Tuesday, September 7, 2010

Health care

File this under irony - My kid needs a medical test. Insurance company has not approved it yet. I cannot show up at the doctor's office with cash in hand to get the test because my insurance company has not yet approved it. Feeling confident about more government regulations?


bmbull said...

I've long argued that insurance is not the answer, but rather it is a large part of the problem. And I keep seeing more and more evidence to support that belief.

Quick Takes Pro said...

I cannot knock all insurance. At least they negotiate a rate somewhat less than the doctor wants to charge. But Dr. No is not who I need when I get sick.

So if insurance is the problem, what is the solution? Tort reform?

bmbull said...

It'll never happen, but I think we need a health insurance model that is more like our auto insurance model. Have insurance to help cover "wrecks" -- serious illness and injury, but go back to the old days of paying cash for "oil changes" and "fill-ups" -- doctor visits for cold and flu, standard tests, etc.

I remember that my parents used to just pay the doctor bill when we left the office, or it came in the mail. Today, people are far too reliant on insurance -- so they don't have any sense of what things cost, and the doctors and insurance companies know it. It has destroyed any sense of competition in the H.C. industry.

And I think that standard testing like cholesterol screening, and maybe even simple prescriptions for things like antibiotics and things could be done by nurse practitioners or the like in stores like WalMart, etc., much as is done with contact lenses and eyeglasses today.

I did a post on health insurance years ago, long before the health care bill discussion started:

Oh, and yes, tort reform would help as well.

MrWave4 said...

Its a shame the US cant adopt the Australian Medicare model (when I go to my doctor I only have to pay a very small amount the rest is covered by Medicare - kids are free). All public hospitals are free.

Quick Takes Pro said...

I agree. My family deductible is 10 grand with 100% coverage after that - something they used to call major medical. I like the auto and WalMart analogies, too.

bmbull said...

Nothing is 'free'. The money has to come from somewhere to keep the hospitals running, and to pay the doctors, nurses and employees. They aren't doing it for nothing!

But there again, there is no competitive market to help hold prices down.

bmbull said...

Oh, and BTW -- there are 'cash' clinics around, and many doctors will give hefty discounts (I've gotten between 30 and 50% off their 'normal' pricing) for paying cash rather than using insurance.

That should tell you something right there...

Quick Takes Pro said...

Not one doctor we know, and we live on Long Island SURROUNDED by doctors, thinks health care reform as it stands now is a good idea.

Speaking of cash clinics, those who can, will fund their own emergency accounts and wean themselves off insurance companies altogether. I would recommend that 20-somethings not only fund an IRA but also a personal health account. That is a lot of money not going into the pool to spread the risk and keep premiums from skyrocketing.

bmbull said...

I haven't spoken to doctors about this, but I have to believe that many will choose to exit the 'system', and become part of the 'cash for health care' subsystem.

The extreme would be that the gov't would make that practice illegal and shut them all down.

I also have to believe that the idea of becoming a doctor isn't nearly as attractive as it once was for the younger folk. As a result, we will likely have far less of them in the future.

John said...

I work in a clinic where clients can pay cash and receive a discount for same day payment. Shop for your health care.
As far as MD's not liking what is Health Insurance Reform, perhaps it is because the Medical Industry is counting on continued inefficiencies to protect their cash cow. Bandaids and supplies are way,way cheaper at Wal-Mart than what is paid by our purchasing department. Industry requires Total Quality Management Best Practices of 2010, not 1980.

bmbull said...

That's been exactly my point, John. People don't shop around for their health care because they have insurance. And that lack of effort and awareness on the part of the consumer has allowed the industry's cost structure to grow to where it is.

As I've argued before, the costs of health care need to be forced out of the closet and out into the open, and the consumers have to be the ones to do that. That alone would start to bring some of the costs down.

I won't hold my breath waiting for it to happen however. But I will make the effort on my own behalf.

Amalan said...

There are too many lobbies that support politicians for any other type of healthcare system to work. The insurance industry is very large and powerful - there's no way anyone can diminish their size, or beat them. Though I have heard many doctors blame the insurance companies, they are dependent on them for payment, because not everyone will be able to pay for every visit - if you insist on cash payments, the number of doctor visits will go down, and the revenue for the docs along with it. And people who postpone care will them clog emergency rooms. For now, the docs complain against insurance because they just don't like the paperwork.

As a Harvard study showed, the main reason Healthcare is such a mess is because there is no incentive to gain efficiencies.

The U.S. is more concerned with protecting business than it is with protecting the public. Europe does the opposite, but we don't want to be Europe either - at least that's the message we hear.