Tag Archives: healthcare reform

Four Health System Fixes Neither Party Will Touch

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Here’s an interesting article at Vox that outlines four ways the US health system could be improved, but neither political party will dare touch.  They are:

  1. Let in more immigrant doctors
  2. Curtail pharmaceutical monopolies
  3. Let non-doctors treat patients
  4. All-payer rate setting

Those first three are fairly self-explanatory, but the fourth is a little more complex. This excerpt helps explain it:

In Germany, the Netherlands, and the exotic foreign land known as Maryland they practice what’s calledall-payer rate setting. That means that instead of each insurance company negotiating separately with each hospital group on prices, a government commission sets a price that everyone pays. And it works. Maryland has curtailed cost growth without inducing any noteworthy shortages of health care facilities

Another advantage to all-payer rate setting beyond the simple ability to set low rates is that it would eliminate some of the necessity of doing everything through an insurance company middleman. Right now, one of the services your health insurer provides is a real insurance function that helps you hedge against risk. But for many people, the insurer’s most important practical role is as a negotiator. Since the insurance company has a lot of scale, it can get a good price from a doctor or a hospital. An uninsured person would have to pay at a much higher rate.

Reducing the insurance company’s role as a negotiator would let insurers focus more on the insurance function, and allow routine care to be handled in a more consumer-focused way. And by eliminating some of the advantages to sheer scale on the insurance side, it could also promote more competition in the health insurance industry.

No Need for Healthcare Reform? Really?

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Two months ago our daughter was in Myrtle Beach for beach week and while there make the regrettable decision to drive a jet-ski.  The result was an accident that led to a trip to the ER in an ambulance.  Initially our health insurer denied the claim because we hadn't cleared the trip to an out of network ER with them, but once we appealed and pointed out that she was already at the ER before we even knew about it they reversed the decision. That's a good thing, because if they hadn't I'd be writing this from the poorhouse.

The final bills just came in and this is what they show:

  • The original hospital bill totaled: $21,214
  • Our insurer paid $4,151
  • We owed $150
  • The ambulance ride cost over $800, mostly due to a non-resident fee imposed by the county where the accident happened.  We owed $400.

A couple of thoughts here.  Our daughter was discharged hours before we could even get to the beach.  She was in the hospital's care for maybe 2 1/2 – 3 hours, so even taking into consideration that  due to the nature of the accident they treated her in the trauma unit and ran the various MRI-type scans, how can that possibly total over $21,000?  Also, what happens to the poor schlub who doesn't have insurance?  Does $16,000 magically disappear from his bill too?

Believe me, we're very thankful for the care our daughter received.  I'm also not so bitter about the insurance premiums that are deducted from my paycheck because, frankly, our insurance is getting a workout this year.  In addition to this accident we've had a surgery and an illness in our family so we've gone from hardly ever using our insurance to being uber-users.  Of course our premiums are likely to go up again next year, but at least we aren't being bankrupted in the process (at least not yet).

Still this episode drives home the point that there are many people out there who ARE bankrupted by our health care system.  I'm not going to sit here and point the finger at any one person, company or industry, but I am going to say that anyone who thinks our health care system doesn't need fixing has a head full of rocks.