In reply to: They’ve also made the peer to peer review process a PITA posted by Wrathofsorin
Eventually a single payer could deny claims to meet budget, and insured patients have no recourse or alternatives. At least now, other companies ostensibly exist to provide an alternative to UHC and Cigna’s denial of claims and therefore a more desirable option.
However right now healthcare is controlled primarily by insurance companies, and to a lesser degree hospitals, and patients/doctors are caught in the middle.
Also, even the majority of government payor contracts are administered by managed care organizations that are paid to administer the Medicare/Medicaid plan. So the private company still benefits from not paying, even when the government is the original payor.
The government is inefficient, but at this point I'll take inefficient over evil.
for most people. Few people get to choose their health insurance company. It is done for them by their company’s HR exec and CFO. Those are Cigna’s true customers.
The cost to the employees is paramount in our decision process. It’s not quite as comfy a relationship as you insinuate.
and the nuances of service will rarely be apparent in that process
By not approving claims. It's all a big vicious circle.
A large portion of most outpatient docs day is fighting these denials. That takes up time that could be used seeing other patients.
Then there's the fact that some percent of patients will switch insurance or die in the window you're denying them. As long as that outweighs the likelihood they end up in the hospital and cost you more than they otherwise would. You win.
Then you get large systems over billing in response because of their incentives, and a lot of money gets tied up in an arms race to fight the claims process better.
Every actor is doing things that are in themselves rational, but it creates a highly irrational system.
I am saying the individual does not have much or any say in choosing the insurer. Or has the ability to switch to another if they find the service provided unacceptable. It is a fundamental problem in our employer based system.
It is good that you strive to get the lowest cost for your employees. I suspect that for most of them that is the prime concern. For me it was secondary. However at no time in my career did I have any choice in insurance companies. That decision was always made for me.
The fact remains that the employer is the primary customer, not the individual insured.
Providers can go out of network. Employers can select a different plan. It’s not happening, but it’s at least possible in a way that isn’t with a single payer employing the same predatory strategy.
We’ve got one plan to choose from, only option is the level of deductible.
When I lived in Cali, we could opt for Kaiser HMO or HDHP, but even the Kaiser option was eventually scrapped by my company.
Do most companies give multiple options?
It is only employers and providers who have any leverage when the insurance companies behave badly. But optionality for those constituents theoretically keeps worse behavior in check. My point was to refute the claim that “single payer is the only answer”. I think the lack of optionality means that is not the case. In fact, one of the cases for single payer is that it will reduce cost specifically from the leverage the singular payer will have over providers.
Germany, France, or Switzerland than the UK. They've shown what happens when the government has the option of slowly gutting the system to balance the budget.
JAMA put out a policy editorial proposing we create a regulated exchange that rationalizes/places rules about how insurance companies and hospitals interact (basically take away the incentive to overbill on one end and blanket deny on the other).
I'm not sure if the public realizes that medical funding is close to 50% government funded. We haven't had a "free market" system in a long time.
I was contrasting the Bismsrk model with that. I think that
A) it's more likely to get to through gradual reform/evolution and
B) Harder to screw up in the long run (more actors to stop you from arbitrarily freezing benefits) and
C) easier to incorporate supplementary insurance/split off things that are able to be priced in a more free market manner.
I think proposing single payer gives insurance companies something to run against (big gov taking your docs away) vs attacking insurance companies for distorting the market and regulating them.
Granted, the new way to attack reform seems to be calling anything that reduces spending cutting Medicare, so this probably won't get resolved until we're staring at the edge of the fiscal cliff.