We've seen several younger and old influencers who seem to have some things right, yet they make really dumb statements about intelligent people who feel the for-profit health insurance industry needs to be replaced with a single payer or Medicare-for-all system.  

For clarity's sake, we've seen people who would be deemed by most as "intelligent" say that the for profit medical insurance system is the better system compared to single payer or Medicare for All, and their basis is typically because it's a capitalist system, even though nothing about that reasoning passes the smell test. 

Medical Billing is done with 5 digit codes.  A doctor and/or their billing company submits five digit codes to the insurance company and they get money in return. When the codes are submitted no evidence the appointment even transpired is required.  It's a trust based system.  

99201 - A 10 minute appointment. Must also take 3 vital measurements.*  Pays $50
99202 - A 20 minute appointment. Must also take 5 vital measurements.*  Pays $90
99203 - A 30 minute appointment. Must also take 7 vital measurements.*  Pays $130
99204 - A 40 minute appointment. Must also take 9 vital measurements. *  Pays $160

* - the Private insurers never ask for any verification an appointment actually transpired, the vital measurements are not presented with the bill, and no  appointment start or or start and end times are submitted with bill submissions. 

An example of the paper bill that was submitted prior to digital billing can be found at:

https://www.ricvalentineacupuncture.com/hicfa-form-explained.html

How many ways can you see for the doctor or their biller to defraud the insurance company?

1. Submit claims for longer appointments when short appointments were done

2. Submit claims for different types of appointments than what transpired (example later)

3. Submit claims for appointments that never transpired, with or without the knowledge of patients, depending on the scheme in play

In a system like this, the private insurers are the only group that has standing to sue doctors  for fraud because the private insurers are the payors.  But what incentive do they have for suing? Becuse mis-billing is morally and ethically wrong?  Because it's criminal?  Since when has that affected a for profit company?  They don't and won't sue because they make a flat percent on all money that flows through their company.  

In a system like this, the patients can't sue their doctors for financial fraud because the doctors are contracted for fees with the insurance companies not the patients. 

In a system like this, the patient can't sue the  insurance company for individual fraud because they turned over financial consideration rights to their insurance companies as part of coverage. (this is different by similar twist to the indemnity granted to vax makers in the 1980s that has destroyed the collective US immune system) 

How bad is the bad billing?  Great question...   

Now.   Watch this... 

A Doctor can do six 10 minute appointments in an hour. His face time requirement for a 10 minute appointment is only 6 minutes, but remember nobody tracks anything, so he may not have had to even put his face in the room if a nurse took the vitals and told him what was needed.  

Instead of billing for six 10 minutes appointments, h can bill for six 30 minute appointments instead, with no oversight.  

• He can literally bill for 3 hours of services for each hour he sees patients AND it gets worse if he sets up agreements with some patients who have good insurance who allow him to bill for visits they never attended.  

• Heck, those didn't even need to be on his calendar because nobody checks a thing...

Because Doctors see patients from different insurance companies,  the only way an insurance company "might" get suspicious is if they ended up with 24 hours of billing for an eight hour day.  

But are they even running queries for that type of fraud?  

AND most Doctors  and Billing Companies who engage in this type of "thingy" are smart enough not to make it that obvious.   

Who needs the entire feast when skimming at a lower level can pay for Yachts, homes in exotic lands,  and an entirely separate , dark economy, that few even know exists. 

Doctors also now do NOT do their own medical billing anymore. 

The computer systems are complex, and arguably, far more complex than they need to be. It is presumed some of that is to encourage the outsourcing of billing services.  Thus, the doctors sub out medical billing to companies not from their local towns who now sub it out to overseas technicians. 

Any person living outside of a community has less interest in the commercial health of that community. That's just a fact of humanity right now, but you may be shocked how many people living in a community may not care about their peers either.   

Thus subbing out medical billing to anyone outside of a medical practice, introduces lower accountability than is ideal for such an important task.

But think about how bad it has actually gotten now... 

Overseas technicians have no need to care for the US Economy. An oversees technician who can over bill for a single appointment for just $50 or $100 a few times a day could generate a week or a months worth of local profits if they live in the Philippines, and it's actually worse than that when you know what they are doing with simple surgeries, where they may be over billing by $5,000 to $20,000 or more via a single typo or two that "could be" deemed negligent if caught.  This last example is not hypothetical.  I watched the attempt and it was clear the local billing agent at the surgery center was in on it too. 

Currently everyone involved in billing, starting with the doctor and flowing through their billing companies to the insurance companies to the attorneys that protect them are all "for profit" entities.  A "non profit" is a for profit entity too. That status gives them tax breaks it has nothing to do with not making as much money as possible.    AND the American People simply believe everyone is going to act appropriately with no locks on the cookie jars?

IF the number for a bone spur surgery for $6k was 33455 and the number for an ankle  replacement surgery for $26k was 33554, AND you, as a billing company knew that every for profit entity in the billing system benefited from a "typo",  and you realized the patients weren't seeing total billing numbers anymore, only their co pays, would you "typo" things from time to time for a $20k benefit that could be waived off as an accident IF anyone could figure out who to question about it? 

Our Medical Industrial complex costs almost 5 TRILLION dollars per year, because foreign interests have taken over the entire Medical System and we, as citizens who pay into for profit insurance companies can't even fight them in our own courts.

I am no fan of Kamala Harris at all. Not even remotely close.  But when she says we need a single payer system or Medicare for all,  she may be on to something so foundational, the poop can't even smell it's own wiff. 

Not all Trust Based Systems are bad.  The Federal Banking Systems supports "check writing" and that is a trust based system.  It works well because  violating the system is a FEDERAL OFFENSE and there are no loopholes for offenders.

IF "trust based systems" are setup in commerce, they must be protected by the forces of a Federal Government that is kept in control by those who are positive enforcers, with penalty of death for the most extreme of offenders. 

This is why a "medicare-for-all" system is the only real solution.  Not only is it required to check and track over billing using reasonable technology, those who offend the system go straight to a federal penitentiary, or worse, depending on the offense.