Health care isn't a "right"

[Catkin]

4 million dollars in one state insurance's budget could not make "a discenable difference" in healthcare?  Agree to disagree, I suppose. 

As I said before, the CEOs pay comes to about a dollar per person.  Where does all that other cost come from?

In your case, you said you've spent 5k plus premiums.  The CEO pay is one dollar of that cost.  Again...one dollar.  What do you think caused the rest of it?

I already told you.  Claims.

The rest of the quotes you attributed to me but were actually from CHF.

That's for things that fall past the "limit" of what they'll cover or are considered "experimental" even though his team of doctors has plenty of research proving otherwise and are participating in research on the subject as we speak.  Oh, and it helps him.  And then you have medications, which you also have to pay for.  Most of the meds are newer (as GI research is a fairly young field).  And then he alone pays roughly $4,000 in premiums.  So around $10,000 a year for health care in the free market.  He was healthy when he joined them as a customer nearly 10 years ago.  And rarely made claims.  So they made a good $3,000 a year off of him for 6-7 years, and now he has health problems and he still has to pay for a majority of them.

There is one CEO.  How many executives are there?  How does the CEO travel?  Does he pay his own gas?  Does he pay for his own vehicle?  How do the other executives travel?  Do they all carry blackberries and laptops?  Etc.  In a big company, the pay package for the execs is just one of the perks.  It's not the only thing which drives up prices, but it is a contributing factor.

I guess that extra $50 a month in premiums all next year will cover all the mailers BCBS sent out to folks crying about how hard it is for them to make money.

It's kind of a vicious cycle that bites them in the keister.  They price most folks out of their services.  Those people go to the hospital and run out on their bills.  The hospital raises their prices to cover for the people who couldn't afford their services because they can't afford insurance.  The insurance company gets charged more.  They whine about how little profits they're making.   They would make a lot more profits if they lowered their prices to ensure a lot more people and the medical industry could charge a price which didn't have a built in tax to cover those who can't afford it.

[RJLeeb]

4 million dollars in one state insurance's budget could not make "a discenable difference" in healthcare?  Agree to disagree, I suppose. 

As I said before, the CEOs pay comes to about a dollar per person.  Where does all that other cost come from?

In your case, you said you've spent 5k plus premiums.  The CEO pay is one dollar of that cost.  Again...one dollar.  What do you think caused the rest of it?

I already told you.  Claims.

The rest of the quotes you attributed to me but were actually from CHF.

That's for things that fall past the "limit" of what they'll cover or are considered "experimental" even though his team of doctors has plenty of research proving otherwise and are participating in research on the subject as we speak.  Oh, and it helps him.  And then you have medications, which you also have to pay for.  Most of the meds are newer (as GI research is a fairly young field).  And then he alone pays roughly $4,000 in premiums.  So around $10,000 a year for health care in the free market.  He was healthy when he joined them as a customer nearly 10 years ago.  And rarely made claims.  So they made a good $3,000 a year off of him for 6-7 years, and now he has health problems and he still has to pay for a majority of them.

There is one CEO.  How many executives are there?  How does the CEO travel?  Does he pay his own gas?  Does he pay for his own vehicle?  How do the other executives travel?   Etc.  I guess that extra $50 a month all next year will cover all the mailers BCBS sent out to folks crying about how hard it is for them to make money. 

Where did you get that $50 a month stat?  Is there any logic behind that?  How did you go from 1 dollar a year to 600 dollars a year?

The other executives get in their cars and drive from their homes in Cary, Raleigh, Chapel Hill, etc.

Look, I can already tell you're not going to be logical about this.  You're upset about your husband's condition and you're obviously looking for something to blame.

Consider your propensity to place blame where it doesn't belong (i.e. the CEO of BCBSNC instead of rising claims) we might be able to make some other deductions.

We know that stress affects IBS.  Now we have some idea where that stress might have come from...

[RJLeeb]

They price most folks out of their services. 

Also, do you care to back up that claim?  You're saying most people can't buy insurance?

I thought about 65 percent of people are covered by private insurance?

[snowcamper]

As I've said before (Belle, I'm still waiting for your response)... you won't eliminate "all of those other executives" with a government plan.  If anything, you'll add to their numbers.

