Open thread Nov. 18, 2017 Dan Crawford | November 18, 2017 3:39 am Tags: open thread Comments (7) | Digg Facebook Twitter |
This is the one thing will make Medicare for all possible
Thalia K. Robakis, MD, PhD November 15, 2017
“Hence the central conflict of interest inherent in for-profit health insurance: Insurance companies make more money by refusing the service they ostensibly provide — payment for health care. The more claims they deny, the bigger their profit margin. This is why insurance companies spend so much money paying people who figure out how to deny claims. In fact, private insurers have up to five times the overhead of Medicare, which doesn’t plow money and effort into figuring out how not to pay claims.
“To add insult to injury, this army of foot soldiers dedicated to not paying claims has spawned an equally expensive counter-army of personnel on the doctor side of the equation, with endless finance administrators, insurance specialists and medical billing coders dedicated to combating the efforts of insurance companies not to provide payouts. That’s an enormous amount of money currently being wasted on the arms race overpayment.”
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“A better approach is to mandate that health insurance companies operate as nonprofits. That means all surplus money must be put back into company improvements — not distributed to shareholders. In one fell swoop, this would disable the entire apparatus of actuaries, claims reviewers, claims adjusters and administrators who are dedicated to figuring out how not to pay claims. If all of the company’s profits are going to be put back into improving the quality of service, there is no incentive to try to avoid providing that service to improve the bottom line.
“Transitioning from a for-profit to a nonprofit insurance model would be much smoother than transitioning hundreds of millions of people off of their existing employer-based plans and onto Medicare.”
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“Medicare for all!” sounds great, and it might be great. But simply moving to nonprofit health insurance would be cheap, straightforward and an important step in the right direction.”
There is an ACA Appeals board to contest denials of treatment.
“The more claims they deny, the bigger their profit margin.”
Sounds logical, but it is wrong. Medical loss ratios come into play. If insurance companies do not pay out the required % of premiums on claims they have to refund the money to their policyholders.
BTW, this is not a defense of insurance companies.
“board to contest denials of treatment”
That’s now how the doctors see it. On KevinMD I’ve seen assertions that doctors now spend two hours on paperwork (computers) for every hour with a patient. My doctor says one hour. You should take up reading something on KevinMD everyday.
Kevinmd.com is not a source of information that should be used.
Most of his stuff is wildly incorrect, ideologically based trash.
Has been for years.
Where’d you ever get (pardon me) a crazy idea like that. It’s just medical doctors reporting on their personal experiences — mostly medical, not mostly political (you’d have to count protest endlessly multiplying bureaucracy and paperwork as political to even come up any amount of that). It’s a view of medicine from the bottom up instead of top down.
No, it is not. It is the ravings of one person.
To believe him, you have to think that the medical profession is the only profession in the entire world that has not profited by computers. You have to believe that doctors were able to transcribe medical records with paper and pencil better than digitizing them. You have to believe that doctors could do billing better with paper and pencil than electronically.
I will ask you, and this cretin, how many insurance companies accept invoices by mail?
I know the answer, it is zero.
Do the math.