The Make Macedonia Great Again Healthcare Model

Breaking news: the nation of Macedonia will convert its health care plan to mirror that of the United States. Macedonian President Petre Erenei expects his country’s economy to skyrocket with this change.

Today, Macedonia’s economy lags far behind the US economy, as shown here:

Hihai Voromnin, Macedonia’s Minister of Economic Development, explained that expanding the health care industry is the key to Macedonia’s economic growth: “Today, Macedonia’s healthcare system is a single payer, centralized, and mandatory social health insurance model. This system lacks a critical element of the US healthcare system which stimulates economic growth,” Voromnin said.

“Macedonia currently treats all people equally. We need to divide them into combative interest groups. Then we can copy American healthcare financial model, where every healthcare institution attempts to STICK SOMEONE ELSE WITH THE BILL.”

Like the US, Macedonia will create three groups of users:

• Privately insured: Macedonia will provide employers with tax incentives to fund health care plans. Then covered employees will think they are sticking their employers with the bill.
• Government insured: Emulating the US, Macedonia will create two government-insured groups: Medicare for people over 65, and Medicaid for people too poor to afford health care.  Those covered by government insurance will think they are sticking the government with the bill.
• The uninsured: One quarter of Macedonians will have no health insurance.  They will go to hospital emergency rooms for health care and think they are sticking the hospitals with the bill.

In turn, the government, employers, and hospitals will strive to stick someone else with the bill.

The Government will first try to stick health care providers with the bill by cutting fees, adjusting rates, defining procedures, and imposing price controls.  Failing this, the government will simply stick the next generation with the bill.

Employers will react by:

• Reducing coverage, increasing deductibles, and shifting costs back to employees.
• Replacing full-time employees with part-time employees with no coverage, thereby sticking hospital emergency rooms with the bill.
• Limiting choice by forcing employees into HMOs. By paying a flat per capita fee, employers hope to stick the HMOs with the bill.

Hospitals

As in the US, Macedonia will have two types of hospitals, for-profit and non-profit.  For-profit hospitals will have incentives to increase revenues and decrease costs so top executives can make big bucks.  Non-profits, however, will have incentives to increase revenues and decrease costs so top executives can make big bucks. 

Through clever cost accounting, creative interpretations of rules and definitions of procedures, ingenious allocations of overhead costs, and constant price increases, the hospitals will attempt to stick private insurers with the bill.

Insurers, however, will not get stuck with the bill. Insurers will stick someone else with the bill by:

• Negotiating large discounts (forcing providers to raise their prices even faster).
• Employing a procedure known as downcoding to both deny valid claims and improperly lower the amount of money paid to hospitals and doctors.
• Not selling insurance to people who really need it by marketing to the healthy and rejecting the sick.

HMOs, not to be outdone by their insurance brethren, will try to stick their members with the bill through “denial management” techniques such as:

• Determining that a provider is not part of their network.
• Penalizing doctors who order long hospital stays.
• Requiring hospital recertifications and then alleging that they were not informed in time.
• Not recording bills as received and then denying claims because they were not filed in a timely manner.
• Subjecting patients to rigorous credit approval, complicated forms, and endless waivers. (HMO’s expect to soon discover DNA markers for poor credit and litigiousness.)

Lawyers will seize the opportunity to sue doctors, forcing them to order unneeded tests and procedures to avoid malpractice suits.

“The beauty of copying the US is that no one has incentives to restrain spending. Since they think they can stick someone else with the bill, they are incentivized only to bill high, pay low, shift costs, deny claims, and lobby politicians,” President Erenei said.

“In Macedonia, such incentives will stimulate economic growth and improve health. Under our ‘Great Big Beautiful Stick Someone Else with the Bill Bill,’ Macedonia will spend an average of $7,000 on healthcare per person, as does the United States.

“This robust healthcare spending will be a shot in the arm for our economy, creating new jobs and new wealth,” Erenei promised.

“The administrative costs of Macedonians trying to stick someone else with the bill will exceed $50 billion. This means jobs for tens of thousands of claims deniers, lawyers, guideline writers, cost accountants, forms designers, complaint processors, price negotiators, and reimbursement analysts.

“Our single-payer system, lacking the ‘Great Big Beautiful Stick Someone Else with the Bill Bill’ infrastructure, never created a single job in these categories.

“Most importantly, this new healthcare plan makes Macedonia healthier. Among all nations, we currently rank only 87^th in life expectancy. With our new plan, we expect to approach the United States, which ranks 62^nd, even though US healthcare spending is double that of peer countries.

“Even Alexander the Great never imagined that his fellow Macedonians could achieve this.”