Simply put; Paul Ryan's "Voucher System," for Seniors keeps me up at night. After spending twenty years in healthcare I consider myself an expert in the insurance game and can state without reservation that the insurance carriers make Bonnie and Clyde look like The Salvation Army. Insurance companies represent an extremely powerful lobby whose influence on Capital Hill makes me wonder how much they contributed to the Romney/ Ryan campaign chest, now and prior to his nomination for Vice President ?
One of the biggest frustrations faced by any practice administrator is the constant battle to receive reimbursement for even the most carefully prepared, cleanest transmitted, and authorized up the gazoo claim ! Working on an accounts receivable can drive the most dedicated and experienced billing employee to distraction. But I digress. Let's look at the dynamics behind a voucher system for Seniors and discuss the obstacles that make this system such a poor idea.
Alternative health insurers have spent decades wooing seniors in communities throughout the United States and offering them Medicare alternative plans that would free them from the yearly Medicare deductible and provide prescription coverage with either a small or zero co-payment. Seniors who found the Medicare deductible a financial hardship and whose prescription costs were skyrocketing signed up in droves.
The first problem was that at least 50% of those seniors who adopted the Medicare alternative plans had no idea that they would be giving up their Medicare Part B coverage. They presented for care in physicians offices with their Medicare card, without realizing that they retained only Medicare Part A.
Secondly, some plans did require a referral from the patients primary care physician and these referrals were also absent at time of visit, especially for those that presented for an emergent visit, where the staff did not have the time to verify their coverage and in many cases were under the impression that the patient was covered by Medicare, where a referral was unnecessary.
In addition, patients had no real understanding of which tests and procedures were covered under the new plan and many hospitals that these patients had used for years; hospitals in their own community, as well as some of the hospitals who provide specialized care for cancer treatment, etc, did not accept their new primary coverage.
In short, a large portion of the seniors that were treated in facilities that I personally managed had less than a clue about any of the above problems.
The practices that I spent the majority of my time managing were all located on Long Island, twenty short minutes from Manhattan, one of the most cosmopolitan and sophisticated cities in the world. If my patients were confused, can you imagine expecting seniors who live in rural areas of the USA to suddenly start shopping around for competitive insurance rates and to outline their health histories and needs for specialized care, before deciding where to use their voucher coverage? People, this is just ridiculous! As an Administrator for Cardiology, it was a herculean effort to staff my front office with enough employees to answer the countless questions regarding testing procedures and physician instructions. Whose practice, or what organization is going to be responsible for assisting seniors in making their insurance choices?
I guess the insurance companies can sponsor more breakfast and luncheons, but based on my past experience this will not be an adequate salve for the problem. As far as the Ryan plan forcing the insurance carriers to become rate competitive, I can hardly keep a straight face! These companies are big, profit driven, monsters, whose bottom line is profit, profit, profit. Once rates for companies participating in Ryan's plan are established, trust me, there is no where they will go but up. Is Ryan going to assure us that there will be a cap on voucher costs? I think not!
Campaign rhetoric is full of the promise that Medicare is no longer a viable system and will collapse in the years ahead. Those who oppose the Obama Health Care Plan tell us that small businesses will go bankrupt providing health care coverage for their employees. Perhaps I live in the age of the dodo, but we baby boomers most often chose our jobs based on the benefit package available, including health care coverage, which, by the way, was most often free of employee contributions. Companies who did not offer coverage were often stuck with the lot of substandard employees who had a hard time finding work anywhere. During the ten years that I worked for Varig Airlines, I was 100% covered by Cigna Insurance after my probationary period was successfully completed. In addition, Varig matched my pension contributions dollar for dollar up to 6% of my total earnings. Those were the days, when the CEO of companies based in America collected a fair wage for performance and profits from a hard days work were shared equally, up and down the line.
