Government health insurance, good or bad.

I know that the idea of the government 'interfering' in our health care is something many people do not even like to think about. But would it be all bad?

First, one of the main concerns people have is that some bureaucrat would be making decisions about their health care. Exactly how would that be any different than some claims clerk making those same decisions. Do people really think that a DOCTOR looks at every medical claim submitted to private insurance companies, and determine if the claim and the treatment are valid? That is certainly NOT the case.

Perhaps a broad determination is made, based on a broad set of criteria. But every time we see our doctor, every time we get a prescription, or every time we need surgery, the decisionm to pay or not is certainly not made on an individual basis by some doctor who has our well being at heart.

So, if we had the same or similar set of criteria, but within a government plan, the decisions would also not be made on a case-by-case basis by a doctor, but by a claims clerk. The same as we have now with our private insurer.

Second, with a single payer system the amount of time and paperwork required to process a claim should be cut drastically. And the additional time it takes for claims to be processed in the event that a patient has multiple coverages would also be cut. That could not help but cut the cost for coverage, plus be "green", as the amount of paperwork would be cut.

For example, in 2007 I saw my primary care physician. The bill was something like $200, and I had TWO coverages, Medicare and the insurance from my husband's employment. Because his employer had more than a certain number of employees, that made his work insurance my PRIMARY insurer, and Medicare my secondary. Although I clearly explained that to the insurance CLERK, the claim was filed incorrectly, with Medicare as first and the employers insurance second. It was denied by both, for the reason that the primary coverage was the employer.

So, I got two denials. I called the billing for my primary care physicain. I explained what they had done wrong. They said they would refile the claim correctly. They did refile, incorrectly. Another round of denials, and another call to the claims office. Another assurance that the claim would be filed correctly. It was not.

Third time is a charm. The third time I called them the claim was actually filed correctly, first to the employer insurance, and the doctor finally received payment from the primary coverage. The insurance claim department now will file the secondary claim to Medicare. Medicare will then pay their portion. The latest correspondence on this 2007 claim? One week ago, two years and one week after the actual doctor's visit!

With a single payer this could NOT have happened. When you take into account the time wasted, the fact that the doctor did not get paid for two years, and the patient frustration in having to try to get the "professionals" to file the claim correctly, it is clear that a single payer system would have been much better in this case, and I suspect in many cases.

Third, although there is a lot of concern about the government not having a say in your health care, in my experience with Medicare it is efficient, pays claims promptly, and the explanations of benefits is understandable. That makes it much easier for the patient, the doctor and all providers to be paid in a timely manner.

Another situation that would be mitigated by a single payer system is that for each medical issue the claim would be the exact same amount for everyone, instead of the way it is not, where each plan may pay more or less of a claim. That is, maybe plan "A" pays doctors $100 per office visit, while plan "B" pays only $75. If there was a single payer the amount paid would be the same no matter what. That would eliminate the need for claim filers to keep track of the different amounts they are to bill depending on what insurance the patient has!

Under a single payer system there could also be great savings on other medical claims, like prescriptions. If there is a single payer the pharmaceutical companies would get a flat rate for their drugs. Period. No multiple costs that have to be 'negotiated' all the time.

As to how to pay for a single payer system, it seems clear that whatever people are now paying, and to whom, would then be paid to the single payer. The cost then could be spread out over a HUGE patient base (everyone) and while some people would pay a little more, some would pay a lot less. A percentage could be paid by employers, based on factors like number of employees, annual gross income etc. That way even the smallest companies could pay part of the cost and their employees would have the same benefits as people employed by huge corporations.

And for those who say they don't want to pay for someone else to be insured or have health care, they already DO. Whether they understand it or not, through their taxes they already pay to help the poor who cannot afford private health care, AND they pay to cover those employees of small companies that cannot afford to offer health care for their employees. So, that would not change, except that the small employers would now be contributing at least something to the plan, whereas now they contribute nothing, and their employees are forced to rely on public assistance for health care.

So, think about this. If you agree, call your Congressman and urge them to back some sort of single payer, government run health care insurance program. It is a national disgrace that we, in the leading country in the world, do not have this coverage that citizens of many other industrialized nations have had for years!@