The government uses more people in management per unit of output than does private industry.

Meaning, the very issue Catkin is complaining about won't be fixed by a national plan... it will get worse.

Yes, we might get rid of a CEO... but do you think that the "director" or "HC Czar" or "cabinet member" or whatever you call it won't have a car.. benefits... travel... a staff?  If you believe that, I've got a bridge to sell you.

So really, we're reducing (not eliminating) the possibility of a CEO's salary.  In the case of BCBSNC, that would be $3.5 million per year, spread over 3.5 million policy holders, per year.
or about $1 per policy holder per year

You are refusing to acknowledge this simple fact.  You are not discussing this issue honestly.  You apparently can't see past your greed-laden emotional response that "it's because of the CEO's salary" and you can't think logically.

Fair enough, but you're wrong.

[Catkin]

Where did you get that $50 a month stat? 

I don't think you read it quite properly, I was talking about how our premiums went up 50/month, and that I guessed that was what had covered a mail out which had been sent.

The other executives get in their cars and drive from their homes in Cary, Raleigh, Chapel Hill, etc.

Other executives don't provide a service which can be the difference in life and death.

Look, I can already tell you're not going to be logical about this.  You're upset about your husband's condition and you're obviously looking for something to blame.

Consider your propensity to place blame where it doesn't belong (i.e. the CEO of BCBSNC instead of rising claims) we might be able to make some other deductions.

We know that stress affects IBS.  Now we have some idea where that stress might have come from...

Actually, I think my husband and I are very lucky.  Had he be uninsured or had a more serious condition, we really would be "up the creek".  I use his condition as a "real life" example of how the system is flawed.  A man with a common and treatable condition has just spent $10,000 a year, including his insurance.  That does not seem reasonable.  It's not even life threatening.  I shudder to think what our lives would be like if he'd been diagnosed with MS or some similar disease instead.  We're lucky where others have not been.

I think that your personal attacks are absolutely adorable.  Maybe now you'll claim now that I gave my parents cancer since I mentioned that in relation to insurance as well.     It seems a common tactic, "I can't browbeat you into agreeing with me, so I'll just insult you instead."  I haven't stooped to insulting you, even though I disagree with your positions.  I like that you've presented your side, and I think that you've done it well and have given me a lot to research and think about.   Claiming that I make my husband sick is pretty nasty and over the line.  Enjoy the discussion, I'm not participating in a petty exchange of insults.

[snowcamper]

Other executives don't provide a service which can be the difference in life and death.

But their jobs are still necessary to providing health care.  Without the executives and middle management, you'd have a team without a coach... an army without a general... you'd have no one with final decision making authority.
You'd have no innovators, no leaders, no people to turn to when things went wrong.

This statement makes absolutely no sense in the real world.  Maybe in a fantasy communist/cooperative/hippie commune world, but not in the real one.

[bobsyouruncle]

One of the big lies being pushed by the socialists is the claim that insurance companies are raping people for unconscionable profits. 

That's just an ugly, messed up thing to say.  Argue as much as you want on behalf of the insurance companies, but stick to what you know.

[bobsyouruncle]

The "shiftless lazy slacker" can go to the emergency room right now and get treatment.  It is against the law to turn them away, regardless of their ability to pay for it.

But only emergency treatment.  No chemotherapy.  No surgery to keep from going  blind... etc  A lot of people in bankruptcy today because of medical bills HAD INSURANCE.  Who cares?  You know that already.

...Like someone else said, I think it was Snowcamper, if we looked at BCBSNC, each person paying for insurance pays about a dollar a year for the CEO's pay.

Yeah that's right.  A dollar.

I have to wonder if it has ever occurred to those that yell about executive pay for insurance company CEOs that all this is some sort of red herring.  Their pay doesn't make a discernible difference in the cost of healthcare...

Let's have a show of hands of anyone who thinks that $4 million is anything more than a drop in the bucket for BCBSNC.   No one?

Snowcamper jumped to his own conclusion about why people talk about the amount of compensation  insurance executives get.  It's not because anyone thinks that money is a significant expenditure in the overall budget of insurance companies. What is unattractive is the reality of people getting rich off insurance premiums while they sit in meetings thinking up ways to siphon off more money from premiums they collect before it can get to the actual people who provide the health care. 

