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#360626 - 10/29/0908:27 AMRe: What to do about healthcare? Can it be fixed?
According to figures from the National Compensation Survey by the US Bureau of Labor Statistics, in 2005 US companies paid between 6.6% and 16.5% of payroll on health coverage for their employees. The average was 11%. It is higher today. Basic laws of economics says that given a choice of an 8% penalty or 11% (and rising) cost, most companies will choose the penalty and will cut or eliminate health insurance. Who could blame them?
The average profit margin for health insurance companies in the US is 3.3%. That is hardly the outrageous profit margin portrayed by proponents of health insurance reform. (I can't call it health care reform as little to nothing has been said about reforming or improving the actual health care received by individuals.) Their profit margin is in stark contrast to the 25.9% earned by beer manufacturers, 22.7% by software companies, 17.4% by cigarette companies, 6% by sporting activities .......
A medicare for all type program will naturally develop as employers opt to pay the penalty and stop offering health insurance. In a medicare for all type program, average health care received by the average individual will actually decline. The average claim rejection rate by insurance companies is 4.05%. The average rejection rate by Medicare is 6.85%. The rejection rate would be even higher if providers did not "know" in advance what Medicare is likely to pay and not pay for (significantly less then the average policy) and so generally not ordering or offering those services to those patients. The reality in "Medicare World" is that a provider can not receive payment from the patient for a service that is denied by Medicare. (So your doctor may think that you need a specific test or procedure, but if Medicare guidelines say you don't, either you don't get it or the doctor eats the cost - more frequently then you would think.)
The funny thing about insurance EOB's is that the charges on them are nothing but leprechaun gold and fairy dust courtesy of the US government. Medicare and Medicaid legislation dictates exactly what the government will pay for specific services. At the same time, legislation requires that providers give a discount to Medicare/Medicaid. That discount must be greater then any discounts given to any other entity. The discount is large for Medicare and even larger for Medicaid. Take the Medicare allowable amount, add back the discount and voila you have the "fee". Insurance companies negotiate rates with providers - getting a discount because of volume and more guarantees of payment then they would have with an individual. The "fee" for service on your EOB is the "fee" inflated by Medicare/Medicaid rules. The amount paid on your EOB is the pre-negotiated amount. Leprechaun gold and fairy dust ...