Before the Affordable Care Act (ACA), America’s healthcare delivery system was a gravy train, making every player rich and leaving the putative beneficiaries — patients — deeply unhappy. Pre-ACA healthcare delivery was a cash cow, a gravy train for all the health care providers, including doctors, hospitals, pharmaceutical companies, and device manufacturers. According to the 2011-2012 Physician Salary Survey, most doctors earned upwards of $200,000 a year. Not bad for a profession where nothing unique is invented and all the techniques are industry-standard practices.
Health insurance is a nasty business. There may be no more complex business on earth. Insurance needs to turn a profit, pay attention to federal and state laws, and stand as middleman between sick people and the bad guys: greedy doctors, hospitals, Big Pharma and medical-device manufacturers.
I worked my way through college at a large Midwestern teaching hospital. Then, in my profession as a software architect, I spent nine years working for a variety of health insurance companies programming claim systems. My unique experience taught me a lot about how health care is delivered in the United States. Under the old system, known as “fee for service,” the incentives were lined up to encourage doctors to perform as many procedures as possible. With few exceptions, the more procedures — CPT/HCPCS codes — a doctor performed, the more money they made. In fact, many doctors even figured out how they could get more money by breaking up their procedures into smaller sub-procedures so they could bill for them separately.
LiberalAmerica.org | Obamacare Explained By An Insurance Industry Insider - LiberalAmerica.org
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