Monday, March 29, 2010

Making Health Care Insurers breath hard!

Have you ever sat in on an Argument where 3 lawyers discussed the Intent of specific legislation? Avoid it if possible, but if forced to attend, expect a real flow of BS. We are currently at that stage of health care description, and everyone is shocked about the purported lack of clarity. The language of the health care legislation is not confusing; lawyers simply claim that it is, a carrying capacity to get other lawyers, this time called Judges, to agree with the ambiguity. Everyone knows what is expected from the legislation, everyone knows what is wanted from the legislation, and everyone knows that the delays of implementation can mean huge Profits for the Insurance companies. Want to stop the Argument from even occurring? Simply pass a Codicil which states there is an ex post facto element to the new law, where Insurers must pay the health care costs of the five previous years for every insured Individual, with premiums set based upon the payment schedule of those 5 years. Threat of this Codicil will probably shut down this discussion within minutes of it’s proposal. By the way, the governance of future conduct nullifies any disagreement with the Constitution on the fact of such legislation; Insurers are not specifically ordered to pay past charges, only ordered to reimburse past charges if they seek to make a Profit off of ensuring Individuals for health care.

Did you hear the gasp of lawyers and their employers as they read this definition of the law? It is likely that even the judges are swallowing hard! Why? Because it immediately draws to the fore the Concept that health insurers who had previously denied Coverage to Individuals because of preexisting conditions might be forced to pay those Expenses anyway through the length of those existing conditions. Here is where lawyers will really begin to sputter! The Courts might have to define was health care insurance actually means, and entail the minimum conditions under which it might be issued. A scary Thought, where health care Insurers cannot utilize their organizational skills and Wealth to rewrite their policies anytime it gets too expensive to meet the residual guarantees of the policies.

Does it seem like We are getting in deep water here? We are, but there are simple solutions to the problem, which can be settled by Congress itself. I propose a 5-Step program of Health Insurance, based upon segments of Insurance. These Steps would simply be financial levels- say $10,000 per Step per Insurance year. Insurers must pay up to the level of the Step on which premiums were paid, if Medicare will pay for those procedures. Universal health care coverage will insist that everyone must get at least Step One, with all subsequent Steps being optional; the kicker here is that the Insured must be liable for the remainder of the Cost of the health care when the bills reach $60,000; lower if Step premiums are avoided. Now We come to the crux of the Argument, with All screaming that Everyone will be left without health insurance again. Not True, as medical facilities and Providers quickly shift away from Charging for Procedures, and settle in on Charging for overall care. It is much simpler, and incredibly cheaper, to charge for Standard Care rather than Procedural Health Care; every successful universal health care program in the World utilizes this system. The Question becomes Why doesn’t the United States? lgl

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