Our current system, filled with political corruption, high costs, excessive profits, denials, retroactive exclusions and fraud.
By Jack E. Lohman
The system is filled with the profit motive, even at the expense of the patient, and the politicians share the profits. So the political fix is not going to be easy, regardless of which of the two parties are in control, because they both take campaign bribes.
Hospitals have evolved from non-profit church-run institutions to corporations with CEOs and shareholders, too many of which give cash dollars to politicians so the rules are weakened to satisfy their profits. Cash dollars (campaign bribes) flowed before the state legislature nullified the Certificate of Need (CON).
The CON prevented hospitals from building wherever they wanted, and here in Milwaukee we saw new hospitals built near old hospitals “to compete.”
But they didn’t compete because they bought up the local physician clinics (their referral base) and are actually allowed to pay the doctors “productivity bonuses” for admitting patients and performing even more expensive MRIs and other tests and surgeries (whether needed or not).
Thanks but no thanks. We don’t need that type of competition, which drives costs up, not down.
Doctors, incidentally, should be paid very well, but not on the basis of how many tests or surgeries they perform or don’t perform (which is now the case). It’s what they call fee-for-service and applies to both private insurance and Medicare, though Medicare reimburses at a lower (though still profitable) rate. Indeed we have seen doctors who have maxed out their schedule refuse Medicare patients and hold out for non-Medicare patients.
Insurance companies are middlemen that simply profit from the system. More so from well people who need no medical services, and less so from people who really are sick and need care. Remember that only those requiring care increase our costs.
The insurance industry is virtually unregulated where it counts and have even cancelled insurance policies retroactively in what are called rescissions. One woman was refused breast cancer coverage because she failed to report the acne she had as a teenager, as just one ploy they use.
And denials of care are common, like the liver transplant for a 17-year-old girl in California. CIGNA finally approved it after months of public and media pressure, but the girl died the afternoon it was finally approved. Thanks CIGNA, for keeping your profits up front.
Fraud happens, mainly because virtually any outside billing system allows it. Bad guys obtain social security and insurance numbers, even after the patients die, and both private and Medicare are affected. Any time outside billing is allowed, inappropriate billing will occur, and in our case it is estimated at 10% of our total costs.
The Feds should reward outside contractors to pursue villains.
Sadly, we must rely on our politicians, who get a piece of the action in campaign bribes to keep the system broken.