Thursday, June 25, 2009

What if health insurers ran the DMV?

I thought opponents of the "public option" had gotten past this lame talking point, but I heard Boehner mention it last week: "Do we want the same people that run the DMV in charge of healthcare?"

So I had been wondering: What if the people currently in charge of healthcare (health insurers) ran the DMV?

  • If you had ever been in an accident (regardless of who was at fault), you could only get a driver's license through your employer. The cost would vary by a factor of 10 depending on who your employer was.
  • If you lost your job, you could keep your license on a month-to-month basis, but only for 16 months, and by paying more than most people make per month, and only if your employer was still in business.
  • If you drove more than 5,000 miles1 in a calendar year, you would have to submit extensive documentation, and wait for months for a decision, before being allowed to drive any more that year.
  • If you had not ever been in an accident, and got your license without your employer's involvement: If you did get in an accident, and the DMV can find evidence that you had ran a red light at any time since you started driving, your license would be retroactively revoked.
  • If you went to a repair shop2 approved by the local DMV office that issued your license, and saw a service advisor also approved by them (and the lists are different for every office), most of the costs of the repair would be included in your license fees.
    • Except if the service technician, janitor, tool salesman, or the guy that drives the cars into and out of the garage turn out to not be on the approved list. In that event, each of those people can bill however much they want and you're stuck with it.
  • Repairs would be the most expensive for the unemployed3. The more repairs your car needed, the more each repair would cost. The same repairs from the same shop would vary in cost by a factor of 10 depending on who your employer is4, with no way to find out the costs ahead of time5 6.
  • Nobody would need a written test before driving. However, the "rules of the road" would be 10,000 pages long, and the most you would ever be able to see would be a five-page summary. The DMV would not tell you any of the detailed rules7 (because someone might find a loophole!), but you'd still get a ticket if you violated any of them.

[1] The usual average is 12,000 miles a year. my use of 5,000 is intentional.
[2] I know repairs aren't regulated by the DMV, but I think they fit the analogy better than license plates.
[3] An annoying suboptimality of the world in itself: Lots of things are more expensive when you're poor.
[4] I've seen this. My daughter's NICU bill: $60K. After BCBS writedowns: $6K. You bet your ass I'd have been on the hook for the whole $60K were I uninsured.
[5] Go ahead, try to find out the post-writedown cost of a procedure from your insurer, even armed with CPT codes. I'll wait.
[6] Likewise, try to find out what your insurer considers "UCR" for a particular procedure, so you can know how much extra you'll have to pay (for some reason, it's never possible to find someone that actually charges anything close to the "UCR" rate). I'll wait.
[7] Again, try to find out what the detailed criteria for whether a particular procedure is covered or not. Your insurer will treat it like a state secret.


Criss L. Cox said...

Brilliant, and oh, so true.

llt said...

Criss L. Cox says it perfectly - Brilliant! And much too true.

r321 said...

I think Boehner is a bonehead! Any politician that says they're representing your interests, while lining their pockets with special interests money, they lie with a smile in their face!

Why shouldn't we get the same health care benefits that he gets? "all inclusive health care" paid by us the taxpayers.

Crisatunity said...

One of the few things the US government (all levels) has actually done well for a very long time much better than private institutions or other countries' governments, historically, is bureaucracy.

It's time to stop villanizing that which isn't villianous.

ciarastarling said...

Quite brilliant! I work on insurance verifications and authorizations -- this is to a tee, for certain! Well done!

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