the use of the car, so it is a claim against the homeowners. However, the homeowners policy will claim there is no coverage as it is principally an auto claim. Citizen B’s responsible decision to have multiple layers of insurance has now shot him in the foot. He has paid two companies to insure, but neither will and citizen B’s car remains in the driveway unfixed while the two insurance companies sue each other over who is to cover the accident.
Now, put citizen B in the car, suffering personal injury from the tree. Citizen B’s health insurance will not cover as it is an auto case, the auto won’t insure because it is a homeowner’s claim. Now 3 layers of insurance and yet, no coverage while three companies duke it out all paying top litigation attorneys to decide who pays.
Now add that citizen B was on his way to work . Now workers compensation insurance may cover, health insurance may cover, homeowners may cover or auto, BUT no one will be paying while these companies battle out this now huge and unmanageable matter through the courts, coordinating 4 companies and their lawyers. Meanwhile hospital remains unpaid and debt collectors are calling the injured citizen B (who has FOUR layers of insurance against this risk).
All of the waste of the insurance in-fighting can be removed by a simple, citizen B got medical treatment, Company B pays, no matter what. If you are in a car accident, your insurance fixes your car, no recourse against the other driver or their insurance just straight insure against loss. Premiums equal total payouts for the year divided by the number of insureds (plus say 2% for profit).
If this was the case, there would be no need for the entire claims handling process for these companies. The only bureaucracy would be to handle the paying of bills. A true SINGLE PAYOR…Solved!
If that were indeed the concept, then either health plans would have no maximum expenditure limit or there would be a societal expectation that people would be willing to die when care gets too expensive.
However, that is, de facto, the case in any medical system, since something has to ration expense.
no maximums, the catastrophic loss will truly be pooled and that cost shared. The flip is unnecessary care raises the costs for all…
Eric,
“Once again, “our” national legislature is throwing around named programs like “single payor” which sounds good, but turns out to be putting the DMV in charge of healthcare.”
Actually single payor is not on the table as so few in Congress support it and the Obama administration has rejected this idea.
“Each suggested healthcare plan focuses on who makes the decision as to health care. What everyone wants, and no one suggests, is that the DOCTOR should make this decision, not a insurance company adjuster and certainly not a program like the DMV single payor.”
Actually many physician groups desire single payer largely because this is our best shot of reducing outside interference. Medicare is far less likely to get in the way or bug us with unnecessary paperwork than many private plans.
Basically scare stories about government health care and “socialized medicine” stopped working in the last several years when corporate run health care turned out to be far worse than government financed plans.
As for the rest of your comments, it does happen that we have problems with battles between multiple potential payers trying to pass the buck to others and avoid paying. This, however, is a very rare problems compared to the other insurance problems which health care reform is attempting to fix.
Actually you are making an argument for single payer. As long as we have private plans there will be the potential for problems with disputes as to who is primary payer. The real way to eliminate that problem, (if it was the major goal) would be a single payer plan which did cover all health care costs.
President and former Chair of the Department of Family Medicine at the University of Washington. The huge number of people affected by medical bankruptcies 2 million each year – means the average doctor has two or three of them in their practice. Yet I suspect that few of us have been aware of this epidemic.
I can’t say how many doctors are aware of the problem, but I am aware of multiple patients who have declared bankruptcy.
There are also probably many cases among people who, due to limited coverage, were not established with a regular primary care physician, making it less likely that doctors would notice their cases.
The bankruptcies are also probably not evenly split. I’m sure that there are doctors in some areas who have limited numbers while others have much higher numbers.