by Marc Noon

Created on: July 30, 2010

President Obama has put forth a lot of effort in last year and a half to take health care reform off life support.  In the end he has had to make some concessions in congress and with the justice system on the language and nature of health care reform.  The language is geared for re-writing and re-coding a broken system in the hope that it might work.  Unfortunately a broken system will remain broke if the physicians and patients are taken advantage of by an unbridled competitive system where contracts are created by unwitting physicians or patient claims management companies.

The internet and Wikipedia have outlined some of the areas that need help such as the Wikipedia article "Health care Reform in the United States". But I would like to bring to bear my personal observations from the health care industry and paying claims.  What I have discovered while working at a small clinic is that billing and claims services can run into serious trouble.  The problem stems from competition, and dumping high risk patients and physicians onto unsuspecting carriers or claims management companies.

This type of activity, which I have dubbed "Ploinking", is rampant in any competitive industry.  You get rid of the bad or high risk variables (old or sick patients and new or struggling physicians), and you renew with low or tepid variables (healthy and rich patients, or highly qualified physicians).  The Health Care Reform Act does not look very closely at this serious problem.

Now you might be thinking, what meets the guidelines of risky, and how is it possible for companies to renegotiate contracts in order to dump both risky providers and patience into a financial abyss?  Hey, isn't this why we got into the health care quagmire to begin with?   The answer is quite simple: pure unfettered greed.  But capitalism can work when the competition is aware of these types of issues, and health care reform can fight back by helping physicians and claims management companies understanding how to negotiate for contracts between providers and health insurance companies.   So this is where the state and federal health departments should come to the rescue.  Instead of going to the accounting department, they should head over to the contracting department of patients and physicians of the "Ploinkers" and "Ploinkees" (The dumper of high risk patients, and the receiver of high

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