The $1 a year argument is bogus.  Hey,  $100 million a year would just be pennies a day from each customer.  But that's not the point.

We don't need insurance companies and they know it.  That's why they have been spending $1.3 million a day on efforts to stop a public option.  They wouldn't worrry about a public option it they didn't know that what they do can and should be done more efficiently, honestly and humanely.

They back health care reform that requires everyone to have coverage as long as it has to be purchased from them. Insurance companies are the ones pushing for severe penalties for people who don't buy insurance.  And they will happily take all the tax subsidies they can get. 

It's funny to see you guys toting water for millionaires after hearing your righteous indignation over minimum wage. 

[RJLeeb]

I like that you've presented your side, and I think that you've done it well and have given me a lot to research and think about.   Claiming that I make my husband sick is pretty nasty and over the line.  Enjoy the discussion, I'm not participating in a petty exchange of insults.

Actually, I appreciate your comments here, because they disprove one of Bob's assertions:

It's not because anyone thinks that money is a significant expenditure in the overall budget of insurance companies.

Yeah right Bobs.  That's why Catkin said this:

There is one CEO.  How many executives are there?  How does the CEO travel?  Does he pay his own gas?  Does he pay for his own vehicle?  How do the other executives travel?  Do they all carry blackberries and laptops?  Etc.  In a big company, the pay package for the execs is just one of the perks.  It's not the only thing which drives up prices, but it is a contributing factor.

I guess that extra $50 a month in premiums all next year will cover all the mailers BCBS sent out to folks crying about how hard it is for them to make money.

As you can see, people obviously DO think that executive pay drives up costs.

You liberals have made insurance companies out to be some sort of boogeymen.  All of that is just a distraction from the fact that CLAIMS are the thing that has driven up costs.

Let me say that again for those of you that just don't seem to get it.  CLAIMS.

For those of you supporting the single payer option, or the public option, please explain to me how the government intends to deal with that.

After all, one of the big arguments the Democrats are using for all this is cost.

If we took every CEO out of the picture, as if they didn't earn a penny, what difference would it make in the cost of healthcare?  Tens of millions of dollar?  A hundred million?

Do any of you have any idea how small 100 million dollars is in relation to 1 trillion dollars?  Apparently not.

The liberals supporting so-called healthcare reform have been duped into believing that the enemy is group of CEOs.  They've used the whole class warfare angle and you've fallen for it hook, line and sinker.

This is indisputable because the quality and delivery of healthcare is going to suffer due to costs going up in the coming years.  Right now the government is telling you that by giving it to them, people won't have to deal with less care in the future.

I hate to break it to you, but they simply can't deliver on that promise.  This is nothing more than a bid for control by our government. 

The next 10 years will prove me right, but by that time it will be too late to do anything about it.

[bobsyouruncle]

I'm not going to spend a lot of time  going over things I've said over and over before, but if you aren't familiar with insurance and billing and hospital admitting practices etc, and you are predisposed to be against any initiative championed by Democrats, you won't pay attention anyway.

Here are two points--briefly:

Hospitals, doctors offices and insurance companies spend a lot of money on personnel to deal with billing and claims. Patients all come in with different policies in terms of what is covered, deductibles and co-pays (what has already been met). 

In addition, insurance companies have to pay a sales staff, and often people in insurance sales continue to collect a commission off a policy as long as it is in force.  Companies pay for advertising and lobbyists. It's been proven that they also pay people to find reasons to dump customers.

But back to billing and processing claims.  On Medicare claims, the hospital knows exactly what Medicare will pay because the coverage is standard.  They bill--Medicare pays quickly, and then the hospital or clinic has a formula for which services are considered paid in full or what co-pay is left for the patient, who may or may not have a supplemental plan.

