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5/13/2009
Health care reform - up to each of us
President Obama “engineered a political coup” (the New York Times depiction, not mine…), hosting a group of health care leaders at the White House Monday. The prez proclaimed it “a historic day, a watershed event.” Doctors, hospitals drug makers and insurance companies voluntarily [hmm..] committed to $2 trillion dollars in cost savings. Yup, Obama’s plan would “reign in costs.”
What do you hear every time somebody from the administration talks about health care? You can tell just what the memo must say. Talk about the need to cover everyone. Guarantee choice. Talk about affordable. Talk about coverage that stays with you when you lose your job. Talk about a Public Health Plan that will compete fairly with private health care plans (yeah, right).
And every single conversation you hear, they say we must control costs. They say we can’t do anything unless we control costs.
In all of this talk about controlling costs and health care reform, the government is everywhere, but the consumer is missing. How can any system control costs without informed, discerning customers who have access to accurate, easily obtainable information?
As I’ve mentioned here before, my husband and I are on a very high deductible health insurance plan. In addition to paying a high portion of our health insurance premiums, we also budget thousands of dollars annually to fund our own HSA and pay for all our health care needs. So it’s our money we’re saving and by gum, we’re being wise consumers, doing our part to be careful about health costs.
That’s not to say we’re stingy. We’re smart. Not stingy.
A presentation by Greg Scandlen at the Heartland Institute Friday illustrated the positive results of HSAs and ‘consumer-driven’ health plans (CDHPs). The numbers indicated HSA users were significantly more cost sensitive than non-HSA users. More sensitive maybe - but the numbers were still disappointing to me. For example, one 2007 research study found CDHP enrollees are more likely to research doctor costs – but only 14% of the CDHP group did the research, compared with an even paltrier 4% of non-CDHPs. 14%? That’s embarrassing. Certainly not many comparison shoppers out there.
Over the weekend, I was concerned about a lingering, painful earache. I drove over to Urgent Care on north Richmond Street (Appleton). How much does it cost? “Well, it depends on how the provider codes it, beginning at $120.” Hmm. Well, that was a pretty straightforward answer. Good! But I was looking for the $39 variety clinic visit. A couple of folks were in line, and I felt a bit sheepish about it (gosh, why?), but politely I said, no thank you, I believe I can pay less. Isn’t there another clinic nearby?
Indeed, there was a ThedaCare clinic a block or so away inside a ShopKo store. $45 for a visit with a nurse practitioner (same as the staffing at the first clinic). I loved it. No line (I was lucky). And two delightful staff members. Took my HSA debit card, no insurance filings. And I (and the whole system!) saved at least $65!
My husband recently had dental work done; an antibiotic wash was prescribed. I recalled the last time he brought this stuff home, the bill for 16 oz. was $36. I suggested he try a hydrogen peroxide rinse (99 cents) for a day or two to see if it did the trick. And did the trick it did. Ok, thousands on dental work and I’m trying to save $36. It’s the darn point of the matter – and more of us ought to be doing it.
If you didn’t read this piece by Pete Kennedy (in FP News last week), you must take a look at it. Pricing questions get under dermatologist’s skin. All Pete wanted to know was how much it was going to cost to get his darn wart removed. And he was politely obstinate about it.
We’ve got to all be doing this stuff guys. All of us. Repeat after me: “How much will it cost?” “No, not just the co-pay, how much will the whole thing cost, my insurance company and me?” “Please don’t tell me ‘it doesn’t matter how much it costs because the insurance company will cover it.’”
No, don’t you dare tell me that.
Addendum: NRO agrees with me (!) - and does a great job in this piece this morning - Obama has no real plan to control health costs.
Jo Egelhoff, FoxPolitics.net
COMMENTS
Wow, Jo, that's pretty smart. And you even practice medicine too! Wonderful. Let's hope your practice doesn't end up killing one of your loved ones someday. Got to save that $45, don'cha know.
My daughter has a high-deductible. She was pretty smart too. At least until her 3 year old daughter was diagnosed with childhood diabetes a year ago. There go all the extras in life for a few years. Now the insurer won't upgrade her policy with the pre-existing disease, so don’t you go getting real sick and need real care for a long time.
>>> "How can any system control costs without informed, discerning customers who have access to accurate, easily obtainable information?"
Ahhh, you price shop! Forget that bad doctors might charge less to attract patients. Some day you are going to realize that there is no such thing as competition in health care.
