Sounds like a campaign strategy by Karl Rove! But these are the only people who will be spending health care dollars in their old age, in Beckie’s grand plan. A good one it is too. Despite being reasonably well-versed as a frequently injured layperson concerned with his health care bill and a 2-semester grad student in bioethics, this was a notion I have never heard of before.
This won’t be a long rant, but its no mystery that the US industry is plagued by all the wrong incentives in health care consumption. The consumer is not cost-conscious cause of insurance, the doctor spends too much out of fear of lawsuits, and insurance is concerned more with its process than the individual. Instead of rationing by wait time like other countries, we don’t ration at all, and have created a culture of unchecked medical entitlement. We don’t have a valid calculator of risk, we blame smokers who likely cost less than obese people, births are treated like coming-out parties instead of one of the most predictable and commonplace procedures of all time, and a ridiculously disproportionate amount of money is spent when the quality of life it supports offers minimal returns.
Dental spending is the ideal model – individuals bear a significant portion of their own costs, prices are accurately quoted by providers, costs are affected by supply and demand, information is transparent, and doctors are used to acting as expert consultants instead of all-knowing medicine men.
Beckie’s idea: everyone gets a finite amount to spend over the course of their life, anything beyond is paid out of pocket. Anything left when you die goes to your heirs’ fund. Market incentives and personal choice would cause much more efficient use of your funds. The only really old sick people opting for costly treatments would be those not believing in an afterlife, or those afraid of it. Brilliant.
As a former healthcare administrator, I would be happy to dialogue and debate this topic in person. We’re a family who pays the full cost (yes, non-subsidized) for healthcare coverage, so I know precisely how much we spend for coverage versus actual care. To lower the premiums, you have to find a way to make insurance universally available and affordable for everyone while at the same time holding insurance companies accountable for their revenue. All healthcare is not and should not be equal. It doesn’t work that way for any other insurance product. If I can pay for better coverage, then I want better coverage. You really can’t blame the healthcare providers for running up charges when it’s the only way to gain back a little reimbursement from the few commercial insurances that still exist in order to offset the unbelievably low reimbursement they get from most other insurance providers. Unfortunately, it’s the patients without coverage (or very poor coverage) who suffer the most in this system…and the cycle continues. BTW – to Beckie’s comment – no way! You can’t predict who at age 2 or 20 or 40 will end up with cancer. Healthy living will not always protect you from medical catastrophe. If it happens to anyone I love, you better believe I want full access to every medical service available, cost be damned. I’m paying for it…and I want it. Allowing someone aged or terminal and no longer with options to die with dignity is a different discussion.
you are missing the point of market-based forces changing the system dynamics, and are still focussing on cost transferals. Who should pay for the uninsured, how they should get paid, and what the level of coverages are separate discussions. Having insurance entitles you to more care than the guy without, but not unlimited care. You have to start by limiting expenses that dramatically exceed your coverage levels (whatever those may be) and letting supply and demand affect prices. A part of that is doctor’s do not explain what they are selling, and don’t feel they need to – no other provider operates like that, and “sells” you something you might not need without your consent. Perhaps Dr. Holmes will have a better reply.
I’m not missing your point, but the overall insurance system is based on two key factors: coverage selection versus risk to insure. It’s not market driven and I doubt it will ever become market driven. Simple market factors (i.e., supply and demand) do not apply because of the influence of other factors like control, selection, and risk. I sincerely doubt those will ever be pulled out of any insurance calculation. They are in place in countries with socialized medicine – we’re not going to eliminate those influences here and move to a completely market driven system. BTW – having insurance does not entitle me to care more than someone without insurance. We all need to see this as important. You’re trying to apply simple market dynamics to a much more complex system. Plus, it’s unreasonable to simply blame doctors for service provisions. Consent is always required. If someone doesn’t understand the reason for a treatment or diagnostic service, then it is their responsibility to gain that knowledge before consenting to a procedure. In this case, fixing a body is no different than fixing a car. Just because someone tells me I need 4 new tires…or a new knee…doesn’t mean I have to purchase them. That’s not what’s responsible for our healthcare crisis.
