Thursday, September 23, 2004


Kerry has (among other things) proposed to address catastrophic care with his health plan. From the website:
Cut Premiums By Up To $1,000 For America's Workers. Paying for catastrophic care can pose enormous problems for businesses, especially small and medium-sized ones. Catastrophic injuries and illnesses are impossible to predict, and caring for them is extremely expensive. As a result, a single catastrophic case can drastically raise the price of health insurance for all the employees of a small business. To ease the burden of businesses in caring for catastrophic cases, the Kerry-Edwards plan will reimburse businesses for 75 percent of the cost of catastrophic care.
We heard on the radio that "catastrophic" would be defined as costs exceeding $50,000, but can't confirm that yet. In any event, this aspect of Kerry's plan has an interesting advantage. It makes fraud very difficult. How does one fraudently rack up huge medical bills? It's not easy. What is easy, is to have a program that reimburses lots of small medical bills. Then the fraudster can slip many hard-to-challenge cases into the mix. It's far easier to lie and say somebody suffered from a sprained muscle and needed some pain killers than it is to get a healthy patient (undeservedly) into the ICU.

Attacking the health care issue from "the top" of expenses is a clever way to have a program that minimizes fraud.

NOTE: Yes, we are aware that there can be some instances where a doctor and co-conspirator patient can test and medicate so much that the bills get really big, but on the whole it's a hassle to create that scenario.


This means that a week in the hospital with surgery is now defined as "catastrophic". Heck, my two day stay came to some $28K six years ago.

Catastrophic -- the price of a Hummer.

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