Do people in the health insurance industry have good insurance? Would they back single payer?

[yurbud]

It occurs to me that one hiccup in a single payer system is what happens to all those people who process claims for the insurance companies. They will be out of jobs.

The executives I don't care about. They should be in prison for premeditated murder.


But I wonder if there would be some value in telling lower level employees that they would be needed to work for the single payer system. That might be easier if they are being screwed by the insurance companies, which isn't hard to imagine from a business that depends on denying service to its customers and letting them die.

A distant second solution would be to contract insurance companies to administer the program as a non-profit, but with pay and other things determined by the state.

[supernova]

1. That's a good question

whether or not people in the industry have good care, i.e. that they don't get claims denied when they try to see the doc or have tests.

My impression is that they don't.

[JDPriestly]

2. Some of them will still have jobs in the insurance industry.

There will be new jobs managing the single payer healthcare -- and these jobs will be more secure and more numerous. If you insure everyone, there will be more claims to process. We will pay less per person for healthcare but not necessarily less overall because the amount of healthcare provided will increase. There could even be an increased demand for claims processors and other health insurance related jobs.

[Nay]

8. National Healthcare would have *no* claims, per se. Thus no need

for all the paperwork processors in the insurance industry. This was demonstrated in SICKO - All you had to do was produce your national health card (or its equivalent) and you were treated. There ARE no "claims." Updating your medical record is the only "paperwork" involved.

I took "single payer" to mean, essentially, national healthcare. If we still involve insurance companies in any way, then we are still screwed. Their paperwork pushers exist to deny claims, obfuscate policy language, drag out responses to requests for treatment, etc. They must cease to exist in a rational national healthcare measure.

[JDPriestly]

11. You don't make the claim, your doctor submits the claim

so that he or she can get paid.

The doctor doesn't just become and employee.

Also, there is room for private insurance. You might buy special insurance so that you could have a private or double room for hospital care for example. There are lots of situations in which people will want to have special care available. The single payer system would be for basic healthcare.

[Spazito]

13. Actually, that is not quite correct wrt claims

There is paperwork but it is extremely minimal in regard to claims. Here is how it works in an office, the same would, in effect, be in place in hospitals regarding the submission of claims:


You come into the doctor's office, either produce your healthcare card/number or, if you have been there before, confirm the number is still valid.

The patient's file is both in hard copy, which goes to the doctor and on the computer, the computer file is updated to reflect the visit and, once a day in a big office or in smaller practices, once a week you run a program that lists all the visits of all the patients during a specified period with a specific code designating what the visit was for, starting from the last day you previously submitted and ending on the day of your submission, and within that program you simply transmit the claims to the provincial government agency that handles the claim. The claims are paid on a regular schedule, with most going through without a problem unless a medical # is incorrect.

Edited to add, hopefully, more clarity.

[yurbud]

15. you are assuming either privately administered public single payer system. That would be better

than nothing, but the potential for abuse would still be higher than an all public system.

[bluestateguy]

17. Private insurance is much more bureaucratic than the public system

Private insurance requires more employees beucase of the marketing aspect of it. Many of these people work on the business and marketing side of things, rather than the processing of claims and serving of customers.

The fact of the matter is that only some, some, of the private insurance employees could be picked up for employment under a public health care system. Many others would simply have to look for work elsewhere.

[yurbud]

23. give them jobs as prison guards tormenting their former employers.

[ikojo]

35. One of my co-workers needed a hysterectomy

two years ago. She was bleeding profusely. Her doctor's nurse practitioner literally sat on the phone and argued with the insurance company for eight hours to get the hysterectomy approved. The RN at the insurance company was trying to delay the procedure by saying my co-worker needed tests that had already been done!

So, no, just because one works for an insurance company does not mean one gets preferential treatment. About the only way it helps is knowing someone on the inside to go to when claims are not paid or are paid to the wrong provider.

FYI: Most claims are not reviewed by a human being. Most insurance claims are submitted electronically and reviewed using software programs meant to question every code billed by a hospital and doctor.

[nonconformist]

3. A single payer system would create jobs

And I'm sure that people that are experienced in the health care industry will have first dibs.

They'd also be government employees, and all the benefits that go along with that (like a pension).

[sandnsea]

4. Claims will still need processing

Those people will just go to work processing claims under a new system.

