Thursday, July 23, 2009

Ideas on how to fix the American Health Care system

At the moment, all talk is about 'Obamacare' and how President Obama's much-touted plans to reform the American health care system are either 'great' or 'gruesome.'

I don't care much for his proposed spending plans, but I'll tell you this for free - the sniping, bitching and whining from Conservatives about this issue is both counter-productive and, frankly, rather pathetic. They're spending so much time trying to scuttle Obama's proposals that they've totally failed to come up with any viable alternatives themselves.

Even the Republican's own 'great brown hope,' the Louisiana Governor Bobby Jindal, was lack-luster in his much-touted 'bipartisan solution' to the health care crisis. In a column in the Wall Street Journal, he boasted about having all the answers -but wasted his column inches attacking Obama's proposals rather than outlining his own.

The fact is, the right-wing is universally useless because they simply refuse to acknowledge the failures of the current system. When Democrats like Obama make proposals to improve, they're normally shot out the water by the GOP simply because they're not perfect.

Perfect? Perhaps not - but they're still more streamlined, cheaper, efficient or just plain better than the current system. However, because they don't match up to some hypothetical Conservative fairy-tale of what health care should be (even though it isn't), they're not willing to back any change.

But my ire isn't limited to the Republicans. Democrats are equally useless in tackling the crisis. Most of them have their heads in the clouds - with no idea about how much heath care really costs or how it could be realistically delivered.

A perfect example of how out-of-touch Democrats can be found within the pages of Democratic Party chairman Howard Dean's new book: Howard Dean’s Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer.

He touts a universal, government-funded medical care system like Medicare, or the British National Health Service, seemingly unaware that neither of them work. Medicare is bankrupt and the British NHS is a crumbling, ineffective dinosaur.

No, the solution to America's health care woes lies with neither the right or the left. Politics aside, we have to tackle not only the problems inherent in the current health care system - but also embrace its strengths.

Because if you can afford it, and have access to it, American health care is still very, very good.

You might remember my wife raising money for brainstrust.org.uk a couple of years ago. That charity helped send a young woman with a brain tumor to America for treatment, because the British NHS simply couldn't tackle her deeply-embedded malignant tumor. The British health care system had given her a death sentence - but the American system gave her a new lease on life.

As far as I'm concerned, witnessing that forever won me over to the strength of the privately-funded health care system. It saved a life that socialised medicine had already written off - and for that reason alone, I'm utterly convinced that the future of medical care - including much needed, groundbreaking advancements in treatment, pharmaceuticals, care and surgery - is best left in the hands of private industry.

But saying that, let's address two real issues that have broken America's current system. These are the problems I've experience and I'm simply astonished that nobody's discussing them in all the hours of debate about 'Obamacare.'
The medical billing system is disgraceful. I challenge you to find a more inaccurate, poorly managed, bureaucratic and ineffective system than what passes for 'medical billing' in America.

The system is so convoluted and complicated, it's a wonder it operates at all. Considering that the health care system is supposedly 'private' and patients are actually 'customers,' it's disgraceful how the billing system treats them.

Where else in the 'free market' would anybody put up with a business that bills you in dribs and drabs, months after the due date - and regularly (at least 1 out of 3 occasions that I've experienced) f**ks up your invoice?

Personally, I think the whole co-pay system is ridiculously over-complicated and adds reams of expensive bureaucracy to an otherwise fairly straightforward system. It alone adds up to over 5% of current health-care costs - and still can't get the job done even then.

I think the government needs to regulate medical billing so the following is guaranteed:
  1. Medical bills will reach the consumer no more than 30 days after treatment. If they do not, the consumer is not required to pay.
  2. All bills should be consolidated - one hospital visit equals one invoice. Currently, a single hospital visit can lead to a dozen or more separate invoices from various 'providers' all located in the same hospital!
  3. Health care providers should be fined - heavily - for incorrect invoices. This is simply unacceptable in the 21st century.
  4. If a medical care invoice is incorrect and undercharges, the health care provider should not be allowed to send a later invoice to 'make up the difference.'
Sounds severe? Think about it - these restrictions would mean that medical billing finally finds itself required to deliver the same standards as regular businesses.

