A nuts and bolts diagram: What Single Payer will

June 22, 2009 at 4:41 PM (Uncategorized) (, , )


Non-reimbursed indigent care for citizens. = Major bucks.

The big players in the Healthcare Industry:

Anthem Kaiser United Cigna Aetna

Each have four or five Cost Avoidance Mini Bureacracies, where employees toil every day to say either “No,” or “We’re going to reduce this.” I’d imagine the smaller players do as well.

Other Party Liability Aka Coordination of Benefits Aka Subrogation.

What that means in English is that the doc or hospital billed the person’s health insurance and more than likely got reimbursed, but…Another insurance company is the primary carrier and the correct place of payment. (Private insurance carried by a parent or spouse…Worker’s Compensation injuries…Auto accidents covered by auto insurance.  Lawsuit or liability of a person or corporation.) Legitimate, but there will be many many fewer of these kind of knotty snafus in a single payer system.

Fraud…great idea in theory, and they should continue. But insufficiently documented rescission of coverage should be given up immediately. Conversely, legitimate fraud should continue to be pursued aggressively.

Duplicate Payment Recovery: Legitimate.  If they’ve paid two times for the *same* exact line item from the same exact provider on the same exact day…(Not just rejecting related services ) that[s overbilling and private and public insurers should get that back.)

Denials of appeals.  Correct documentation of appealed procedures vary by carrier and that nuttiness would again, greatly reduce under a single payor system. Also, I doubt there will be ‘quotas to say no’ under single payer.

Now, multiply the cost to run these departments by five. Salaries and benefits of these employees. Five of each of these, instead of just one…. In addition  The cost to providers of service waiting out delays that are ultimately resolved by a payout would be reduced dramatically

Under a single payer system there would be one set of cost avoidance bureaucracies, not five.

The fraud department *alone* under single payer would probably be large enough to absorb most of the former employees of the private cost avoidance departments, and would save the US more money due to their experience than just increasing single payer’s fraud unit by new  federal employees that may not have experience tracking abuse or fraud down.

Other party liability would lose much of it’s “Other health insurance policy responsible” delays and costs in productivity as would Duplicate payment recovery.

Businesses wouldn’t have to pay for US worker’s healthcare.  (I know the unions are peeved about that….but sorry…that’s a huge cost savings. Can’t the unions offer primo dental and vision still? )

More medical and behavioral health coverage means, ultimately less medical costs and less homelessness.

50 million more insured people.  That would up reimbursments to hospitals and doctors.  They’d actually get paid *more* not less due to the reduction in indigent health care costs, and the fact that *some* of those presently without insurance are healthy and wouldn’t drive costs into the system immediately.  More people insured means more $$$ going to providers under the present system by aggregate, even if individual patient’s bring less $$ in.

The need for medical billers and claims processors would skyrocket, creating jobs that could easily be ‘moved into’ by former employees of private carriers (not to mention help the economy)

Our present system of economic rationing would be drastically reduced.

There it is.  Why it hasn’t been disseminated to the Senate and agreed upon is beyond me.


  1. bridgett said,

    Putting on my historian hat for a minute…unions offered the first collective health care programs for workers (I know somebody real close to me who’s writing the book on that!), but participation varied enormously and tended to terminate when the employee was out of work as a disposable expense. They still do health care programs, often as as supplemental insurance.

    There are a couple of reasons why unions believe that employers should pick up the cost of health care. First, it’s a negotiated part of the contract — employers now want to walk away from an inconvenient deal without any corresponding give-back to the workers they bargained with. If they want to raise wages sufficiently so that younger workers could buy their own care, I don’t think there’d be as much of a squawk; older workers, who may not be able to get new policies, or retirees, who earned their health care much like they earned their pension, are in a different position and need to be considered differently. Anyhow, employers want to cut the cost of care (radically reducing a worker’s package of benefits) and that changes the terms of employment for which a worker agreed to come to work. It’s like taking a 40% pay cut. Who (union or not) wouldn’t be pissed?

    The other big reason that unions want employers to have to pay for health insurance is safety. Employers who do not pay the premiums have zero incentive to keep workplaces safe. It’s been something of a problem, historically. The thinking is that if you know that exposing your workers to carcinogens will cost you long-term, you might not do it. However, if it’s the worker’s problem to solve twenty years from now, party on.

    • imfunny2 said,

      At present, my understanding is that each state has a Bureau of Worker’s Compensation….that pays out money for workplace injury…completely separate stream of money than health benefits….

      But….OSHA wouldn’t/isn’t slated to change the safety requirements for workplaces if they no longer provide health insurance is it? So, whether they were paying for health insurance or not, wouldn’t businesses still be on the hook to follow OSHA’s guidelines?

  2. imfunny2 said,

    Here’s another piece that got lost in the POTUS press conference this am.

    In the “combined” plan if there was a *mandate* for employers to continue to offer private pay insurance, that’s the lifeline for the private co’s to continue. We don’t know whether employer mandates are part of the current plan….

    If Public option is there, and there is no mandate for employers to continue coverage using a private insurer….the “Public Option” would kill those companies that didn’t suck it up and move to vision or dental.

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