I sure wish there was some way to exclude people like you from a single payer option. But sure enough, after saving all their money over all these years, when they get old or get sick they’ll want to opt into the public system everybody else has been paying into over the years. And if we don’t let them they’ll simply go onto the public dole.
There is a practical fix, Medicare-for-all. But getting people to put pragmatism ahead of ideology is not easy.
Jack Lohman (Wed May 13 07:14:27 2009)
Jo,
Was the Shopko clinic subsidized? Do you think they made a profit on your visit? Was the treatment competent? Were leeches and bloodletting part of the treatment?
If so, Urgent care must be making huge profits.
I hope you feel better.
David (Wed May 13 07:18:05 2009)
I knew it. Jack's going to tell me the government knows what's best for my family. Well Jack, you're wrong. Completely wrong. I know what's best for me and my family, I know how wise it is to stay healthy and monitor our health, I know how important it is to take in that long list of questions to my doctor periodically. I know too, that experts are out there for a reason, and be assured, we use them. Please, please don't tell me someone else can take charge of my health care and my family's health care better than we can.
Dave... hopefully ThedaCare is covering their costs at the ShopKo location, because I hope they stay there. (We used them once prior to this weekend, for my son, also with an earache.) Very competent folks. Remember, they're not set up for extensive diagnostics and testing, and are very careful in suggesting what they are able to do and not able to do. And... they won't file insurance claims. Therein lie the cost savings.
Jo (Wed May 13 08:01:15 2009)
Jo, under a Medicare-for-all system all medical decisions remain between you and your doctor. Or just you if you want to continue self-treatment. But you are mischaracterizing single payer.
But I do agree that we need more urgent care centers staffed by nurses that can treat minor ailments (providing they know when they have exceeded their capabilities). I've hired nurses for 25 years and find some of them more qualified than lower-end doctors.
Jack Lohman (Wed May 13 08:13:29 2009)
Jack, I know Jo asked you before...PLEASE TAKE THE BLINDERS OFF. Don't tell me "decisions remain between you and your doctor"! Just the other day, I heard one of the drs at work (I DO work in healthcare) say, "If I'm only going to get paid $15, I'm only going to do $15 worth of work." Meaning, that his Medicare pt was NOT going to get tests, etc. that they wanted unless they made more than one office visit.
For cryin out loud, I LIVED in a universal-healthcare country, and you most certainly do NOT get treated as you would in the US. I KNOW we don't have a workable system, but since our politicians can't even balance their budget, why should I trust them?
It's be better to take out ANY third party whatsoever (whether insurance or medicare), and pay doctors the way we pay plumbers or electricians...the way we used to until CONGRESS had to go sticking their noses in, during WWII by freezing wages. That is when the whole insurance ball started rolling. I quote from a recent letter to another blog I read:
"Well done! It is nice to see somebody talking sense about these things for a change.
I live in the UK and our National Health Service is costly and provides very poor service.
The reason is that the system detaches the people who pay from the people who get paid.
Every accident and emergency ward is packed nightly with the drunken underclass, demanding their “RIGHT” to have their self-inflicted injuries treated immediately, with the latest medical technology, while hurling abuse at the doctors and nurses who try to treat them. People call out doctors in the middle of the night because they have a headache.
You don’t need a PhD in economics to realise that if something is free the demand for it is going to be very high and the value people place on the providers of the service will be very low.
From the patient’s side things are no better. The doctors and hospitals get paid by the state regardless of the quality of the service they provide to “their” patients.
As a result they treat the patients as an annoying inconvenience to their preferred daily activities. They don’t see the patient as the one who funds their lavish lifestyle; they see them as the annoying people who take up their time!
Of course there is also the age-old problem of effective resource allocation in a communist system. The market through the pricing mechanism does an unmatched job in allocating resources to where people want them. Politicians allocate resources based on what gets the best PR, what the tabloid press is currently attacking them for and what they think will hoodwink the most voters into voting for them.
When the state has spent more than it can afford, it starts telling people how to live their lives to reduce its costs! Headlines in the press like these: “Smoking costs the NHS X Billion a year”, “Obese people cost the NHS Y Billion a year” I even heard that apparently women wearing high heels costs the NHS over 20 Million a year”
The patients are such an inconvenience that the state wants to run their lives for them to reduce the cost of healthcare!!!
I am thankful that at least somewhere in the world, the ideals of liberty and freedom survive. Here in the UK we slip relentlessly towards a socialist nightmare.
