Fee-for-Service . . . an Anathema to Single-Payer Global Health Insurance
July 20, 2010 UPDATE: You don’t think our communist government is attacking healthcare? Here is a new law banning all new Doctor-Owned hospitals and larger Professional Associations. http://www.cnsnews.com/news/article/64034
The 1100+ page healthcare bill, HR 3200, creates a new ‘contract’ between citizens and access to their doctors. On one side of the politician’s mouth is the message of “affordable healthcare for all.” But, if the other side would speak, you’d hear details of a massive plan that takes your medical care from the intimate privacy of your doctor’s office to back room analysis from “accountable care organizations.” (ACO’s)
An ACO is “composed of hospitals, physicians and/or other clinician and non-clinician providers working as a team” and would “accept responsibility for all or most of the care that enrollees need.” This group, not your doctor, would oversee your healthcare.
Healthcare rationing, conflicting care philosophies and priorities, or concerns over costs contribute to the unpredictable outcomes of ACO oversight. The trend is an end to ‘fee-for-service’ medical care in favor of ‘capitation’ within ‘global payment.’ If you don’t know what these terms mean, good luck in understanding the agenda of healthcare reform.
Let’s say your HMO is hospital-based with doctors as employees or a doctor-owned professional association. When your doctor orders tests for HIS diagnosis, his HMO covers those costs. The advantage is excellent healthcare determined by the skill and care of your doctor. The only disadvantage is that when you move to another region, you must seek similar services.
Then, there is the Blue Cross and Blue Shield model. BCBS has entities chartered in every state, but no hospitals. If your doctor decides to order those same tests, BCBS’s board may decline payment, and then the hospital will bill you for the balance. Maybe the tests were essential to diagnosis, but the BCBS board flagged the tests as ‘repetitive,’ ‘duplicative,’ or other code words for defensive medicine.
So, you pay the bill or challenge it. But, the advantage to BCBS is it is portable from one state to another.
Loss of Coverage and Pre-Existing Conditions
If you lose your insurance and have a pre-existing condition, it can be costly if not impossible to find a new insurance policy. The first suggestion is not to lose your original policy that you’ve been paying into faithfully for years. That is the definition of insurance in the first place. State oversight through their Public Corporation Commission is supposed to prevent such loss of coverage.
However, if you do lose coverage and can not find a new insurer, you may be eligible, for a limited time, under your state’s ‘high risk medical pool.’
Nevertheless, some ‘fall through the cracks’ and end up with no insurance. They are the small percentage who must rely on ER indigent care. These are whom government is basing changing the entire health insurance industry for . . . illegal aliens, indigents, or persons who messed up on paperwork due to lack of personal initiative or ability.
The Federal Solution is Potentially Unconstitutional
The problem is that the Federal solution to this small percentage insists on global coverage and the eventual extinction of fee-for-service patient:doctor relationships.
Here is the danger of the extinction of fee-for-service. If the Federal plan denies fee-for-service for those who can pay to extend or save their lives, the legislative act that eliminates private care unconstitutional.
There is a law in Article I, Sec. 9, Cl. 3 of our constitution that bars the legislation of ex post facto law, and a little archaic thing called a Bill of Attainder. What is a Bill of Attainder? Attainder, or to attaint, was a common law practice of stripping a man, and his successors, of his title . . . his estate . . . and all civil rights. Our founding fathers, while recognizing the contributions of English common law to subjects and civilization, decided the Bill of Attainder was in conflict with a citizen’s inalienable rights, and banned it.
Similarly, a legislated Federal healthcare system denying direct access of a citizen to a doctor in a fee-for-service transaction is disturbingly analogous to Attainder. The irony is that Federal law mandates that a private hospital treat, at a potential cost of multiple millions of dollars, an indigent illegal alien; but that same law will deny private service to a paying citizen.
There is the ‘rub.’ You may feel you are reasonable promoting a tax-based healthcare system, but if you take from the rich to service the poor, there won’t be “no rich no more.” (I’d Love to Change the World, Alvin Lee, ‘A Space in Time’ by Ten Years After) That, in effect, will create a ‘global’ Bill of Attainder. The rich, even the middle class, won’t be able to afford doctors’ services driving the market forces that gave us the most advanced medical system in the world in the first place.
For a more immediate and ‘fair market’ solution to reducing health insurance costs, making it affordable to just about everyone at any age, see https://paraleaglenm.wordpress.com/2009/03/05/personal-injury-attorneys-and-liability-insurers-stealing-from-hmos-and-injured-parties/
 Commonwealth of Massachusetts. Recommendations of the Special Commission on the Health Care Payment System. July 16, 2009. (Accessed July 27, 2009, at http://www.mass.gov/dhcfp/paymentcommission.), as cited by; ‘The End of Fee-for-Service Medicine?, Dr. Robert Steinbrook, M.D., New England Journal of Medicine, July 29, 2009 at http://healthcarereform.nejm.org/?p=1247?query=TOC