Something has got to change.
Our health-care system is broken, and I have the proof. But before I go into that, let me give you a little background.
I am a conservative who has moderate leanings. Or I’m a moderate with conservative leanings. Either way you look at it, I’m no raving far-right type, but I’m no liberal either.
I work for a large multi-national company with excellent PPO medical insurance. I have a fully-funded Healthcare Spending Account (HSA) that my company generously seeds with money every year. I consider myself and my family fortunate.
Here is where it gets interesting. And problematic.
My wife was hospitalized twice earlier this year with long stays both times. Without giving away too many details, there is a chronic pre-existing condition that we continuously struggle with. Thank you, Obamacare.
We are now dealing with the fallout of these events. In previous years, we had Kaiser and never realized the blessing that it was to us. Health Maintenance Organizations (HMOs) are generally integrated insurance/provider health-care solutions that enable patients to focus on healing and recovery.
PPOs, on the other hand, are self-managed and fraught with pitfalls. Now we face mountains of bills that need to be reviewed, cataloged, entered into a spreadsheet, and resolved.
My wife spends between one and three hours daily trying to understand and reconcile the many bills that we have received. I estimate that a full 75 percent to 80 percent of these bills have errors that need correction. Interestingly, the errors almost always benefit the provider in some way.
We found one physician who visited my wife nine times in the hospital. These visits were probably less than five minutes each. Imagine our surprise when we discovered this doctor was out-of-network and charged us $550 per visit!
Upon challenging the billing, the office manager grudgingly lowered the bill 50 percent, inferring that he was “doing us a favor.” Needless to say, we are not done dealing with this fellow.
What is becoming so clear to us is that our system is so fraught with incompetence and fraud that there may be no reasonable way to save it. Most medical providers do not bill on the basis of the service/item provided but by how much insurance will pay.
This is completely wrong. Think about it. Suppose you went into a grocery store and bought a watermelon. At the register, the clerk looks at your Louis Vuitton purse and says, “Oh, you can afford to pay $27 for this melon.” Would we stand for that? Nope.
So why do we allow the price of medical services and goods to be set by the ability to pay? This is not capitalism. It is a warped system where costs are allowed to spiral with no limits.
All attempts to create a “free market” in health care have failed here in the United States. Understand this: in the U.S., we pay far more in public monies for health care without a true public health-care system than European countries pay for full socialist health-care systems.
Let that sink in. Simply put, we pay more and get less. It’s just that simple.
And, unfortunately, I think it’s the insurance system that is to blame. If we remove pure insurance companies and have a more managed approach, like a Kaiser or any other HMO, we can more effectively control costs and manage care.
Insurance companies are not evil but they have to make money. So they will pass all costs along to you or your employer in the form of higher premiums. Insurance people don’t care about rising costs – they aren’t the ones who ultimately pay. They take their cut and are out of it.
It may be time for us to start considering a single-payer system to control costs and manage care. Let’s not kid ourselves – health care was not, is not, and never will be a free-enterprise system.
A few people (like insurance companies) have made a mountain of money. For the rest of us, we suffer with expensive and cost-ineffective care.
This is where uber-conservatives begin to howl about “socialized medicine” and how people are harmed by delayed elective surgery. These same folks are usually in good health and don’t think much about those who are poor, sick or injured.
But here is the great irony. Everyone, at some point, will need detailed health care at least once in his or her life. Very expensive health care. Unless they are hit by a bus or otherwise die suddenly.
These costs are inevitable and growing. We need to change how we think about our health-care systems now. Maybe it’s time to look at a single national pool of risk where everyone pays and everyone benefits.
Costs can be mandated. However, if extra services are desired, supplemental health-care coverage could be offered at a price. This will result in driving much of the confusion and fraud out of the system.
Would this be perfect? Nope, not by a longshot. But we have to consider doing something different because our current system is an abject failure.
Steve Lunetta is a resident of Santa Clarita. Angry emails can be sent to [email protected].