After more than a decade of delays, it appears that North Carolina finally will join most other states in expanding medical insurance coverage for poor people. These are folks who don’t even have enough money to qualify for the regional private insurance markets established years ago.

Data estimates vary between 500,00 and 600,000 people who may qualify in the state for the proposed coverage. The North Carolina General Assembly passed bills, but they will not take effect until the new biennial budget for 2024-25 takes effect. When that may occur is open for debate. North Carolina passed a budget last year on time for the first time in many years. But there are other contentious issues in the hopper, such as Medical Marijuana for certain categories of diseases and illnesses. Then there is the proposed “Don’t Say Gay” copycat bill. Other southern state legislatures have taken a hard lurch to the right with the Republicans in control. Since the losses in federal elections 2020 and 2024, the Republicans have focused on the states and the courts.

So why is health insurance such a contentious issue? Simply because health insurance companies don’t want to give up their profitable market. Even though in many cases, they also serve as administrators for claims of public programs such as Medicare. They pay the claims that dictate who qualify for what and who gets paid.

Insurance is simply the tip of the iceberg for the lack of universal medical care. The pandemic exposed the unique mixture of public and private programs, providers, hospitals, etc. that represent a hodge-podge delivery system where many people fall through the cracks.

Fee for service is a business model for graft and corruption that invites fraud and eliminates innovation and reliable delivery of service.

If you bill based on the number of patients rather than the quality of service, providers often opt for the highest number. They claim they need do that because insurance doesn’t cover their costs. If you eliminate clerks in the hospitals and doctors’ offices processing unique claims from many insurance companies, then the process would be more efficient and less costly.

Electronic Medical Records have not eliminated the problems. They’ve just added to the duplication in processing of records. If you’ve had to wade your way through the “patient portals” that most providers now require, you understand the frustration of the current systems of billing.

A single payer system intuitively would seem to create a giant bureaucracy, but by eliminating silos it would create a more efficient system. It still could be administered privately based upon regional markets, and it works in most other countries.

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