People also ought to be realizing that we have non-profit health care now, and it isn't any cheaper than for profit.

[yurbud]

16. how can non-profit NOT be cheaper? You don't have the overhead of for-profit

in at least profits, and probably in exec salaries and the like.

[sandnsea]

25. Here

http://www.peacehealth.org

Email and ask them.

[Kingshakabobo]

27. Why don't YOU back up YOUR claim? n/t

[sandnsea]

29. dupe

[sandnsea]

30. That's where I get MY health care

And it isn't cheaper.

Why don't people know how many non-profit health providers this country has??? I would bet MOST are non-profit.

[Kingshakabobo]

31. I see. Perhaps I mis-understood.

I don't think you can compare a "not for profit", operating in today's market, with a national single payer system with the profit motive (and all the corruption it buys) removed.

Not for profit doesn't equal a government run system and its economies of scale.

[sandnsea]

33. See #20

Not sure every person really understands the health care system we have, which makes it difficult in moving forward.

Some folks around here might be surprised to know that George Bush has advocated, and funded, a government clinic in every county. That's pure socialized medicine, and somehow or other, we don't get behind it if that's the direction we want to go - or beat him up because HE'S implementing socialized health care. :crazy:

[yurbud]

39. healthcare providers aren't the same as insurance companies

[sandnsea]

43. BC/BS

They were nonprofit until 1994, and there are still BCBS nonprofits.

http://www.consumersunion.org/conv/bcbs.html

Kaiser is nonprofit.

http://www.kaiserpermanentejobs.org/aboutus_history.asp

The answers to our health care problems are not simple.

[Warren Stupidity]

44. We have to define what we mean here.

Otherwise the discussion becomes meaningless.

Not-for-profit healthcare delivers its services, per service delivered, at a lower cost FOR EQUIVALENT SERVICES than the same service delivered by a for-profit system. This is a given as the equivalent service must be charged at a for-profit rate by the for profit provider, while the non-profit provider does not have to charge for the profit.

Where this becomes difficult is that comparisons are rarely looking at equivalent services. Instead they may look at 'per patient cost' for example. Consider a routine doctor's visit. The for-profit system may be increasing efficiency (and thus maximizing profits) for routine office visits by strictly limiting doctor-patient 'face time' to 15 minutes. The for profit can then process four patients per doctor per hour, maximizing income and minimizing costs. (The doctor is assumed to be paid per hour not per patient.) The non profit may in fact have a charter that requires it to focus not on efficiency but on quality. It might have no such strict routine visit face time regulation for doctors, and its doctors might average 30 minutes per patient. The non profit's costs for running a primary care clinic will in fact be higher than the for-profit clinic. The difference is that you get vastly superior service at the non profit clinic.

[sandnsea]

46. Not in my experience

First of all, I've worked in the alcohol/drug treatment field and am familiar with both profit and nonprofit treatment. There was no functional difference. The difference in care started as cosmetic. The private facilities started with big investments and good benefits, and could recruit the top professionals. Over time, however, most of the people with ethics left. Between the corporate games and insurance games, it just wasn't worth it. Ethics doesn't equate to quality care, however. Perfectly good doctors, nurses, counselors, can be good at their job and figure there's no sin in providing service to those who can pay for it. Anybody with money is going to want to go to the facility that has a gym and quality food and new furnishings. For the person working for the underfunded nonprofit - it gets wearing. I would never blame anybody for packing it in and taking the job where they have motivated clients and money to do their job. Therefore, the quality of care was a toss-up and mostly depended on philosophy of the facility.

I have also received treatment at nonprofit, government funded, health clinics. None of them have been superior to a private doctor's office. The typical nonprofits - all the religious hospitals and whatnot, they've been about the same as private in my experience. I've actually always lived in areas with a strong Catholic medical system so I may have experienced health care differently than folks with a mish-mash of public/private care.

I also did billing for an opthalmologist, although not collections. The interesting thing to me was that the only people who could write a check for expensive care were senior citizens. He also usually saw 6 patients per hour, 9-10 hours per day. He never had off time, there wasn't a day he didn't get called into the emergency room for something. He never even knew how a particular patient was paying him, he didn't have time to care.

Most doctors say they couldn't get by on Medicare/Medicaid payments. That's nearly half of all health care as it is. What keeps those patients from being a burden is the doctor's ability to overcharge insurance and wealthier patients.

