Wednesday, December 02, 2009

One Percenters Day Four: Yes, I'm still on this, and you should care because you're going to go bankrupt.

One percenters are those people who are willing to say "I'll pay 1% of my gross income as higher taxes if it means providing universal health care so that nobody dies sick and alone due to a lack of insurance."

Day Three is here.

Consider this argument made against allowing the government to run health care: The government is inefficient, people say.

I think that the IRS, the Post Office, the US Military, and NASA, say otherwise. But whether or not the government is inefficient isn't really the point, because private insurance companies are equally inefficient.

That's the message I get, at least, from the Newsweek article about the Cleveland Clinic. The Cleveland Clinic, as detailed in that article, is a marvel of private industry efficiency on the medical provider side; they routinely reduce health care costs by as much as 50% through use of high-tech approaches, novel compensation packages, and other measures (like not hiring smokers -- a genius idea, since smoking should be outlawed).

But the Cleveland Clinic, one of the most efficient of private medical providers, runs into a massive glacier of inefficiency when it hits the private insurers that pay for much (but not all) of the care they give. As Newsweek reports, the Clinic employs 2,000 doctors... and 1,400 clerks to take care of billing.

Why so many clerks? One reason is because private insurers make it difficult to make claims: They count on rejecting a certain number of claims out of hand, to keep the money in their pockets longer.

Imagine if you could take all the bills you get this month, and simply reject them, and then pay them next month, with no penalty and no interest, while your money remains in the bank another 30 days earning you interest! That's what private insurers do, and they do it on purpose-- they deliberately make the claims process difficult (efficient? HA!) and refuse to clarify it. Newsweek reports that "Lyman Sornberger, executive director of patient financial services [at the Cleveland Clinic], keeps asking the insurance companies for their rules so he can submit a "clean claim," but without much success."

To paraphrase: The insurance companies won't explain their own rules on billing. Then they use breaches of those rules to reject claims.


Another reason that so many clerks are necessary is that each insurer has its own rules for what it will cover and what it will pay for what's covered, making it necessary to have different kinds of billing procedures for different insurers.

Again, let's translate this into the "real world" Stupid Mean Insensitive Child-Killing Republicans love to talk about. Imagine if Bank of America, one of the largest mortgage lenders and servicers, had to bill mortgages to you and me the guy up the street and everyone else, but each of us imposed our own system for billing. So I would insist that BofA had to send me an itemized statement with two receipts, while you simply want a quick disclosure form, while the guy up the street says his has to be received in triplicate at a different address... how efficient would BofA be, if they had to do that?

Suppose grocery stores had to do that: Tote up costs for each person based on how that person wanted items rung up: When I check out, I want my produce rung up first, and separately, then all the carb-loaded items billed individually so I could write a separate check for each. How much would the cost of groceries rise, and how much longer would grocery shopping take?

But medical providers have to bill every insurance company separately and count on separate reimbursements and different reimbursements. They have to have, essentially, billing specialists on staff to determine how they're going to get paid!


The Cleveland Clinic tried to make the system better: they said "Let's have package deals," telling insurers that for each procedure, say, giving birth, they'll accept one consistent payment -- say, $10,000. Some births, they know, will be more expensive. Some will be less -- but the Clinic figures they'd even out in the end, and the Clinic figures they, and the insurers, would save on money and transactional costs.

That sounds efficient, right? That sounds like the kind of private efficiency that even Mean Stupid Child-Killing Republicans could get behind.

But not the insurers. They rejected it. They rejected the chance to simplify, to efficiency-fy, their billing procedures.

So. Efficiency, that hallmark of private industry, has been rejected by private industry.

Keep that in mind when the Mean, Stupid, Child-Killing Republicans (and some Mean, Stupid, Child-Killing Democrats) continue to oppose health care reform on grounds that government is inefficient. It is private industry that is inefficient, and private industry won't change. (Government can change; we can vote it to change, as voters have done from time to time. But you can't force private industry to change. If the Cleveland Clinic can't do it, you certainly can't.)