For private insurance claims, every patient will have different policies that cover different procedures at different percentage rates.  What happens constantly is that insurance is billed, they don't pay immediately.  They are rebilled and meanwhile the patients are calling to complain that they are  getting statements for charges that should have been billed to insurance.  Insurance may pay, and then patient is billed for the remainder.  Patient complains that something should have been covered.  Dr.'s office or hospital patient accounts calls insurance company who explains one of a several things.  Patient is actually correct and claims need to be rebilled, patient wasn't actually covered at the time, patient hadn't met deductible or only partially met deductible, this procedure is not covered under the policy, company has never heard of this person,  spouse's policy is primary and should have been filed first with this policy billed after the first policy paid (at which point the hospital or clinic has to get back in touch with the patient and and find out all the information on the other policy)... I could list 20 variations on this I have dealt with myself.  Plus each company will have negotiated the reimbursement rate with that particular facility.

For instance, I had a Mutual of Omaha policy once with a high deductible but then insurance covered 100 % of covered charges.  With UNC Hospitals, the deal was that the company paid 75% of the hospital charges and that was considered that the company had paid 100%.  That percentage changes with every company, and patients without insurance have to pay 100% of those charges, which are understandably inflated so that the hospital doesn't take a hit when it takes a lower percentage for all BCBS patients.

It is terrifically complicated, Leeb, and takes a whole staff of people and lots of time by patients.  Each employer has to have an individual or staff to deal with claims.  It takes training in all the different ways different payers operate.

Single payer like Medicare would simplify all that.  Any hospital or doctor's office will tell you that Medicare claims are paid quickly and accurately.  Under a single payer system, more money spent for health care would be used to pay for health care. There would be no need to pay out the money that comes from premiums and goes to sales and commissions, advertising, billing patients for premiums , rebilling, time in admitting patients in which personnel has to contact each insurance company to get authorization for admissions, surgeries or particular treatments or medications, explanations why patient didn't use an authorized hospital or doctor within the "network."

You'll read that administrative costs for private insurers are generally 20% or more and that Medicare's administrative costs are more like 3%.  Insurers have spent a lot of money paying their think tanks to attack the 3% figure, but they know that Medicare is more efficient and cost-effective.  That's why they are fighting as hard as they possibly can against a public option.

If health coverage for everyone was included in how our taxes are figured, there would be no billing for premiums and no sales force and commissions to pay, no advertising staffing necessary. No lobbyists to pay.  The cost of products made in the US would not be burdened with the cost of health insurance, making our products more competitive globally.  Small businesses wouldn't be penalized for having smaller groups with smaller risk pools which makes makes their coverage more expensive.  j

Individuals could feel free to go out on their own because they would not have to worry that age or pre-existing conditions would make it difficult to impossible to get health insurance coverage.  People wouldn't lose their jobs or not get hired because of a family member with a chronic condition that made them undesirable to an employer-sponsored group plan.  No one would lose their coverage because they got sick or older.

The risk pool would be optimized because it would include all citizens.  The premiums of the young and healthy would help offset those of the elderly or chronically ill, without some insurers having an advantage of cherry-picking  more profitable customers and dumping older ones.


If single payer worked like Medicare, everyone would have the same coverage.  Medicare would be billed and paid--no sweat over knowing the specifics for each individual's insurance coverage,  what is covered, who is primary and secondary insurer, no question of deductibles, no hassle over which procedures are covered and which aren't. 

My other point is about the bogus "class warfare" argument.  You have ignored or characterized as "sob stories" all the documented  cases of illegal and unethical practices by insurance companies. 

I can talk from firsthand knowledge what a headache and an expensive mess it is to deal  insurance billing and claims.  Someone will read this and understand something they didn't realize.  That's why I'm taking the time to respond.

Without insurance companies spending our money to confuse and scare people, it would be obvious how much simpler and  less expensive it would be to simply pay a health tax along with our income tax and totally do away with the mess.  You'd have standardized billing and claims.  All insurance companies have active fraud units.  Medicare does too, and it would be easier to spot fraud with standard coverage.

The movie Sicko was made to give a particular point of view, not a comprehensive treatment.  That said, it's very effective. 

(This is probably full of typos, but oh well.  It's too pretty a day to stay inside and proofread.)

[djkelly]

Liberals do not think a universalized health care payer system will solve all the problems we now have in the system.  No one thinks that.  (I was just talking to all the liberals, just today, as it was raining and we were all hanging out at Bo Jangles in Siler City.)  Liberals just see the current system as seriously broken, and we notice that many other countries do have a single payer type system, or in some other way try to achieve universal health care for their citizens, and these countries seem mainly to be in other ways much like the US, except perhaps with a less vibrant health insurance business sector.  

