We are near Hartford, Connecticut the Insurance capital so my views are biased in favor of the industry. More so when I learnt that Aetna Chairman and CEO Ronald Williams has regretfully announced 625 job cuts in the next four months.
As any business person would tell you, if the market expands by 10 % ( the 30 million uninsured) the health insurance companies should not be firing people, like Aetna, but hiring them.
Unlike say Australia, the Government is not taking over health care but sort of extending a Medicare type coverage to the uninsured.Just like so many reforms of the Obama Administration, the healthcare reform speed is great, intent is wonderful but implementation issues are not clear,upfront. Think the “Cash for Clunkers” program and the endless back and forth about how the auto dealers were not getting paid by the Government and so on. I suppose things worked out eventually, after a lot of heart burn across the clunkers value chain.
Back to the uninsured, talk to any doctor or dentists ‘ office or beleaguered patient and you’ll know how nightmarish the whole claim process can be. Some doctors’ offices are better at navigating the existing systems of Medicare and Private Health Insurance, others never figure out and unintentionally harass insured patients.
Understanding the claim process is a question of organizational learning (what code will be both appropriate and facilitate reimbursement for a procedure or treatment). Compounding learning problems in the doctor-insurance company-patient chain are differing technology and software that is highly fragmented.
The simplest implementation solution would be for the Government to negotiate with the handful of medical insurers to cover pre-existing conditions etc and even dictate a price or profit margin for the uninsured market segment. Although not ” free market ” this would be a far simpler alternative to implement. A new entity – even if a clone or extension of Medicare will take at least 5 years to get properly organized and communicate well with its stakeholders like uninsured patients,doctors office. I am not even thinking of how the 30 million bottom of the US pyramid will actually sign up or pay up the premium no matter how less the premium amount is unless they are on some type of social security payment from which deductions are made at source.
It is likely that the above idea is available in one of the many versions of the reform bill – but I bring it up because every worthwhile policy must ultimately be implementable- preferably quickly.