And this doesn't even get into the cost of medical equipment and the profit there. Unless we're going to take the profit out of all of those manufacturers too.

[Warren Stupidity]

5. Medicare will be hiring.

Yes of course some people will lose their jobs, but the insurance industry is huge and can absorb some of lost health insurance jobs and medicare will have to hire to expand its claims processing operations. We are not talking about a huge number of people.

I've got an idea, how about we implement a decent unemployment system to go along with a decent healthcare system? The current one is massively shitty.

[yellowdogintexas]

24. I worked in medical insurance for years.

1. Medicare is subcontracted to carriers who bid for the claims work. I worked 8 years for Equitable Life which was the carrier for the physician side of Medicare. We paid claims, and I do mean we paid them. Yes sometimes we denied them but they were for services clearly not covered. There are provisions in every insurance contract, which must be abided by.

2. Medicaid is also subcontracted out to carriers. Lowest bid gets the contract.

3. When I worked for Equitable, AEGON, UICI and Pacificare, I had great benefits. Not because they were insurance companies but because they were BIG companies. The bigger and more diverse the risk pool, the less cost per person to administer the plan. I work for a company w/ over 40,000 employees and we have pretty good coverage. No One's coverage is as good or as moderately priced as 20 to 30 years ago but still, not bad.

4. Even when I processed claims for small group and individual plans we were not ever pressured to figure out how not to cover a service, especially if the age of the policy were past the pre existing limitation in a given state. Sure, if a policy was 2 months old, and we got a claim for cancer, we had to determine if (a) they were within the continuous coverage rule or (b) the cancer was diagnosed since the insurance was purchased, because we could rescind the coverage if the cancer was known at time of application and not disclosed.

Errors do occur: like the time I had a first claim submission and the diagnosis code was quadripelegia. We nearly killed ourselves laughing over the idea that the agent who sold the policy overlooked the fact that the customer couldn't walk or move his hands. However as it turned out when I called the physician's office to request the office records, the nurse asked why I wanted them for a simple thyroid followup? (nobody ever investigates for thyroid, it is not one of the big scary things, you know). I said well, tell me this, does he have any trouble walking? No, she said he was just in here yesterday to pick up some samples of a new medicine. So I told her she might want to consider a corrected claim for the earlier visit...then I read her the diagnosis code and she nearly killed HERself laughing. It was a code transposition on the diagnosis box.

5. Most coverages have specific exclusions and limitations built in to them, and they are pretty standard. There are also state mandated things which must never be denied. A group which is designing its own coverage contract with a carrier can build in things which its members especially want.

6. From the time I worked in claims for Medicare, I have maintained that if every employed person in this country who either has no coverage or has very limited coverage were combined into one large group, which would be in fact a much healthier group than Medicare, we could have decent care at reasonable cost.

7. Yes there are policies sold in this country which basically cost a lot of money and don't cover crap. Yes big Insurance does not want a national plan because they won't make as much money. But we will still need paperwork, it will just be of a different type.

In the early Clinton years, when their plan was being discussed, the VP of my then employer, which designed, sold and managed small group and individual plans held meetings for two days with employees hearing anti-health plan propaganda from a couple of attorneys, a lobbyist and the VP himself about how this plan would destroy our jobs. IT was a cheap shot and it mad me so angry I had a migraine over it; it was Christmas Eve and we had to listen to this, when we really wanted to go home early. I had work to do for crying out loud, which I thought should be of more importance than listening to him

I also think a national plan will create more jobs in the claims industry. A great deal of the work is imaged and auto processed from tapes but if the info is even the tiniest bit irregular it kicks out and has to be manually reviewed.

Enough ranting for now.

[yurbud]

40. this is the most informative response so far!

[SharonAnn]

42. And will be outsourcing for administrative services. LIke my company which is

self-insured by hires Cigna to administer the claims.

[Hekate]

6. Lower level workers have no say in management decisions. Transitioning them to other employment...

...is a compassionate idea, but I think the whole idea of single-payer is to remove the vast majority of the claims-processing bureaucracy.

The problem with the health-care industry is that it is actually an insurance industry -- that is, "industry" is the wrong paradigm for health-care delivery in the first place, and second, that it runs for the benefit of the corporate insurers and not the doctors/nurses/patients. So ever more paperwork gets processed by ever more low-level employees. I don't think a single-payer system needs so many employees.

