Increasing Frustration

By Marcy Zwelling Aamot, MD

Americans’ frustrations are increasing. While we were promised that the cost of healthcare would soon stop its upward trajectory, we have yet to see any evidence of anything of the sort.  My individual premium is going up every year while my co-pays also go up.  Every business person with whom I speak complains about their healthcare costs and that includes the deans of our university where their health care costs are consuming so many dollars, they are starting to cut classes and decrease opportunities offered students.

The debate continues in Washington, DC and the promises are coming a mile a minute right along with the threat that we are all going to have to “take it in the shorts” one way or the other.  I wonder if individual Americans wouldn’t be better off managing our own healthcare demands rather than leaving things in the hands of the government or the insurance companies that have not earned our trust or our respect.  The latest budget debate and near closing down of the government assures me that things would be better in the hands of the average American.  We seem to appreciate the value of a dollar and understand value much better than our elected officials.

The solution is really quite simple.

1) We need transparency in health care.  How can we even start to manage our dollars without knowing the cost of care?  Every medical facility and establishment should be require to post their retail cash prices.  This costs nothing and at least starts to bring some honesty to the discussion.  We can start that today by asking our city councils to demand that every medical facility business license require the posting of  retail prices. You may be surprised to find that a mammogram costs less than $100.00 and yearly lab can be purchased for less than $50.00 cash.  Those who use their insurance and pay their deductible know that the cost is goes up when the payment for services is circuitous through insurers or the government.

2) Congress should require every insurer and itself (including Medicare) to sell a catastrophic only health care insurance plan that is actuarially based and open to all patients including those with pre-existing conditions.  The premium for this policy would be affordable and available to all.  Community rating does NOT apply. Patients must be charged the actuarial value of the policy but it should be available to all.  Surely, that person with hypertension will pay some additional cost but smart insurers will find a way to attract those patients by offering them a reduced rate for proof of adequate medical treatment.  This also puts patients in charge of their own healthcare.  As it is, there are many “pay for performance” opportunities for doctors but they have all failed because they have not offered incentives to the right person.  It is always the patient who should reap the benefit of his or her investment in their health.

A free market is the only way to bring competition back into the medical care marketplace and healthy competition drives innovation and excellence.  The current fixed pricing system offered by Medicare and health insurers has taken away opportunities afforded by human nature, our competitive spirit and drive.  The cost drivers are all the middle-men and regulations imposed on what should be a transparent and open marketplace.

In the end we want a healthcare delivery system where the patients can be empowered to be responsible for their own health and life investments.  Doctors need to direct our care to our patient’s specific individual needs and we must be answerable to that person in our exam room, not the government or an insurance company.  History has taught us that with freedom of self-determination, America will always find its way to excellence.  Why can’t we assume the same in the healthcare market place.

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5 Responses

  1. Hmmmmm……..Like everything else, according to Obama, it must be George Bush’s fault!

  2. Yes, I think hospitals should post retail prices. Though I don’t know how I’m going to be able to shop for the best emergency room price while I’m having a heart attack.

  3. If an insurance plan is acutarially based and open to all regardless of pre-existent conditions it will not be affordable for long. Those who can get on a plan that is underwritten and only available to those without pre-ex will migrate to that plan(s) and only the sick will be left on the plan that takes all comers. Simply put, you must get people to buy insurance before they need it to have any hope of an insurance type system working. My recommendation, make health insurance coverage a factor in credit ratings, as well as make health care incurred charges non-dischargeable in bankruptcy. Let those who chose to wait until they get sick to think about health insurance pay for their foolishness. If you really want, make it possible for someone to purchase health insurance during their birth month with pre-ex covered, but with a six month wait before the coverage for pre-ex kicks in if they have not been maintaining insurance. For those who have been maintaining insurance immediate coverage on pre-ex. This would allow people who do have health problems develop to move insurance if their company or plan became unsatisfactory.

    • If someone receives uncompensated care, the hospital issues them a 1099…simple. The lack of transparency is due to the “private-public partnership” between CMS and the AMA. CMS sets the rates, AMA sells the rates,a nd the rates ensure that great doctors, terrible doctors, and PA’s all get paid the exact same amount for a 99413. This is not free market, it is price fixing, and unsustainable.

  4. The basic premise of our current government-managed health care system is that no person in America should have to suffer or die because they personally cannot afford the very best health care available. This is irrational, and when you consider that the flip side of this “free” care is a gun pointed at some innocent tax payers, it is immoral.

    If a person doesn’t care enough about their OWN health to take care of themselves, I don’t know why I should care to the tune of tens of thousands of dollars. Americans are incredibly generous people and I simply don’t buy the argument that the “truly needy” wouldn’t be cared for if we depended on voluntary assistance.

    When I’m lying on my death bed, do I WANT to have to consider whether it’s going to cost me another $5,000 to keep me alive another couple of days, so my kids can see me one last time? Of course I don’t. But IF I don’t, if I’m spending someone else’s money, that’s how we end up with each 65-year-old representing an approximately $100,000 liability on society’s books. (That’s the difference between the NPV of future government-paid health care expenses and the NPV of past Medicare contributions.)

    Health care has COSTS, both financial and otherwise. Pretending it doesn’t, and using government’s credit card to perpetuate the illusion (at the expense of our kids and grandkids), is just wrong.

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