My personal position against single payer healthcare is summed up thusly - if the government can't tell me whether or not I can put a dick in my mouth, the government can't tell me whether or not I can put a donut in there either.  Yes, yes, it's crude but sums it up nicely I do believe.

I also have professional reasons against it.  The short version is this - if there's single payer health then there will be a healthcare lien against every single civil action out there.  That isn't the problem, the problem is going to be the impossibility of dealing with the governmental entity in charge of handling this.  If it's anything at all like dealing with Medicare now, then this is going to be a disaster.

tl;dr below the fold

One more thing before the fold:  I do find it completely hilarious that the trial lawyers massively supported someone who will make being a personal injury trial attorney nearly economically impossible.  I do believe that the esteemed Nelson Muntz summed that up best. 
Under federal law, Medicare is what's known as a secondary payer when someone is injured by a third party's negligence.  That means that Medicare pays first and then has to be paid back out of any recovery.  If not, then the lawyers can be fined and even go to jail.  The money is taken out of the client's Social Security checks until paid in full.

I want to stress that I support this as a matter of public policy.  Why should Medicare, and by extension me as a taxpayer, have to pay for harm someone else did?  Plus with Medicare's insolvency, this is another way to get money back in the system.

Of course, my agreement as a matter of public policy does not extend to the fact that dealing with Medicare on this is like dealing with a bunch of retarded gerbils.  No insult to retarded gerbils intended.  You would think that the question "How much is the lien?" would not be that difficult.  After all, Medicare paid the bills, so it should be a matter of sending a print out and then using the magic of a calculator to add it up.  Ahahahahahahahahahaha no.  Not even close.  There's all kinds of difficulties, including that apparently health care providers can take up to 2 years to submit bills so Medicare won't agree to any payment until that 2 year period is up.  That's really really fun when the case is settling and the client is still treating.  Then you have the lovely times when you get different numbers and Medicare insists that each of them is correct.  Or the fact that Medicare's version of handling things quickly is to take six months to acknowledge that it received the authorization from the client to talk to The Firm.

My personal favorite is that it is Medicare's official position that Medicare, not the lawyers, gets to decide what injuries are involved.  Now, there is some rationale for that.  The point of that policy is to try to keep people from avoiding huge liens by leaving out certain claims.  But again, theory and practice are different.  War story time:  The Firm had a very elderly client who fell and broke her arm.  She also had a history of heart problems.  While she was in the hospital overnight for observation, she had a heart attack.  The Firm was not claiming that the heart attack was caused by the fall since there was no way of proving that it was.  Medicare kept including the care of the heart attack.  The Firm kept saying no.  The Firm was actually threatened with being reported for attempted Medicare fraud by a representative of the company that Medicare hires to deal with this.  Ultimately, it took intervention by the woman's Congressman to get this resolved. 

Then there was the time that I was forced to start screaming at someone on the phone in order to get the proper form to use to show that there was an accepted compromise and release on the amount of the lien.  Seriously, it took me 15 minutes and some very unprofessional behavior in order to be told that we needed to use Form XYZ not Form ABC. 

And, of course, there was the time that a case went to a jury verdict and the verdict slip had an itemized list of damages, including the medical expenses.  The Firm spent 17 months attempting to get a final number from Medicare to use as the stipulated medical lien for use at trial.  This included sending multiple letters explaining that this number was going to the jury and the jury would be told if it must award that amount if the defendant was liable.  At trial time, The Firm went with the largest number provided by Medicare.  The jury awarded that amount.  The Firm sent Medicare a check for that amount along with copies of the verdict slip.  Medicare decided that ooops that was the wrong number and wanted more money.  Again, threats of attempted fraud were made.  This resolved by the simple expedient of the client dying so The Firm was able to point out that there wasn't any money left. 

See, here's the thing.  There's no such thing as collateral estoppel against the US government.  If a private company screwed up like that, the court's response would be too bad, so sad.  Collateral estoppel, the short version, means that if a company says you owe X and you act in reliance on that, then the company cannot later come back and say you owe Y.  But that doesn't apply against the US government.  So Medicare can take forever and can keep changing the numbers and can do whatever it wants because there is no recourse.  And if single payer goes through?  It'll be like that for everything.

Hell, if single payer goes through, I fully expect that the auto insurance industry will start agitating for recission of the requirements that medical coverage be included in auto policies.  I mean, why should that be included when everyone has health insurance now?  Not to mention that I presume that all private employers will stop offering healthcare coverage.  I think a solid argument can be made that a public company is violating its duties to its shareholders by continuing to maintain an expense which is now unnecessary.  So that bullshit about not being forced out of your current coverage is precisely that, complete and utter bullshit.  But I digress.

Now, I appreciate that screwing over lawyers may be considered a feature, not a bug for nearly all of you.  I am very very sympathetic to that position.  But the long winded point I'm trying to make is simple.  Single payer health care will inject the tentacles of the government into every single area of life.  Every last one.  And you and me and everyone else will be forced to deal with the stunning efficiency and diligence of government workers about our health.  Yeah.  No.

Posted by: alexthechick at 02:09 PM | Comments (9) | Add Comment
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