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Who Stills Profits in Era of Obamacare? The Middlemen

Although there are some really good things in the Affordable Care Act, it was largely designed by that same for-profit insurance industry to preserve their business model. That is why the law is so fantastically complex. (Photo: Thomas Hawk / flickr / cc)

I was at a restaurant in Boston, sitting next to some high-powered business professionals. I heard words like “hospital network,” “insurance” and “pay structure” coming from their table, so I had to eavesdrop.

It turns out they were bankers whose expertise was helping hospital systems collect the money they are owed.

You need to understand that billing for health care services has become a specialty unto itself – the whole process is a giant mess. This is because there are so many different insurance companies with so many different plans and rules and networks that it is impossible to know how to get paid.

Plus, the for-profit companies that create these plans are obligated to place their shareholders over patients – they do all kinds of things that range from incompetent to nefarious to create obstacles that make it hard for providers to get reimbursed.

And all this wastes a huge amount of money. Studies estimate that up to 30 percent of our health care dollars are burned up paying for paperwork, consultants, computer systems, administrators and all the other things required to simply process the payments.

Think about that. Every time you try to figure out which network you are on, or which drug costs you less, or how much your copay is, you are experiencing a tiny part of this confusion.

And Obamacare only perpetuates the problem. Although there are some really good things in that law, it was largely designed by that same for-profit insurance industry to preserve their business model. That is why the law is so fantastically complex. The rules about mandates, subsidies, actuarial value, exchanges – all that exists to ensure profitability for those companies, allowing them to successfully stay in between patients and providers.


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Which gets back to those bankers. The system is so confusing that people can make a lot of money if they can help providers figure out how to get paid. And that is the real problem. Our health care system is filled with good people who feel they are bringing real value to the system, but they are just feeding off needless complexity while the rest of us struggle to pay our insurance premiums and medical bills.

There is another way to do this, a way where all that cost and complexity disappears. Back in 2009, Congress could simply have raised our Medicare taxes by an amount far less than what we pay for all this bureaucracy, and then we could all start with basic coverage using Medicare. But that approach is so far off the table that most Americans don't even realize it is an option.

And the problem is not just limited to those bankers – it applies to for-profit insurance companies, consultants, billing services, pharmacies, advertisers, administrators and all the others that are piggybacked onto the simple act of going to see a doctor.

There are so many people in our health care system who make money from confusion, and they are so certain they are really helping us, that any attempt to streamline or improve things is met with powerful resistance – often in the form of aggressive lobbying and potent messaging that avoids the real issues.

But think how much better our system would be if all those people were doing useful things like patient care or research instead of making money of off confusion.

Those bankers actually said it best. At the end of their meal, one of them commented how our health care system is a real mess. Another one immediately said, “Yeah, but if it wasn't, we'd be out of a job.”

As you watch your money disappear into copays, deductibles and premiums, you should be asking whether their job is one that you really want to be paying for.

Jonathan Walker

Jonathan Walker

Dr. Jonathan D. Walker is an ophthalmologist in Fort Wayne, Indiana.

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