My wife works from home as a remote coder and auditor in the healthcare world.
Today she was watching c-span and after all the bullshit and lies were spread around (not unlike springtime in the farming world when they spread a years worth of manure on the fields) she felt compelled to write this.
I think this is one of the most concise, clear arguments for single payer that I have seen yet.
Slink and nyceve, feel free to reprint, disseminate and use the following words to their best advantage
This was written by my wife Mrs. Tinfoil Hat, a
Registered Health Information Technician
Certified Coding Specialist
Credentialed by the American Health Information Management Association
She will be watching the diary tonight and replying to comments as well she can while working.
If any of you have questions that are not addressed in the comments, my contact info is in my profile
Join us after the big orange jump
In keeping with Occam's Razor sometimes the simplest answer is the most obvious one – Medicare for All is a workable concept. Ten things you need to consider.
1.Expanding Medicare from a benefit for the elderly and disabled to a plan for all would not put the insurance companies out of business. The current setup for Medicare is that it is funded by the government, the rules of operation are established via Federal Regulation and the plan is administered by, wait for it, insurance companies. The list of insurance companies benefiting from administering the Medicare program is by no means a small list.
2.Medicare, unlike traditional insurance companies which have an overhead ratio of greater than 25%, operates on approximately a 3.5% overhead.
3.The rules of operation are already established. In the healthcare consulting world, operational processes and procedures are based on what is referred to as "The Gold Standard" and more specifically those "standards" are the Medicare regulations.
4.Since healthcare facilities and physician practices already have policies and procedures in place to comply with Medicare regulations, it would simplify the entire operation across the board if one set of regulations would govern the entire operation.
5.Medicare has established a prompt payment routine for providers by guaranteeing an approximate two week turnaround time on submitted claims. While the reimbursement may appear to be lower than other insurers, the amounts are known up front and are in the bank promptly. There is no varying the routine because the rules are established, the processes are in place and working and the reimbursement is guaranteed.
6.Again from the provider perspective, there is no wondering about whether the service will be paid for because of a hidden pre-existing clause. Coverage for preventive services is well documented and reimbursed based on the clearly documented provisions of coverage for Medicare recipients.
7.Medicare is fair and equitable. Ask a Medicare recipient if they are satisfied with their coverage. Ask a provider about how clear the claim submission guidelines are and how smoothly the reimbursement process operates. In the complex world of healthcare billing and reimbursement, Medicare is the one reliable, consistent option out there.
8.Because the rules are already there, because the reimbursement processes are already there and because the guesswork and loopholes have been worked through in the last 40+ years of operation, there is no need for a lengthy transition period. Looking at implementation time frames of 4 years or more is not going to solve the pending immediate potential tragedy of financial and health care devastation for the American people.
9.The Medicare program already has choice built into it. There is no government mandate that you have to go to a specific physician or hospital; you choose where you want to go to receiver your healthcare. There are no pre-existing conditions limitations imposed that restrict your ability to get healthcare when you need it.
10.Setting healthcare provider – physicians, therapists, hospitals – reimbursement rates at the Medicare level would radically change the complexion of the costs associated with healthcare. Hospitals currently contract with major insurance providers to receive a contractually-reduced reimbursement in return for signing the contract and being listed as a preferred vendor. If an individual were to go to a hospital finance office and present themselves as a self-paying customer, they are presently able, in the majority of cases, to negotiate a 40% discount over the usual rate. What they don’t tell you is that this is pretty much the same discount that they give to the major insurance companies in order to attain "preferred vendor" status. The same discount policy also applies in physician practice settings.
If you are worried about the costs involved, you need to know that the present administration is serious about pursuing fraud and abuse and appropriately sanctioning discovered instances in order to return the money to the Federal Government who they have stolen the money from in the first place. In a recent article highlighting the top healthcare fraud recovery cases for the year (2009) so far, if you total up the documented fines and penalties, it already totals over $500 million dollars and the year isn’t over yet and the penalties have not all been assessed.
Another item on the cost list is the operating overhead that healthcare providers deal with due to the inconsistency of requirements in conducting business with third-party payers (aka insurance companies). If there were one set of
regulations and guiding principles, providers could operate more efficiently. There would not be the need for having different financial tables for estimating reimbursement from the wide variety of insurance companies. The reimbursement alone would be consistent and abiding by one set of documentation requirements would improve operations by simplifying the entire bill creation process and minimize the complexity of operating issues.
Medicare has promoted quality and innovation in healthcare and has already implemented processes that encourage the streamlining of the operations of healthcare providers. Medicare takes a yearly look at healthcare innovation and researches carefully the benefit and makes well thought decisions as to the merits of making a reimbursement decision for new technology. It is consistent and not subject to arbitrary interpretation.
Lastly, Medicare coverage is transportable in keeping with the initial principles of the Health Insurance Portability Act from 1996. Who can say that about the private insurance world?