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.

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When Insurance Holds People Hostage…

May 10, 2009 at 11:40 AM (Uncategorized) (, , , , , )

What if dating people aren’t ready for marriage, one has good insurance and the other gets gravely ill…they have to consider marrying for that spouse to get help (eventually after the preexisting condition waiting period is over…)

How many people can’t do what they’re good at, but stay at a job that isn’t a good fit because that’s where the benefits come through?

What would happen if we had our own insurance and could work at something we were good at?

And single payor isn’t exempt from ‘hostage taking’ much as I support it.

Couples have had to divorce, so that one spouse’s income didn’t prevent the other from getting life saving hospital care under Medicaid.

(A close family member had to go through this, and chose not to divorce, thus leaving a huge debt behind…)

Potential or present illness should not hold people hostage…

But it does

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