If you look into the details of those countries with some type of single payer system you'll find that most of them are facing serious financing problems.  This is true even though they have set spending limits, which we don't have on Medicare, which is what leads to the rationing and waiting lists people complain about.  The costs of medical care have and continue to increase dramatically around the world largely because it's become effective and so many more treatments and procedures are available now.  No one has really come to terms with how much we should be paying for health care and how to pay for it.

[djkelly]

I never said anything about who would benefit from a government plan.  Do we someone earn the right to someone else's goods even if we can't afford them just because we work?  It's a fundamental principle that we don't have a right to someone else's labor.  If we did we'd have anarchy and anyone could walk into anyone else's home and take whatever they wanted whenever they wanted.

When "affording" those goods is literally the difference in living and dying, there needs to be some basic guarantee that services are available.  A person should never have to make a decision to bankrupt their family or die.   

That's why we need to focus on reducing the actual costs of health care and focus on a way to help those that need the help in a way that doesn't hurt everyone.  Mandating that someone else whould pay for it doesn't solve the underlying problem.

Your argument would be better served if you would step away from exaggerations like "slavery" and "anarchy".  I mean, looking at this objectively, you're saying that a universal health care system will lead to the fall of the entire government and a state of lawlessness ala 'Mad Max'.  That is a silly argument. 

That's why I never made any such argument.  Those statements were about the fundamental issue of what are rights and why the number of actual rights are so limited.  That doesn't mean the government can't be involved in providing some of the things discussed but if they are it's for reasons other than because they are rights.  I've been discussing health care reform very objectively but what I'm hearing from most supporters is a lot of emotion and very little objective reasoning.

We can wish that created a government run health plan will solve all our problems all we want but it won't change the reality that it won't.  This is a much bigger issue and the usual political solutions won't solve it.

I've never claimed that at all, and in fact explicitly stated that it came with its own set of problems and ordeals.  In my opinion, it is the best of many imperfect options.  I have family in other countries with universal health care.  Overall, they are pleased with it, and the system serves them well.  While they admit that there are problems, they are baffled at the amount I have to pay for health care.  I have had two parents with cancer in this country and my husband does medical billing.  I am overall unhappy with the system, as a person who has dealt with it from both sides, is gainfully employed, and who provides my own insurance.  I don't think this way is the better option.

The majority of people in this country feel our system serves them well although they also agree there are problems that need to be addressed.  It's also not hard to find people in countries with government run insurance that feel it has failed them.  There are always anecdotes, sometimes large numbers of them, on all sides. 

No one is saying that it's perfectly ok to let people die of cancer or infection.  What many people are saying is that we need some fundamental changes in our approach to healthcare that control the costs so no one has to make those choices.  The public option doesn't do that, it just shifts the burden to someone else and makes it even harder to do what is necessary.

The burden is already shifted to us by paying for people that file bankruptcy when they cannot afford their medical bills.  When they are forced to let debts go because they can't afford them, we buy that.  We pay higher prices for all of our medical care to support those who cannot afford it.  Entire countries provide their entire populations with medical care for less than the US spends on Medicaid alone.  It is not unfeasible that a single-payer system in the US could save us money. 

So if we're already shifting the cost now, shouldn't we be making sure we actually reduce the real costs instead of just shifting them some more?  I don't see a single payer system will reduce the cost of healthcare unless it's just to put some cap on the amount spent. 

Entire countries may also have a lot fewer people in them to provide health care for.

A person who goes to the doctor every 6 months because they can afford it has health problems that are caught early and managed reasonably, as opposed to being hauled in by ambulance to a hospital for a week after they're seriously ill, and then being unable to foot the bill and filing for bankruptcy.  To use a car analogy, we're replacing the engine in the car every year instead of simply paying to have the oil changed when it needs it.

Now who's being dramatic.  We do need a lot more work in patient education and access to health care.  For example, despite giving low income people Medicaid so they have access to doctors, Medicaid patients are still generally among the largest users of the Emergency room.  This is an availability and education problem, not an insurance problem.

