c) Most medical jobs pay very well.
As they should. They involve the highest levels of skill, massive educational expense, and constant threat of litigation. They SHOULD pay well.
d) There is significant costs associated with malpractice and the USA legal system.
Yes, I agree -- this is a key problem I should have listed separately.
e) There is a very inefficient payment system with very high effective overhead.
The payment system is fine -- except for state medicaids and medicare. Large payors like BCBS and UHC do an excellent job of claims processing. While some smaller payers -- like state workers comp programs -- are less efficient, they are also processing small volumes of claims.
I hear a lot of discussion of the "payment" system as a problem, but as one who deals with it day in day out, I can state without reservation that the biggest problems in the payment system are with --
a) Medicare;
b) Medicaids (almost all states); and
c) DMERCs (all of them).
Note that these are all government operations (actually, government farms them out to private companies, but because of an insane government bureaucracy, they are unable to perform at an acceptable level). Take for example, CIGNA, which does a great job of processing CIGNA claims and claims for hundreds of smaller insurance companies. In the states where they process Medicare claims it is a train wreck.
Here's an example. If you submit a claim to Medicare and it is denied for certain reasons, it may be impossible to resubmit that claim electronically (requiring paper claims to ultimately get the claim paid). Yet, Medicare for many facilities, requires electronic claims and will deny paper claims without consideration. So, a clinic with such a claim may have no option. Eventually, it means phone calls which translates to cost for the taxpayer.
Payors like BCBS, CIGNA, AETNA, UHC, HUMANA -- have highly efficient systems that the government could never match. I'm not sure where you got the idea that the cost of such systems is high. The state I live in has a single processor for all BCBS and Medicare claims. The EDI department is manned with a staff of 11. This is not expensive when you're talking about many tens of millions (probably 100 million) claims a year.
This argument that payment processing is part of the cost problem is just silly. Aside from government payers, it is probably the best functioning aspect of most insurance companies. |
