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When even the screamingly Progressive The New York Times recognizes the new government health care “system” is a disaster, it’s time to undo the damage quickety-quick:

In addition to the difficulties many face in proving they have coverage, patients are also having a hard time figuring out whether particular doctors are affiliated with their health insurance plan. Doctors themselves often do not know if they are in the network of providers for plans sold on the exchange.

But interviews with doctors, hospital executives, pharmacists and newly insured people around the country suggest that the biggest challenge so far has been verifying coverage. A surge of enrollments in late December, just before the deadline for coverage to take effect, created backlogs at many state and federal exchanges and insurance companies in processing applications. As a result, many of those who enrolled have yet to receive an insurance card, policy number or bill.

Just as these government hacks couldn’t build a website a 15 year old could on the cheap (see any number of travel or storefront aggregation sites), they can’t seem to figure out a drop-in payment system or how to shunt the sign-up information to the providers. This would seem a fairly critical bit of infrastructure, wouldn’t it?

Now ask yourself: How well are the bureaucrats that get hired on to “manage” your care going to do when it comes to authorizing critical, time-sensitive care? Hey, maybe they’ll “reimburse you” for out-of-pocket  costs for that Stage 3 cancer you have. What..? You don’t have $250,000+ in your wallet? Guess you’re f#$%ed.

In Los Angeles, Hilary Danailova, who is almost eight months pregnant, said she had to pay $630 for an ultrasound on Thursday after failing to get an ID card or any confirmation of coverage from her new insurer, Anthem Blue Cross. Ms. Danailova, 38, said she signed up just before Christmas and sent her first month’s premium of $410 by overnight mail on Jan. 3. She has repeatedly tried to reach Anthem to see whether the company has processed her payment.

“At this point I am facing the cold dread of not knowing whether Anthem ever recorded my enrollment at all,” she said.

Bet she doesn’t get that $410 back if she’s not…

And the fun’s only getting started. The Washington Post — another progressive rag that has been touting the (Un)Affordable Care Act — suddenly noticed the disruptions in the individual market were now about to spread to small and medium businesses…the ones without the lobbying clout to get unconstitutional “waivers” from the administration:

Some of the small-business cancellations are occurring because the policies don’t meet the law’s basic coverage requirements. But many are related only indirectly to the law; insurers are trying to move customers to new plans designed to offset the financial and administrative risks associated with the health-care overhaul. As part of that, they are consolidating their plan offerings to maximize profits and streamline how they manage them.

‘If they do it one way, the word canceled gets attached to it. If they do it another way, they say they are amending the policy. It sounds more gentle but it’s the same thing,’ said Gary Claxton, an expert in private insurance at the Kaiser Family Foundation. ‘The basic point is, for many people in the small-group market at some point soon their coverage is going to change.’ 

So much for keeping your policy, but then again, it was unfair of Presbyterian not to cover my completely-unnecessary gynecological exams. In total, Forbes estimates about 30% of the nation is going to lose their preferred health plans to “end discrimination” toward the 7-10% of the population (depending on whose numbers you use) who either weren’t offered health insurance or decided not to purchase it.

And, of course, the big insurance players are just fine with the disruptions and massive costs of the system — case in point, Blue Cross Blue Shied has already lined up at the taxpayer trough for the “bailout”.

Blue Cross Blue Shield Association CEO Scott Serota asked members to lobby Congress against repeal of the ‘risk corridor and reinsurance program’ which is little more than an insurance company bailout.

Serota rolled out the big gun scare tactics, saying repeal ‘jeopardizes the entire private health insurance market and will ultimately lead to a single-payer system.’

(Never mind the “risk corridor” program will expire in 2017, anyway.) Well, Mr. Serota, considering Congress’ plans were for a single-payer system, anyway, I guess BCBS, Kaiser, Humana, and the rest of the insurance companies that though they were getting a captive market and truckloads of sweet, sweet taxpayer “bailout” money if it didn’t work out got rolled.

You want to “fix” the health care system in the United States? Get rid of the “system” mentality. A health care market, one in which insurance exists for catastrophic injury or illness, and if you want a maintenance program (kind of like on your car), that’s a completely different animal.

