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When I went on sabbatical, I said I would still have something
to say if something really important or really stupid came about.
How was I to know that the government would call in my promise
so quickly.
Something really stupid is going on in Washington. The idiots
are at it again. This time about the health care industry. Of
course, they are polarized. Some of these idiots want the government
to take over the health care industry and make it all like medicaid.
(Puke, puke, puke.) They know they can't get that through so
they offer another plan. They would pour billions of tax moneys
into medicare for a drug program. Then they are offering something
called a patient's bill of rights. They are countered by others
who want to give carte blanche to the HMO people who would rather
murder their victims than pay the legitimate cost of their medical
care.
On the one hand, we have a President with the moral fiber
of a harlot pretending to the throne of moral leader of the free
world. He is flanked by some unlikely heros. A fat, waddling,
over indulged, end of a dynasty, political hack, pretending to
the throne of America's political patriarch. Everett McKinley
Dirksen, he is not. A diddly old man from Michigan, pandering
to the union brass, with nothing more important to do than compete
in the Ben Franklin look alike contest. (Tell me it's not conscious.)
A New York pseudo intellect, pandering to an Arkansas carpetbagger.
Why would she want to join that fraternity. Until that happened,
I thought she had some class. Of course, there are others, not
noteworthy enough to disgust.
On the other hand we have a wolf pack of bible thumping, fascist
thugs who have recently distinguished themselves through their
blood lust. They have, with malice aforethought, supported a
witch hunt which did irreparable damage to the office of the
presidency itself. They have put themselves into the pocket of
the NRA, and the religious fanatics. Now, they are climbing into
the pockets of the Health Menacing Organizations. They would
like to "give" away moneys in a huge tax cut and let
the HMO assassin have their way with us.
It's all political evil doing, on both sides. It has nothing
to do with rational thought or behavior. It has to do with the
purchase of votes. Your votes! I will discuss the tax cut proposal
at some other time. For now, I will simply say, a tax cut for
a people who are, in fact, prospering is totally irrational.
It is what we have come to expect from those idiots in Washington.
About a patient's bill of rights I will say, what good would
it do if you leave the current structure in place. To make it
stick, the cost of legal procedures alone would bankrupt the
system. Nothing that they have proposed is rational. Nothing
that they have proposed is needed.
Two years ago, I laid out the solution to the HMO menace in
a book named The Gaffer's Shorts in an essay I called Whipsaw.
Wesoomi Publishing sent copies of that book to most of those
idiots in Washington. Why, I don't know. They have proven time
and again that they don't want input from the people. When they
pretend to go home for input, they go to their political cronies.
Not to us.
My essay did make these points. We do not need the government
to take over the health care industry. We do not even need to
put more money into the health care industry. There is already
enough money there, in spades. There are gross amounts of moneys
being stolen and pissed away. From Medicaid, from Medicare, and
from the American corporations which are bearing the brunt of
the HMO dishonesty. I have touched up the essay to bring it up
to date. Here it is.
When a person writes a check and gives it to a merchant, the
merchant deposits it to his bank. The check is cleared and accounts
balance in a matter of hours, sometimes seconds. All of this
is done through a clearing house system established by the banks
to make banking possible and to make commerce flow well. The
cost of this entire transaction is measured in mills rather than
cents.
It would seem crazy for a person to write a check and then
have it rejected at every turn in the system causing him to have
to follow it up with letters, phone calls and harassment from
various banking institutions until finally getting the check
cleared weeks, months, or even years after it was first written.
No one in our culture would think that was rational. The cost
would be enormous and commerce would stagnate.
Given that, why do we believe it is rational for the medical
insurance claims system to dysfunction the way it does? For any
family which has medical insurance, and especially families that
are covered by more than one insurer, there is an ongoing whipsaw
effort by the insurance companies. This requires the insured
people and the providers to follow up almost every claim with
letters and phone calls. They must actively fight evasion and
harassment from the insurance institutions, before they finally
get the claim settled. The cost is enormous and the system is
stagnant. It smells stagnant.
This whipsaw creates a bloated bureaucracy of claims adjusters
and clerks ad infinitum. Just the cost of wasted paper forms
is beyond measure. The cost to our forests is sickening. The
waste of human energy is staggering. The hope of the institutions,
of course, is that the insured will give up and pay the bill
just to end the struggle. The stupidity is, the institutions
spend enormously more than the value of the claim in their whipsaw
effort. I believe the whipsaw effort is deliberate and systematic.
There is no way a health insurance company should be allowed
to handle claims against the company without any audit. In fact,
they should not be allowed to handle claims at all. There is
no reason whatsoever why the medical insurance industry cannot
work the same way the banking industry works; smoothly, quietly,
and quickly, behind the scenes.