On the other hand, I see a lot of people against the single-payer option, which is their right (and I'm glad it is), but I'm not really seeing substitutions for how to drive prices down on medical care so that people can afford it.  Their entire position seems to be "I am against single payer".  What is the suggested alternative?  And why is that not being pushed forward and promoted instead of the ridiculous "OBAMACARE WILL KILL YOUR AUNTIE AND PUT YOUR NURSES INTO SLAVERY AND CAUSE ANARCHY IN THE STREETS" rhetoric that's getting thrown around?

There have been so many alternative proposals made on this very board as well as many other places that if anyone hasn't seen them yet they must be relying solely on the MSM for all their information or are refusing to see what's out there.

[djkelly]

Health insurers routinely deny coverage to people, leaving them without access to health coverage in a country where relatively few people have the resources to pay for costly hospital care and medical procedures out of pocket.  The insurance industry has forfeited its right to a monopoly.

Whenever you say this it makes me think that most people are denied coverage for no reason.  I agree there's a problem with the individual market but that's mainly because government meddling in the market has driven the vast majority of people into the group market through employers.

Just what does the insurance industry have a monopoly on?  the insurance industry?

They cut older people out of health coverage years back because they weren't profitable.  That's the situation Medicare addressed, with private companies happy to sell supplemental plans now that Medicare pays the major cost of claims.

That's not entirely true.  Health insurance coverage was fairly limited until the 50s and 60s.  The number of elderly insured was growing, with about half of the elderly covered when Medicare was passed.

[djkelly]

What alternative plan are those who are against universal health care proposing?  How does it differ, and what would its benefits be?

Why the free market, of course. Just accept the status quo. You can see how well that has worked out.

If you believe the current system is a free market it's no wonder you don't understand what the problems are.

[djkelly]

I'm not going to spend a lot of time  going over things I've said over and over before, but if you aren't familiar with insurance and billing and hospital admitting practices etc, and you are predisposed to be against any initiative championed by Democrats, you won't pay attention anyway.

I currently work in medical billing and I've dealt with plenty of my own medical billing issues so I found your descriptions interesting.

Hospitals, doctors offices and insurance companies spend a lot of money on personnel to deal with billing and claims. Patients all come in with different policies in terms of what is covered, deductibles and co-pays (what has already been met). 

In addition, insurance companies have to pay a sales staff, and often people in insurance sales continue to collect a commission off a policy as long as it is in force.  Companies pay for advertising and lobbyists. It's been proven that they also pay people to find reasons to dump customers.

It's been proven that a few companies have had their employees do this.  It hasn't been proven that most do.  It's also been proven that some people fill out fraudulent applications which is why they review them and look for errors.  In order to save money they don't review every application in detail because most people won't make a claim during their pre-existing condition waiting period.  A full review requires obtaining medical records from all doctors the patient has seen in a set amount of time so that's a lot of work for the insurance company and the doctors.  An insurance policy is a contract and both sides have to live up to it.  If insurance companies were routinely dumping people for no reason there would be lots of lawsuits being filed against them for breach of contract.

Medicare is usually accurate but then so are most private insurance companies.  Although Medicare is not routinely the faster payer out there.  Last year I spent about nine months working with numerous people at CIGNA, the contractor for our area,  to get half of our Medicare claims paid.  Having half your claims denied for nine months and not being able to find someone who knew enough to solve the problem for nine months does not inspire confidence in the system.  Especially when it was a change in their system that caused the problem.  It was only solved when I lucked out and got someone who had worked in both of the departments involved who went outside proper procedure and went to a supervisor in the other department.

For private insurance claims, every patient will have different policies that cover different procedures at different percentage rates.  Plus each company will have negotiated the reimbursement rate with that particular facility.

I've experienced every one of the situations you've listed either myself or at work.    While they do happen, the vast majority of the time claims are processed just fine with most companies.  Most offices will have a large number of patients with the same or similar policies and an established patient base that have been verified so it's not quite as confusing as it sounds.  The State Health Plan is very common as are other BCBS plans.  For routine procedures you quickly learn how those common plans are handled. 

I don't think doctors should bill patients until any claims questions are resolved.  Unfortunately with the push to automate so much of billing and claim processing, it's likely that many bills are never reviewed by a person before they're sent out.

