Writing on the Double Yellow Line

Militant moderate, unwilling to concede any longer the terms of debate to the strident ideologues on the fringe. If you are a Democrat or a Republican, you're an ideologue. If you're a "moderate" who votes a nearly straight party-ticket, you're still an ideologue, but you at least have the decency to be ashamed of your ideology. ...and you're lying in the meantime.

Location: Illinois, United States

Monday, August 27, 2018

Doctor Mengele, I Presume?

Doctor Mengele, I Presume?
©2018  Ross Williams

Have you tried going to the doctor recently? the optometrist?  Any place that accepts health insurance?

…the same health insurance that Obamacare mandates everyone have, that only a small share of the uninsured who demanded health insurance actually went out and got when they were given the chance?

…because it suddenly got even more expensive than it had been?

…when it was merely obscenely expensive before?

…because “Affordable Care Act”?

You’ve noticed what they make you do now.  Apart from filling out your health history [4-12 pages], reading through the dozen or so sheets of HIPAA disclaimers, signing a few HIPAA consent forms which effectively negate any benefit HIPAA was written to provide, and forking over your insurance card, they now require that you provide a photo ID that they will scan in a little ID scanner with Ethernet connection.

I’ve asked why they were doing this [I already knew the correct answer] and they told me “It’s our policy.”

Incorrect.  It’s not your policy.  You didn’t come up with it.  Not one doctor’s office, hospital, clinic, or optometrist in the land came up with this idea.

I’ve asked what they do with the ID they’re scanning [I already knew the correct answer to this, as well] and I eventually got told “We forward it to our head office…”.  This is true enough, but grossly incomplete.  It’s like asking facebook what they do with all our mouseclick captures and being told, “We save them.”   Yes.  True.  But you’re hiding quite a lot with that answer.

Also hiding quite a lot is the hefty staff of each and every medical office which accepts health insurance when they evade direct questions and dissemble their answers regarding a patient’s healthcare.  …which the patient has a moral and − significantly more importantly for most − a legal right to have a correct answer about.

Late last winter I developed a minor medical issue that resulted in major pain and I spent three weeks being shunted around from one medical office to another, until someone was willing to actually do the very trivial medical thing that needed to be done.  Each stop on this miserable journey saw me spending forty-five minutes filling out the health forms listed above, and providing my documentation.  And because I abhor bureaucratic impertinence of every form regardless where it occurs, I did what I’ve done for almost forty years now: I quizzed them about why we were going through bureaucratic impertinence.  I never once got an honest, accurate or more-than-partially truthful answer.

The stop at my primary care physician’s office whom I’d seen for over a decade, toward the end of this maze, I’d had my fill.  It wasn’t enough that they had bureaucratically purged me from their patient files, thus rendering me to “new patient” status where I had to fill out all the health history forms again.  The pretty young fräulein who demanded my ID  was a complete snot about demanding my ID.

I asked her why I had to give it.  She said, “It’s our policy.”

I said no it isn’t; you didn’t come up with this idea.  Unless you tell me why you want it, it’s not happening.

She asked one of the eight other clerical nazis behind the large check-in desk why they wanted ID.  The answer came back “It’s our policy.”

“See?” the pretty young fräulein said, “It’s our policy.”

I informed her that two people being incorrect don’t cancel each other out.  I’m going to go sit over there until I get to see the doctor. 

And I did.

Just a note about this doctor…

About 18 years ago, my previous doctor − a young guy just starting his practice − discovered that his having a private practice not associated with a “medical group” did not earn him enough money to pay malpractice insurance premiums for working in the “legal hellhole” that my county was [and still is] known as.  So he quit his practice, went back to his alma mater to teach medicine and do some doctoring on the side, and he politely gave all his patients a list of doctors in the area he respected.

So my wife and I needed to find a new doctor.  Our local newspaper had a health column, where a local doctor answered letters from the readers.  One such letter was extolling the virtues of various forms of government-controlled medical care, and it asked the doctor, “Wouldn’t you love to have this kind of system?”

The doctor wrote back, “Not at all.  Such systems make doctors into technocrats allowed to do only what bean counters in government permit them to do, and not necessarily what is wise or necessary for the patient.   These systems turn doctors into government employees who have no incentive to see the last few patients in the waiting room at the end of the day.  In the end, patients suffer and doctors don’t get paid well.

