I came across a brilliant article that takes on the insurance industries scare tactics regarding insurance companies. The article titled “The only thing health insurance companies are good at is scaring us about socialized medicine” takes on the industry and shows how they are using scare tactics to sway public opinion away from a more social system of coverage.
If you ask most Europeans, they may complain about their system, but when asked if they want an American system of healthcare, they will say no. The truth is, we pay more for healthcare than in any other country and get less for what we pay here in the USA. Hospital systems, drug companies and insurers are making a fortune, at the expense of patients and their healthcare providers. This needs to change.
Medicare is a social system and so is Medicaid as well as the V.A. in the USA. Many Americans rely on these systems for their healthcare, but Medicare is the one most of us will eventually have when we are 65 years of age.
As a healthcare provider, I am envious of seniors who have Medicare. They have one thing in common; they all are happy with it. If they want better coverage, there is a plethora of Medigap plans people can purchase from private insurers that will give them additional coverage for items not covered by Medicare.
This is very different from Medicare replacement plans that are run by private insurers. Medicare replacement plans offer a choice of private insurance that follows Medicare rules, but offer smaller networks, pay your doctor less in most cases than Medicare would and can have other unexpected costs when going out of your home state.
Medicaid is sold through healthcare exchanges, and is also a social system. Unfortunately, most providers are unwilling to take these plans due to sub par reimbursement levels.
A tactic now being employed by insurers is to use third party processing companies such as NIA or ASHN. These companies will contract with an insurer and then limit coverage using “medical necessity guidelines” . These plans act as middlemen making it difficult for both providers they and patients to get the services they need, by placing limits based on precertification protocols. Simply explained, they make money by limiting care using the term medical necessity. This often results in people having fewer visits or services available to them that their doctor deems medically necessary. Some, such as ASHN will offer a lower fee schedule than the plan actually used to offer, while they limit care. This frustrates doctors and the patients that need them. Some patients become scared to use their insurance, while others end up paying for the services themselves if those services are valuable to them. It is scary that in NJ, the Department of banking and insurance has allowed this to go on.
Some healthcare companies have tiers such as Horizon Omnia. In this scheme, what it did was make less expensive providers and hospitals more expensive while larger system were rewarded with more business. Incidentally, 95% of the chiropractors in NJ who can help solve the opioid crisis are tier 2 and have been made more expensive to visit due to the tier system. Worse, the second year of Omnia, they raised premiums 25%. Now, that is scary.
Medicare is not scary at all, since they do not use middlemen to do their dirty work to make a buck. Yes, this is a social system and if we expanded it to everyone over a period of time by allowing Americans to buy in like a public option, it is likely that most Americans would be thrilled by a plan that costs them less while having a low deductible.
Sure, insurance the insurance lobby can offer a long list of scary socialist healthcare talking points such as long waits for procedures and tests, but the fact is that seeing certain specialists in the USA can take a few months many of the tests doctors order are often negative, and unnecessary. If you have tried to visit certain specialists, I am sure you would agree that we wait too.
Truthfully, there is nothing scarier than having evidence based medically necessary care wrongly denied, and then having to pay a huge deductible before your insurer actually pays anything. There is also nothing more irritating for your doctors office than to have to jump through hoops to get you approved for what you need and to then jump through more hoops to actually get paid for approved care. Healthcare administration needs to be much simpler, and seeing a doctor must become more holistic in its approach for it to be more affordable and safer in the USA.
Medicare is in the best position to negotiate hospital prices since many hospital systems have gotten bigger due to the activities of the large insurance companies. Medicare in most cases will pay your bill reliably. Having one insurer who does not use third parties to make doctors and patients frustrated will make everyone’s life earier. So what is so wrong with a less complicated social healthcare system that eliminates profit motives?
If you are scared to a social health system, perhaps, you may remember years ago when you visited your doctor you had a relationship with, paid him a reasonable fee and got the care you needed. Most doctors would love to have those relationships again. It is impossible to have in our current system that has administrative tasks running amuck, while insurers are making a fortune. Perhaps, a social system that is about people rather than profits would allow citizens in the USA to sleep better at night knowing that if they ever get ill, they are going to be taken care of. Currently, Medicare is the best system available and yes, it is socialist.
The only thing health insurance companies are good at is scaring us about socialized medicine
In a new column in the LA Times, business columnist Michael Hiltzik makes the argument that the only thing health insurers have done with any effectiveness is scare us into thinking that the socialized medicine services that every other advanced country has will not work in America.
Insurers are not even good at being profitable: the waves of mergers and acquisitions that has resulted in mass-scale concentration in the health insurance sector resulted in billions in losses, the bill for which was passed on in the form of higher premiums.
Hiltzik cites the work of Wendell Potter (previously), the Cigna exec who defected to the public’s side of the health-care debate and is an excellent source of inside dirt on how dysfunctional and profit-driven the health-care industry is.
It’s Potter who identifies the industry’s most valuable, reliable product as scare stories about socialized medicine, with actual health-care provision lagging far behind.