One of the oft-ignored reasons that there is little progress in terms of removing the barriers of costs to consumers in obtaining NEEDED health care services is because both parties have only a minimal commitment to changing the status quo while knowing they need to "talk" about it to satisfy constituents.
This was made abundantly clear by the abomination of Obamacare and the failure of Republicans to counter this bad law.
OBVIOUS SOLUTION TO GETTING LAWMAKER ATTENTION AND INTEREST: PUBLIC EMPLOYEE, LAWMAKER INSURANCE OPTIONS SHOULD BE OUR INSURANCE OPTIONS, NOT THE RICH BENEFITS THEY RECEIVE FOR PREMIUMS THAT ARE PAID FOR BY TAXPAYERS (UP TO almost 75 percent of their premium costs) in spite of Congressional salaries of almost 200 grand a year, that's who they're protecting, themselves.
Obamacare did not live up to its namesake's promises, many of which were outright lies such as the insistence that there was "universal health care" (2007), the failure to address high drug prices (2010) and specifically scrapping goals in 2016, fixing the Obamacare created family glitch (2010), lies that if you like your health care plan you'll be able to keep it, (2014) and the list goes on. Similarly, the Republican plans were just as bad substituting semantic differences that meant little to consumers, such as the continuous coverage provisions that resembled the individual mandate except the money would go directly to insurance companies instead of the government.
And now we're hearing it all again, the old-time and defeated plan of Medicare for All circa 2009-'10 that lost out to Dems backing Obama's plan. We're hearing that soaring drug prices will be addressed with posturing shows of impotent machismo much like Obama used in pretending he'd address the problem. So, why does the problem persist? The answer is simple, lawmakers actually don't want to change anything because their health insurance is a carve-out deal especially designed for them that ignores their rich salaries and provides them with superior coverage at taxpayer expense.
Sure, they'll all mouth "concerns" and "plans" to address the problems of noisy consumers, but make no mistake, public employee lawmakers are ignoring obvious solutions because they AGREE that to do otherwise would require real change and really taking on rather than partnering with the rich business of insurance and its lobbyists.
FRAUD, OBVIOUS SOLUTION, ADDRESS FRAUD BY FIRST UNDOING THE 80/20 RULE AND THEN INCENTIVIZING FINDING AND RECOUPING FRAUDULENT PAYMENTS BY WITHHOLDING STATE-AUTHORIZED RATE INCREASES TO CONSUMERS THAT INCLUDE INSURANCE COMPANY FRAUD COSTS.
Take the "fraud" business of insurance. Statistics indicate that health insurance fraud could be in the HUNDREDS OF BILLIONS OF DOLLARS, which is passed onto consumers. All our alleged representatives and advocates including President Trump promised to take it on.
Yet, once again, no one's pushing to address fraud including insurance companies for the simple reason that they simply RAISE prices or REDUCE coverage for fraud losses, treating fraud as just another cost of doing business where that cost is passed on to consumers.
There are simple solutions to begin to address fraud. First and foremost, incentivize insurance companies to use their resources to go after fraud. Right now, under Obamacare's 80/20 rule, the cost of going after fraud falls into the 20 percent allowable spend by insurers for administrative costs, including their salaries. So going after fraud in a meaningful way is actually discouraged, because it eats into their 20 percent spend-on-us money when they can simply pass these costs onto consumers.
Instead, going after fraud should be incentivized with both carrot and stick as the lawmakers like to say when it comes to us. Insurers who go after and regain fraud dollars could easily receive tax breaks, etc. Further, state insurance departments who are largely responsible for approving rate increases can specifically deny rate increases based on the costs of fraud.
When it comes to governmental program fraud, CMS likes to tell consumers to report fraud because it hurts them and accounts for wastage, but consumers get no reward for doing the work of fraud detecting and reporting. Like whistleblowers, consumers who are doing the government's job for them should be compensated in money.
Further, the Federal Government should be prohibited from absolving itself for responsibility for insurance fraud. Obamacare created and accounts for much fraud because it prepaid for insurance plans, oftentimes for individuals who did not exist and for individuals who were ineligible. When these multi-million dollar fraudulent payments were discovered, the government claimed it could not pursue going after fraudulently paid dollars and-or that it would forgive the overpayments. It's our money, not theirs. Further, there were no recalled reports of public personnel who lost their jobs over the snafus.
BAN BALANCE BILLING FOR ANY INSURED INDIVIDUAL, WHETHER THAT BALANCE BILLING IS LEGITIMATE OR ILLEGITIMATE UNDER CURRENT LAW. Obamacare brushed the surface of balance billing only when it comes to emergency room treatment prohibiting balance billing in emergency rooms but ONLY for "treatment" meaning stabilizing a patient.
It might seem amazing, but patients are still held liable for balance billing by providers who step in as part of their medical services process, whether they know the individual is a non-participating provider to their plan or not. This is currently legal. There have been cases reported, and probably underreported, of providers, physicians, etc. banding together so that they include non-participating providers in a patient's care, balance bill the patient and split the extra bucks this practice brings in. This practice is supposedly illegal, but is not frequently prosecuted.
Any person who has insurance should NOT be balance billed unless they sign a form acknowledging that a provider is a non-participating provider and noting how much they will be billed for.
FAMILY GLITCH, OBVIOUS SOLUTION, ENCOURAGE FAMILIES TO COVER THEIR DEPENDENTS BY PUTTING CAPS ON TOTAL PERCENT OF GROSS INCOME PEOPLE CAN BE CHARGED IN PREMIUMS FOR FAMILY PLANS: The family glitch created by Obamacare was an insurance company way of getting around the limitations on how much can be charged in premiums for SELF-ONLY health insurance, but failing to include a similar limit on how much in premiums can be charged for self and other dependent, or family health insurance premium costs. This meant that for millions of families the cost of OBTAINING HEALTH INSURANCE, premiums, was too high to be affordable and their families were uninsured. Obamacare added insult to injury on this one by providing that these family dependents were ineligible for Obamacare because their working head of household had an employer provided insurance option.
REINSTITUTE THE PRE-OBAMA TAX DEDUCTION FOR MEDICAL EXPENSES THAT EXCEED 7.5 percent of gross income. Obama raised that amount making the medical expense deduction available after spending more than 10 percent of gross income. Bring back the 7.5 percent.
Scrap Obamacare service plan coverage for people who don't want it: Under Obamacare, true coverage was replaced with the idiocy of "preventive" care, used by insurance companies to charge more in deductible, premium, copay, and coinsurance, the cash costs to consumers for obtaining and using health insurance. Coverage of preventive care was long recognized as in insurance company interests because they wouldn't have to pay for disease undiscovered if they could get patients in early enough. Preventive care is of value to consumers, but is NOT an insurance (contingency) expense and certainly should not be used as a justification to charge more for policies or needed medical services.
Further, Obamacare's coverage of endless defensive medicine, whereby providers send individuals for all sorts of "diagnostic" testing and screening in order to cover their own tails, often at physical and emotional expense to individuals should be DISCOURAGED not ENCOURAGED by making it "free" for patients.
Health insurance is likely to take center stage as both sides talk emptily about how they'll help improve the access to needed medical services and care by addressing the barriers to treatment, including first and foremost the obscene cost of obtaining (premiums) and using (deductibles, copays, coinsurance, exclusions) NEEDED medical services. However, it's the things the entitlement receiving public employees won't say that are the biggest barriers to consumer progress.
