Simple and straightforward methods a Nationalist Party of America would use in order to fix our nation's looming health care crisis...without costing taxpayers a trillion dollars. by Billy Roper
(libertarian)
Wednesday, December 2, 2009
Once upon a time, America had affordable, quality healthcare. Doctor's office visits were reasonable -- as were most hospital bills -- and even insurance premiums were fairly inexpensive. In fact, healthcare worked so well, that Medicare was created using the exact same system. Then, one day the big bad HMO came along and ruined healthcare as America knew it. At first, doctors loved the HMOs. Under the creation of "networks," they were guaranteed patients. Even better, HMOs were exempt from many laws, including lawsuits. This meant that doctors operating under the umbrella of an HMO, no longer needed to carry malpractice insurance. What a savings this was! Malpractice insurance was expensive, and being able to operate without it was like winning the lottery. As we have come to learn from all fairytales, nothing is without consequence; every action has an equal - and opposite - reaction. Under the HMOs' rules, doctors could no longer tell their patients what was wrong with them. They had to report their findings to the HMOs, who of course, never told the patients. The idea was to make the patients pay out of their own pockets, by going outside the "network" to find out what was wrong with them. By the time many of them did this, it was too late - too much time had passed - and over the years, thousands of people died needlessly from advanced cancers and other conditions that could have been treated easily upon diagnosis, but were instead put off by pencil pushers in the HMOs. This lead to Congress passing laws that allowed patients to sue their HMOs, and soon afterward, most of the HMOs dissolved; unable to stay in business in a world that did not allow them special favors. The system they created, however, remains in affect today; PPOs, or "networks," that cause our medical coverage to triple in price or more, are a lingering malady of the HMOs. The lessons learned from this story, although sad, can still lead this nation to a happy ending. Let's examine the facts; knowledge is power, and power is key to returning this nation to the respected, independent superpower it once was. By reading the healthcare reform platform of the Nationalist Party of America, You will understand not only how health insurance in this country works, but also how the 8 Points of Healthcare Reform will return this nation to an inexpensive healthcare system that works very well. Once most of you understand how insurance works, you will be outraged. You will understand why your rates go up, even though you may never use your health insurance. You will understand why your rates are many times more than they should be, and how America can return to premiums well under $100.oo a month. Interested? Intrigued? Outraged? Simply curious? Read our 8 points below, to learn how the Nationalist Party of America can return this nation to a healthcare system that is not only affordable, but also easy to understand.
1) Abolish HMOs
Health Management Organizations, or HMOs, arrived on scene around 1990, give or take a year or two, one side or the other. The HMOs opened up a whole new direction for healthcare in America ; one that proved detrimental for many people - and in some cases - even deadly. They removed the responsibility from the doctors, of making decisions; instead, believing themselves more qualified to make these decisions than the doctors. In reality, however, it boiled down to profits; not medicine. HMOs strictly regulate the healthcare that their policyholders have access to. This includes what doctors they may see, demanding "referrals" for additional diagnoses, what the doctors may (or may not) tell their patients, scheduling of procedures and the application of treatment itself. HMOs are basically small socialized medicine plans. That is why they have failed. So, Obama's healthscare plan is nothing but a giant, government-run and controlled, HMO. Additionally, HMOs created PPOs, which triple the rates of healthcare, and reflect dramatically on the cost of insurance premiums. More info on that under Point 2.
2) Abolish PPOs (networks)
Preferred Provider Organizations, or PPOs, are the main reason our healthcare is so expensive in this country. PPOs are also known as networks, and it is your network that your doctor accepts, not your insurance. Insurance is universally accepted; any doctor will take any insurance, but they may not accept the PPO, which is critical to getting your bill reduced. Therefore, you may still end up with a huge bill if you are "out of network." PPOs are nothing more than price reducers for health insurance. Think of it this way: as a small business owner, you buy products at the dealer cost but resell them at the retail price. Insurance is no different. When the HMOs created PPOs, they guaranteed doctors all of their patients. The catch was that they must give those patients a discount. The result was, that just as in a yard sale where you mark up the price of a table expecting to be talked down to what you want for it, doctors began charging 3-4 times as much for their services, expecting what they wanted after price "negotiations." This is why when you look at a medical bill, you see the total, the dollar amount your insurance paid, the amount not covered by insurance, and a balance due of $0. The amount not covered falls into the "markup," and you think your insurance has paid the whole thing, when in reality, you've probably already paid it yourself, ahead of time, in overpriced premiums.
