Jiggered: The Healthcare Insurance Industry; Unraveled, Explained and Exposed
Jiggered: The Healthcare Insurance Industry; Unraveled, Explained and Exposed
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Product Details
| ISBN-13: | 9781450256377 |
|---|---|
| Publisher: | iUniverse, Incorporated |
| Publication date: | 09/23/2010 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| File size: | 187 KB |
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Jiggered
The Healthcare Insurance Industry; Unraveled, Explained and ExposedBy C. E. Nash
iUniverse, Inc.
Copyright © 2010 C. E. NashAll right reserved.
ISBN: 978-1-4502-5635-3
Chapter One
A Little Business; A little Background; A Big Reality Check.
Never forget the basic premise that wherever there's big money to be made, there will be big corruption to capitalize on the financial opportunity.
You may personally think that everyone should be entitled to healthcare because it's the humane thing to do. That might be fine in Utopia, but it doesn't work in the real world. While that's a laudable ambition, it is not a reality. You have a choice. You can have the best healthcare system in the world with some limits on access or you can have mediocre care available to nearly all. Limits are naturally imposed by the number of people available to provide the service. Is there a balance somewhere in between? Probably; I believe there is but it will never be achieved with politicians making the decisions.
Let's look at Washington and their recent healthcare reform bill. Healthcare reform is a misnomer. There is nothing wrong with the healthcare provider system in this country. The bill that passed in Washington DC was not about healthcare at all. It was about reforming the payment system. Its stated objective was to provide healthcare to forty-seven million more people. The current bill didn't even come close to achieving that goal. It did; however manage to increase the cost of what we already have at the expense of the taxpaying public. Without going into specifics in the bill itself, just take a look at who actually decided the healthcare fate of our nation. Given the basic premise that healthcare is a business, we should look at the background experience of our senators and representatives. Only a very small number of our congressmen (and congresswomen) actually have some experience in the healthcare industry. Those same representatives had virtually no voice in the legislative process. If you're going to completely overturn an industry, wouldn't it make sense to have a thorough understanding of its workings? The vast majority of the decision makers who were involved in this process in Washington DC have no business experience, no medical or healthcare experience and have been in the netherworld of politics for years; some for decades. Many are wealthy and have probably never held down a hardworking, honest job in their lives. Talk about a disconnect from reality! And they're making our decisions for us! No wonder we're in such a mess. It's said that the best cure for liberalism is to start up your own business. You'll most likely turn into a conservative overnight. Perhaps Nancy and Harry should give it a try.
Most people think of healthcare providers as their doctors and their hospitals. Hospitals have a huge number of employees but they also have something else that most Americans overlook. They have a very large number of small business owners under contract to provide your care. That's right, a vast amount of your healthcare is being provided by small business owners. Your primary care physician is most likely a small business owner. Many physician groups set up private practices and provide services to hospitals under agreement or contract. They provide care from the emergency room to the surgical suite and everywhere in between. If these healthcare provider groups don't like their contract terms, they can and sometimes do, take their business elsewhere. That's why you periodically see a hospital change its service base. All of a sudden, your local hospital no longer provides OBGYN services, Pediatric Intensive Care services or Level I Trauma services. For whatever reason, the medical group was not able to negotiate a favorable contract with the hospital. Cost driven rationing? Most likely.
Those same small business healthcare providers also contract with Federal and State Government agencies to provide healthcare for Medicare and Public Aid recipients, and agree to provide healthcare at a markedly reduced fee for their services. They provide medical care and then bill the appropriate government agencies for services rendered.
More and more healthcare providers are canceling their contracts with State and Federal agencies because reimbursement for those services has fallen far too low to cover the increasing costs of providing your medical care. Hear we go with rationing again. The Feds don't actually need to mandate rationing in order to cause it. They can achieve the same ends by simply manipulating production costs upward and forcing reimbursements downward. Then, when rationing occurs out of necessity due to scarcity, they can play innocent, blame the healthcare providers and insurance companies and cry foul when they're accused of creating a rationing atmosphere. I believe the political term the Feds would use here is unintended consequences. Do you think, for one minute that those consequences are either unexpected or unintended?
Healthcare providers and hospitals are in the middle of a very nasty squeeze. On one hand, they are facing ever escalating costs to provide your care and on the other hand, they are facing less and less income for the services that they render. During all of the heated debates over Obamacare, you never heard one word about trying to lower the costs that the healthcare providers incur in order to provide your care. In fact, you heard the exact opposite.
