Full circle about single-payer health insurance

by Rachelle Chang, Better Hawaii, February 21, 2017

I never understood why there is so much support for a national, single-payer healthcare system – until I started working in a small medical office.

Just last year, I believed that commercial health insurance is good for consumers. It is better for us as patients, in terms of flexibility (choosing the plan that fits you), choice (access to doctors you trust), and price (insurance plans must compete for your business, keeping their premiums reasonable and benefits attractive). It is better for healthcare providers, because they can choose which healthcare plans to accept; insurance companies with unreasonable requirements or low reimbursement rates could be avoided. Theoretically.

For healthcare providers, our current healthcare system can be a nightmare. Each healthcare plan has different copays, different deductibles, and vastly different levels of reimbursements. Some payers reimburse providers promptly; some payers may take months. It’s not fair to providers, who may have to wait a long time before they get compensated for their work. How many of us would go to work if we are not sure how much we will get paid, or when we’ll get a paycheck?

Even a small medical office, with a limited number of healthcare providers and billing codes, generates a lot of paperwork. Electronic billing helps, but there are still pre-authorizations, progress notes, requests for documentation, paper claims for payers who don’t accept electronic billing, and customer service phone calls to find out the status of a claim or why a claim was denied.

I’ve had problems with two insurance companies who each insist that the other is “primary” and should be billed first. I’ve had claims that get lost in the system, and then have to be “escalated” for payment. I’ve learned that military plans are “secondary” payers – except when they are “primary” payers.

For healthcare providers, I see the allure of a single-payer system: one claim form, one customer relations contact, one billing contact. Theoretically.

But the more I learn, the more I realize that a single-payer health insurance could be an even bigger nightmare than our current system. A monopoly on healthcare coverage, authorizations, and payments would not be good for anyone.

Consumers would have a limited choice of plans and providers, and under current law would be forced to buy health insurance that they may not be able to afford. Healthcare providers would have little recourse if the single-payer refuses a claim or underpays a claim.

In a short time, I’ve realized that the government health insurance payers (military, veterans, Medicare, and Medicaid) are the most difficult payers to work with. Government payers often take longer to reimburse providers – sometimes three times as long as commercial insurance companies. Government payers often pay providers less – sometimes 25% less than commercial insurance companies. Government payers often fall short in informing people that they need to have an authorization before they see a healthcare provider – and there is little recourse for appeals.

I was beguiled by the idea of single-payer health insurance, until I realized that the single-payer would be a government payer. I’ve come full circle, skeptical that single-payer health insurance would be an improvement over our current healthcare system.

If you work in the healthcare profession, what has been your experience with medical billing and claims? If you’ve lived in a country with a single-payer health insurance, what has been your experience with medical costs and care?