Efficiency, though, is not the only hallmark of a good health care industry. Efficiency isn't the only thing we should be striving for. We should be asking: What do we, as a people, want for our own countrymen when it comes to healthcare?

Another Newsweek article a while back argued that a country's health care system reflects the moral values that country has. That article pointed out that, alone among developed countries, America's moral values are expressed as this:

The poor get only emergency medical coverage. The rich get everything they want.

is the moral value that opponents of health care reform are standing for: They will let poor people get emergency care that might bankrupt them, while protecting the right of the rich to get any medical care they want or need.

With medical bills being the cause of more than 60% of all bankruptcies -- middle class bankruptcies -- we can expect more poor people in the future, as our efficient medical system bankrupts the middle class and makes them poor, while America continues to protect the rights of the rich to get any medical care they want.

Consider this, from a study of bankruptcies and their causes:

"The medical debtors we surveyed were demographically typical Americans who got sick. They differed from others filing for bankruptcy in one important respect: They were more likely to have experienced a lapse in health coverage. Many had coverage at the onset of their illness but lost it. In other cases, even continuous coverage left families with ruinous medical bills."

Demographically typical Americans: That's me and you.

"Even continuous coverage left families with ruinous medical bills."

So you think that you, because you have coverage, are immune to problems, and isolated from this debate?

You're not. You could end up bankrupt, too. You just have to get sick and be denied coverage, or have coverage lapse, or simply hit the limits of your insurance, and you'll be in bankruptcy court, some of you no doubt arguing still that government is inefficient.

Health care is not only an economic issue, as countless billions of dollars get wasted on billing inefficiencies of private industry; it is a moral issue, as America grapples with the question of whether the poor and middle class are just as deserving of medical care as the rich. Every other developed country in the world has answered that question with a resounding yes. America, so far, has said Suck it, poor people.

Time for that to change: Today's politicians to contact, as the Senate gets prepared to debate a bill that only nibbles at the edges of the problem:

"Senator" Max Baucus: Remember "Senator Max," voting down the public option in the Senate Finance Reform Committee, and opting to let your children die in the street?

Want to know why Max wants to let your children die while insurance companies get rich? Here's why: "Senator" Max has taken in over $3 million bucks from insurance, health professionals, and other health lobbyists; those groups make up six of his top 8 lifetime contributors. Three million bucks is the going price, it seems, for letting kids die. Contact "Senator" Max by clicking this link, or by calling him at 202-224-2651, and ask him how much you would have to pay to buy a vote in favor of letting people live; maybe you can outbid the insurance companies for Max's soul.

Since that's unlikely, tell Max, too, that you support a public option insurance plan and that you're willing to pay a nominal amount more in taxes (1% of your gross income) to support it.

The representative for today is "F" James Sensenbrenner, from my own state of Wisconsin. "F" James said this about the House's health care bill (which he voted against):

I voted against this terrible piece of legislation because it is a government takeover of health care that will raise taxes, cut health care services, and perhaps most alarming, set our nation on a dangerous path in which the government encroaches on our lives even more.

"F" James then goes on to say:
"The U.S. Constitution declares “We the people,” not “we the government,” and in my opinion, the government and the United States would be better served by us remembering that."

"F" James probably didn't have time to read any farther in the Constitution than the first three words; if he had read farther, he'd have gotten to the part about how the Founding Fathers were writing the Constitution to "promote the general Welfare," and that as part of that they were granting to the Congress the power to "provide for the... general Welfare of the United States," to "regulate commerce" and make other "necessary and proper" laws to do those things.

In my opinion, we'd be better off without faux-scholars like "F" James in Congress. But we're stuck with him, so you can email "F" James by clicking this link, or call him at 1-800-242-1119 and tell him that the Constitution allows the government to regulate industries, and that you're in favor of the public option and true health care reform.

Just don't expect him to listen: the insurance companies are his second-biggest contributor and have given him over a quarter-million bucks. (Apparently, "F" James can be bought for a lot less than "Senator" Max.)

Still 6 days left in the contest: Comment on this post! You could win a book or magazine subscription (details here) and you'll be making me happy (details on that here.)

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