My wife read the column to me, and we both concluded − after looking him up in our phone book and learning that his office was relatively near us − that we had found our new primary care physician.  We transferred all our medical stuff to his office.

It was this doctor whose nazi staff couldn’t even bother being polite nazis to me this day.  I got called into a room.  Had my weight, temperature and blood pressure taken by a P.A., who not so subtlely inquired as to why I didn’t feel like complying with their policies.

That wasn’t the issue, even though I will not politely submit to justifying my existence for anyone.  The issue is that I could not be given a correct answer to my questions.  The P.A. spent a good three minutes futzing around the office, doing nothing meaningful, just to have an excuse to scold me for being a pain in their bureaucratic ass.  It doesn’t take long, she rationalized.  You aren’t ‘justifying’ anything.  Heck, I have to give my ID when I take my kids to their pediatrician.  Everyone does it.  Just go along with it.

When I didn’t budge, she sighed loudly, said the doctor would be in shortly and left.

The doctor was in shortly.  He immediately remembered me, despite my being a “new patient” and all.  Hey! Long time no see!  So … why be rude to my staff?

I don’t recall being particularly rude, although your staff was rude to me.  I was just unwilling to cooperate with bureaucratic nonsense when I couldn’t get an honest answer to a question I am entitled to know the answer to.

Well, she wasn’t trying to be rude….”

Irrelevant.  She succeeded in being rude.  Doesn’t matter if I’m trying to run over little children by driving 75 miles an hour on your cul de sac.  It only matters if I succeed.

He saw my point, but was curious about the “honest answer” I didn’t think I got.  Why do you think you need to supply an ID?” he asked.

I had been in fairly major pain for over a month, and was not up to a discussion where I didn’t have rehearsed retorts already in my head.  Government, I explained.

His reply was almost exactly as follows, “Government doesn’t have anythi… well, yeah, you’re right.  But still, we have to do this.  I have 4,000 patients, and I’m not going to make an exception for one.”

This, at least, was honest, if not exactly full disclosure.  I briefly thought about asking what happened to the medical columnist who had been so dead-set against government control of the medical system because patients would suffer and doctors would not be able to pay off their student loans.  But I didn’t.  I decided to allow him his own Winston coming to terms with Big Brother moment in his own time.

He checked me out, sent me to a specialist, and reminded me that if I didn’t submit to his fräulein, he could no longer see me.

I exited the room, went to the front desk, handed my ID to the girl and told her to not say a word to me because I find it very difficult to be polite to nazis.

She complied.

*   *   *   *   *   *   *

The basic bottom line is this:

The thoroughly misnamed “Affordable Care Act” had the net effect of nationalizing the health insurance industry.  By the government buying health insurance from private carriers on behalf of the uninsured working poor, those health insurance carriers must agree to comply with federal regulatory requirements.

The major problem with government requirements is that the government doesn’t care about cost or cost-effectiveness.  Their intention is not to make a profit, hence they don’t care about profit.

It doesn’t matter what it costs to comply with a government regulation; failure to do so is illegal.  If a business cannot make a profit and comply with government regulation at the same time … oh well.  We have seen the failure of many insurance carriers in many states due to this exact cause.  They cannot comply with regulation and earn a profit at the same time.  They fold.  Their customer − the uninsured working poor this whole thing was designed to help − are hurt.

The government regulation in question is that which seeks to reduce-to-elimination the occurrence of health insurance fraud.  Health insurance fraud − when perpetrated against a private insurer − is weighed against the cost of tracking it down, prosecuting, and recovering damages … which are almost never recoverable.  As a result, the health insurance industry routinely failed to do much about health insurance fraud.

Health insurance fraud − when perpetrated against a government-controlled health insurance industry, however, is considered a crime against the government, and it doesn’t matter what it costs to track down the perps, prosecute them and fail to recover damages.  It also doesn’t matter what it costs to prevent it from happening in the first place.  Or how many provisions of the Constitution need to be sidestepped, or outright trod upon, to do it.  The government has an obligation to spend a thousand dollars to prevent the loss of a single dime.

