1. Insurance companies do NOT provide healthcare. Insurance companies are in business to make money. How do they do this? They take from consumers (policy purchasers) and they take from providers. The insurance companies couldn’t care less about the health of the policy holder or the plight of the provider (examples: Blue Cross of California’s refusal to carve out implants for surgery reimbursement in developing contracted rates, and insurance companies delaying or denying medically necessary treatment). Eliminate the multiple-payor (health insurance) system, and watch health care costs plummet. Providers and hospitals would not be forced to charge extraordinary prices if they knew in advance they would be compensated fairly and that balances could be negotiated with patients.
2. We all ready have Medicare, which is funded by all workers receiving paychecks, in place. Medicare should be used as a base for reimbursement, not total reimbursement. We all pay into this system and we should all have the system available to us. Instead of paying insurance premiums, increase the Medicare contribution 20 percent, since all deductibles and co-pays would no longer be an issue by eliminating the “middle man.”
3. There is tremendous waste and incompetence in government-funded healthcare. The amount of money that could be saved by developing IT for government healthcare and eliminating waste and incompetence would result in savings of millions (perhaps billions) that could go to provide healthcare to people who need it.
4. A provider must accept Medicare-allowable reimbursement as the total fee. Changing this rule to let providers and patients negotiate balances would result in a reversion to free enterprise in medicine. If the CMS-allowable rates for healthcare goods and services were increased 10 percent and used as a BASE for reimbursement (as opposed to total reimbursement), and if the healthcare decision-making was put back where it belongs between provider and patient, and if providers and patients were allowed to negotiate the balance of what CMS allows and the actual provider’s fee, patients would be taken care of and providers would be paid fairly.
5. The above methodology could be put in place using a modified version of existing systems. This would create a one-payor system with oversight from the Department of Health and Human Services, with strong input from the Commerce and Treasury departments.
6. There is variation amongst providers in quality of care, experience, and practice philosophy. Patients have the capability and RIGHT to choose their providers. We don’t need government or insurance companies telling us who our providers should or could be as long as the provider is state licensed and is functioning within their scope of practice.
7. There is no rational purpose for the establishment of provider networks or HMOs. Eliminate the insurance companies, and PPOs, IPAs, HMOs become non-existent. No more extortion by insurance companies perpetrated on providers to allow participation in provider networks. Provider networks are a scam perpetrated by the insurance companies to extort discounts from providers. They promote the provider networks to the public as quality healthcare, but the fact is, these providers agreed to discounts so they could be promoted by the insurance company as part of the “network.”
Pandering to insurance and pharmaceutical industry special interests by federal and state legislators and policymakers has created an environment that is counter-productive to quality healthcare and coverage for all those in need. The recent election of Barack Obama as President of the United States created the “new politics” of refusing major campaign contributions from special interests. Obama raised hundreds of millions to run for president from millions of supportive individuals looking to take back government from corporate America. From what I understand, Obama has established rules for his staff regarding relationships with special interest to guard against undue influence.
If the middle man/insurance company were removed from the equation, the amount saved in profits and waste (including, but not limited to, unnecessary fighting over reimbursement and stupid, unnecessary insurance company policy), could provide healthcare to all residents of the United States at very little if any additional costs. If patients and providers were allowed to negotiate balances, people would get healthcare, healthcare costs would be reduced significantly, providers would be paid fairly, and the healthcare crisis in this country would be on the way to resolution. This methodology could be and should be administered by a single-payor system.
Contact Dr. Rubin at hsrubin@aol.com.
