I mentioned awhile back in a thread that I had some ideas about how to fix healthcare in this country. I've finally had some time to put my thoughts down and since the ACA comes online in a little over a week this is as good a time as any to post my ideas. Perhaps you can think of somethings I haven't.
Disclaimer: I work for Humana Health Insurance. One of the largest healthcare companies in the US. I've worked with insurance and healthcare for almost a decade now. I know how the system works, for the most part.
While I work for an insurance company, I think for profit healthcare is not the best way to do it. But unfortunately that's the system we have and its not going away anytime soon. Millions of your fellow Americans are employed by health insurance companies as well as the supporting industries (printing, claim auditing, etc). If we ditched the insurance industry now, a lot of people would be out of jobs. So we have to learn to improve the system we have now.
Medicare Part C: The central theme of my plan is Medicare Part C and how it works as replacement for Medicare. Undoubtly most of you have false impression of it, no idea what it is, or how it exactly works. Per his comments in one of the debates from the last election, it sounds like Obama has no idea either, but its not surprising.
Medicare Part C in its simplist definition is basically Medicare replacement administered by an insurance company instead of government Medicare. Insurance companies apply to CMS (Center for Medicare/Medicaid Services) to be able to offer replacement plans to the of age public. CMS reviews the plans that the companies offer and either approves or denies them based on factors such as cost to the member, benefits (copays ect), network adequecy (providers in certain counties in a given state), etc. The plans HAVE to cover all of the same things that Medicare covers (diagnosis, treatments, etc) and CANNOT be subject to pre-existing conditions. Medicare members CANNOT be turned away by a plan.
There are multiple companies that offer multiple types of plans (depending on geographical area). During the open enrollment (in the fall) members can both choose which company (Humana, Aetna, etc) they want to go with and then what type of plan (HMO, PPO, etc) they want. And then over the course of the year that they have that plan, they can decide if they want to keep the the plan or switch or if they don't like the company then they can change companies all together during the next open enrollment. They can even decide they don't like Part C all together and just go back to regular government Medicare A & B. Part C plans offer members more than government Medicare can offer like various gym programs, 24 hour nurse hotlines, Rx coverage, etc. So in this enviorment insurance companies are in constant competition with each other at the individual level. Competition is always good for the consumer, no? Companies strive to be as efficient as possible. I'm sorry, but private companies almost are ALWAYS more efficient than government. Efficiency improves profits.
Insurance companies have to have their plans and costs approved by the government every new plan year or they can't sell their plans. Insurance companies get a payment from CMS for each person enrolled in their plan. CMS also watches very closely how the insurance companies market their plans to the public. Its very regulated. During one of the debates when Obama said insurance companies target "healthy seniors" for their plans, that's simply not true and is just your regular old liberal talking point scare tactic. CMS won't allow that and it doesn't make good business sense. Companies want as many people enrolled in their plans, no matter their age. Its illegal for them to turn any senior away.
It really is a very successful government-private partnership. Its one that many people don't fully understand or even know that much about.
(Part 2 follows in the next post)