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Edited on Mon Oct-04-04 05:44 PM by Princess Turandot
many of the Blue Cross Associations did it for years. (Many of them have now gone for profit.)They also process Medicare claims: the government doesn't process Medicare claims itself: it farms it out to insurance companies. In New York at least, a company often pays an insurance company not to 'insure' claims but rather just to administer them. (A percentage is added to the cost of actual claims processed.)
One problem is with the for profit insurers of the world, including the HMOS. They have to pay for larger executive structures, and depending on how they are structured, may need to pay dividends to investors.
I've been working in healthcare finance in NY for about 20 years now, both as an external CPA/consultant and an internal fiscal administrator. Up until the mid-90's, HMOs could not negotiate contracts with hospitals because the rates for all payors except for Medicare, were effectively set by the state. Most of our employees did not opt for HMO plans, but we did have some as options. The year discounting became legal, the largest HMO we dealt with demanded a 25% reduction on the inpatient hospitalization payment rate they previously paid to us under the state formula. At the same time, as a buyer of their services, they increased our premium for those employers who chose them by about 12%. Those reductions in payments & increases in premiums substantially left the healthcare system.
Insurance companies are a 'necessary evil' IMO because no one wants to take on the insurance industry, which would take a financial hit if the current system substantially changed. An employer for example, could buy their healthcare coverage from the government: a national system does not need to be paid for completely through taxation.
The single thing abt the Clinton Administration that upset me the most was its botched attempt at 'healthcare reform'. In reality, it was still including the insurance companies in the mix, by creating a ridiculous set of 'buying groups', so people could pay a little less for their insurance premiums. It also IMO made the HMO concept the be-all and end-all of proper healthcare, but left that management in the hands of the insurance companies, whose only motivation to keep a person 'healthy' is to make more money. And worst of all, it created the idea that healthcare reform had to be profoundly complex.
And no matter how people spin it, high quality healtcare is not going to be cheap. There are ways to keep costs down somewhat, but if you want the best healthcare in the world, it's going to cost you.
Imagine if you had a brain tumor in 1965. The best picture they could get of your brain wouldn't have been a whole lot better than a chest xray. Now we have MRI's which take beautiful pictures of the brain. It will cost you $3 million or so to buy one, and another $500,000 at least to install one, because they require substantial lead shielding. NYC probably has a few more MRIs than we need, and there are probably areas in the country that don't have enough, and something should probably be done about that. But I don't think we can have care 'reform' without people coming to grips with the fact that effective healthcare, which keeps us alive, cannot be done cheaply in a country the size of ours. But is paying for Star Wars defense systems a better investment?
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