This is a reply to Rex Bradford on a paper I submitted in my OLLI class dealing with a non-government controlled health plan for children.
On November 18th, 2007 at 08:07 PM, John E. Maloney said:
Rex- Under this plan, every child is entitled to basically unlimited health care. Basically under this plan, everyone pays in proportion to what they are able to pay as measured by federal tax returns after taking the number of dependent children into consideration. Using the federal government's taxing system to determine the "fair share" keeps Blago from messing with it.
The only role of the State is to have the State Treasury figure out, how much is needed and to deposit that amount in the State Treasury to be distributed to the providers. But here again, my distrust of the State as a reliable payor is so great that I build in another protection that insulates the providers from the State.
I do not have the providers directly tap into the pool, but rather, have them sell their claims to insurance companies on a discounted basis. Since every child will be on this insurance and since everything is covered there will not be very much argument, but I suspect that the State, as it always does, will try to screw the providers.
To further prevent the State from questioning claims or elgibility for payment, I have the paper work and verification that the service has been provided to elgible recipients processed by the insurance companies after purchasing budles of these claims from hospitals and doctors. How valuable do you think it will be to a provider not to have to deal with the State or have to process reimbursement from a hundred different insurance companies, and track their payment.
The insurance companies will buy them on a discounted basis. The providers will be paid up front on a discounted basis and then sell their bundle to the State pool. The insurance company will make their profit processing the claims and taking the risk of delay, etc.
If the State tries to screw the insurance company , the insurance company can appeal this determination to the feds and if successful, the money (together with a bad boy penalty) will be assessed against the State, paid immediately by the feds, and subtracted from the grants that the feds normally pay through the State. Thus the State will not be able to make up some stuff that the doctors were over charging. If their is a question on whether their is overcharging, the "reasonable and customary" rates owed by the State to the insurance company will be resolved by taking an average of the ususal and customary rates in like sized demographic areas in other parts of the United States.
Although this may seem to you to be somewhat overdone and unnecessary, the reason behind this elaborate mechanism is because this will eventually be the way that special education monies are funded by a combination of federal, State, and local tax dollars.
It is a little hard to understand at first, but it really is very simple.
(1) One standard policy means no arguments as to what is covered and what is not.
(2) A mechanism that is a fair way to determine reimbursement rates and charges.
(3) A simple way to insulate the providers from the State so they can practice medicine and not have to worry about collections, State reimbursements, or processing insurance claims.
(4) A simple way to insulate the insurance companies from the State so that they do not have to litigate any problem with the State of Illinois in the Court of Claims which is essentially just an arm of Blago.
(5) "Fair share" on premiums is also not determined by the State, but in the same manner that federal income tax is determined (less a loss of certain dependency deductions).
What you have left is essentially a State Universal Health Care for Children funded not through taxes, but under a mechanism that is fair to the parents of the kids, fair to the taxpayers (not regressive), fair to the providers, fair to the insurance companies, and certainly fair to the State because administrative costs of the children's system will be cut in half. It is also fair to taxpayers because federal monies, earmarked for Special Education, can be distributed to the State through this mechanism. This will have the effect of eliminating local property tax dollars from funding of special education programs.