You didn't mention the other headache of claims billing.  Some insurance companies use different codes and have nonstandard ways of filling out the standard claim form.  Yes, there is a standard claim form now.  Actually for me it's Medicare and one other company on the different codes and only Medicare on the non-standard claim form.

Some of the problems mentioned are caused by patients that don't give the doctor the correct information or don't correct information with their insurance company.  I usually verify new patients or any new insurance and most companies make this fairly easy. 

Generally doctors are part of networks and the networks negotiate reimbursement rates with the insurance companies, not the individual doctors.  They just have to decide if the rate offered by the company is enough or if they can risk losing patients with that insurance.  The larger the insurance company the lower the rate it can set.  Medicare generally has one of the lowest rates although there's not a lot of variation.  It's rare for a plan to pay a percentage of the actual bill.  Most companies have set fee schedules.  That's one reason it's so hard to get an accurate price.  Also, the current reimbursement method pays doctors for each separate procedure so it's hard to give an estimate ahead of time if you don't know what will be needed.

Medical billing is a headache and that's why some doctors are starting to not accept insurance if they have the type of practice that can manage it.  Medicare is not much different from the private companies so unless we truly went to a single payer system and did away with private insurance all together the proposed reforms don't help the situation at all.  While private insurance companies have their own networks, remember that not all doctors accept Medicare and even fewer accept Medicaid.

You'll read that administrative costs for private insurers are generally 20% or more and that Medicare's administrative costs are more like 3%.  Insurers have spent a lot of money paying their think tanks to attack the 3% figure, but they know that Medicare is more efficient and cost-effective.  That's why they are fighting as hard as they possibly can against a public option.

If you still believe this after all the discussions of why Medicare's efficiency claims are flawed we'll have to disagree on this one.  Of course if you assume that the think tanks are just saying that because they're being paid by the insurance companies instead of really thinking about what they're saying it's no wonder you feel that way.

If health coverage for everyone was included in how our taxes are figured, there would be no billing for premiums and no sales force and commissions to pay, no advertising staffing necessary. No lobbyists to pay.  The cost of products made in the US would not be burdened with the cost of health insurance, making our products more competitive globally.  Small businesses wouldn't be penalized for having smaller groups with smaller risk pools which makes makes their coverage more expensive. 

There'd be no choice of what kind of coverage best suits an individual's needs either.  Do you really think there'd be no more lobbyists?  The drug manufacturers, hospitals, medical equipment manufacturers, and trade groups for every health care specialty would be lobbying to make sure their interests were covered and paid for. Every disorder and disease would have it's advocacy group in Washington to fight for coverage.  Things wouldn't change much in terms of lobbying.  Of course now a lot of that lobbying goes on at the state level which is where coverage mandates are currently set.  With a single payer plan they would all move to Washington and people would no longer have the option to move to a state with lower insurance rates. 

Our products wouldn't be any more competitive globally because they'd include the cost of the additional taxes to cover that single payer health insurance instead of the cost of insurance.

You could solve the problem of small employers and individuals stuck in small risk pools by shifting the tax deduction for health insurance to individuals instead of to business.  It was the government that created the system of employer provided health insurance in the first place not industry or insurance companies.

The risk pool would be optimized because it would include all citizens.  The premiums of the young and healthy would help offset those of the elderly or chronically ill, without some insurers having an advantage of cherry-picking  more profitable customers and dumping older ones.

Of course the young and healthy who are just starting out and maybe trying to support a young and growing family might not appreciate paying higher premiums to subsidize the sickly, including those that have problems because they fail to take care of themselves.

If single payer worked like Medicare, everyone would have the same coverage.  Medicare would be billed and paid--no sweat over knowing the specifics for each individual's insurance coverage,  what is covered, who is primary and secondary insurer, no question of deductibles, no hassle over which procedures are covered and which aren't. 

hmm, everyone has the same coverage, so men have maternity benefits as well as 75 year old women.  No chance to pick and choose what types of coverage might suit you as an individual based on your lifestyle and health risks as well as ability to pay.  Patients will still have questions about what is or isn't covered.  Medicare doesn't cover everything and has a deductible so you'd still have that to deal with too.

A single payer system might solve some of the problems with today's billing and claim system but it would also have a lot of consequences I don't think are worth it.

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