How has the payment of health care providers evolved over time?

Question

What caused these changes?

Answer 1

Prior to about 1966 with the unconstitutional creation of Medicare, people paid their own medical bills. There was some insurance, but most folks could pay for what they actually used. Doctors would work out payment plans, sometimes "barter" (OK I will take x pounds of beef from you Mr. Rancher), and frequently reduce or eliminate the bill. Hospitals weren't ridiculously overpriced though the bills could be too much for some folks.

In 1971 the first real HMO was started up and soon people were believing the lies that docs had been "milking the system" and that HMOs could save people money. Now we saw the start of the takeover of the medical profession by lawyers and businessmen instead of doctors.  Things continued to spiral downward.

Insurers saw this as a great way to reap massive benefits, especially with bad law that resulted in things like the ERISA shield (see Jamie Court's book "Making a Killing" at http://www.makingakilling.org/contents.h... which allows HMOs to, with impunity, deny legit claims for the very ill. IF the patient dies before a lawsuit could be filed, the family gets nothing. If the patient is still alive, only the cost of the procedure can be awarded.

Government at both the state and federal levels has continued to meddle in health care, jacking up costs with their assorted stupid regulations (part of the cost is by the states. You can only offer a plan if it carries THESE provisions, etc.) You can't buy health insurance "across state lines," per se--have to get what YOUR state thinks is an "appropriate" plan. Medicare, of course, a fed program, has insurance plans that also vary by state when people select an HMO, PPO, or PFFS for plan.

Bottom line, insurers have become maniacal in their greed. Linda Peeno, MD testified about how she routinely denied care for legit claims to save the company money: http://www.thenationalcoalition.org/DrPe...

United Health Care is embroiled in scandal but it is like the other FEW major insurers who dominate and rule health care so doctor's can't. We taxpayers and patients as well as doctors pay for that big time. Here's PART of that article:

"While growing into a colossus, UnitedHealth has repeatedly failed to perform its basic job of paying medical bills. UnitedHealth, which covers 70 million Americans, has been sanctioned in nine states for paying claims slowly; shortchanging doctors, hospitals, or patients; or poorly handling complaints and appeals.

One Nebraska woman complained to state regulators that UnitedHealth's computers had incorrectly rejected claims related to her son's surgery six times.

At one point, UnitedHealth owed Dr. George Schroedinger, an orthopedic surgeon, $600,000. He and his clinic sued UnitedHealth of the Midwest in 2004.

Deciding for the clinic, U.S. District Judge Stephen Limbaugh of Missouri declared that the company's claims processing systems were "flawed in many ways, denying, reducing, and improperly processing claims on a regular basis. And despite innumerable requests, United was unwilling to remedy the underlying errors in its systems" (Star-Tribune Dec. 12, 2007).

Payment troubles continued after the verdict, and Dr. Schroedinger filed a second lawsuit. "These people can never get it right, which says to me that they just plain lie," he said in an interview.

Failure to pay isn't the only complaint. The insurer also gives incorrect information on which physicians are in its network, creating enormous problems for physicians' staff.

The AMA said that no other insurer has prompted as many complaints as UnitedHealth about abusive and unfair payment practices. AMA officials have met with UnitedHealth executives 16 times since 2000, with little to show for it.

"They have always got a new plan to fix it," said Dr. William G. Plested III, past president of the AMA. But "nothing ever happens."

It seems to us that this case is just the tip of the insurance iceberg. More and more stories are appearing daily in the news media about how insurance company are instructing employees their jobs are to deny claims and/or delay payments.

With such a high percentage of medical premiums and other costs going to the legal profession, to maintain compliance with endless government rules/regulations and being hoarded by the insurance companies and executives — is it any wonder medical costs are increasing so dramatically?

It's time to take a closer look at the medical insurance companies.

http://www.newsmax.com/medicine_men/medi...

Furthermore:

"the vast majority of health insurance policies are through for-profit stock companies. They are in the process of “shedding lives” as some term it when “undesirable” customers are lost through various means, including raising premiums and co-pays and decreasing benefits (Britt, “Health insurers getting bigger cut of medical dollars,” 15 October 2004, investors.com). That same Investors Business Daily article from 2004 noted the example of Anthem, another insurance company. They said the top five executives (not just the CEO) received an average of an 817 percent increase in compensation between 2000 and 2003. The CEO, for example, had his compensation go from $2.5 million to $25 million during that time period. About $21 million of that was in stock payouts, the article noted.

A 2006 article, “U.S. Health Insurance: More Market Domination, More CEO Compensation”

(hcrenewal.blogspot.com) notes that in 56 percent of 294 metropolitan areas one insurer “controls more than half the business in health maintenance organization and preferred provider networks underwriting." In addition to having the most enrollees, they also are the biggest purchasers of health care and set the price and coverage terms. “’The results is double-digit premium increases from 2001 and 2004—peaking with a 13.9 percent jump in 2003—soaring well above inflation and wages increases.’" Where is all that money going? The article quotes a Wall Street Journal article looking at the compensation of the CEO of UnitedHealth Group. His salary and bonus is $8 million annually. He has benefits such as the use of a private jet. He has stock-option fortunes worth $1.6 billion."

--Save America, Save the World by Cassandra Nathan pp. 127-128

Now predatory lenders have been invited in to feast on the most vulnerable:

http://www.businessweek.com/bwdaily/dnfl...

Bottom line, health care has been hijacked by outsiders--government bureaucrats, lawyers, and fast-buck "businessmen." We need to get back to doctors running the show AND insurance being for the purpose of preventing bankruptcy and up until that point, people need to pay most of their own medical bills just like they pay their rent or mortgage.