But those employees' livelihoods are at the mercy of their corporate masters now just like the employees of AT&T.

Hekate

[yurbud]

18. call it "billing" then. Doctors would still need to submit bills to the new system.

[Hekate]

38. This is true. nt

[Hippo_Tron]

7. I think they've already started outsourcing claims processing

Only a matter of time before their jobs are gone anyway.

[yurbud]

19. so you talk to someone in Bangladesh who gets paid a handful of rice a month.

[ikojo]

36. Most claims are submitted electronically

by the provider and are not touched by a human.

Many customer service jobs have been outsourced to cheap labor states in the south or southwest or out of the country to Jamaica or Phillipines. UnitedHealthGroup uses customer service and claims processors in Jamaica and the Phillipines.

[proud2BlibKansan]

9. My sister works for big pharma and she has GREAT insurance

[Stinky The Clown]

10. This thread brings up some currently unaswerable questions

By 'single payer' do we mean one payer (the government) and multiple private providers? Or one single government system were providers are, in fact, employees of the health care system?

[supernova]

14. You're talking about

basically the differences between the different systems.

As I understand it, Canada has multiple providers but they all get reimbursed through the Canadian gov't.

The British National Health Service, providers (docs, nurses, techs) are all employees of the gov,t.

France seems to have some sort of hybrid of both. (you can go to the state run ER or call a private doc to make a housecall.)

I'm not sure that's entirely accurate, just what I've been able to learn so far. If anybody has more info, I'll be glad to learn.

Bottom line: these are issues worth discussing and debating before we set up our own system. (Personally, I'm in favor of as small a role as possible for insurance cos.)

[yurbud]

22. I think insurance companies should be allowed to cover cosmetic surgery and colonics for cats.

[supernova]

32. If you can successfully give

a cat a colonic, then YOU'RE definitely going to be in need of the ER!

:rofl: :rofl:


Ideally, I would love to see insurance companies die. Period.

[yurbud]

20. one national "insurance" and private providers

seems to be the most radical option to have broad support. I wouldn't mind seeing private hospitals and all of that taken out of the loop altogether, but that would just be frosting on the cake.

[Warren Stupidity]

45. please separate 'healthcare' from 'insurance provider'.

Then it all becomes clear. Medicare for everyone. Private healthcare providers, both for profit and non profit, would continue, as is, to provide healthcare. Single payer removes Cigna, Blue Cross, et al from the middle - the middle which provides nothing at all in terms of healthcare but which extracts billions in profits for passing payments from one party to another. Just scrap the whole middle. Everyone pays in through FICA, everyone gets the same basic coverage through medicare. We get to vote on what the coverage is and how much it costs.

[azurnoir]

12. Ny sister-in-commonlaw

worked for Delta Dental in short NO,even her dental plan was crappy the lowest level Delta offers, my SO on the other hand works for a European owned company he gets a very good health plan the same one from my employer was twice as much (I work in health care) and the high level Delta for less then his sister pays for the low, BTW this company also offers domestic partner coverage no matter what gender you are and coverage for not only our son but my daughter from a former marriage.

[yurbud]

21. I teach college and had NO employer based healthcare for eight years. Now for myself only

if I had a significant other or kids, they would not be covered.

[azurnoir]

28. I worked for the University of Minnesota and they offered

domestic partner coverage for same sex couples only, because gay marriage is not legal here, so the reasoning goes if not same sex you could be married.

[nealmhughes]

26. Do you mean like all the textile industry employees who lost jobs when NAFTA and then

CAFTA and then China came in?

Guess what happened to them throughout the South and in NE in the shoe industry? Please tell me, because I honestly don't know.

[ikojo]

34. I work for a health insurance company.

I DO NOT have free health insurance. I am single and pay approx $25 every other week toward the cost of my insurance. If I want to see my primary care doctor it is a $10 co-pay. If I want to see a specialist it is a $20 co-pay. A visit to the ER is a $100 co-pay.


I support universal health insurance.

Many people where I work swallow the corporate propaganda, though. It's all they hear.

[yurbud]

41. thanks for the response!

[siouxsiecreamcheese]

37. I worked for a major health insurance company..

and had horrible coverage, still paid about 200 a month for it.