3) Abolish associations
Associations are third party companies that are typically owned by the insurance companies. Associations actually own and retain your insurance policy. What you are getting is a Certificate of Coverage, not a real policy. Here's why: The owner of the policy is the only entity that can allow non-regulated rate increases. Therefore, if the insurance company wants to increase your rates or drop you, all they have to do is ask the owner of the policy. It's not you; it's the association. The insurance company contacts them and asks their permission, not yours, to raise your rates! There are only two insurance companies left in America that actually issue a policy to you: United American and Reserve National. If you aren't covered under either of these companies, you can be dropped or have your rates increased for any (no) reason, and you have no say-so in this.
4) Abolish trend factoring
The average person goes to the doctor or hospital for something major, once every 8.5 years. Insurance companies are not stupid; far from it, and they have developed a formula to get the most bang for their buck: the trend factor. Thanks to associations, you will see a typical rate increase of 20% each year, across the board, for everyone. On top of this, is an increase known as trend factoring. Here's how it works: Trend factors range from 18% - 23% each year. This means that from Year 1 to Year 5, your rates are supposed to triple. The idea is to get as much money in premium from you before you cost them money (5 years as opposed to 8.5), and then get you to go somewhere else and start over because your rates are so high. The trend factor is in addition to the standard rate increase. Unless you are young and perfectly healthy, you will see rate increase up to 43% a year. Calculate your rates when you first started with your current company, and compare the increase annually with your current bill. Now, you can better understand why your rates are so high, and why they continue to climb. Trend factors operate on little to no use of your insurance. If you use your insurance extensively, say for a major operation or cancer, you may very well find yourself dropped due to something called an escape clause. Let's learn about those next.
5) Abolish escape clauses
Most insurance policies have in them somewhere, something called an escape clause. This means that they can drop you at any time, for any reason, and there is nothing you can do about it. This typically happens while you are in the middle of a serious claim. What good is insurance if they can cancel you when you need it most?
6) Make doctor and prescription copays optional, not standard
Another beast to emerge from the HMOs is copays. Under the guise of smoke and mirrors, we are led to believe that we are getting something for nothing. Here's how life works: you NEVER get something for nothing! Let's examine copays: Let's deal in Monopoly money for a minute. Every month, you give me a dollar, whether you go to the doctor or not. On top of that, when you DO go to the doctor, you give him a quarter. Is that a good deal? Of course not. Now, let's add some zeros to that and deal in real money. Every month, you pay $80 - $120 in your premium, toward copays. This is whether you use them or not. When you do go, you pay an additional $15, $25 or $35 depending on your plan, to see the doctor. So, you've spent $1,200 extra in your premium each year, to also give the doctor another $25 when you do actually go, and you think it's a great deal, don't you? It's not. The average person doesn't need insurance coverage for the nickel and dime items. Their main concern is for catastrophic coverage; the heart attacks, transplants and cancers. Why then, should they be forced to pay extra premium each month for copays they may not use? Let's make those copays optional.
7) Stop using emergency rooms as doctors' offices for Medicaid and the uninsured
One of the biggest wastes of money in the healthcare system is the use of hospitals as doctors' offices. This not only ties up the ER for true emergencies, but it racks up huge debts every year that are simply written off (and incorporated into our costs when we use the hospital for real treatment) by the medical system. Here's how we stop that: The law states that anyone who seeks treatment at an ER must be accepted. This leaves huge gaps in the system. If, for example, someone on Medicaid needs a checkup, they are required to pay a copay at their doctor. If they go to the ER, it's free. This needs to be stopped. Since anyone can be admitted to the ER, many people will give a false name and leave after treatment, but before documentation can be verified. This includes illegal aliens and American lowlifes looking for free treatment. By doing this, it is impossible to bill the patients, and we absorb the costs into our healthcare. ER stands for Emergency Room, and it needs to operate as such. Under our plan, true emergencies, such as accident victims, would still receive the treatment they need, regardless of identity, but abuses of the system will cease.
8) Return to a build-a-policy system with low, per-incident deductibles
Prior to the HMOs coup of the healthcare system in this country, both healthcare and health insurance were cut and dry. This is why Medicare was patterned after this system; it worked, and it worked very well. There are two types of medical insurance; limited benefit and major medical. Limited benefit pays on a per-incident deductible, with low deductibles and no lifetime maximum, but with limits to each malady. You see this in Medicare. This is why you need supplements. Major medical insurance simply means that you pay everything out of pocket until you reach your deductible. After that, the insurance company pays 100% of usual and customary charges.
So,what do you think? This, or Obama's trillion dollar fiasco?
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As somebody who works with insurance and healthcare, I have to say, much of this is ACTUALLY workable, unlike most Libertarian suggestions. ESPECIALLY trend factoring!
