Three Best Health Care Reform Ideas

[BoiseBYU]

Here are mine; I'm curious what yours might be

1. Prohibit pre-existing condition insurance exclusions
2. Elminate antitrust exemption for health insurance and the ban on competing interstate
3. Allow the federal govt to negotiate drug prices for Medicare recipients

[hawkwing]

I like #2 the best, I think that would be huge in driving down costs.

[BYULV]

How about getting doctors out of the insurance business. Do not allow doctors to bill insurance plans directly, rather require each individual to bill their own claims. This accomplishes a number of positive things:

1) the potential for fraud/abuse is nearly eliminated (I have heard estimates of $billions yearly due to false claims);
2) patients will know what their costs are upfront, before they see the doctor (medical services will start to become commodities sensitive to supply and demand which they currently are not)
3) medical office operating expenses will be cut by $50K - $100K yearly per physcian by eliminating interactions with insurance companies (multiplied by # physicians in America = $$$$$$).
4) patients become more active participants in their healthcare by being sensitive to the insurance coverage they have, by knowing what things cost and by being the true consumer of healthcare from the physician rather than through the 3rd party insurance companies.
5) other benefits I'm sure, but these are just off the top of my head.

[Qman]

1) Interstate competition
2) Bill the patients for all the reason BYU LV listed
3) Change health insurance into 'emergency' only coverage - checkups and most procedures are payed for with tax free accounts
4) remove the corporate health care tax deduction and just pay the employees the addition amount. Let us find our own insurance
5) have strict laws about malpractice suits a la Texas-only malpractice suits that have been signed off on by a practicing doctor in the same field go to court. Lower costs in malpractice insurance, lower overall costs.

[ABYUFAN]

How about getting doctors out of the insurance business. Do not allow doctors to bill insurance plans directly, rather require each individual to bill their own claims. This accomplishes a number of positive things:

1) the potential for fraud/abuse is nearly eliminated (I have heard estimates of $billions yearly due to false claims);
2) patients will know what their costs are upfront, before they see the doctor (medical services will start to become commodities sensitive to supply and demand which they currently are not)
3) medical office operating expenses will be cut by $50K - $100K yearly per physcian by eliminating interactions with insurance companies (multiplied by # physicians in America = $$$$$$).
4) patients become more active participants in their healthcare by being sensitive to the insurance coverage they have, by knowing what things cost and by being the true consumer of healthcare from the physician rather than through the 3rd party insurance companies.
5) other benefits I'm sure, but these are just off the top of my head.

We had a family vacation in Yellowstone and there my son's finger was shut in the van door. Fearing a possible broken finger we took him to the local medical clinic for an x-ray (not broken, we just put a splint on it.) I paid for that out of my own pocket and sought reimbursement from the insurance company directly. Over the course of more than a year, I literally heard five (FIVE!) different reasons why they wouldn't pay for that claim - one person indicated that I should have driven the 15 hours back to my region to see his primary health care provider who would then have referred us back to the local guy in Yellowstone, so we could then drive the 15 hours back there to have to possible broken finger looked at.

Ultimately I had to initiate the mandatory arbitration provision of the policy for me to get my $100.00 that I was owed.

I can see why a Doctor would want out of that crap, but I cannot see how by giving an insurance company more latitude to screw over the average American, we would end up with a better system.

If they fought me that hard over $100.00 imagine how hard it would be to collect on a $50,000.00 surgery.

[BYULV]

How about getting doctors out of the insurance business. Do not allow doctors to bill insurance plans directly, rather require each individual to bill their own claims. This accomplishes a number of positive things:

1) the potential for fraud/abuse is nearly eliminated (I have heard estimates of $billions yearly due to false claims);
2) patients will know what their costs are upfront, before they see the doctor (medical services will start to become commodities sensitive to supply and demand which they currently are not)
3) medical office operating expenses will be cut by $50K - $100K yearly per physcian by eliminating interactions with insurance companies (multiplied by # physicians in America = $$$$$$).
4) patients become more active participants in their healthcare by being sensitive to the insurance coverage they have, by knowing what things cost and by being the true consumer of healthcare from the physician rather than through the 3rd party insurance companies.
5) other benefits I'm sure, but these are just off the top of my head.

We had a family vacation in Yellowstone and there my son's finger was shut in the van door. Fearing a possible broken finger we took him to the local medical clinic for an x-ray (not broken, we just put a splint on it.) I paid for that out of my own pocket and sought reimbursement from the insurance company directly. Over the course of more than a year, I literally heard five (FIVE!) different reasons why they wouldn't pay for that claim - one person indicated that I should have driven the 15 hours back to my region to see his primary health care provider who would then have referred us back to the local guy in Yellowstone, so we could then drive the 15 hours back there to have to possible broken finger looked at.

Ultimately I had to initiate the mandatory arbitration provision of the policy for me to get my $100.00 that I was owed.

I can see why a Doctor would want out of that crap, but I cannot see how by giving an insurance company more latitude to screw over the average American, we would end up with a better system.

If they fought me that hard over $100.00 imagine how hard it would be to collect on a $50,000.00 surgery.

