Government run health care ran by private health insurance companies...

[cynatnite]

For the last year and a half, I have been studying to be a medical transcriptionist and a medical coder & biller.

Color me naive, ignorant or whatever, but we got into an indepth discussion about this today in class.

Don't let anyone tell you that Medicare or Medicaid is strictly ran by the government. These are called fiscal intermediaries. The Medicare fiscal intermediaries are private insurance companies that serve as the federal government's agents in the administration of the Medicare program, including the payment of claims. Blue Cross Blue Shield is a major player.

It's been said that a single payer system would be too disruptive to the current system we have in place. My question is how is that possible when big insurance companies who run the current system are also running the government one?

After learning all this today, I feel like I'm getting it from both ends.

[Oregone]

1. Something I don't understand

If it is profitable enough for a private company to administrate Medicare at such low overhead, why is it permissible to create a reform that allows them 15 to 20% overhead?!? And if they are willing to do this model, why even put them in charge of negotiating rates? The insurers could remain and handle the paperwork, and that would be progress.

[grantcart]

4. I am guessing the answer is that they get a set fee for administering

Medicare and have no risk in claims.

The Netherlands has a single payer system that is run along these lines. Very low MLR, universal coverage but the insurance companies are not liable for payment of the claim just administering the plan.

In effect they serve as 'Third Party Administrators' and not as insurance companies.

But I am just guessing on this.

[kenny blankenship]

2. An industry report showed 'farmed out' public programs were the big profit growth center

for the big insurance companies last year.

You THINK they are public programs, administered by the govt. like Medic -are, -aid, or SCHIP but in fact the insurance industry is leeching away tens of billions off them. And THAT's where their business has been growing - $$ from ostensibly public programs.
It's sort of like Blackwater, but the dead people die of bureaucracy, not bullets.

This was the same report that came out this year on last years' data that showed the top 5 or 6 insurance racketeers experienced 56% profit growth last year.

This Guaranteed Insurance Profits Progressive Emergency Reform (GIPPER) being pushed by Obaucus is not something completely unprecedented, it just expands on the existing model of shoveling billions to the insurance mafia in exchange for their political donations.

[cynatnite]

3. And yet the RW says that the poor insurance companies will go out of business if reform happens. n/t

[kenny blankenship]

5. Maybe...It might be possible to choke to death on so much free money

The esophagus and the jaw can only open so wide... But I'll defer to the opinion of a qualified anatomist on that.

[cynatnite]

6. kicking n/t