Wednesday, January 11, 2012
Back in the glory days of employer-paid for health insurance, the secretary of a dentist fixing my teeth tried to comfort me when I saw how much he was charging me for tooth repair.
“Don’t worry about how much it costs, you have dental insurance,” she said.
Indeed, back then I did, until employers got wise to the rising premiums insurance companies were charging because dentists and doctors everywhere decided they could charge more without an immediate impact from their patients.
Things got even more hairy when insurance carriers leaned that doctors were bilking even more big bucks from insurance companies by referring patients to clinics in which the doctors had an interest, and set fees that allowed them to own Mercedes, mini-
mansions and still manage to pay off medical school.
Insurance companies responded in several ways, by setting up HMOs and other contractual agreements that set prices for various procedures.
This was not a government imposed restriction, which would have been a kind of socialized medicine, but an agreement that had hospitals, clinics and some doctors agreeing to set limits for various procedures in exchange for insurance companies agreeing to steer patients to those hospitals, clinics and doctors.
All well in good except that nobody really lived up to the bargain.
Doctors, hospitals, insurance companies all found loop holes.
Doctors set up their own clinics like they did in the 1970s, and began to siphon off business that formerly went to hospitals.
Insurance companies began not honoring legitimate claims forcing hospitals to hire legal teams to get back the money, and then to settle these suits, insurance companies offered to pay a percentage of the original claims. Hospitals desperate for cash agree, slowly going broke, because even at the agreed on discounted price, hospitals did not make up for the cost of providing services.
Part of the problem was that even though the procedure was discounted, doctors still demanded and received full price, often inflating these costs by two-minute or less consultations that allowed them to bill a patient, hospital and ultimately the insurance company, increasing the number of claims insurance companies refused to honor.
Other fixed costs such as supplies and salaries of other staff did not go down just because a procedure was discounted. So gradually, patient by patient, claim by claim, hospitals went broke.
On top of this, even state and federal governments got involved.
Medicaid and Medicare payments for specific services wound up to be among the lowest of any insurance provider.
Some states even required hospitals to provide charity care, offering to pay for it – only to cut back on these payments year by year as legislators cut budgets to lower taxes.
Ultimately, the doctors made out best. It is difficult to learn if insurance companies are making money because they won’t open their books to public scrutiny. But hospitals suffer the most if they continue to provide services for which they are underpaid, and patients suffer, forced to pay high premiums for insurance and bigger deductibles and co-payments.
Obama came into office determined to fix some of this, and eventually pushed through a bad medical system commonly called Obama Care, which forced companies to get insurance and uninsured workers to buy insurance, without ever dealing with the fundamental problems of the system. So insurance companies collected more from more people, and skipped merrily to the bank to deposit what they did not have to pay out to doctors, who also skipped merrily to the bank to deposit their share all the time saying, “Don’t worry about how much we charge, you have insurance.”
All this hit home this week when I finally started getting the bills for my eye surgery and realized that I could have bought a new car for what my insurance would not pay for, and though I think my doctors did a great job, I certainly wish if they would share in my economic pain. These days, you have to worry if you have insurance – worry that the federal government won’t be breathing down your neck, worry that the doctors won’t charge an arm and a leg, worry that the insurance company won’t screw you and make you pay more, worry that hospitals will even exist after all is said and done.
Back in the glory days of employer-paid for health insurance, the secretary of a dentist fixing my teeth tried to comfort me when I saw how much he was charging me for tooth repair.
“Don’t worry about how much it costs, you have dental insurance,” she said.
Indeed, back then I did, until employers got wise to the rising premiums insurance companies were charging because dentists and doctors everywhere decided they could charge more without an immediate impact from their patients.
Things got even more hairy when insurance carriers leaned that doctors were bilking even more big bucks from insurance companies by referring patients to clinics in which the doctors had an interest, and set fees that allowed them to own Mercedes, mini-
mansions and still manage to pay off medical school.Insurance companies responded in several ways, by setting up HMOs and other contractual agreements that set prices for various procedures.
This was not a government imposed restriction, which would have been a kind of socialized medicine, but an agreement that had hospitals, clinics and some doctors agreeing to set limits for various procedures in exchange for insurance companies agreeing to steer patients to those hospitals, clinics and doctors.
All well in good except that nobody really lived up to the bargain.
Doctors, hospitals, insurance companies all found loop holes.
Doctors set up their own clinics like they did in the 1970s, and began to siphon off business that formerly went to hospitals.
Insurance companies began not honoring legitimate claims forcing hospitals to hire legal teams to get back the money, and then to settle these suits, insurance companies offered to pay a percentage of the original claims. Hospitals desperate for cash agree, slowly going broke, because even at the agreed on discounted price, hospitals did not make up for the cost of providing services.
Part of the problem was that even though the procedure was discounted, doctors still demanded and received full price, often inflating these costs by two-minute or less consultations that allowed them to bill a patient, hospital and ultimately the insurance company, increasing the number of claims insurance companies refused to honor.
Other fixed costs such as supplies and salaries of other staff did not go down just because a procedure was discounted. So gradually, patient by patient, claim by claim, hospitals went broke.
On top of this, even state and federal governments got involved.
Medicaid and Medicare payments for specific services wound up to be among the lowest of any insurance provider.
Some states even required hospitals to provide charity care, offering to pay for it – only to cut back on these payments year by year as legislators cut budgets to lower taxes.
Ultimately, the doctors made out best. It is difficult to learn if insurance companies are making money because they won’t open their books to public scrutiny. But hospitals suffer the most if they continue to provide services for which they are underpaid, and patients suffer, forced to pay high premiums for insurance and bigger deductibles and co-payments.
Obama came into office determined to fix some of this, and eventually pushed through a bad medical system commonly called Obama Care, which forced companies to get insurance and uninsured workers to buy insurance, without ever dealing with the fundamental problems of the system. So insurance companies collected more from more people, and skipped merrily to the bank to deposit what they did not have to pay out to doctors, who also skipped merrily to the bank to deposit their share all the time saying, “Don’t worry about how much we charge, you have insurance.”
All this hit home this week when I finally started getting the bills for my eye surgery and realized that I could have bought a new car for what my insurance would not pay for, and though I think my doctors did a great job, I certainly wish if they would share in my economic pain. These days, you have to worry if you have insurance – worry that the federal government won’t be breathing down your neck, worry that the doctors won’t charge an arm and a leg, worry that the insurance company won’t screw you and make you pay more, worry that hospitals will even exist after all is said and done.
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