I am not willing to abandon a market-driven approach just cause the current system is fucked up. The idea that everyone is entitled to the same care is fundamentally wrong – it violates the very basis of a market-driven price structure, and completely explains the status of the whole industry. Yes we should provide a floor of basic free coverage, but it should be basic, and rationed just like a welfare check. There is no one going to airlift me to a trauma center if I get hurt in Mexico, but illegals get airlifted here in AZ regularly when their van full of 20 crashes running from the cops; 100 years ago a baby born 3 lbs like a crack baby would be drowned in the river cause babies are cheap to make. 100 yrs ago women spent 10 years of their lives pumping out kids, but now we value a woman’s freedom over her biology more (which I agree with) but have also forgotten that not all women suffer the same opportunity cost of pregnancy, mostly cause the policy and advocacy is being written by the very women who have moved on to a more “advanced” relationship with their biology. Most women around the world are not PhDs and health care admins. And a kid is cheapest as a newborn when society has invested nothing in them.
Under the current system a person with insurance is taxed twice, and has little ability to consent to the taxation. This is the only industry that costs shifts, and everyone within the industry just throws up their hands and goes “oh well” but its total bullshit. Coverage and risk could very easily be mapped to a dollar value just like in car insurance, its all the cost-shifting to provide a bottomless well of services to those who can’t afford them which prevents that, and which is the basis of the problem. Give me a price or near approximation. This is also the only industry where you can get huge bills, not pay them, and not go to jail. Here is a simple example – a birth, more or less, should be a mostly accurately estimatable expense. If you can’t pay for it, you choose less service like a midwife and no epidural. If you can’t pay for it, you probably can’t afford a kid.
Doctors are serving themselves a lot more than they should be. They order tests etc to protect themselves from minimal exposure, knowing its not the patient paying for it. I had a doctor drop me as a patient when I refused to pay for lab work that I told him at the time I did not want – how is that required consent? Doctors also have the world’s most powerful union – if you have more entry-level and mid-level doctors\RNs\phys. assts performing simpler tasks, it would make care more affordable for the poorest people cause of an abundance of suppliers. Even a GP working in a “poor” neighborhood can do pretty well for themselves, they don’t all need to make $250k, they don’t all need to be trained to such a level of service. I don’t need a doctor who spent 4 yrs at med school to put in stitches or set a fracture. As it is, you pay to see specialists, why not just run with that model?
Ok – there are so many inaccuracies in your statement above that I absolutely can’t keep up via writing. I’ll respond now and then would love to discuss this by phone or in person. How about Sept.?
Before you totally trash the industry (and, I agree with you, it needs trashing and major fixing), you need to first understand it.
1. Care and service can be determined to the relative dollar just like any other industry. Believe me – we know what it costs to provide service.
2. All coverage does not have to be equal. As I stated earlier – I can afford better coverage and I value that coverage. I will pay more to get more. While this does occur in some cases, I do think we’re way, way too far off and the current healthcare system does need to get to this point.
3. There are consequences for not paying bills. Many do age accounts and then forward them to collection agencies. By the way, there used to be (and may still be )a law that required healthcare providers to bill all patients equally, even if the providers knew that the patient was unable to pay. Providers were not supposed to give a discount up front without going through a series of billing cycles…even if they knew in the end they were just going to write off the bill. Why this waste of time? Because the insurance companies stated that if a patient (self pay or other)could receiv a discount for their out-of-pocket portion of the bill, then the ins. companies were entitled to an equal discount. You could avoid this after making a reasonable effort to collect, but had to have “reasonable” definined in a written policy. That’s the ludicracy of our system.
4. Before slamming docs for their salaries and charges, you need to understand how services are reimbursed. It’s based on a series of calculations tied to the procedure, complexity, length of time, number of days, concurrent patient health issues and other like factors. In its simplest form, most reimbursement is based on what the government reimburses for Medicare. Medicaid is obviously much, much lower and all others are generally equal to Medicare rates or a factor above. So…despite the charges, reimbursement is often low for the service provided, especially for the docs who are handling the primary care side of medicine.
