Summary
The article covers ongoing debates over many ideas put forth to quickly fix long standing, national, complex matters equally applicable to both government and commercial payors such as (1) expanding & applying appropriate health care administration management oversight (2) reigning in health care administration costs; and (3)establishing clear guidelines for which population segments are legitimately in need of and lawfully eligible for public funded healthcare programs.
Analysis
It is good to see debate as it pushes people to think through both sides of an argument towards a comprehensive solution to address all concerns presented. However, as someone who has worked in the health care industry going on 16 years...on both sides of the table (National Director position for provider of care and VP position for payor of care) and as someone who owns a small business today, I can say that I am deeply troubled about how the process of health care reform is being handled by our government bodies that are suppose to have the good long view of our country's best interest in mind as their guiding light.
I have to wonder who is advising our President and the parties pushing for expanded government administration. I would find it hard to believe that any such advisors have the background of working both on the commercial insurance payor side and also on the healthcare provider side of the healthcare delivery system equation .....or at least earned a paycheck OUTSIDE of the government payroll.
If our government takes money OUT of Medicare Advantage plans and traditional Medicare/Medicaid funding, those insurance plans that currently manage Managed Medicare and Managed Medicaid will exit that business segment which will only reduce jobs in the free market and reduction of "free market' jobs means less money being paid INTO the tax pool.
The idea that seems obvious to me is to push more CMS beneficiaries to the commercial insurance companies and just expand government oversight functions over the administration of commercial payor insurance. If the government did this - they would have less government workers on their payroll. They could reduce the size of the government Medicare workers and push them into the private sector market. Obviously, this would cause less need for taxes to cover the current plans for expanded government workers and all the ancillary costs that come with government expansions.
If our government takes money OUT of Medicare Advantage plans and traditional Medicare/Medicaid funding, those insurance plans that currently manage Managed Medicare and Managed Medicaid will exit that business segment which will only reduce jobs in the free market and reduction of "free market' jobs means less money being paid INTO the tax pool.
The idea that seems obvious to me is to push more CMS beneficiaries to the commercial insurance companies and just expand government oversight functions over the administration of commercial payor insurance. If the government did this - they would have less government workers on their payroll. They could reduce the size of the government Medicare workers and push them into the private sector market. Obviously, this would cause less need for taxes to cover the current plans for expanded government workers and all the ancillary costs that come with government expansions.
Significant amounts of money would be saved if the government would let the insurance companies manage all of the CMS beneficiaries because.... trust me... I make my living off of fighting with insurance companies daily for every dollar I negotiate for my health care providers..... insurance companies would not let anyone get away with over utilization or "fraudulent claims" which happens frequently under existing Medicare and Medicaid government managed plans. Commercial Payors do manage their medical dollars closely. I agree we need more oversight and legislation to tighten up the rules on payors and require better beneficiary coverage standards. However, taking a failing government managed Medicare and Medicaid plan and "de-funding it" to add another government healthcare plan is only asking for a 3rd failed government plan.
The insurance companies are rich because they know how to run a business, they know how to manage their medical cost dollars. Yes, they need to be reigned in and be more accountable with their profits and use a greater portion of profits to cover more services and pay the healthcare providers reasonable reimbursement. I am sure everyone can agree to that point. However, let them do what they do best. Let them manage CMS beneficiaries, let them manage ALL Medicare and Medicaid beneficiary dollars.
They will reign in the costs on those programs. If we need another public option, then make it a Medicare "Part P" for Public Option but only make it available for those who are at a certain poverty level. We do not want everyone having access to that option, only those that need such an option today. For example, I make enough money to buy insurance from a premium insurance plan which keeps them in business hiring other people and those hired people can buy houses and cars and vacations because they have a job... because millions of people like me buy premium health care coverage and we keep those insurance companies in business and their workers keep other americans in business and this all generates more tax dollars being paid INTO the system.
Commercial Payors can work in tandem with "Government Oversight" to implement P4P programs and increase quality practices, reduce inefficiencies, etc.; and with all that money being saved, more funding could go to the insurance companies so they could offer better rates to their providers than medicare and the health care providers would make more money and expand their health care practice and hire more health care providers and cover more patients and insurance companies would grow thereby creating more jobs....and more jobs creates more "ancillary businesses" to support the expanding additional jobs (real estate, travel, restaurants, business insurance, business equipment, business supplies, dry-cleaning, more cars, etc.... all kinds of ancillary business expansion goes along with job expansions in the private/public sector.
The path to economic recovery and improved healthcare delivery systems is to reduce the government foot print and promote more non-government jobs to improve the economy...... not the other way around. Expanding the government is not the answer.
The path to economic recovery and improved healthcare delivery systems is to reduce the government foot print and promote more non-government jobs to improve the economy...... not the other way around. Expanding the government is not the answer.
Dara Lynn
www.LynnConsultingServices.com
This author consults with leading institutions through GLG
Analyses are solely the work of the authors and have not been edited or endorsed by GLG.
