Health Insurance Industry, Bucking For Civil Service Status?

By Kenneth Bean
VP Operations, Pediatric Prosthetics Incorporated

Nationalized health-care is one vote away from becoming a reality if some changes are not instituted very quickly. The most caring and responsible parents, health-care providers, and corporate officers across the country are going to be swept away on the tide of angry voters who do not want to hear excuses any longer. The founders of The United States came up with a novel idea; “let the people govern themselves”. A key part of that self-governance is the ability to self-insure ourselves against those calamities to which we are all vulnerable.

Many of the culprits are going to wake up one morning to say, “What happened?” All their lobbying and deal cutting will have made no difference. Their “campaign contributions” and other inducements to put a finger in the dike will not hold. The irony is that the very government officials who have “gotten along by going along” are the very people who will design and implement that nationalized health care system. Oops!

The Lawyers who have indiscriminately sued physicians, hospitals, and other medical care professionals………and even worse…intimidated physicians into ordering every diagnostic test known to mankind for every hang-nail…won’t be able to sue civil servants and institutions. Oops for them!

A tiny minority of Physicians and Surgeons and associated health-care providers have abused their responsibility to their patients and tarred the scrubs of the vast majority of their honest, hard working peers. Sadly, they will not experience the “Oops”, but will shirk their responsibility once again and count on honest bureaucrats to cover for them…once again. Another irony: that same minority has a turn of mind that can make them great “head bureaucrats” in a nationalized health service regime. Oops for every American!

Directors and Officers of Corporate America are culprits as well, though primarily by omission. They have delegated the task of structuring their group health insurance contracts to their “Human Resource” departments, then given their HR managers a pat on the head for saving a dollar a month per employee…….regardless of the often devastating results among their employee populations. Again an irony: These Directors and Officers spend enormous sums on their health insurance contracts…and have only the vaguest idea what those contracts do…and do not cover. They have no idea why their company morale goes in the “waste-water plumbing fixture”, and why they keep loosing their most productive employees to their toughest competitors.

Health Insurance Companies’ HMOs and PPOs ... a good idea that didn’t work. Oops!

The “Idea” was to set up a preventive maintenance paradigm that would save money in the long run for everyone. The idea was to have negotiation power with primary health-care providers in order to lower costs. The “Idea” was to cut down the horrendous costs involved in the claims process with the existing “at need”, (indemnity) type insurance contracts readily available.

The reality seems to have no relationship to “the Idea”! The claims process is actually as cumbersome as it ever was, compounded by the fact that the number of claims has grown exponentially. Every time an “insured employee” goes for a simple visit to the doctor, in order to pay a piddling amount…the claim processing trail begins anew. In addition, there have been added several additional layers of bureaucracy to handle these “nuisance claims”. Countless man/woman hours of work are involved, plus the cost of the “policing” functions to keep the insured employers and employees honest.

We The People...of the United States often do not realize that one of the crucial elements of the unique economic miracle that is The United States...is the private... competitive...insurance system. At it’s best, it is magnificent. Up until the second half of the 20th century, the primary economic motivator for most Americans was “saving up for the inevitable rainy day”. My own father shared an anecdote with me that illustrates the limitations of that economic model:

“When I was a senior at Baylor University,” he recalled, “ in 1931, and broke my neck playing football, my father, (a small farmer), told me that he desperately wanted to help me finish school, but that He had to save that money...against the rainy day. I replied to him “ Papa, it’s raining like hell...right now!”

(My father never did finish school.)

The unique brilliance of the American “insurance idea” is stunningly simple! With a simple contract, and the stroke of a pen, “savings for the inevitable rainy days” can be instantly created.

Well...I for one would enjoy seeing the best of our insurance companies make all the profits the market will bear.

• The insurance companies who operate efficiently, and whose actuarial tables reflect the grinding hard work that goes into them
• The insurance companies whose claims departments are encouraged to find a way to pay a reasonable claim....in a reasonable period of time.
• The insurance companies whose customer identity cards say “This family is covered”...end of paragraph.
• And finally, the insurance companies who equip their sales personnel with an insurance contract they can sell... with courage and conviction!

I hope to be invited to write in this forum again. I have to believe that among the pretty bright professionals from a host of disciplines who read this magazine, we can generate a “prescription” to begin healing this mess. Please! Send any ideas, thoughts, information, or your personal insights to me at pdpr@sbcglobal.net .

In a recent issue of this magazine, the President of the AMA, Dr. Palmisano, suggested that physicians “...do what physicians always do-apply the scientific method to the problem...”

That hasn’t worked in this instance! The AMA has been losing this battle for a number of years trying to be logical, and truthful, and thoughtful. Perhaps you physicians need some reinforcements who are not quite so civilized. Perhaps we need some “rabble rousers” to take this fight to the streets, and right now. Perhaps we need to realize that the lawyers leading the opposition have absolutely no interest in scientific ” fact”, but rather spend their professional careers dealing in “arguments”! Perhaps right there is the crucial advantage the “culprits” have utilized. It is one thing to begin a sentence, “Arguably.......” and a different matter altogether to begin a sentence, “In fact........”

A couple of thoughts to provoke your thinking: Let’s think about creating a PPI ! (Preferred Insurance Provider list) Let’s begin to identify the insurance companies that try to work with us, and their customers, and send a letter to every CEO in the country on their behalf. Let’s also identify for those CEOs, the insurance companies who routinely shirk, and dodge, and who sell insurance contracts that don’t insure. Let’s bring the power of the free market place to this battle.

On the liability front, let’s think about simply refusing medical services to every Senator and every Congressman, except from the hours of 9AM to 5PM...Weekdays, such as the American public would experience in a nationalized civil service system. “In fact”...we would see some decent legislation, and quickly! Thank you.

Frankly, Bean begins to sound like a fundamentalist preacher when he begins to rail about insurance companies who only pay for metal hooks for our arm-amputee population. He gets downright hyperactive when those amputees are our children. He actually showed us one insurance contract “with prosthetics coverage” but which limits that coverage to $1,000 per year. “They ought to be ashamed and we ought to shame them publicly,” he concluded.)