Here are my current thoughts on what I see as a much better way to at least handle the malingering problem. I wish I could say I think it could solve it entirely, but that’s probably not realistic. People are people, and some people seem utterly incorrigible. But even if the following cannot totally solve the malingering problem, the basic gist strikes me as quite promising, and at the very least I think that pondering this sort of approach out in the open could be productive and eventually lead to whatever the best solution(s) may be. Anyway, here’s what I’m thinking:
- Insurance companies should not be allowed to make any of their own claim payment decisions. That is just asking for trouble. Their job is just to design and sell policies, collect claims, etc.
- The decision to pay or deny claims should be made by a neutral party, whose job it is to collect the relevant information and make the decision.
- Doctors should have the right to prescribe a medical leave, and given such a prescription, the initial, default decision should be to pay the fucking claim. This is totally consistent with the core principle of our Justice system to assume innocence and demand proof of guilt. It is also consistent with the way FMLA claims are processed, where’s it is primarily the doctor who decides.
- The doctors should be held accountable for their decisions with random audits, and if the auditors discover evidence of fraud on the part of either the doctor or the patient, that evidence should be brought to the appropriate investigative authorities.
- If insurance companies and investors don’t like the profits they can make under this system, they should go into a different line of business. This will motivate the establishment and development of suitable non-profit alternatives.
Aside from putting a lot more power in the hands of doctors to provide the kind of care their patients need, it will also reduce the risk of “fox” bias in the decisions regarding which “chickens to eat”. It will also lower the risk of accidentally punishing an honestly but “invisibly” disabled person for being punished for the fraudulent behavior of others.
I’m sure that a lot more could be said about the above, but I think that’s a good place to start.