I actually agree with that people should have some skin in the game. However, telling someone to send 2-5k to some charity organization to improve healthcare coverage is nonsense.
I think we are approaching universal healthcare. The public will demand law makers to fix the system once healthcare expenditure is > 25% of the country GDP.
It's hard to fix a system when there are so many players who are making millions from it. The default "fix" will be medicare for all.
I used to think this was nonsense but the more I learn about how payors operate the more that makes sense.
Someone mentioned the blight of hosptial admin growth. From a money side, this is reactionary from hosptials. Without that, our system would lose around $50,000,000 a year from insurance denials.
Here is a rundown of the process currently used with commercial insurance/managed medicaid/managed Medicare (ALL NON-GOVT ENTITIES):
Around 70% of our claims are not challenged (which makes sense, UHC makes money denying claims but they cant realistically deny someone as inpatient status who is intubated for his entire stay)
Actually as an aside they did do that to me once and I had to point this out. But anyway...
30% or so are denied
Here is the process
1) a UM nurse in our department (making 80k/ yr) flags a case as inpatient
2) if it meets strict guidelines as IP status they just tell attending to upgrade. If they aren't sure they ask me. Next step is same regardless
3) the claim is sent to a payor as a request for inpatient authorization.
4) another nurse making 80k/yr but this time working for a payor is incentivized to find a way to look at the same guidelines but see that they don't "meet" for inpatient. For the record, both nurses are looking at the same data and the same pretty clear guidelines but making different interpretations and its usually the payor nurse just making **** up
5) payor nurse flags case for denial
6) payor nurse refers case to a payor medical director (MD). MD, from my experience, just does whatever the Ai or denying nurse says and half the time never actually reviews the case, which is obvious when I talk to them
7) MD denies case
8) payor RN faxes our RN a denial letter
9) our RN contacts me to see if denial is worth fighting
10) I review case and conclude inpatient status is appropriate and the denial is not
11) I tell RN to challenge denial
12) RN contacts our scheduling assistant, someone making 50k/yr, to reach out to MD scheduling assistant who makes probably the same or more
13) a peer-to-peer is scheduled where I spent 2 minutes clearly pointing out to MD this denial is nonsense
14) MD agrees to overturn denial
15) I inform our staff of p2p result and to anticipate a fax
16) MD informs his RN case is overturned
17) payor RN faxes my RN an approval code and inpatient is approved.
This is all assuming MD agrees. If this goes to appeal you can add another 30 steps. Some MDs just deny because they can, regardless of medicine or logic. This is a topic unto itself, but there are some cases I know I will win or lose just because of the name on the calendar.
Look at this nonsense I just wrote. Then multiple it by 100 every single day. Every. Single. Day. THIS is private insurance. This is "competition." How can you look at this and not conclude it's a waste of time, money, and resources?
Yet, this is necessary. These denials are so complex and so common that regular docs cannot do this--they would be left without any actual time for patient care.
NOW, here is the process for full Medicare...actually real federal government insurance
1) nurse flags case as inpatient. Either meets for inpatient or, as with before, they ask my opinion
2) patient is made inpatient
The end.
Everyone thinks about government and insurance as a horrific bureaucracy but look at what i just outlined. Let me ask you this: which system would YOU rather work with?
Now, a logical conclusion is, well, if you can just make anyone inpatient wouldn't that increase risk of fraud? Answer is not really.
Every state has a QIO designated to watch for fraud (quality office). They will randomly pull out charts made inpatient and if >20% are flagged as inappropriate (or especially a 1MN stay that was unwarranted as IP) they can come down hard on you.
So there is a fraud protection mechanism that works very well and it isn’t an entire line of BS that UHC et al invented to siphon profit from hospitals.
So I do actually agree now a federal medicare for all program would probably cut a lot of red tape.
Problem is, it would cut TOO MUCH. It's not politically viable. It would lay off hundreds of thousands of people dedicated to this process and most importantly companies profiting off of denying care would cease to exist. These are the same companies handing checks to congressmen to make sure it never happens for the obvious reason everyone on the inside knows it would be better but too much profit would be lost....so it will not happen, not with the current political climate, anyway.
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