Wonkonians Send Gekkonians a Message

Posted on October 12, 2007
Filed Under Gekkonian Rationing, Wonkonian Rationing |

Joseph Paduda of Managed Care Matters comments (here) on the recent New York Times report (here) that private health insurers are, to be technical, screwing thousands of Medicare patients. According to federal auditors, the insurers accomplish this crime by employing devious sales tactics, misrepresenting their products, improperly terminating coverage for people with expensive diseases, and creating enervating inconveniences designed to discourage consumption of healthcare services.

The bottom line of this unsavory episode is nicely summarized by Mr. Paduda:

If you’re a single payer advocate, you get to sit back and watch the private sector prove your case.

DrRich agrees with this assessment, but when examined more closely there’s more to this story than first meets the eye.

One aspect that comes out in the New York Times article, for instance, is that the health plans may feel they are being treated unfairly here. As absurd as this proposition might seem, let’s play with it for a moment.

All the abuses duly tabulated by the federal auditors, of course, amount to standard operating procedure for Gekkonian health plans. It’s their business model. Covertly rationing healthcare is not easy - indeed, it’s a thankless job. But somebody’s got to do it. And we, through our elected representatives, have deputized the health plans to do it for us. If we’re going to send the for-profits off to accomplish the covert rationing for us, then we’ve got to give them the means to make a profit doing it, don’t we? After all, it’s only fair.

The unfairness of criticizing the health plans for doing what we asked them to do is reflected in the plaintive words of John H. Wells, compliance officer at Bravo Health, who said (as quoted by the New York Times),

“The appeals and grievance process is very complex. It is very difficult for any plan to be fully compliant. In many cases, the government’s guidance is unclear, so it’s impossible for a business to know what to do.”

Now, DrRich will not sympathize with the Gekkoninan health plans. They show no mercy or empathy for the sick people in their charge who are harmed by their unfair policies and Byzantine procedures. Why should they expect any quarter when they themselves are skewered by similar policies and procedures promulgated by the feds?

But nonetheless, Mr. Wells has a point. Even if the health plans wanted to be good citizens, and wanted to be fully compliant with each of the laws, rules, regulations, and guidelines spewed forth with great regularity by myriads of federal agencies, they couldn’t. The health plans are inherently caught up in the great Regulatory Speed Trap. If you’re working in the healthcare arena today, then each and every day, no matter how careful and meticulous you may be, as you navigate the monstrous and seething regulatory tangle in one way or another you’re committing healthcare fraud.

The great Wonkonian regulatory hammer can be brought down any time the feds want, on anybody they want. Indeed, on closer examination it becomes immediately apparent that the Wonkonians aren’t even all that serious about it this time. Consider: Given the list of abuses reported by the federal auditors, heads could have rolled, executives imprisoned, companies shut down. After all, real people were done real harm here; some might have died. Instead, the feds merely fined 11 companies a total of $770,000 - a pittance, a trifle, not even a substantial part of the profits they’ve made by doing these evil things, an amount they can make up by foregoing one or two TV ads (aimed at convincing us of how caring they are).

But the Wonkonians aren’t yet ready to deliver the fatal blow. The people aren’t quite ready for what that would mean. (It would mean what Mr. Paduda says it would mean.) This time the Wonkonians are simply sending the Gekkonians a message, and they’re doing it publicly enough to render the people (i.e., us) just a bit more resigned to their inevitable endgame.

Mr. Wells has heard the message. “We’ve got you where we want you, Gekkonians. Behave yourselves and we’ll let you play a little longer. But don’t kid yourselves. When the time is right, it’s all over for you.” Wise Gekkonians will be carefully packing their Golden Parachutes.

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