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by vinc3nt on February 11th, 2007
LynnfromNM did and excellent job of describing how the US Healthcare system is expected to work. Here is a description of some problems that are pushing us to NHC (National Healthcare) in the US. In an effort to maximize profits (which is capitalism) the private insurance industry has made Individual policies extremely costly and not available if you have pre-existing conditions that may be expensive. Group insurance through employers or trade unions are the only alternative because pre-existing conditions are accepted and the employer gets a tax break for providing the benefit. Private insurance industry then uses the volume of insureds that they control in these group plans to restrict payment to those healthcare providers who have agreed by contract to take a fixed fee for each service. This forces all types of healthcare providers to sign a contract or go broke (not exactly free-market capitalism). All healthcare providers are required by law to submit claims using a system of uniform format, codes and patient identification. The insurance companies are not required to use a uniform method nor recognize those codes nor make payment to the healthcare providers. Some do not respond at all. The declining fees allowed by insurance and increasing overhead costs, make NHC more attractive to independent doctors.
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