Health Care Solution For Our Broken System

Solutions For Our Health Care System

Health insurance premiums are ridiculously high, and there is a reason for this…..there are way too many people employed by insurance companies to review claims to reduce what they will pay or deny the procedure all together.  This is also causing doctors and hospitals to employ countless people to deal with the insurance companies.  I have a health care solution that worked great several decades ago, and it just needs to be updated for current technologies:

  • All medical providers already use procedure codes that are common to the codes the insurance companies use. Require the medical providers to publish their charges for each code on a website and in a common database.  Require the insurance companies to publish their reimbursement amounts for each code on their website and in that same common data base.
  • The insurance companies can use that database to easily determine the charges per procedure code for a given area to determine the “reasonable” amount they are willing to reimburse.
  • The medical providers can view other provider’s charges and insurance companies reimbursements to help them determine what they want to charge.
  • Patients can “shop” services easily by accessing the information in the common database. They should be able to download the information into a spreadsheet that will help analyze what is a reasonable amount they should pay.
  • The medical provider is still required to upload the patient’s information and procedures to the insurance company, but that is where it ends. The medical provider knows in advance what the reimbursement amount is for that procedure from the insurance company’s database. The patient deals with the insurance company from that point on.  The patient pays the medical provider any difference between what the insurance company reimburses and what the doctor charges.  This is done in advance, so the patient can refuse to have the procedure.
  • The insurance company would be able to substantially reduce staff since they do not have to review every procedure and determine whether it is necessary or not. Their policy will dictate whether they pay for it or not.  The insurance company should not be in the business of determining whether a procedure is medically necessary or not.  That is the job of the medical provider not the insurance company, and the patient will be able to determine if they want to pay for the procedure or not.
  • Patients will be able to “shop” their services, so normal competition will drive medical prices. Currently, few patients ask how much a procedure costs, and many times medical providers cannot tell you that accurately. This system will encourage patients to be more aware of how much their medical care costs BEFORE the service is rendered, giving them more control over their health care costs.
  • Medical providers will spend a fraction of their time dealing with insurance companies, which will allow them to spend more time practicing medicine, which makes them more profitable, which allows them to be more competitive in their pricing.
  • Insurance companies will be able to substantially reduce their costs, and they will be much more able to predict their claims from year to year. This should reduce insurance premiums.
  • There will be more competition among insurance companies, and hopefully new insurance companies enter the field, which also will reduce premiums.
  • Insurance companies should be allowed to offer policies that require proof of insurability again to encourage consumers to become healthier to keep their premiums down. Those that choose not to stay healthy will pay the price.
  • We have to stop believing that we deserve any procedure regardless of the cost just to stay alive. America and Americans can’t afford the current healthcare system.  We have to change it.  Those that want expensive transplants, expensive cancer treatments, etc should be able to buy a supplemental policy for those procedures, but offer policies that are less expensive that don’t include those procedures.
  • Insurance companies should simply be in the business to reimburse expenses they are willing to reimburse and not be in the business of telling medical providers and customers what medical procedures they need or don’t need.
  • Medical providers should not have to go back and forth with insurance companies.  Instead they should practice medicine and provide medically necessary services to the patient.


If you liked this, consider reading one of our other posts. Such as:

Medicare Supplement: Switching Isn’t Easy


How to Control Spending