Real choice in health care
There’s so much confusion out there about health care reform, and it’s all to the detriment of consumers. For one thing, the very phrase “health care reform” is a misnomer. What we really mean when we talk about health care reform is “health insurance reform,” because the real problem with our system is how we pay for health care.
You see, it’s just too expensive for the average person to pay health care costs given today’s system. Someone we know recently had to spend the night in the hospital for tests when he thought he might be having a heart attack. At the time, unfortunately, he was uninsured.
When he went in, he was told that he could apply to the hospital for charity forgiveness of a portion of his bill. He filled out the necessary forms to establish that he was uninsured and unable to pay. After he was billed separately by both the hospital and the doctors for each individual test and diagnosis, he received a response to his charity application, which was really a summary bill from the hospital. For his one night stay, he was shown a “charity care amount” of $10,626.00. The hospital said it only expected him to pay $3,542. Keep in mind that this was after he had already been billed almost $2,000 for various tests, services and doctor’s fees.
$3,542 for what?
What did he have done? A test of blood enzymes to determine whether he’d actually had a heart attack, limited additional blood tests (primarily a lipids panel), a chest x-ray and a stress test to determine how strong his heart was.
Had he been insured, however, the insurance company would have put a limit on what it would pay for each of those services, as well as for his bed and so on. We’re certain that same night in the hospital would have cost the insurance company less than half what it cost someone who had just proven he was destitute! An amount on the order of $10,626 would never have been mentioned.
In this case, the issue wasn’t with the health care per se. It was the manner of payment—the same thing we’re proposing to fix when we talk about health care reform.
Ideally, someone thinking he’s having a heart attack in a strange city shouldn’t be faced with a dilemma about how to pay. He shouldn’t have to pay more for being out of state (which was a factor in this case) and he certainly shouldn’t have to pay more for being uninsured when it was not his choice to be so. After all, he’d been dumped by his insurance company.
Choice of hospitals and doctors wasn’t really much of a factor in this case. Our hero went to the closest hospital and was treated by the doctors on duty—absolutely no choosing for him at all. But had this not been an emergency, he would have had the option of shopping around for a doctor under a single-payer system.
Why should there be “out of network”?
By contrast, most private insurance plans expect you to pay more for a doctor who is “out of network” if they will cover such visits at all. And if you belong to an HMO, good luck! Your choices are highly proscribed and you are very likely to be told you can’t have certain treatments, just because giving them to you will have an adverse effect on the HMO’s bottom line. We’ve seen it happen in real life.
Insurance companies tell you they’re giving you choices, such as whether to pay a higher premium and get a lower deductible, or vice versa. But the meaningful choice in health care isn’t getting to choose an insurance plan, which merely determines how you pay. Meaningful choice is about who treats you, where you go for treatment and which treatment you will receive. You want to have control over those things, as well as over what conditions you think merit treatment. Since a single-payer system provides private delivery of health care (just like we have now) it wouldn’t change the meaningful choices. The only part it changes is how the bill gets paid. A single-payer system centralizes payment so that it is done either by the government or by a publicly owned agency. There’s no insurance company middle man.
Australia and Canada, for example, have single-payer health care systems. Those two countries rank 7th and 8th, respectively, in life expectancy among nations, according to CIA figures. The U.S. ranks 50th. In 2003 (the latest year for which we could find the figures, calculated in U.S. dollars) Australia spent $2,886, Canada $2,998 and the U.S. $5,711 per capita on health care.
What choices best serve the consumer?
As we go through the debate about health care reform, one of the issues informed consumers should watch closely is whether or not a single-payer option is put on the table. This is the solution least likely to be offered because it is the most beneficial to the public and therefore the least profitable for industry. In fact, a bill in Congress—H.R. 676—represents just such a single-payer system, based on expanding Medicare coverage to cover all. (The bill, introduced by John Conyers of Michigan, is called “Expanded and Improved Medicare for All,” not so surprisingly.)
You won’t find many in Congress or the Senate standing up to push H.R. 676, though, because it is precisely the bill the health insurance industry does not want to see enacted under any circumstances. If it passes, over $400 billion in annual profits will disappear from the health insurance industry, along with a lot of perks for congressional supporters.
And what’s worse, the CEO of United Health Care will have to give up making $120,000 an hour, or at least find some other industry in which to make it.
We bet you’re going to lie awake nights now, worrying about him.
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