The frustration continues as I listen to politicians argue
about what they refer to as healthcare
when all they are really talking about is insurance. They act as if making the insurance
affordable will solve the problems of increasing healthcare costs, the need for
consistent quality and making the process easier for everyone involved. The answers to those assumptions are: doubtful, not likely and definitely not.
First, making it easier to pay for something never brings
down the cost. It increases the demand,
which is sure to raise prices unless supply increases correspondingly.
The government and insurance companies can insist that
prices drop by setting limits and restrictions, but that may backfire on the
quality side. As this article points
out, one current requirement that hospitals are rated on customer satisfaction
is driving some hospitals to “focus on making people happy, rather than making
them well.”
Additionally, insurance does not make it easy to do business
with hospitals or doctors. It establishes
the dynamic of insurance companies standing between you and your doctor. You go to the doctor and possibly pay a
co-pay charge at the time of the visit.
Then you wait for weeks to receive an explanation (EOB) from the
insurance company. It tells what the
doctor usually charges, how much they have agreed to pay, how much the
insurance will pay and how much you owe.
If you disagree, you must negotiate with your insurance. Otherwise you wait a few more weeks until the
bill arrives from the doctor and hope it corresponds with the EOB. Otherwise you negotiate with the doctor’s
billing department. (Don’t complain to
the doctor because he or she is busy helping other patients and usually has no
clue about the billing process or pricing.)
This is unlike any other transaction in our lives. We receive a service without any indication
of how much it is going to cost and then wait to see if all the paperwork
matches up. Usually no one can tell you
how much it is going to cost and you have no opportunity to “shop around” to
other providers based on reputation, services or pricing. In fact shopping around is discouraged, because
the insurance company has negotiated contracts and if you go “out of network”
or to a doctor not covered, even if that doctor is cheaper and more
experienced, it will cost you more.
(They show you this right on the EOB.
The same is true of dentists, by the way.)
The answer is to reduce (not increase) the role insurance
(both government and private) plays in healthcare, to open it up to the
consumer (patient) in the same way we buy our food, electronics, auto repairs,
airline tickets, haircuts, mortgages and so many other goods and services. For all these we know the cost up front, our
friends and neighbors share their experiences, and if we are not satisfied with
any aspect of the transaction, we can go elsewhere without penalty. Because of this ability to compare and shop
around, the price and quality of these are in better control.
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