If you had to fight for even the most basic reimbursements all the time like you did in this case, you would be looking for a new insurance plan. Insurance plans would have to start catering to their subscribers and be more honest to keep their clients. It's a self-correcting problem. Your experience is what a doctor's billing office goes through every day with a huge portion of claims. Currently doctor's offices are paying this cost and the insurance companies are getting away with this type of abuse. Doctors can do very little about correcting this problem because they are not the subscriber of the insurance plan - and as patients we don't do anything about it because we don't usually realized there is any kind of problem because the doctor's office is dealing with the insurance company's denials. Think about an auto insurance plan giving you that much trouble, it wouldn't happen becuase they know you would find another company.

Additional evidence to support this theory is the advertising of auto insurance companies. How often do you hear ads for auto insurance based on customer service related issues (quick claims approvals, immediate call response, roadside assistance, etc)? The auto insurance industry is driven by providing good coverage at comptetitive rates with good customer service. Making health insurance more direct to consumers in a similar fashion will naturally bring health care insurance more along these lines as well.

[ABYUFAN]

If you had to fight for even the most basic reimbursements all the time like you did in this case, you would be looking for a new insurance plan. Insurance plans would have to start catering to their subscribers and be more honest to keep their clients. It's a self-correcting problem. Your experience is what a doctor's billing office goes through every day with a huge portion of claims. Currently doctor's offices are paying this cost and the insurance companies are getting away with this type of abuse. Doctors can do very little about correcting this problem because they are not the subscriber of the insurance plan - and as patients we don't do anything about it because we don't usually realized there is any kind of problem because the doctor's office is dealing with the insurance company's denials. Think about an auto insurance plan giving you that much trouble, it wouldn't happen becuase they know you would find another company.

Additional evidence to support this theory is the advertising of auto insurance companies. How often do you hear ads for auto insurance based on customer service related issues (quick claims approvals, immediate call response, roadside assistance, etc)? The auto insurance industry is driven by providing good coverage at comptetitive rates with good customer service. Making health insurance more direct to consumers in a similar fashion will naturally bring health care insurance more along these lines as well.

In the last 15 years I've had half a dozen different health insurance companies (but amazingly one car insurance company) I've hated every single health insurance company. perhaps they would be easier to deal with in a more open system, but it won't be an easy transition.

And I figured that that is the kind of crap doctor's offices had to deal with on a daily basis, which is why I super-bolded my belief that Doctors would love to get out of that system. And, perhaps it would lead to lower cost of services when a Doctor's office isn't paying hundreds of thousands of dollars every year for employees that do nothing more than try to get the money from the insurance company that the doctor's office rightfully earned.

So maybe it would work, but I'd hate to see it "as applied" in the transitional phase

[CougarClaw]

are any of you running for office? I'll vote for you.

I really like the transparency idea. have the doctor's give me a "menu" of things I want done INCLUDING PRICES and let me make my own decisions. I would hate dealing with insurance companies, but if it meant service improved and prices came down, I'd live with it.

Limiting medical malpractice has to come in here somewhere since doctor's two largest expenses are 1) customer who don't/can't pay and 2) malpractice insurance. I'm all for having recourse against truly negligent and poor care, but the proliferation of trial lawyers and predatory medical cases only clogs up the judicial system and prevents people from forgiving each other.

And here's something that will take a real political hero to attempt: Get rid of Medicare/ Medicaid and Chip (frees up about 40% of the federal budget instantly) and replace the institutional elderly supportive care (no more free electric wheelchairs!) with infant through teenager preventative medicine. Sorry Grandma, I love ya, but babies are more important than you.

As long as AARP is the most powerful lobby group in america, it'll never happen, but we can't keep supporting this level of care. The money simply is not there. It's going to break the system.

[BYULV]

are any of you running for office? I'll vote for you.

I really like the transparency idea. have the doctor's give me a "menu" of things I want done INCLUDING PRICES and let me make my own decisions. I would hate dealing with insurance companies, but if it meant service improved and prices came down, I'd live with it.

Limiting medical malpractice has to come in here somewhere since doctor's two largest expenses are 1) customer who don't/can't pay and 2) malpractice insurance. I'm all for having recourse against truly negligent and poor care, but the proliferation of trial lawyers and predatory medical cases only clogs up the judicial system and prevents people from forgiving each other.

And here's something that will take a real political hero to attempt: Get rid of Medicare/ Medicaid and Chip (frees up about 40% of the federal budget instantly) and replace the institutional elderly supportive care (no more free electric wheelchairs!) with infant through teenager preventative medicine. Sorry Grandma, I love ya, but babies are more important than you.

As long as AARP is the most powerful lobby group in america, it'll never happen, but we can't keep supporting this level of care. The money simply is not there. It's going to break the system.

I agree with you on these points.

hopefully when the insurance companies are required to be more transparent and people actually know what their policies do and don't cover there will be a need for the insurance companies to become more subscriber friendly. Right now they can make claim denials a commonplace thing because the people paying the bills (policy holders) aren't involved and therefore won't take any action. If you actually have to provide services to the people who are buying the policies, then you will automatically become customer service friendly or will go out of business.

[scott715]

So why do we have hearings with politicians on how to fix it? Why don't we get a room of Doctors and see what they suggest?