Manufacturers of medical devices are now about to be levied with a heavy tax on their products. These companies are, for the most part, large publicly traded corporations and are not about to eat the increased cost to produce their products. They need to make a profit to satisfy their shareholders. Manufacturers are going to pass that tax on to the healthcare providers who purchase and use those devices to provide your healthcare. That cost will be passed on to the patient population in the form of increased costs for pacemakers, wheelchairs, monitors, IV pumps and everything else you can think of. Countless increases in actual business expenses such as this one are forcing the cost of providing your healthcare through the ceiling. In this instance, the Feds just manipulated the cost to provide your healthcare upward. Where will the money come from to pay for these increases? The Feds know fully well that these costs will end up being passed on first to the healthcare providers and from there on to the consumers. You're going to have to pay or do without. If you follow the money, you will easily understand that the Federal government has every intention of placing such an overwhelming burden upon the private sector of the healthcare industry that it will rapidly collapse and they will then be able to seize control of another business "to big to fail" and completely socialize the system. There is no business "to big to fail" and that includes the Federal government. We have Greece to look to for an example.
Don't let any politician tell you that any monies will be saved under the "new" healthcare system known as Obamacare. It's just basic economics and Washington believes the American people are too stupid to understand how it all works. So now, I will give you a short introductory lesson in the basic principles of finance and economics.
It's common sense. If the cost of producing a product remains constant (or escalates) and you decide to increase its supply in the marketplace, you will have to increase your financial investment in your marketplace product. If you decrease the supply of any product the opposite will hold true. You will have decreased the cost of putting the product out into the marketplace by decreasing the amount you produced. However, when you decrease the amount of product you are making available in order to control your costs, you will be unable to meet all of the demand for the product. Therefore the cost to the consumer will rise due to scarcity and many consumers will go without. Many people who want your product will not be able to find it due to the limited supply available or afford it due to its expense. Supply and demand are the issues here. When a product is plentiful, costs fall due to availability and lack of competition. When a product is limited, costs rise due to scarcity. Healthcare is a product and has a limited supply; limited by the number of people who work in the industry. Under Obamacare, that product will become increasingly more difficult to find as the demand for the product increases.
The law of supply and demand is very easy to understand. It's completely logical. Let's apply that law to healthcare providers. If you suddenly place a large number of new healthcare providers into the marketplace and the number of patients remains reasonably constant, the healthcare providers will need to compete for your business by competitive pricing and high quality service. If the opposite happens and the supply of healthcare providers goes down but the number of patients remains about the same, some patients are not going to be able to find anyone to take care of them and the price for healthcare will most likely rise due to scarcity. Now let's look at what happens when the number of consumers (or patients) changes. If the number of healthcare providers stays the same and then there's an increase in the number of people who want healthcare, there won't be enough to go around. This is exactly what Obamacare is all about. Supply and demand are key elements of healthcare services that the Feds can and will manipulate to meet the needs of their own agenda. However, there's one major fatal flaw in the Feds plan. They can't provide healthcare to a large number of new consumers because they're not going to be able to increase the number of healthcare providers. That, at least for the time being, is not in their hands. They can; however, withhold reimbursement for medical procedures and care they deem wasteful. If granny needs a hip replacement and she's beyond the age the Feds decide to fund, she can't have that new hip The Feds are in absolute control over who gets funding for what care.
As you read through this book, ask yourself "is this a supply problem or a demand problem and who is controlling the distribution of our healthcare goods and services; the end product?" Watch out for unintended consequences and ask yourself if those consequences were really unintended at all. The Obama administration knows fully well that the cost to provide care for our elderly seniors is on the rise and will reach a fiscal crisis point sometime over the next two decades. This administration appears to be bent upon seeing to it that we don't waste our national wealth by providing too much care for this sector of our population. Limiting the type of healthcare services the government will approve for payment is an effective method of reducing costs. The Feds can, and will limit healthcare in the elderly population. They already do. Medicare does not cover anywhere near the amount or type of healthcare services that a private insurance company does. By limiting care to the elderly, the monies saved can then be redistributed to other patient populations deemed more worthy; an assessment based upon their probable future productivity and contribution to society.
The Obama administration has determined that we will be able to supply healthcare to several million additional people without increasing the cost of doing so and with no plan in place to increase the supply side of the equation; the healthcare providers. In fact, the administration would have us believe that we can increase the supply of the product with the same resources currently in play and save money at the same time. There's only one way there could be any reduction in the overall cost. Reduce the amount of money being paid to healthcare providers for Medicare and Public Aid services. That absolutely won't work. The further you reduce the amount of money paid to the providers for their services, the fewer providers you will have available to get the job done and the less product you will have to spread around to those who need it. If the providers are unable to cover their costs, they can't continue to produce their product; your healthcare services. They either quit altogether or they decrease their services and no longer provide care to Medicare and Public Aid recipients. That's already happening to a certain extent and will become epidemic with further decreases in reimbursements.