And that is just about the size of it.  It is historically far simpler for uninsured healthcare-seekers to get medical attention from an emergency room and dodge the bills than to sponge off someone else’s insurance policy.  Insurance sponging is what the government is trying to prevent with its in-clinic policies that I balked at.  These policies are imposed upon every “health care provider” by insurance companies, which are required to adopt federal anti-fraud practices irrespective of cost or cost-effectiveness, simply because they take government money under the auspices of Obamacare.   And despite identifiable health insurance fraud being, quite frankly, microscopic.

I looked up some stats this morning.  The annual cost of paid  healthcare in this country, nearly all of which is covered by insurance, is $3.2 trillion [as of FY 2015].

A watchdog outfit for insurance fraud [insurancefraud.org] reports that the amount of health insurance fraud identified for FY 2017 was $2.4 billion. They estimate that it might reach tens of billions.  …which includes Medicaid fraud − which is extant.  Medicaid fraud is the elephant in the room; health insurance fraud is a mouse.

$2.4B into $3.2T results in two-thirds of one-tenth of one percent loss to fraud.  Name any for-profit industry anywhere which cannot swallow, whole, without so much as a hiccup, a two-thirds of one-tenth of one percent loss to theft.  Internal auditors would be dancing naked in their cubicles.  Two-thirds of one-tenth of one percent loss to theft is so close to zero as to be, well, zero.

But when the government gets involved, this doesn’t matter.

The government has mandated all health insurers, through insurance regulation imposed upon any health insurer which accepts US government premium payments [which is all health insurers], to require any health care provider accepting their insurance to screen all healthcare seekers by demanding a photo ID which is forwarded − ultimately − to a government database.  Every time you seek medical attention, this process occurs. 

The cost for establishing this process − in millions of healthcare providers’ offices − is tens of billions of dollars [I’ve read an estimate of $50B, but don’t know how reliable it is].  The cost for establishing a database large enough to hold the data being collected is billions of dollars.

The cost for hiring new office personnel in each of millions of healthcare providers’ offices just for the added work of complying with the new regulations imposed upon those millions of healthcare providers through the nationalized health insurance industry is hundreds of billions of dollars in on-going costs of wages and benefits, which include − ironically − healthcare.  The maintenance costs of the data system, and those employed to make them work, is tens of billions annually in recurring cost.

And simply because it’s the government doing all this, my years as a DoD data analyst suggest that you double it and add a zero just to the left of the decimal point in order to get a figure in the same universe as the correct final cost for any government program.

All to save two-thirds of one-tenth of one-percent of the cost of insured healthcare lost to the theft of fraud, that the for-profit health insurance industry largely ignored as “not worth it”.

The government is spending tens of billions annually, and demanding that the healthcare industry spends hundreds of billions of its own annually, all to prevent the fraudulent use of health insurance of $2.4 billion annually … of which only a tiny fraction is owned by the federal government.  The rest is owned by the privately insured, which the insurance companies themselves − rapacious, money-hungry bastards − have concluded is not worth pursuing.

I really hope I don’t have to remind people that the bottom line effect of all this is increased cost of healthcare.  The doctor has to hire new office staff to do the new tasks required by government regulation.  The doctor has to buy new equipment to comply with government regulation.  Every new expense imposed upon the doctor by government regulation means higher costs to the patient for every doctor visit.

Oh, but insurance covers that cost!!!

The insurance company has to hire new employees to perform the new tasks imposed by government regulation.  The insurance company has to buy new equipment to comply with government regulation.  The insurance company has to reimburse doctors an increased amount due to the doctor’s increased costs of complying with government regulation.  Every new expense imposed upon the insurance company by government regulation means higher insurance premiums for everyone who buys health insurance.

The nazification of every medical office in the land is just a side effect of all this.

And if the nazis don’t wish to have me call them nazis when they act like nazis, then here’s what they need to do:

Provide a correct answer when I ask them why they are demanding I justify my existence just to see my doctor.

That correct answer is: Barry Hussein nationalized the health insurance industry with Obamacare and required that health insurers demand documentation to eliminate the trivial likelihood of insurance fraud.  Because we accept their insurance as payment, we are required to collect data for the insurance companies.  All this information ends up in yet another government database that is used to track what you do.

If this is too difficult for the nazis at the front desks of health care providers, then they may substitute the following phrase:

Die dokumenten, mein Herr.

They may add a nazi salute at their own prerogative.