5. Healthcare providers who run their operations will absolutely maximize their use of support and ancillary staff. They can’t afford not to do so. Oh…and that GP working in a poor neighborhood…why don’t you ask him/her how much he/she is really taking home. You’d be surprised. Most can barely afford their malpractice insurance and school loans.
6. If you want more choices in who you see, then you should enroll in a PPO plan that allows you to self-refer (if you’re not already in such a plan). However, if a provider feels strongly that they need a diagnostic test to provide the best treatment for you, and you decline, they do have the right to drop you. Consider your own industry – would you want to keep working with someone who doesn’t take your advice and then blames you if something goes wrong?
Ok…I’ve written way more than I intended. BTW – a newborn may not seem that expensive unless they end up in the NICU. I’m not talking about preterm babies born to moms without prenatal care. Consider the full term, well cared for child (and mom) who happens to experience an unavoidable complication. Ask me to see Brandon’s medical bill sometime for the 2 days he spent in the NICU.
3&4 – don’t care and don’t care. 1 fee per service, pay your damn bill or get sued or declare bankruptcy or go to debtors prison. A homeless person should not be given 1M in care, period. There should be no uninsured – there should be coverage, and it should get rationed if you can’t afford a private plan.
5. Yes they maximize what they can do with RNs etc, but I can not get treatment from a non-physician (supervising). That is stupid – I should be able to see someone licensed to do fewer things. This would also affect their loans and insurance, which would be comparable to the risk of services they are providing. Money should be able to be made under these conditions.
6. First, don’t order the test when I explicitly tell you not to. Second, that is a slippery slope towards taking the patient’s wishes out of the equation under the assumption the almighty doctor knows all. Do you know that I had no means to file a customer service complaint against him, there is no Better Business Bureau for patients unless you have been medically mistreated.
I didn’t say a newborn doesn’t have complications, but that the costs are largely able to be estimated accurately aside from complications. And if you get the insurance Birth Package Special, you get way more than you need or would taken if you were paying yourself.
3&4 – That’s exactly what’s happening. Fees vary based on the company (there’s your market influence) but the payments are generally the same per ins. co. and region. I do agree that services can be disproportionately provided (re: homeless example). Problem – once you touch it, you own it.
5. In some cases, staff can provide treatment. Depending on situations (it varies), different levels of independent practice are permitted. Again – oversite is no different in healthcare than in any other industry – it’s just more transparent. Consider – “I’m for my boss to sign the document.”
6. You’re right – recourse is tough. HMOs (and most ins co’s) have evaluation forms, hospitals do consider letters towards advancement/priviledges, a large practice always has a chief, and there are several online rating systems that will come up when you search on a Dr’s name. No – it’s not easy, but if enough people complain, then they take notice. Best bet is always word of mouth and, if referred by someone (another doc), tell them about your experience. It may influence future referrals.
Birth Package Special – is this for real? Maternity services, including prenatal care, are traditionally packaged. Did you actually have a choice on what you could select? Just curious – what would you have cut out?
they didn’t offer us a “package”, but basically set you up in a suite and pampered the hell out of us. For both kids, we left a day before we had to. Beckie ate everything they put in front of her, and accepted all the services offered. Had it been pay-as-you-go, we would have probably done a small room, less food, less time, possibly no inducement etc. She can comment further – hell she started all this sitting on the beach reading the Harvard Business Review and being all serious, I just wanted to get drunk and play in the surf.
Re: drunk and play in the surf. Much better use of time! Can I do that too?
I think the pharma system is most of the problem. How many times do people go to the doctor just to get a little bloodwork adn some pills? Why cant I pay $100 for the lousy test and make my own decisions about further treatment/testing? If I have a virus why can’t I just go buy the meds I want.
Our friends to the south manage to do it and not drop dead, I’m pretty confident that I can as well.
Sounds like a plan….as long as getting supplementary insurance is outlawed and Black Market providers are ferreted out and prosecuted!
Hey the pics in Mexico are super. That one of Alana in the blue bouncy chair looks exactly like G at that age.