The issue is one of supply and cost transparency; Access has never been a problem. Until this crap bill, if you went to the emergency room you had to be seen. Yes, you would get a bill, but over half of the hospitals in the United States are tied to religious groups which often have some kind of indigent care insurance and funding. That wasn’t coming out of taxpayers’ pockets. Public-funded hospitals often have “poor folk” programs, as well.

Repealing ACA and instituting a few small, uncomplicated laws would fix much (but not all) of the main issues.

1) Get the American Medical Association (and ADA for dentistry) out of the business of restricting the market supply of health care providers. Allow the medical schools to accept as many applicants as they see fit. Perhaps the reliance on MCATs and other tests weeds out terrible candidates, but it often closes out good ones, as well. The quality of student would be quickly tested in the program; let them get weeded out in the process. How many good doctors have we lost thanks to test issues but would have done well once they were in the program?

Lowering the costs of medical school should be another priority, which would again create more supply for the market (as would more H1 visas for skilled immigrants like nurses, doctors, and other specialists.) But cost of college is another third-party payer issue to be addressed separately…

2) Change the residency requirements. A general practitioner doesn’t need two to three years doing 48 hour hitches in the ER at some city hospital…that’s not what they’ll be doing. You want to be a surgeon — yes, you should have emergency room and operational experience commensurate with what services you will be performing. But I can do almost the same thing my family doctor does 9and often do) with WebMD and a few other websites that run you through the same checklist of symptoms the doctor would use. (We really need a Chilton’s Guide to the Human Body.)

3) Residents are the graduate assistants of the medical world — slave labor that is used in a way that endangers their patients due to long hours and high stress. More residents=less ridiculously long work shifts that leave the practitioner a danger to others. Another benefit of more medical students.

4) Insurance should be just that — as with car or home insurance, a hedge against catastrophic illness. Health maintenance plans should be something separate. Decoupling the services would certainly lower the cost of the former (and probably the latter, as well, depending on age group and other actuarial issues.) Getting the insurance companies out of — or at least reducing their involvement — in the payment of doctors and hospitals would lower the regulatory and administrative burdens of small providers (like most GPs) and allow costs to be better contained. How…?

5) Cost transparency — one of the greatest issues is that a third payer handles your payments. You think your colonoscopy cost $40 in copay. The hospital charges twice what it thinks the service was worth just to get close to what their billable hours were from the insurance companies. There’s no way to set a reasonable fee for service when the insurance company doesn’t care what that “machine that goes ping” costs, the hospital is trying to recoup the investment in said machine, and the billing staff are more concerned with pulling as much dosh out of the insurer than setting a fair price. Worse, the customer has not idea what the medical care they are getting actually costs, and they cannot make informed decisions about their cost-benefit ratio.

By getting the insurance companies out of the payment business would lower the administrative costs and time lost dramatically. (There’s a reason most general practitioners I’ve talked to will accept payment “under the table” for much less than they would charge the insurer.) Additionally, having providers post (or at the very least inform customers of) their costs would allow patients to better judge whether that $40 to see a GP or nurse practitioner over that sniffle is worth it.

6) Less important, but still a good idea, would be some manner of tort reform to lower the costs of malpractice, and hence malpractice insurance — another major cost to providers in these litigious, “get money quick” times.

There’s a special issue with drugs and drug companies. Most of the world has some kind of subsidy/cost control legislation in place that makes drug research and production less profitable than it could/should be. The only two markets where drugs companies can make up their development costs (then continue to rape their customers on cost) are the United States and Japan. With this kind of market manipulation, it will be hard to come up with means to lower the cost of drugs (although cost transparency will help.) One thing might be some kind of streamlining process for drug approval — one that recognizes, say, the acceptance of drug safety from other markets like Europe, if the company petitions for a waiver.

Less government, less medieval guild bullshit from groups like the AMA, and more market competition is key to lowering costs and raising access to medical care. No, with this sort of market wouldn’t necessary get rich being a doctor, but pushing medical service as a public good (like we do teachers and police and firefighters) would still draw people to the craft.

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