I'll take a shot at explaining why a single-payor system might not be all that great for us. As background, my entire career has been spent working with the Medicare and Medicaid programs. (http://srgllc.org/ leaders.html) I started in 1976 as a Medicare auditor, working for Blue Cross Blue Shield of South Carolina under their federal contract as a fiscal intermediary to administer the Medicare Program in the state of South Carolina. After 3 years working for the Program, I spent 11 years working for a non-profit 5 hospital system, and a for- profit proprietary chain of 110 hospitals located across the country. For the last 20 years I've worked as a consultant, advising hospitals, skilled nursing facilities and home health agencies with regard to being accurately paid by the Program and staying out of trouble in trying to maneuver their way through a hopelessly complicated series of regulations that govern the payments they receive from the government.
The Medicare and Medicaid Programs were initiated in 1965, with Medicare intended to provide health insurance benefits for people over the age of 65 and Medicaid intended to provide benefits for the poor. While Medicare is 100% funded by the federal government, the Medicaid Program is partially funded by the feds and partially funded by the individual states. While each Program was initially a relatively small part of the federal budget, each has ballooned into an unmanagable behemoth, teetering on the verge of bankruptcy and threatening to break further an already broken federal budget. The Medicare conditions of participation have become so intrusive that many hospitals find it virtually impossible to meet the federal requirements and still remain viable operating entities. Nationally, approximately 50% of total hospital admissions are paid for by either Medicare or Medicaid. While roughly half of hospital admissions are accounted for by the Programs, nowhere near half of hospital revenues are paid for by the Programs. The simple explanation for this is that the government has consistently expanded benefits while being completely unable to pay for the benefits it has promised to its beneficiaries. Hospitals and other healthcare providers have been forced to engage in a practice called "cost shifting" - in essence seeking to make up the government payment shortfalls by seeking additional reimbursement from private insurance companies and uninsured patients with financial assets. There are many major insurance companies offering health insurance coverage in the U.S., but the largest has traditionally been the Blue Cross Blue Shield Plans that operate in most states. Some Blue Cross plans are for profit and some are not-for-profit. A few are publicly traded companies. In administering the Medicare Program, the federal government contracts with many of the Blue Cross plans as fiscal intermediaries to conduct the day to day claims and audit activities of the Program. The myriad of laws, regulations and Program instructions that healthcare providers are required to be familiar with and follow are unbelievably complex and voluminous. No single person could possibly be familiar with all the Medicare rules and most hospitals have multiple departments (reimbursement, claims, compliance, legal, etc.) simply to deal with its complexities. The government has done an absolutely miserable job with Medicare and Medicaid. While you will never hear this from a government official, it is only the private insurance industry that has allowed our healthcare system to flourish as it has. I say this as someone who has made his living from the Programs. If the government were to expand its involvement in the healthcare industry from 50% to 100%, there is no question that my company would flourish. As a business owner I am quite excited by the possibilities. As a taxpayer I am absolutely appalled that it is even being considered. The government is engaged in the most aggressive campaign of disseminating misinformation that we have ever witnessed in the United States. The Obama Administration is deliberately attempting to demonize the private insurance industry in an effort to turn the public against private insurance and in favor of government insurance. They have set up a website for private citizens to rat out their neighbors who are opposed to the government plan ([email protected]) They are now claiming the insurance industry realizes profits of over $80 billion annually from providing health insurance, and are representing hospitals as being wildly profitable entities. Nothing could be further from the truth. While there are some hospitals still operating at a profit, most hospitals struggle to survive and many have gone out of business in recent years - largely because of the overbearing demands and underpaying funding mechanisms of government programs. The Obama Administration is also actively engaged in disseminating misinformation regarding people being able to keep their current insurance coverage. In point of fact, most people would have no option but the government option in a relatively short period of time. The private insurance industry will simply go away. Very few people in this country anymore understand that companies earning profits is actually a good thing. It was from their profits that companies in the medical industry