If you had somebody come to spray your backyard for bugs, you'd never put up with receiving six invoices, four months after they'd visited, all requiring payment for a single service you've received. Why should the medical industry be any different?

Medical billing isn't just a customer service issue - it's obvious failings mean it's an expensive liability to both insurers and suppliers. Medical billing issues result in bills not getting paid - which leads to an increase in insurance premiums and care itself. That's why this is a crucial area that needs to be addressed immediately!

But, secondly:
Covered procedures must be finalized in advance. My European friends are always astonished when I explain this to them - but in the American system, you're health care provider can pick and choose which treatments they'll cover as part of your insurance after the fact.

This leads to situations like this - in which a young woman undergoes a double mastectomy, described as a 'medical necessity' by her doctor (because she has a 99% change of developing breast cancer later in life) and then discovered that her insurance company refused to cover the cost.

Considering that medical expenses can run into the hundreds of thousands - and 60% of all bankruptcies are as a direct result of medical expenses individuals can't pay - I am simply astonished that nobody has ever thought to question the practice of agreeing to cover procedures after they've been performed.

Just like with medical billing, it's a situation that you just don't see in the 'real' free market. It basically means that the consumer has no idea exactly how much their treatment is really going to cost them before they agree to it. It's like going into a family restaurant and ordering off a menu with no prices!

My solution? Make it law that all medical insurers have to decide, within three days of a doctor or clinic recommending a treatment, whether or not it's covered by their insurance - in advance.

And if those insurers say 'no', they have to provide a quantified medical reason why they disagree with the patient's referring doctor. After all, like in the case of the woman with the double mastectomy, receiving one expensive medical treatment upfront will probably prevent years of even more costly treatment in the future.

As far as I'm concerned, until these two issues get addressed, America's health care system could be the cheapest or most expensive in the world - it will still be irreparably broken.

6 comments:

Tom said...
This comment has been removed by the author.
Tom said...

As someone who was just in the hospital getting his navel removed (along with some other needed work), I more or less agree with Roland here.

That being said, at least in my case, the finalization of covered procedures is something my plan requires. Basically, with my medical plan non-emergency procedures must be approved in advance. A few weeks before the surgery, I received a letter from the insurance company agreeing to pay for the operation I had. So, maybe that just needs to be more widespread.

The biggest thing I've been noticing is how much an insurance company serves as a check on medical costs. Take my surgery. The statement of the surgeon's costs came here today. The surgeon billed $4,700.00 The insurance company counter-offered $942.28, which the surgeon accepted.

I've seen this thing a lot. For a medical test, the lab billed $100, the insurance counter-offered $6, and the lab accepted.

The funny thing is, I've yet to get any insurance out of the deal. So far, all my medical bills have been under the $2000 yearly deductable in my plan.

I suspect any serious health care reform needs to address this pricing issue. How much you pay for healthcare shouldn't depend on who you have negotiating on your behalf.

But I don't think Obama is a very serious president, and so what will wind up passing will be whatever managed to get through congress that day, rather than some sort of principled reform.

Roland Hulme said...

Hey Tom! Glad you're out of the hospital! Hope you're on the mend.

I'd actually written more about cost, but figured that didn't really fit in with my 'what they're NOT discussing in congress' concept, because they are. I'd actually mentioned something you wrote in a previous comment - about your doctor billing $600 and your company paying him $197 or something.

I don't know how to fix the costing apart from by market forces, though - I HATE the idea of government 'price control' because it's so open to corruption and skewing the market.

Suki said...

$100 to $6? $7400 to under $1000?

What the hell?? And the US is supposed to be a "developed" country!
Should I be glad I'm opting for UK for higher studies? Or is the NHS even worse?

Tom said...

$900 is not a bad price for a few hours work. (This was the surgeon's fee, I still have to be hit by the bill for the hospital.)

$6 was for running some blood over a test strip, and interpreting the result, something that probably takes a few minutes.

To me, the prices the insurance company paid seem fair, while those that the provider originally billed seem enormous.

Coffee Bean said...

It is a shell game Tom. We get bills like that all the time too. What really makes me mad is when those outrageous fees aren't covered at all by our insurance and we have to pay 20%... why can't we do the same thing the insurance does and say we will only pay X amount of dollars?