Page 3 of 3 The terror of state
health care By Julian
Delasantellis
minutes, that code is
99205. When the doctor finally sees you, 15
minutes or less of face time is coded at 99241,
15-30 at 99242, 30-40 at 99243, all the way up to
80 minutes for 99245.
Of course, doctors
face a lot more varied diagnostic challenges than
just sore throats. Do you have a burn caused by a
terrorist strike where some furniture and/or
fittings have melted? That's on
page
348 of ICD-9-CM; its accompanying code is E979.3.
If you get hurt parachuting, your injury
code is E844, unless you had to jump out of the
plane because it was crashing (James Bond's doctor
is probably pretty familiar with this one) -
that's E840. A cat bite is E906.3 (but a cat
scratch is E906.8). A cobra bite, E905; a
black-widow-spider bite, E905.1; if you've
recently been a guest on The Jerry Springer
Show and were deliberately bitten by another
one of your interlocutors, you've got an E968.7,
unless it was just an accident - that's E928.3.
You get the idea.
What you have
here is the core of the high US health-care ACRs.
Where once a doctor like Marcus Welby could get
away with just Consuelo on the payroll to handle
appointments and answer the phones, these days
doctors and clinics, as well as the insurance
industry, must hire legions of trained and skilled
workers who can understand and navigate this ever
changing system called medical billing and coding.
According to the US Department of Labor,
"The expected growth rate for medical coding
(including billing and medical-records management)
and health-care information management for the
period 2000 to 2010 is 49%. Medical coding is one
of the 13 fastest-growing occupations in the
country. Employment of medical-records and
health-information technicians is expected to grow
much faster than the average for all occupations
through 2012, due to rapid growth in the number of
medical tests, treatments, and procedures that
will be increasingly scrutinized by third-party
payers, regulators, courts, and consumers."
During the Cold War, the superpowers built
intercontinental missiles to attack each other
with. These days, the US medical industry hires
its billing and coders to shoot claims off to the
insurance companies, and the insurance companies
hire their own billers and coders (anti-billing
and coders?) to shoot them down, to deny payment.
What did that guy on Fox say about US
medicine not being bureaucratic?
Doctors
despise this system. The insurance companies love
it. US medicine's golden rule is that "whoever has
the gold makes the rules" and, these days, the
gold goes to the night-school masters of business
administration at the insurance companies, not the
medical doctors from the Ivy League.
Rome
controlled the world with its legions, Britain its
navy; the insurance industry controls US medicine
with the billing and coding system.
Has
the insurance company had a bad day with the
subprime mortgage bonds in its investment
portfolio, and this quarter's earnings are at
risk?
Well, that's easy enough to deal
with. Guess what, doc: where we used to pay 80%
for code 69405, Eustachian-tube catheterization,
now we'll only pay 50%. The patient now has to pay
the rest; if he can't, the doctor or clinic eats
the remainder. If the company's balance sheet
still looks grim, it may be decided that from now
on, lots more 96921s - laser treatment of
inflammatory skin disease between 250 and 500
square centimeters - are going to be classified as
"not medically necessary", no matter what the
patient's doctor thinks.
The insurance
companies' philosophy here is similar to what Bud
Fox's (Charlie Sheen) boss, Lynch (James Karen),
said in the 1987 movie Wall Street: "Well,
somebody's got to pay. Ain't gonna be me."
Seen in this light, America's 47 million
uninsured are not a social crisis to be addressed
by government intervention and remediation;
they're perhaps the only real method of cost
containment currently existent in US medicine. As
administrative costs rise, health-insurance
premiums rise in tandem. That means more and more
employers can't afford to buy health insurance for
their employees, and individuals can't afford to
purchase it for themselves.
These people
get thrown out of the system, so no one has to
deal with their coded billing claims bouncing back
and forth between doctors and insurance companies.
Even if the United States wanted to (and that's a
good question), it could not afford to cover the
uninsured, not under this system.
The
bottom line In 1952, General Motors
president and future secretary of defense "Engine"
Charles Wilson told a congressional committee,
"What's good for General Motors is good for the
country." Even if that was true then, these days,
it is questionable whether
health-insurance-industry-centered US health care
is good for the country; it's certainly not good
for GM.
Since most health-care coverage in
the US is based on a person's employment, the
tremendous increases in health-care premiums
charged by US insurers is a significant drag on
company competitiveness, particularly when in
competition with companies in countries that have
national health systems.
GM now spends
more on employee and retiree health benefits than
it does on steel; it has been noted that, in the
current round of North American auto-industry
plant closings and workforce reductions, the angel
of layoffs has mostly "passed over" the plants in
Canada, where the companies have no financial
responsibility for health care.
The
ability to control costs at will is at the core of
the four major US health-insurance companies' $60
billion in profits this year. As in most of US
business these days, these benefits skew heavily
to the top. After earning $500 million in
compensation during his 14-year tenure as head of
United Health, William McGuire, forced to leave
office because of a backdating of a stock-options
scandal, was offered a $1.1 billion "golden
parachute" severance package to help him out the
door.
It's a profitable industry, and it
wants to stay that way. As the Republican Party
has for decades found a reason to block just about
every attempt to skim and redistribute some of the
industry's gravy off the gravy boat, it is not
surprising that the industry skews its political
contributions heavily in that direction, by a
reported 2:1 ratio in the 2006 congressional
elections. McGuire, during his tenure at the top
of United Health, made just under $149,000 in
political contributions - $4,000 of that to
Democrats.
After they finish buying
Congress, they buy the American public. In 1993,
to fight the Clinton health-care plan, the
health-insurance industry created Harry and
Louise. These were two actors hired by the
industry to star in TV commercials playing the
role of "average" Americans sitting at their
kitchen table reading supposed details of the
Clinton plan with greater and greater trepidation.
The skill and sophistication of the ads
induced nationwide creative suspension of
disbelief, as Americans never stopped to question
just why this very profitable and canny industry
was spending, by some estimates, $45 million just
to publicize the views of these supposedly
"average" Americans.
Then there's all the
media stories about how bad medicine is in places
like Canada or France, stories that, for the most
part, the citizens of these nations find risible.
Supposedly, in "Canuckstan" (what many opponents
of US national health care call Canada) you
basically have to be covered in lesions redolent
of late-stage leprosy before you can see a
dermatologist. The better health statistics in
these nations belies these fables; besides, anyone
who thinks that Americans have easy access to
medical specialists has yet to have an encounter
with a health-insurance company gatekeeper.
And if you don't believe that, how about
that national health care breeds terrorism?
My doctor from India laughed when I told
her about the Fox national-health-care-terrorism
link. I asked her if she ever had any desire to
ram her sport-utility vehicle into the departure
terminal at the airport. "Does that time when I
was late for my flight and the car park was full
count?"
There it is, finally, the root
cause of terrorism. They don't hate us for our
freedom; it's our inadequate airport parking
that's the problem.
Julian
Delasantellis is a management consultant,
private investor and educator in international
business in the US state of Washington. He can be
reached at juliandelasantellis@yahoo.com.
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