The Health Care Debate Continues

As time moves on, the health care debate does too. And all we see is the passionate debate for or against it, with no real discussion of what's broke about the system and what specific aspects that need fixing. It seems that there are 2 schools of thought; Government run health care or increase insurance competition without the government entering the business. HR 3400 is the Republican solution to health care which simply put, has tax credit provisions for maintaining health insurance, and allows for small businesses to pool into groups to purchase insurance for their employees at large group rates, and more blah blah blah about fraud waste and abuse and so on.

Let me tell you something, when you have a middle man administrating the care whether it's the government, in the case of Medicare and Medicaid, or the private sector in the case of all other insurance, rates are predetermined/negotiated. Which means the insurance company or the government tells the provider how much they will pay them for a certain service or procedure regardless of cost. A set up like this encourages fraud waste and abuse on so many levels. Meaning a doctor sees a patient and takes the opportunity to run all sorts of tests and procedures, ordinarily unnecessary but particularly if it is of no harm to the patient in order to increase their reimbursement. All they have to do is justify it medically, and when you are an expert in the game you can justify anything. This is especially easy to do and difficult to prove on older patients or if the patient makes any comment that could be construed to justify ordering this or that, which is another billable item.

What I am trying to say is that as long as there is a intermediary that must employ doctors, nurses and administrative personnel to administer payment on behalf of the patient, fraud waste and abuse will continue. Do you not find it fraudulent that insurance companies can deny coverage on the basis of a preexisting condition? But they can. This is the issue I think Americans can agree on and where we ought to start. That doesn't mean these patients might not have to pay higher premiums or higher deductibles or co-insurance.

Let's be honest, the fact that we pay premiums just means that insurance is just a payment plan for our routine medical care that is expected to even out over time. How else is an insurance company going to make money? For example. My parents were without health insurance when they first got married, by choice. They could have paid for it, but money was tight and it was a risk they chose to take since they are both very healthy. About a year later, dad went to the ER for kidney stones. They paid the discount they were offered to pay in full at the time of service. (All facilities offer this probably doctors too, some just make you ask for it) Calculated out, it cost about what insurance premiums and a deductible would have cost them for the time period of being uninsured. Had they put that money in savings every month, they would have had that money at the time of service instead of having to put it on a credit card.

I will say it again, if doctors and patients ban together to cut out the middle man, whether the government or insurance companies and take back personal responsibility for our health care, (dare I say live healthy lives?) I bet the cost of care would drop dramatically because doctors wouldn't have to employ staff or pay agencies to bill and collect from insurance companies. They could just collect the full amount up front at the time of service and I bet it would be lower than the "negotiated rates" they get from insurance companies or Medicare because Doctors and facilities would truly have to compete for your business. See my previous post about this issue on July 12. But I know 90% or you or more will likely disagree with me on this issue just like 90% of America is going to disagree with me about privatizing social security.

My point of this post is rather than each side insisting on their solution and their solution only, both of which only treats the symptoms, how about we think outside the box and treat the problem. At the very least, let's focus on 1 part of the system that we can all likely agree on (preexisting denial, or perhaps something else) and start there if the majority don't really want to treat the problem. As it is it just seems like a political power grab taking freedom from you and me the consumers.

A Move in the Right Direction for Health Care

Health care is the big item on the White House agenda as of late. It's the hot topic we knew they were going to tackle ASAP and if they get their way, increases the power and influence of government in all of our lives. In my March 31, 2009 post I discussed a need for health care to move away from the current insurance system. This would take providers developing and alternative to working with insurance companies in much the same way Walmart has lead the way for low prices on generic drugs.

On Tuesday July 7, I found this article on msnbc.com. Take some time to read it as it is a great example of where I think health care should go.
http://www.msnbc.msn.com/id/31777054/ns/health-health_care/

Basically it discusses a Seattle Clinic that was started by doctors tired of dealing with insurance companies. The attract new doctors by offering stock options. They offer care to patients from $39-$119 a month depending on age and level of insurance. No one is rejected for preexisting conditions. It also covers round the clock unrestricted care and 30-minute appointments

It doesn't cover catastrophic care, but the article reports that a 30 year old person could expect to pay $133 per month for such coverage. Obviously that goes up with age.

Here's the thing, my employer sponsored premium is $350/month. They cover that but I have to pay deductibles, co-insurance, and co-pays. Every time I go to the doctor I pay $20 or $30 for a specialist. Just think, if my employer didn't have to pay $350 for my insurance and instead gave me a $350 raise to go out and buy my own insurance, the least I could pay anywhere from $172 - $252 a month for coverage. This leaves me an extra $100/month plus any of my copays and coinsurance to cover any medication I might need on occasion, or lab work that I usually have only once a year, or anything else that might not be covered in the services offered by their clinic.

This is a link to the clinic's services that they offer.
http://www.qliance.com/services.html
And while they don't offer all specialty services, they do offer the basic preventative care and disease management which is what most people are needing. They are an example of how specialty care providers could get together and offer their specialty services refusing to work with insurance. Prenatal and maternity care come to mind. Although I know from a previous job that many doctors and providers already have reduced rates for those paying cash for these services. But people always think they need insurance. Radiology groups could refuse to deal with insurance which greatly reduces the staff they need to run the business office, which reduces the costs to you the patient. I'm sure if they put their heads together they could come up with even more ways to reduce your costs, and to encourage people to use their services every once in awhile to help reduce costs over time.

In reality, insurance is just a method of prepaying for services you will use. But we have become so accustomed to our employers providing us insurance or the government doing these things for us that we don't want the responsibility of saving that $200-$300/month just for health care expenses. Trust me people you don't want the government in charge of your health care. If you want health care bad enough, if it becomes a priority to you, you will pay for it. And if you will pay for it, a doctor will see you and treat you. It just hasn't become a priority for most people and they are spending the money elsewhere and are under the impression that they can't afford quality coverage. The reality is they don't want to pay for it so the next step is to demand the government find a solution so they don't have to pay for it. They are just going to take it out of your check each month before you get paid.

What do you all think of what this clinic is doing? They are saving money on the office staff it would required to bill insurance companies, that also have to employ people to process your claims. The providers and the insurance companies are in the business of making money so who do you think ultimately pays for these 2 sets of people to process your claims? They go into the cost of health care provided to you. You pay for it. Don't kid yourself and say your company pays for it or the government pays for it. You're salary is probably a lot less over time because your benefits fall into your compensation package, and you pay taxes to the government to pay for everyone on government insurance. Unless the government is supporting you.