Every government supported entitlement healthcare program out there doesn't reimburse at the full cost of providing healthcare services with one exception; Federal employee insurance plans. Federal employees have it made and the American people are paying out of their tax dollars! They have one of the best private insurance plans available. Let's change that. Let's require that Federal employees pay for their own insurance just like the rest of working Americans and let's take a closer look at their retirement benefits while we're at it.
The results of continual under funding of our healthcare programs will be a rationed and corrupted product. We will need to spread a decreasing supply of available healthcare services to an increasing consumer base. Healthcare providers will spend less and less time with each of their patients in order to see more patients in the same allotment of time. The quality of that care will most certainly be corrupted. The only other way to cover costs and increase the available volume of providers is to tax the living hell out of you guys so that healthcare providers can afford to do their job; so the profession can attract or entice our young people into the profession. Here is an actual example of what happens in the real world of healthcare from a financial standpoint.
Let's say that my ambulance company transports a patient with private healthcare insurance over a long distance and the trip takes about four hours. We receive $3000.00 for our services from the insurance company. Then let's compare payment for that same service to the other major sources of reimbursement; Federally funded Medicare and Public Aid.
Private Insurance: 1 patient is equal to $3000.00 4 hours
Medicare Part B Insurance: 4 patients are equal to $3000.00 16 hours
Public Aid Insurance: 15 patients are equal to $3000.00 60 hours
Not only am I going to receive less money per transport for Medicare and Public Aid patients, I'm going to have to spend a great deal more money to increase the number of ambulances and crews to get the work done. If this was your company and you were selling widgets what would you do? I can tell you for certain, you would sell one widget to the guy who's going to pay you $3000.00, let the rest go wanting and have lots of free time left over to play golf. Healthcare providers are not going to expend huge sums of money in order to increase the supply side of their services for a whole lot less money. That's called the law of diminishing returns. Continuing to poor money into a product that brings in less and less net profit eventually leads to an upside down situation; the point where it takes more money to get the product to market than it can actually be sold for. When that happens, the supplier leaves the market place and the product disappears.
Think about this. When I purchase a new ambulance, no one in the Federal government is going to go out and tell the people who manufacture my ambulances that they must accept thirty five cents on the dollar and make due with it. That would be an invasion of the private business sector and would not be tolerated. Could my ambulance supplier stay in business if that happened? I don't think so. Healthcare providers are told exactly that when they render care to Medicare recipients. So, how do we stay in business? We get the funds to continue right out of the pockets of upper and middleclass working Americans; those Americans who have private insurance policies. You are the only source capable of paying for healthcare and you are absorbing the reimbursement shortfall in federally funded programs. As long as the Feds can't pay their fair share for services, the financial burden will continue to rest with the privately insured patient population. By placing an additional burden of federally funded patients into the mix, the shortfall will continue to increase and the working American public will continue to see increases in the amount of monies they pay for insurance premiums and out of pocket expenses. The providers will have no choice. They'll bill more in order to meet that shortfall.
(Continues...)
Excerpted from Jiggered by C. E. Nash Copyright © 2010 by C. E. Nash. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Contents
Dedication:....................viiPreface:....................ix
Introduction:....................xiii
Chapter 1: A Little Business; A little Background; A Big Reality Check....................1
Chapter 2: Private Insurance Funding: I Have Insurance So Why Is My Healthcare So Expensive? Why Do I have To Pay The Balance That My Insurance Company Didn't Cover? I'm Frustrated, Angry and Don't Understand This Stuff!....................14
Chapter 3: Medicare Funding: At Long Last, Free Healthcare! Not So Fast! It's Not All Free and It's Not All Covered! (and It's Broken Anyway)....................26
Chapter 4: Public Aid Funding: What Funding? It looks More Like 50% Waste, Fraud and Abuse To Me!....................43
Chapter 5: What's An EOB? I Have No Idea How My Insurance Company Did This! Help! I Don't Know What This Says! I Can't Pay This!....................49
Chapter 6: Our Military: Shameful Dirty Doings Then and Now....................63
Chapter 7: Your Not So Ordinary Dry As Dust Statistics; An Eye Opener?....................72
Chapter 8: Fraud and Abuse: The Real Down and Dirty Behind The Scenes Corruption; Who Are Some Of The Really Bad Guys?....................75
Chapter 9: A Word To The Wise When Dealing With Your Healthcare Provider's Bills. We've Heard It All Already!....................102
Chapter 10: A Few Interesting Tidbits. Definitely Worth Perusing! Questions, Answers and Dissertations....................118
Bibliography....................129