Keep up the good work."
OR, according to Ayn Rand, who also puts it nicely :
“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.
“I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it.
That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards — never occurred to those who proposed to help the sick by making life impossible for the healthy.
I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it that they expect to depend on, when they lie on an operating table under my hands?
“Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe, if he is the sort who doesn’t.”
emily matthews (Wed May 13 10:47:11 2009)
PS, Jack, in "universal" countries, the best (or often the ONLY)treatments are saved for the productive members of society, so if you're old, you can forget it!
We still keep in touch w-people in the UK and they are truly frightened to go to the dr, because they know they're "old and useless", and they frankly do not trust the drs. Why should they, when they call the ambulance and then spend more than five hours driving around a bunch of towns trying to find a hospital that will let them "land"?
And don't trot out the old chestnut of Sweden; with their suicide and alcoholism rates, I don't buy it that Sweden is such a utopia.
emily matthews (Wed May 13 11:40:03 2009)
Whether you are in nursing or not, Emily, our free-market healthcare sucks. You and Jo are in the minority. Over 60% of nurses, 60% of physicians and a majority of citizens prefer a single-payer system. A Medicare-for-all system does not mean that you MUST sign up, you can remain on the outside. And even if you sign up and want more services than the norm, you can pay for them on the outside. You know, the free market way. With cash dollars. And if 100% of the people have Medicare, all doctors will get paid fairly and not have to work at Medicare rates. And insurers will jump on board selling Gap insurance.
You forget that the WHO has the US ranked at 37th in the world in terms of quality, access, and efficiency. Good job.
Jack Lohman (Wed May 13 18:06:42 2009)
A single-payer system does not incorporate market/consumer pressures and as such, can not be successful, as costs and utilization will not be controlled efficiently. (What waste I see in the Medicare system...) So if I don't sign up for Medicare-for-all, how much am I paying for health care for everyone else in the country and for myself? And without my paying attention, how will you prevent the fraud that is rampant in the Medicare system? How will you force docs to work for you? Who decides when a doc is "paid fairly?" Let the markets work Jack. Give consumers their due. Get the government out of my relationship with my health care providers.
Jo (Wed May 13 18:40:36 2009)
Jo, you have no idea how much waste and fraud already exists in the private sector. Multiples more than in Medicare. And with 45% of the system already private, how are you liking the "market control" so far?
How would I eliminate Medicare fraud? Strengthen the whistle blower laws and let the employees provide the oversight.
How will I force docs to work for me? I won't. 60% of them already prefer my system and when we get Medicare-for-all another 30% will come over. The remaining 10% will work for the right wingers.
Jack Lohman (Wed May 13 18:50:05 2009)
Jack, I hope you read this. WE DO NOT, AND HAVE NOT FOR A LONG TIME, HAVE A "FREE-MARKET" SYSTEM. We have a THIRD PARTY PAYER system, which is indeed inefficient...and not likely to improve any time soon, "single payer" or not.
HOWEVER, I take issue with your stats ("60 %"). NONE of the drs or nurses I work with, want a system like yours, and statistically, 6 out of 10 SHOULD, if your stats were correct.
Therefore, the population of whatever drs and nurses WERE polled, were NOT representative of the whole. YES, I can say that flat-out. Statistics ARE meant to represent populations, AND IF THEY DON'T, THEY ARE SUSPECT.
To have a truly free-market system we'd need:
1. Gap (or catastrophic) insurance only...the way it started out.
2. Drs being allowed to advertise their fees, and fairly compete with each other, which just doesn't happen currently. (forbidden by law)
3. Alternative care providers not demonized by state medical boards, etc.
4. People taking responsibility for themselves and their own poor or good choices.
emily matthews (Thu May 14 13:20:32 2009)
Emily, We can play with definitions all you want, but in my view a free market system is one where a patient can jump from one doctor to another depending on their likes (looks, bedside manner, charges/co-pays, ect). That’s exactly what we now have. It does not matter whether paid by private or Medicare, that's what we have! Except that we do not have that with DeanCare etc, but this is NOT Medicare. You use your own definition, but it seems that you are of the “everybody-for-yourself” crowd, 1900’s style. So be it. I believe that we should provide health care to all, like we do fire and police and national protection. Basic health should be funded by taxpayers. On the 60%, see here and here. We do not have a competitive system based on "price," and God help us if we ever do. We should have a system that allows us to track performance.
Jack Lohman (Thu May 14 14:59:59 2009)
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