Part of the argument against the government takeover of health care for Americans has been that it would result in rationing of care. Proponents dismissed these claims as scare tactics. But, the simple truth is the Federal Government already runs a portion of health care through Medicare and Medicaid. Those programs provide an example of what we can expect from the system.
Health Care supporters are quick to use the same argument when they are demonizing the "evil" insurance companies that "profit from the misery of the American people." But, the AMA, that group of doctors who supported the President's efforts and showed up with their white coats to the White House, has a report that shows the demonization is a smoke screen.
Will the new Health Care Entitlement result in more denied care? The record indicates that the answer to that question is a resounding yes.
In 2008,
Medicare led the pack of AMA's own National Health Insurer Report Card as the most frequent denier of coverage. Of the eight insurers listed on that report, Medicare was the most likely to reject a claim, sending away 6.85% of requests. This was more than any private insurer and double that of the private insurers’ average.
The
results for 2009 were only slightly better for Medicare beneficiaries. Last year Medicare was no longer the most frequent denier. However the agency was still double the denials of the head of the pack, Aetna. Aetna decreased the number of denials by 5 percent in a year, a full percentage point more than Medicare's current rate of 4 percent.
Could it be that commercial health insurers have more efficient claims processing centers? Could it be that the private sector is just more all around efficient?
In the case of health insurance claims, firms make more money when they deny more claims, right? Those evil money hungry creeps! So how is the profit motive leading to more private-sector claims approvals?
The truth is competition between insurers INCREASE claims approvals. Most physicians and hospitals must take Medicare because it represents so large a share of the healthcare spending. On the other hand, physicians may decide to only accept patients whose insurance companies have prompt payment with fewer denials. This leads to some incentive for insurance companies to DECREASE claims denials. The way to INCREASE access and DECREASE health care problems is to INCREASE competition.
Get it? Yeah? Well, your leaders in Washington, don't.
It is important to point out that the differential claims denial rates also has a lot to do with the demographics of Medicare and commercial insurance enrollees. Almost all Medicare enrollees are over 65, while commercial insurers have enrollees who are of varying ages. Since older individuals are more likely to demand high cost medical procedures, if high cost medical procedures are the ones that are more likely to be denied then Medicare’s higher denial rate may simply be due, in part, to the composition of its enrollees.
Whatever the reason, the fact that Medicare denies more claims than commercial insurers should dispel the myth that the government is simply a benevolent entity, while commercial insurers are ruthless, profit-hungry wolves.
And then there's the absolute ineptitude that comes from federal rules and government agencies as witnessed just recently by a California Medicaid benificiary; a woman with cancer.
Mom With Cancer Gets Insurance Help For Transplant
A Hollywood woman who was dropped from Medicaid coverage while needing a bone marrow transplant is finally getting the coverage and treatment she needs to stay alive.
Diana Smith is battling a rare form of Leukemia and needs the transplant to survive. She managed to raise money to pay for it thanks to her friends and the community, but then last week she found out her Medicaid coverage was dropped – putting her operation on hold.
Smith had gone through six months of radiation and chemotherapy -- one week out of every month. She is in remission and had a donor for a transplant; being in remission is a prerequisite for the transplant.
But her hopes of receiving the transplant were dashed in March, when she says, the Social Security Administration contacted her –without her soliciting it -- and told her that her three year-old son was entitled to receive Social Security disability payments. Even though she didn't ask for it, she signed the form and received her son's first check.
In April, Medicaid canceled her universal health care policy because her income level had risen with her son's payments – making her ineligible for the insurance program.
The problem is Jackson Memorial Hospital could not provide the procedure because the risk is too high. The universal policy from Medicaid helps shield the hospital from liability in this kind of case. Without it, they are subject to liability issues.
Even though Smith offered to cancel her son's disability benefits, she was told it's too late.
CBS 4
Of course, following the report local state officials, and the hospital jumped in to help see that the woman received the surgery. But, should you have to call the television reporter, or a Congressman everytime one of the newly hired Health Care bureacrats decides you and your doctor have it all wrong?