Today, most companies expect their employees to pay a portion of their coverage and the Obama plan is not asking employers to fully fund health care. There are inexpensive plans on the market that provide basic coverage, with slightly higher deductibles, that most small businesses should be able to afford, providing that the small business owner does not expect to walk away each week with the lion's share of the profits representing far more than a fair and equitable wage. The Republican Party is vehement in their opposition of the Obama Plan and threaten to repeal it the moment they take office. Or keep some of it. That seems to be the latest in the Romney/Ryan plan. Politicians have been working to come up with an idea for health care for its citizens for the past fifty years, but when a plan is proposed, it is met with a resounding NO. Eventually NO leads to NOTHING, and this seems to be the hallmark of American politics for the past decade.
When Medicare was born, we had no assurances that it would be a success or fail miserably. This is true for Social Security, the Head Start Program, and programs that put Americans to work during the depression. If the Obama plan turns out to be a loser, we can kiss it goodbye. But to simply deny its existence, or scrap it, in favor of NOTHING? Is this counter-productive or am I living in the land of the hopelessly optimistic? Instead, as the Republicans desire, we should scrap Medicare, and replace it with tickets for coverage. Tickets? Just because most seniors remember the early days of Disneyland, where E-tickets gave you the best ride, doesn't mean that we want to take that ride, or save it for ten years for our fellow cronies to use !
Of course, if we made or produced anything in this country anymore, we could offer more opportunities for business to grow and thrive and the question of a business covering their employees would not suddenly seem as if it was a new and nightmarish idea. All at once, we are proclaiming that the idea of an employer providing his workers with coverage is as horrific as Hiroshima. When did we develop this sense of memory loss regarding the connection between employment and insurance coverage? I would have to speculate that we disregarded the fact that it ever existed in the light of our new desire to covet more profits.
Some would proclaim that our jobs are too slim and our population too large to provide benefits that existed for decades in the past. Well people, if we stopped sending American jobs overseas. If China paid a fair import tax. If we did a better job of patrolling our borders, then perhaps American business could put Americans to work, and protect them in times of sickness and health.
Having owned a start up medical practice, it was my job to provide the employees with coverage. I did the research, I paid the premiums, I investigated new plans each year, and was still able to draw a fair salary for the efforts of my labors. This is not an anti-success idea, nor does it represent a desire to keep small businesses small. Over the past few decades, Wall Street and the banking institutions have flaunted the fact that their bigwigs brought home billions, while those who made those profits possible; well - who cares!
We have become a society that applauds greed and bulldozes over anyone who dares stand in the way while we plunder our corporations, lay off workers, export our jobs, and do it all with a shrug of apathy. If we see it often enough, we become immune to the disgrace of it and literally become the fairy tale of '"The Emperors New Clothes." We keep saying that the king is clothed, while our failures are nakedly apparent. We might start to solve some of our problems, if just one of our politicians decided to finally tell the truth!
Let us also realize that citizens without adequate health care coverage often present in our hospital emergency rooms, where patients cannot be pre-screened and treatment cannot be denied. Overwhelming costs for treating the uninsured have allowed thousands of smaller hospitals to be gobbled up by larger health care systems where treatment becomes standardized, and may be inferior. Forget about bankrupting small businesses; should we ever face the day where our healthcare system is bankrupt, our problems will be far greater than a lack of profitability.
Those who wish to ignore the poor and disenfranchised fail to realize that they may not ignore us. As poverty and unemployment increase; when those without jobs or those who are homeless are ignored, it is not speculative to remind ourselves that crime increases. Desperate people perform desperate acts. Eventually, there is no ivory tower, or apathy to protect us.
Finally, as a representative of the generation who have or will approach the age where we can avail ourselves of the benefits of senior status, I am far from fooled by the constant blather of those who point out that the reserves for our time will not be available. Certainly, Obama, Romney, and Ryan can pay the costs for their health care with the spare change that lines their pockets. Unfortunately, most of my generation cannot do the same. There is enough blame for both sides of the aisle. If the politicians are so concerned with the issue of health care coverage for the uninsured, why don't they just give all of us the same Federal Plan, which covers their every ache and pain so effortlessly.
Perhaps the government should rename the baby boomer generation, AIG, or Morgan Stanley. They might suddenly find a trillion dollars or so to keep the Medicare system intact.
No comments:
Post a Comment