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Today’s New Terrible World-Destroying Statistic

By Jesse Taylor
Monday, December 21, 2009 15:37 EDT
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imageIt has been discovered that Medicare SHOCKINGLY denies every single claim ever submitted to it, or something, which means that it’s drastically worse than private insurance which…denies at the same rate? Or something?

But, when you take the “profit” out of health care, what do you find?

According to the American Medical Association’s National Health Insurer Report Card for 2008, the government’s health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%.

In its 2009 National Health Insurer Report Card, the AMA reports that Medicare denied only 4% of claims—a big improvement, but outpaced better still by the private insurers. The prior year’s high private denier, Aetna, reduced denials to 1.81%—an astounding 75% improvement—with similar declines by all other private insurers, to average only 2.79%.

Why can’t Medicare be as…non-denyey as the private market? My guess is the socialism.

Let’s take a closer look at the data, because it’s data from conservatives about healthcare, which means that virtually any other number from either report should pretty much decimate their entire case. Let’s pick…6,938,431. That’s the number of claims Medicare processed in 2008. The most any of the private insurers? 1.1 million. The entire benefit of Medicare (and, presumably, any public option plan) is that they handle tons and tons of claims, and do so for populations who are the most likely to need health care. A program which specifically targets people over 65 (people who are more likely to need extensive healthcare on a routine basis) is going to have a higher rate of denials simply because the population is going to seek out a much more diverse set of medical treatments.

This isn’t even mentioning the underpinnings of these relative systems (and of the denial metric itself). Over the past couple of years, I can’t tell you how many times I’ve had claims sent in which are paid at a one or two percent rate. I had a $95 doctor visit paid for by my insurance. And by “paid for”, I mean they sent a $1.20 check over. Not a denial! I’m also well aware with my insurance company (for the most part) of what they will and won’t pay for – more importantly, I’m well aware that my coverage as a single, healthy 27-year-old is far less comprehensive than Medicare, as are my in-network doctors.

Oh! In 2009, there were actually two private insurers whose denial rates matched or exceeded Medicare’s, too. Special!

Denial rates as defined by the AMA probably aren’t a particularly good way of comparing Medicare to private insurance, for the precise reason that so much of the opposition to universal health care is so wrong. Medicare is a different system than Aetna. Many of the alleged efficiencies of private insurance come from the upfront screening out of the uninsurable – you don’t have to deny what you made clear upfront that you don’t cover. For what Medicare covers, and how broadly it covers it, the fact that it actually denies less coverage than some major private insurers would seem to speak well of the program and its extension to the public at large.

But, then again, old people don’t get abortions, so that plan’s shot. Fuck a duck, man.

Jesse Taylor
Jesse Taylor
Jesse Taylor is an attorney and blogger from the great state of Ohio. He founded Pandagon in July, 2002, and has also served on the campaign and in the administration of former Ohio Governor Ted Strickland. He focuses on politics, race, law and pop culture, as well as the odd personal digression when the mood strikes.
 
 
 
 
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