British playwright Mark Cuban has taken a page from his fellow bard's book and suggested, "The first thing we do is, let's kill all the insurance companies." Of course, Billy Shakespeare penned the crux of this in Act IV, Scene II of Henry VI, Part II (approx. 1599).
Billy likely did not have a thing for lawyers, per se. Literary Hub suggests it is not a criticism or denigration of the legal profession. Moreover, the characters in the play are planning chicanery, and they predict greater potential success in the absence of intellectuals generally or the law's "staunch protectors" (lawyers). Take a minute to digest that perception of the legal profession. (Perhaps "those were the days, my friend?").
Well, Mr. Cuban is not a playwright; he is a billionaire. And Bezinga reports that he sees a path to better, more affordable medical care if the insurance industry were removed from the equation. He contends that the healthcare process is "very simple" and has been "made complicated."
There is an admission included that innovation and progress are both necessary and expensive. Mr. Cuban does not quibble with that element of medical separation (this patient versus that) or economics (new, more expensive, old hat, and tried and true). He is focused on "margin dollars."
The analysis is built on simplicity. People would secure services and pay for them if they could, and if they could not, well, that is a bit up in the air under his plan, but read on.
Medicine in America has been socialized. Not in the patent, obvious, everyone pay taxes and the government will use that money to provide equal access services for all. No, we socialized quietly with systems designed to spread the cost of care over large populations without a great deal of notice or attention, yes, health insurance, cooperatives, and similar.
One reason that medical care is expensive is that medical education is a long and expensive process. Another is that the supply of medical practitioners is limited and carefully controlled.
The building and maintaining of a hospital is very expensive, and it has to be staffed and ready all day, every day, even when there are few, if any, patients in need of services. That all costs money. There is a cost to being ready for the next SARS-CoV-2, bird flu, etc., even if it never comes.
There is a payment paradox. We have decided as a society that care will be provided by these hospitals regardless of the ability to pay. Hospitals are legally required to provide some level of care, period. The cost of that care could be (1) absorbed by the hospital, a loss, or (2) spread among the paying patients (socialized).
It is worth noting that in various cited examples of broader "equal for all" plans across the world, socialized medicine, the equality of care has come largely through bringing all care down to the lowest common denominator rather than pulling everyone up to the highest. Much like the bread lines in various socialistic utopias, government can cap prices, afford access, and mismanage, but the challenge is in actually delivering services or produce within those constraints.
In the end, medical care is expensive for a variety of reasons. Some of them are difficult to appreciate, others impossible to eradicate, and a slew in the middle that are simply entrenched and largely untouchable. That does not mean Mr. Cuban is wrong. He makes some valid and even compelling points.
His focus is largely on the billing process. He notes that providers "bundle() and upcode() procedures," an effort to "extract as much revenue ... as possible." There are also payers who then strive to unbundle and downcode in an effort to pay as little as possible. The loser is usually the patient who neither understands all that or cares to learn.
Mr. Cuban says that medical bills should list the inputs (providers, equipment, supplies) and the "overhead cost" (the building, the storage fees, inventory costs, etc.) in a plain statement. This, he calls a "bill of materials."
The billing should then show the "markup" or profit on each of those clearly stated inputs to patient care. His theme is that with such transparency, the goal would then be to "remove insurance companies." With the simplicity of patient payment for services, he estimates that "20% to 30% of healthcare costs" are eliminated, along with "another 10% for fraud."
The impact he advocates would be significant if the $5 trillion spent in America every year were reduced 30% to 40%. This largely ignores that saving me 40% on a $12,000 MRI still leaves me on the hook for $7,200. Even if that is the entire bill for the services needed (no doctor, no medication, no cast, etc.), that is a lot of money.
Mr. Cuban says that with the resultant savings to big payers like Medicare/Medicaid, there would be more money for patients' care. He envisions increasing the money flow (apparently to the government) by making employers pay more taxes to fund such programs instead of paying for the health insurance premiums for their employees (or a contribution).
It is perhaps unfathomable, but some believe large government operations may struggle to keep their books and be accountable. See Pentagon says it fails eighth audit, targets 2028 to pass. Or Medicare improperly paid suppliers. Or Medicaid’s True Improper Payments Double Those Reported by CMS. IT appears that large entities make large errors. Will larger ones make smaller errors?
The math is interesting in the Bezinga article. The analysis closes with an acknowledgement that there are "rough edges" in the proposal. Mr. Cuban admits he wrote the entire play in "about 90 minutes," and it is "far from perfect."
Nonetheless, it is a conversation starter. Perhaps we need precisely what Mr. Cuban recommends, or perhaps discussing it will lead us to our own utopian society or at least some improvement.
It makes me wonder if we really spend $1.5 trillion dollars each year (30% of $5 trillion) on the billing, upcoding, bundling, downcoding, unbundling processes. Is there really 10% of fraud and abuse in the American medical system ($500 billion)?
These thoughts are staggering. And there must be a great many people who work in the various efforts to both seek and resist payment. And those people all spend their paychecks to live, consuming various goods and services, which provides incomes to others to do the same.
I am not sure I hate Mr. Cuban's play, but I would want to see the completed (no "rough edges") version of the script before I buy a ticket. And it might matter to the ticket-buying public who will manage the new theater and be in charge of directing the play.
Maybe "first thing we do" is think through the costs and benefits, smooth the rough edges, consider the wider societal impacts, and then start the euphemistic overhaul, a la Billy Shakespeare and the other bards?
