Let Us Buy Medicaid!

The simplest solution to the Health Insurance disaster is right in front of our noses.  Sell Medicaid to those who can’t get insurance elsewhere.  Offer a version of Medicaid as an optional insurance carrier.

There are already several versions of Medicaid and Medicare that can be used as a model for coverage.  We know it costs the taxpayer about $6500 per person who is on Medicaid.

The only reasons I can think of for NOT offering the option of selling Medicaid is protection for the insurance industry.  If you have another reason please let me know!

The old system was uninsured go to the hospital who helps them, gives them a huge bill that they never pay, and the hospital increases the charges on everyone else to cover the unpaid bills.

This led to inflation on health care services so that today we can fly to Costa Rica and stay on the beach for three days, get a colonoscopy by more modern equipment and probably US trained doctors, and return to the US with a tan and cost $1000 less than the cost of a colonoscopy alone in the US. It is a 20 minute procedure and you feel nothing.

I was charged $3500 for a colonoscopy, not including the doctor.  I had insurance, so I suppose I shouldn’t complain.  It didn’t cost me anything, but it costs us all, and it boils down to the un-insureds who cannot pay their bills.

Here’s an example: A child is born with a heart problem. The cost of pediatric heart surgery without insurance in the US is $92k, and a lot of such surgery (below the top 10%) can be over $220k.

Without going into how people can make that much money in a day or why hospitals in the US sometimes charge ten times for an overnight than hospitals in other countries, let’s talk about what happens if the family of the baby doesn’t pay the bill.  Obviously the baby doesn’t die, and there are charities and Medicaid programs that might help.  And again, without going into who pays for the charities and government programs that might help let’s move on.

Health Insurance is not health care.  We pay double or more for health care not only because our insurance system is damaged.  Our whole system is based on adversarial rules which only benefit government employees and lawyers… Well and lawmakers and insurance companies.  And because of that our doctors benefit but have to hire teams of administrators to take advantage of our system.

If someone doesn’t pay a large bill, like a $300,000 bill, like a medical bill for a child’s surgery, they have to go to court.  There is no defense, the bill is theirs.  So they pay weekly, often as little as $35 a week to the hospital which means they would pay  for 167 years by court order.  Or they go bankrupt and the only person who benefits is the lawyer… and the prosecutors and the judge, and the administrators. It keeps the government employees busy on the tax payers dime minus filing fees of  probably under $300.  And the family doesn’t have to pay the hospital, but instead the courts and the lawyers.

Could we have designed a worse system?  Never underestimate the power of bad design, but keep your eyes on the cost of health care (not the cost of health insurance).  You cannot negotiate the $3500 plus doctor fees for a 20 minute colonoscopy or $200k for a half-day’s team effort because your insurance will pay it.  And the economics of why they will pay it are sicker than colonoscopy patients, possibly as sick as the child’s heart defect.

The roots of the system are adversarial judicial systems and the economic advantages of several layers of administrative charges for simple, routine and nearly universally received medical procedures like colonoscopies.

Look at the cost of a flu shot or a vaccine.  Doctors will perform these procedures for precisely what the insurance company will pay.  No one can blame the doctors.  Why would I choose to do the same work as someone else but for less pay?  And if a doctor doesn’t want to make at least as much money as other doctors I might get suspicious.  I have good insurance, I would rather get the best doctor because my insurance will pay.  So if the doctor charges my insurance more money he might very well be a better doctor.

Suppose there was a set fee for giving a shot (there is) set by insurance companies (there is) but the government sets up a system (medicaid/medicare) where the cost of giving that shot is a lot less (life as we know it).  Health care professionals still give the shots, but complain about how little money they get for giving the shot.  They will look for examples of procedures that should be paid a lot higher and lobby congress to raise the cost of giving shots and other medical procedures to tax-payer supported patients.  Again, I have just explained our life in the USA.

Insurance companies don’t want the government to take away their customers by offering insurance to people who might be able to pay big premiums to them and not the government.  So they continue to pay more to doctors than the government does.  Lots more. Now they have the support of doctors who want big bucks for giving shots, as is human nature.

So there is no way cut the crap and change the system  Well, unless we are allowed to buy a version of Medicaid….

Revision:  Based on feedback from people who point out that people look at health care as a freebie, that since they don’t pay (their insurance does, or they go bankrupt) the solution to that problem is simple as well:  Larger co-pays.

Buy Medicaid with a $50 co-pay for all doctor visits and $300 co-pay for the ER or Ambulance…

Copyright 2017 Kent Johnson



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