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Reform Time is Regulation Time |
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America is more open to a public conversation about government regulation of companies than at any time in many, many years. (Yesterday in a discussion with union leaders in a highly regulated industry they could not agree on the starting date for this wave of deregulation. Was it 1965 or 1971?)
Congress is talking about regulating credit cards. Remember, they used to be regulated, state-by-state. Then they all moved to South Dakota or some other lawless place. Now, America wants Congress to start minding the store again. There is strong popular sentiment to outlaw sub-prime mortgage scams and predatory lending practices. The word “predatory” is used openly to describe giant financial companies. Again, Americans want Congress to mind the store.
Yesterday’s “let us do it” letter from big health care industry stakeholders can be seen in this context. They see the regulatory wave growing, and want to be out ahead of it. The only proper response is to step up the call for regulation with teeth. If the industry mends its ways, regulations won’t bother them. If they don’t, the machinery will be in place to act quickly.
We can help people see the need by shining a light on “predatory” practices by insurers. After all, they are financial institutions like banks and credit card companies. Denial of payment should be treated the same as a bank refusing to give you your money. It’s not the insurance company’s money. They are just holding it to pay for my health care.
“Sub-prime” insurance should be outlawed. A policy that does not cover the purchaser is a scam. High-deductible policies are sub-prime. Bare-bones policies are sub-prime. If we don’t demonize them, the other side will describe them as bargains and run a “one size does not fit all” media blitz. If ever there was a time to set a reasonable floor on health coverage, it is right now.
We have to wage this regulatory fight to make the “level playing field” attack less damaging. A public health insurance plan should not have to compete with a high-deductible, low coverage, low premium rip-off plan. The power of the public option is magnified when combined with a strong regulatory wall keeping insurance companies from a big part of their plundering and pillaging business model.
We should join the industry in the call for a “specific focus on obesity prevention commensurate with the scale of the problem.” A good place to start is corporate fat cats and bloated bureaucracies. The recent Georgetown/RWJ study [pdf] shows people can’t figure out their policies, can’t figure out what is covered and what isn’t, and can’t estimate what the real costs will be. They call for truth in packaging. We should add strong content standards.
The public hates insurance companies for a reason. Even Luntz sees it. Turn up the heat on insurance company predatory practices. It’s regulation time for American health care.
Nick Unger works for the AFL-CIO’s health care campaign.
(also posted at the NOW! blog)
I have a serious problem with the most recent health reform effort. Asking or expecting the health industry to reduce costs through self-regulation without accountability is simply ridiculous.
Health care is already completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.
By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.
We rely upon one the ratings of physicians who have self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.
Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.
Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like “Reasonable and Customary Rates%u201D and then choose to pay 80% of that. Therefore, by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.
Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.
The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly “priceless.”
Good luck to those people who actually purchased supplemental plans they saw advertised on TV, you have been duped. Giving people (especially the infirm and the elderly) a false sense of security is unfair and unjust.
Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate for “just in case” scenario that results in major, catastrophic medical loss.
The administrative cost alone on the part of the “Responsible Party” is probably more costly than the initial service they received at whatever hospital for whatever condition.
You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and should be considered a public good.
I would write more, but unfortunately, I just realized that I have some forms I forgot to file an authorized statement regarding the assignment of benefits form. It only seems fair that the appropriate party is paid for providing services in good faith given TennCare’s history of delayed payment.
Elyssa Durant, Ed.M.
Nashville, Tennessee