We're From Washington We're Here To Help You

May 3, 2002
Print
Text Size:
A A
An executive order from President Clinton a decree went into effect Dec. 31 mandating that health insurance for federal workers must provide the same scope of coverage for mental as physical disorders.

Lots of people have lobbied for mental health insurance parity for years. They see the decree as a huge victory generating pressure for identical mandates for the private sector. There is no reason, they argue, not to treat mental illness  the same as physical illness for insurance purposes.

The issue here is mandates. Thanks mandates, the whole American medical industry today finds itself tied to computerized diagnostic and procedure codes. Say the doc finds you have a common skin cancer, a basal cell carcinoma, on your cheek.  For insurance purposes, that diagnosis is code number 1733 which can come only after a 11100 (biopsy) and an 88305 (pathology).

Those codes go on the bill. When the doc removes the growth, the staff types in 17208 (Destruction of malignant facial neoplasm 0.5 centimeter or less in size.) If the growth exceeds a half centimeter, the code changes. Such codes are the tip of an administrative iceberg.

If the patient is a retiree, the staff bills Medicare first. Once Medicare reimburses what it deems a "reasonable and customary" charge for saving a human face from disfiguration, the staff bills secondary insurers for however much they deign to pay. Once that check arrives (after an initial pro forma refusal in some firms' cases), the staff bills the patient. The process takes lots of clerical time. Time is money, and office visit fees, co-pays and insurance premiums rise accordingly.

The codes are a gift of the computer age . . . and a mandate of the Health Care Financing Administration (HCFA), of the U.S. Department of Health and Human Services. The codes are HCFA's way of trying to micromanage the health industry. The states' Medicaid programs and most private insurers didn't take long to piggyback on HCFA's alleged system. When HCFA adds, deletes or changes codes, the health insurance industry lurches with it, with lots of downloading to hospitals' and doctors' computers.

One result of federal health care mandates is obvious to anyone whose first medical visits occurred in the '60s. At the time it was one doctor, one nurse, one receptionist-billing clerk.

But government mandates contain little mandates with smaller mandates inside 'em, and those mandates have teenier mandates, and so on ad infinitum. And they all cost money.

Thus today, it's one doctor, one nurse, one receptionist-billing clerk, three other administrative workers busy in a suite of offices with a nationally linked internally networked computer system usually with five terminals. The industry's rising administrative population is borne of mandates ranging from collapsing reimbursements (price-rationing which, as the night follows the day, pushes fees higher for other patients), to permitting drug companies to spend millions for advertising which, ultimately, all health consumers pay while money-saving generics get forgotten.

Mandates cause insurers to conduct regular procedural audits of doctor offices (charts, records, displays, safety measures, drug sample controls), another set of administrative costs Mr. Consumer ultimately pays. Mandates manifest themselves, too, in hospitals' admission, discharge, administration and computer suites. And don't forget the role of deep-pocket tort parasites, whom most hospitals don't even dare contest any more in fear of adverse publicity.

So, the system is more cost-effective than in 1965, right? And it will become more so as yet other judicial, legislative and executive decrees work their magic on the maze they already have made of the health industry, right?

By the way, the mental health care Web sites are figuratively drooling about the president's latest experiment in re-writing health insurance policies. And that's  not because the mental health types think they'll make more money! Certainly not!

Those Web sites claim the mandate will save billions! Clinical depression, phobias, panic disorders, and bipolar (manic-depressive) disorder and posttraumatic stress added up to almost $200 billion a year in lost productivity. So the president's parity coverage decree will save American society around $200 billion, right? Wrong.

Oh! Forgot one: obsessive-compulsive disorder. President Clinton suffers it. So do most people in government. It's the obsession that they can perfect the very system they compulsively foul up.

It costs us more all the time. 

Editor's Picks

Comments powered by Disqus