Three words describe the world of health care funding – “The Hassle Factor.”
The hassle of endless rules, exceptions, unsupported insurance denials, nonsense exclusions, and a thoroughly phony appeals process. Made by private industry bureaucrats and computer algorithms — signed off robotically by corporate and government medical directors as “medical necessity determinations.”
Many simply opt to give up. All of this directly affects the standard of patient care. Reimbursements are based on a “Rube Goldberg” inspired medical coding system that is even more complex than the Russian roulette fare price codes used by airlines.
It’s not the actual health care professionals who have the greatest impact — it’s the financiers and experts who claim efficiency and cost savings as a ruse for criminal syndicate like activity.
Because Medicare, Medicaid and charity care often involve reimbursement at 10 percent or less of the regular rate, or zero, or even actual cost — regular insurance and private plan rates must be hiked massively to recover the uncompensated care.
Somebody has to pay the costs. The result is simply a classic Ronald Reagan type forced cross subsidy to claim smaller government; while doing nothing more than shifting costs to others. Making it unaffordable for most; but highly profitable to corporate America.
The typical robot politicians and private industry executives’ response is an array of well unsubstantiated nonsense that fraud, waste, abuse, legal issues, and making it all electronic — blah, blah, blah — will take care of it. This is a bigger fantasy than sci-fi and medieval wizard tales.
While the system is described as underfunded and bankrupt, why is it actually massively profitable for Wall Street, corporate providers, drug companies, shareholders and politicians?
Some examples are CVS making a lucrative bid for Aetna, CIGNA wanting Express Scripts, Wal-Mart looking to buy Humana. Another, the three wise men of Amazon, Berkshire Hathaway, and J.P. Morgan getting into health care to show how it should be done.
Why? Because of the huge profits that are reaped in directing and capturing drug and patient care provider percentage kickbacks through contracts. It’s all about the percentages of the grossly inflated price versus the grossly inflated “cost.”
For the mafia, terrorists and criminal money launderers such practices are classified as a crime. If health care and drug companies do it, it’s called an “industry practice.”
I doubt the self-insured State of Alaska’s TPA Aetna makes any real money on the claims processing for the state’s self-insured plan. But the skimming of kickback slice-of-the-gross unaccounted for profits being the drug supplier, and creating “patient care contracts”, is more than worth it.
The state won’t get to the profits in the accounting pyramid schemes of drug pricing because of its complicit contracts couched in “proprietary information.”
Health care funding practices are mired in endless layers of industry financier friendly schemes.
Fifty percent of all health care costs in America go to service 5 percent of population. Preventative health care that could help millions and prevent public health catastrophes’ are massively underfunded; but dying for months is simply much more profitable.
Drug companies spend more on sales and advertising than research. Many generic drugs have had their price hiked by 100 percent in only four years.
The Medicare contribution rate required for decades to fund the plan is about 1/5 of what it should be to properly fund any such plan. The unfunded liability of Medicare alone is $87 trillion — NOT accounted for in the national debt.
The Bush Administration in 2003 crafted a law, instituted in 2006, that exists still today, that forbids Medicare from negotiating lower drug prices for seniors under Medicare Part D. Democrats just as responsible. Generating hundreds of billions for drug companies.
As the Empire limits My Turns to 700 words, this is the first of a multi-part series to show why America is number one in cost worldwide, number 23 in world quality, and health care consumes 17 percent of the entire U.S. GDP.
A system that purposefully forces rationing and devaluing basic human care, while delivering maximum economic extraction for those at the top. No much unlike the general situation in this second Robber baron era in America.
But then it has never been “about how much money there actually is available, but who it goes to.”
• Anselm Staack is registered non-affiliated, a CPA and an Attorney who has been an Alaska resident for over 43 years. He was the Treasury Comptroller for Alaska under Gov. Jay Hammond and worked directly on the creation of the Alaska Permanent Fund Corporation. He resides in Juneau.