What's needed is a medical insurance clearing house, using
the very efficient, bank clearing house, model. This clearing
house would act as the processing center for all claims. It would
be a federally regulated, not for profit service set up by federal
law and supported by the insurance companies. A company's contribution
would be based on the value of the insurance they had underwritten.
As sources of some of the most blatant abuses, Medicare and Medicaid
would be required to participate. Regular audits by independent
companies would assure that the government regulators were doing
their job. Just like in banking.
Being the processing center for all medical insurance claims,
this facility would have all the information of all the insurance
companies and a set of rules to decide which company would pay
how much of what claim. These rules would be constant for all
claims. The decisions would be final. The companies would pay.
Any noise about privacy concerns is a smoke screen. The argument
is no more relevant than one about privacy concerns in the banking
industry. If we hear this argument, we can check the people making
it. They are probably double dipping, a practice almost impossible
to track in the current system. This center would surely put
a stop to that.
All claims would be submitted to this clearing house by the
providers. No claims could ever be submitted anywhere else or
by anyone else. The clearing house would have information on
all providers. Each one would have to be listed to be legitimate.
For each claim a single, one page, itemized statement would be
sent to the patient showing in plain English what service was
provided, how much it cost and who paid for it.
The statement would have a boldly listed hot line number to
call if a person thought the claim was fraudulent. Who do they
call now? In many cases, the alleged patient does not get a statement
at all. Health Alliance Plan never sends statements if they happen
to pay, only rejections when they don't, which is much too often.
How does a patient know if a fraudulent claim has been made with
our current system? Even when a statement is issued, such as
is done by Medicare, it's written in unintelligible gobbledegook.
Along with this hot line, we need a new law to protect these
whistle blowers against unreasonable persecution, prosecution,
and retaliation for pointing out what they might reasonably suspect
is fraud. This allows the patient to become the policeman, filling
a void in the system. The patients, I suspect, would much prefer
to do the harassing rather than be the victims of it.
The providers would get a single online monthly summary as
would the insurance companies. Accounts would be balanced daily
by electronic transfer. No checks would be written. The providers
would start to get paid on time instead of waiting months or
years for a check, but they would get only one payment for each
service provided. Excesses and fraud would show up very quickly
in routine analyses of pay outs. The penalties for stealing from
the health care system should be very long, hard time. It's unconscionable.
The claims centers of the individual companies would be eliminated
with a considerable cost savings. The patient would never get
whipsawed by the companies with that old, "Someone else
is your primary provider" game. "It's them, not us."
The blizzard of paper which flies around the country because
of that whipsaw would be eliminated at a considerable savings.
An enormous burden would be lifted from the post office. There
would be a single online computer form for submitting claims
and a single printed patient's statement for the results.
There would be an easily understood, regulated appeals procedure
for people whose claims were denied. This procedure would be
simple enough to not require attorneys until it reached the legal
process. There should be at least two levels before court; a
state level and a federal level. There could also be a binding
arbitration level for those who desired it.
If there is a co-pay, the patient will get that information
as part of his statement after, and only after, the claim has
been processed. The patient would not be required to pay anything
until that time. This would make it very difficult for providers
to charge both the patient and the insurance company. It would
eliminate that particular double dip.
Most insurance companies whipsaw the patients. They do it
because they know if they force the patients, who, by the way,
are ill and already under enormous stress, to deal with it long
enough, a large number of them will give up and pay the bill.
The insurance companies know the providers are also harassing
the patients for their money because they do not have the courage,
the resources, or the knowledge to go after the insurance companies.
While banks have bankers, many of whom are inherently dishonest,
the banks themselves, as institutions, are usually not dishonest
and banking, as an institution, is generally honest. The bankers
do not control the system. Medical insurance companies also have
large numbers of dishonest people within their ranks. The difference
is, in insurance the managers do control the system to the extent
that the institutions themselves and the institution of medical
insurance becomes inherently dishonest.
This whipsawing and evasion results in an enormous increase
in the cost of insurance as the individual companies, including
Medicare and Medicaid, struggle to shift the burden of payment
to other companies. A central claims clearing house would resolve
this problem. Therefore, we can be sure, the companies would
oppose it.
I believe an insurance claims clearing house would save more
than enough money to provide an adequate level of medical coverage
to all the people the congressional and administration hand wringers
would like us to fret about. That is its strength. Its weakness
is, it would be almost impossible to implement because it would
take power away from the insurance companies and all their petty
clerks. It would put a number of bureaucratic free loaders out
of work. The insurance lobby would fight it vigorously, with
the support of the right wing fascists. |