funded things like research and development and medical education from which new technology such as cat scan and MRI machines were produced. The government is using the public's ignorance to incite them into believing they are being raped by Blue Cross Blue Shield. Baloney! The government also throws around the wildly inflated number of 47 million people as being uninsured, without ever mentioning that half of that number are here illegally and are not citizens or this country, or that millions more are college students whose healthcare needs are largely met my their schools and included as part of their tuition and fees. The Obama Administration outrageously claims that the government single payor system will have no additional costs. Even the Congressional Budget Office, which always underestimates the cost of proposed government programs, estimates that the additional annual expense to the taxpayer from a single payor system will be somewhere between $250 billion and $1 trillion. Compare those figures to the government's wildly inflated estimate of $80 billion in profits for the insurance companies, and ask yourself which makes the most financial sense from a consumer standpoint. Are the citizens better off with insurance companies earning $80 billion through their premiums, or paying up to an extra trillion dollars in taxes to fund the government program? Also consider the fact that the federal government has NEVER administered a single program - healthcare related or otherwise - that it hasn't made a complete mess of. Don't believe me? Name one. Social Security is a mess and on the verge of bankruptcy. Ditto for Medicare and Medicaid and CHAMPUS/Tricare. The federal and military retirement systems are completely unfunded and the unfunded liabilities are not reflected in the already huge national debt numbers. Can you imagine a private company being allowed to issue a balance sheet showing no liability for a completely unfunded pension program for its employees? The Post Office can't compete with UPS or Fedex and is now in a position of having to close hundreds of branch offices. Why in the world would anyone want to put our healthcare delivery system in the hands of these same incompetent idiots? Obama claims that no rationing of care will occur under a federally run system. Bullshit. You say you want a system like Canada or the U.K. How many people from the U.S. travel to either of those countries when they need a complicated operation? How many people from those countries travel here to receive treatment from our fine, private institutions? Do yourself a favor and educate yourself on some of these things before you join the Obama crowd calling for a national healthcare system. It is not just a bad idea, my friend, it is the worst idea that any American politician has come up with in over 100 years. It is far more about gaining additional control over the citizenry than it is about providing healthcare. Are you aware, for example, that the government would not only have access to all your medical records under this plan, but also all of your financial records? That they would have the ability to draft your bank accounts in order to collect your co-pay? It is destined to badly hurt the healthcare delivery system in the country. If you really want to help the industry and the people it serves, do the opposite of what is being proposed. Join a movement to get the government out of our healthcare system, not more involved in it. It would put companies like mine out of the government reimbursement consulting business, but we can adapt to a changing market. Support immigration reform and get the 20 million illegal immigrants who are choking our emergency rooms the hell out of the country. Support tort reform and get the thousands of lawyers who are constantly harrassing our doctors and hospital with frivolous lawsuits to line their own pockets with. There are many things that we can do to help our healthcare delivery system without destroying it or turning it over the goverment bureaucrats with a long established history of fucking up everything they touch - and absolutely no success stories to tell. Use your head. Miami Dan On Aug 10, 9:51 am, ascrodin <[email protected]> wrote: > Why our lawmakers don't try to enact a single-payer insurance system > like Canada or a government-run program like Britain's NHS is beyond > me. Why this "public option" nonsense that keeps the private insurance > companies in business? Seems like a lot of my Senators and > Congresspeople are getting their pockets lined by the insurance > industry...par for the course in America!! :( > > On Aug 8, 10:46 am, Eidem <[email protected]> wrote: > > > > > As far as I can tell, they want to re-vamp our health care system so > > everyone (despite your socio-economic situation) can have the same > > care. The crazy thing is, no one knows what the hell is going on, and > > everyone has a better idea than the next guy. It's ridiculous. I > > don't think anything's going to happen because nobody can agree on > > anything. Kinda like the Beach Boys.- Hide quoted text - > > - Show quoted text - --~--~---------~--~----~------------~-------~--~----~ You received this message because you are subscribed to the Google Groups "Diamond Headz" group. 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