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Why We are Fighting for a Single-Payer Healthcare System

By Terence Redmond McAllister, M.D., and Leann DiDomenico McAllister
Physicians Practice (Baltimore), March 16, 2015

Currently there are a few TV ads — TD Bank’s Bank Human Again and Nationwide’s In the Nation campaigns, most notably — that focus on how “human” they treat their customers. We weep with sad recognition when we see these ads as they are a stark reminder of the inhumane treatment we providers receive from insurance payers on a daily basis.

From coding policies that have nothing to do with NCCI edits to time-consuming phone trees that lead to underpaid, overworked customer service people who hang up on us, we are done with the soul-crushing daily abuse we endure for our crust of bread.

Speaking of which, we were shocked by how much positive press Aetna Chairman and CEO Mark Bertolini, a man who reportedly earned $30.7 million in 2013, received when he raised his employees’ minimum wage to $16 per hour. He might as well have said, “Let them eat cake.”

Bertolini has a long history of putting profits ahead of patient care. Even though fair wages are newsworthy, we see Aetna’s announcement as little more than a PR campaign.

As single-payer healthcare becomes a real possibility, Bertolini is using his fair-wage pledge as a way to win approval from the providers and patients who have been abused for years by his business practices.

While media outlets were focusing on Aetna increasing the wage rate floor for all of its employees to $32,000 a year, many missed the bigger story that the U.S. wastes $375 billion a year due to insurance-related paperwork. It’s worth saying again, so we will: Insurance wastes $375 billion each year.

For readers who might not know the administrative nightmare that is the insurance payment system in the U.S., here are a few recent examples from our practice:

• Eight months ago a small error occurred, technical or human is unclear, were the subscriber’s name was placed where the patient’s name should have appeared on the electronic claim. Today, after four written appeals and a dozen phone conversations, the claim has still not been paid.

• A six-month-old claim has yet to be paid by an insurer who keeps telling us the member’s policy terminated on 11/30/2014. The date of service was 11/29/14 when the policy was active. We’re not sure exactly how many conversations we will have to have with the payer to convince it that November 29 does, in fact, come before November 30.

• One payer is trying to take back money on a claim that is over a year old and was appropriately paid the first time. We have sent two written appeals and tried calling (but failed to successfully navigate the phone tree) to no avail.

We recognize that many of you, our peers, lean conservative. Like you, we’re not interested in taking vows of poverty. As we’ve written before, our goal is to earn a good living for ourselves while keeping work/life in balance and delivering the best primary care that we can. But even the most conservative of you can see that there is a significant different between earning a living and making millions a year and huge profits for investors. For us, the health insurance companies are the problem. The solution is single payer.

We are tired of hearing ourselves complain about the insurance companies and so we’re doing something about it.

Just this month, we both became members of Physicians for a National Health Program (PNHP). PNHP is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 19,000 members and chapters across the United States.

We are not naive; we know that single payer has its own issues. Whatever concerns we have, though, pale in comparison to the $375 billion dollars that the insurance industry steals from patients and providers on an annual basis. Overpaid insurance company executives will have to find a new way to steal from the American people. It’s time for single payer.

The authors reside in Massachusetts. Practice Notes is a space for commentary and news on practice management and healthcare policy. Opinions expressed by guest bloggers are their own, and do not necessarily reflect the views of Physicians Practice, its staff or editors.

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