Mindy Oberne: For-profit health care system is insane
May 15, 2017
"Insanity: doing the same thing over and over again and expecting different results." — Albert Einstein
Putting politics, ideology and fear aside, as long as we continue to have corporate insurance companies as the "payers" of our health care system, then wasteful administrative and complex billing costs will result in less money for actual health care; profits will outweigh patient needs resulting in poorer outcomes; and the present rate of rising costs will ultimately break our economy.
Insurance companies use 20 to 30 percent of health care premiums to run their business. This includes lobbying in Washington for more favorable regulations for their industry and influencing elections. In addition, a whole department (with no clinical training) reviews claims and decides which ones to accept or deny. Other expenses include huge CEO salaries, advertising, and, most importantly, profits for their investors (required by law). If these expenses were eliminated, there would be enough money to cover everyone with better coverage. Comparatively, our current Medicare system (covering the most expensive of our population) runs on 3 percent administrative overhead.
A typical doctor's office has at least one full time staff for handling billing, more likely two or three. That means on average at least 30 percent of office activity is dedicated to billing. This is because we use many health insurance companies that each have their own policies and billing codes, requiring a lot more time for the doctors' office staff to process paperwork and argue with the insurance companies about coverage. With a Medicare system where there's only one payer with one set of billing codes, the billing is simplified and streamlined, resulting in the savings of billions of dollars.
Let’s go back to the original concept of insurance where everyone, healthy and sick, pool their money together so that those who need it will have it.
Health insurance companies' fiduciary responsibility to their investors puts profits before patients. Profits are increased by raising premiums and denying service whenever possible. The outcome results in the U.S. ranking 50th out of 55 countries, making it one of the least efficient health care systems (Bloomberg 2016). We spend twice what other countries do, while they cover everyone and we still have millions of people with no access to health care.
Many opponents of a single payer system say it's too expensive and don't want more taxes or to pay for others who aren't paying for themselves. Fact is, according to a UCLA study done this year, California taxpayers are already footing 70 percent of our state's healthcare costs, 20 to 30 percent of which goes to the health insurance industry. True conservatives should balk at such figures and demand a better bang for their buck. Pharmaceutical and medical equipment costs would be greatly reduced with one cohesive risk pool that allows for much better bargaining power, therefore saving billions of dollars. It's not that we can't afford to have single payer; we can't afford not to have single payer.
If we want true health care reform that will cover everyone with care determined by need, not by greed, and that's fiscally conservative so we don't go broke, then we need to rethink the "payer" part of our system. Common sense dictates that the present corporate multiple payer system is not working. Medicare is working pretty well for most, but the problem is it pays for only the most expensive part of our population, the elderly and disabled.
Let's go back to the original concept of insurance where everyone, healthy and sick, pool their money together so that those who need it will have it. If all of us could pay premiums into Medicare instead of insurance companies, there would be enough money to cover everyone with no deductibles, and include dental and vision care.
With the absence of a profit motive, patient care decisions would return to the doctor and the patient.
With a more efficient, streamlined system, the future of our economy would no longer be threatened by the burdensome rising costs of health care.
Doesn't that sound like the health care system we want?
Mindy Oberne lives in Grass Valley.
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