By Bill Rusteberg
FORMULA: Defined Contribution + Indemnity Fee Schedule (Eliminate/outlaw % of billed or allowed charges) and presto, you get the American middle class back in play.
Anytime you price a service or commodity as a % of something based on a % of something that’s in turn based on a % of something else there’s a high probability it will not be good for you. “We pay 80% of covered benefits based on a 50% discount off 500% of Medicare allowed!” says the kind and caring insurance company.
“That’s really confusing!” replied Joe Sixpack. “Can’t you just pay a set amount per service or procedure, so I know exactly what I owe providers?”
“No, No, No, we can’t do that …….You’re describing an indemnity plan! Indemnity plans are not ACA compliant! said the insurance company. “Besides, our hospital partners will never accept indemnity plans. Why would they want to do that? How would they justify charging $800 for an in-patient oral hygiene device (toothbrush) at a 50% discount knowing your plan pays 80% of the balance! Or discounting a $6,000 MRI to $3,500 that costs $475 two blocks away at a free-standing MRI center?”
“They won’t have to bear that burden of guilt anymore under an indemnity plan. The insurance company pays a set daily amount for each in-patient day” said Joe with a twinkled gotcha look.
Rachael, the cleaning lady surreptitiously eaves dropping in the background as she mopped, stopped. “Listen, I have to say something here! she started. “I couldn’t help but listen to you two guys. There’s already an ACA compliant indemnity health plan covering over 65,000,000 Americans. It’s been around since 1966 when all health insurance plans were indemnity plans. It’s called Medicare. It pays a set amount for any and all covered services and procedures. There’s also scores of state specific plans build on an indemnity chassis, they are called Workers Compensation plans. Then there’s Medicaid and CHIPS. All these indemnity plans cover 50% of the American population! So why can’t commercial health insurance companies do the same like they used to do in the good old days when gasoline was 23 cents a gallon?
“That will never happen!” shouted the now snarling insurance company. “The Medical Industrial Complex is too big to fail, employing millions of American workers whose power is recognized and feared by term-limitless pandering politicians. There’s not a politician on the planet that will vote to eliminate jobs within their constituency!”
“Well, in 1966 when the world’s largest indemnity health insurance plan was created, there was no such thing as a plan that paid a % of a % of a % of something else. Health plans back then were all indemnity plans. They were legal then so they should be legal now, ACA be damned!” huffed Rachael as she continued mopping again.
Meanwhile back at the ranch modified blueprints of the world’s largest indemnity plan have been repackaged, branded as Reference Based Pricing plans with good success. It’s 1966 once again. And the price of gasoline is $2.33 in Victoria, Texas.
No one can argue that all these problems we’re having with the high cost of health care these days are Man Made. It’s time we turn to women to fix it. Like the two Rachels, (Strauss and Means)………Ann Lewandowski, Rina Tikia, Chris Deacon, Ge Bai, and “I don’t give a shit, I’m packing a Medicare card” Marilyn Bartlett.
