The Amazing Maze of US Health Care » A game of Old Maids

Amazing seems a most appropriate word to describe the financing and delivery of health care services in the United States of America.
James L. McGee, CEBS--On Health Care Reform

A game of Old Maids

Approximately six months ago our office began receiving stacks of paper claims for prescription drugs. The drugs originated in various Veterans’ Administration medical centers around the country. They were for drugs that members in our Plan had received at VA medical centers.

It was obvious that there had been some sort of new policy at the VA that required the VA to obtain payment from other payers when veterans had other coverage. The problem in this case is that our Plan had just changed pharmacy benefit managers effective January 1, 2008.

So think about this. Until recently, a veteran who also happened to have other coverage went to a VA medical center and received care. The VA paid for the service and somebody figured out how much it added to national health expenditures. Our health plan did not pay for the services and therefore nothing was added to national health expenditures, other than the cost of keeping that Participant enrolled in our Plans.

Then someone in Congress got the idea that the VA could save money by finding someone else to pay for services. Ignore the macro perspective that it increases the total cost to the system. Now a layer of bureaucracy is added to find who is liable for payment and send the bill to that payer. Remember the card game Old Maid? Who is going to be left holding the poison card? That’s what our health care financing system has come down to.

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