We Need Affordable Health Care, Not Just Affordable Insurance
Posted on July 30th, 2009 by ICR Bloggers in From Insurance Company Rules
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As the wheeling and dealing of getting a health reform bill passed takes center stage in news coverage, one aspect of the debate is not getting the attention it deserves: the affordability of health care. To keep the cost of the bill and of health insurance down, Congress seems to be moving toward more cost sharing by patients even though mountains of research shows that higher out-of-pocket costs lead people to forego medically necessary care. That leads us further from the goal of guaranteeing everyone has access to quality, affordable health care when they need it.
Too many excuses not enough action. Everyone needs to get together and take care of this.
Too much talk not enough action.
Get it done now. More action less talk.
There are two issues in all this. First is the health care insurance, itself, which involves the front-end costs to enrollees and access rights. The main issues here include 1) that health care reform must end the practices of denying coverage for pre-existing conditions and not allowing insurance companies to drop someone because they get sick, and 2)that insurance company profits and overhead must be adjusted down (via real competition?) to reduce enrollee costs.
Second is the actual costs of medical care. We know that there are regional differences, e.g., that Dade County, Florida, is far more expensive in its Medicare costs than Green Bay, Wisconsin and many other places. What we don't know much about is the whole nature of how insurance companies "control" health care costs that they are responsible for. We know that many times they pay much less than the billed amounts from doctors and/or hospitals. And "independent" HMOs, like Kaiser Northern California, need to come forward with their ideas and data to be examined and analyzed. How do THEY try to reduce costs? How are THEY successful or not successful? Also, the overhead and profits gained by the insurance companies would seem to add little or nothing to the value of the health care product. But, again, more research and analysis in this area needs to be done.
So, the change in labelling by the Obama administration to an effort for health care INSURANCE reform makes all kinds of sense. The vast majority of Americans would seem to agree on this concept. The second area, where years of work will need to be done to make progress, is the area of health care costs reform.
I feel good that all of this discussion and education is leading us to a good outcome before the end of the year.
In an article in the current Forbes Magazine, there is a story of a 61-year-old woman who has an emergency room bill for $13,000. She is insured, but finds out that her insurance company will not pay the bill. She talks to the hospital and gets the bill reduced to $4,000. Another story is of a guy who has a $6,000 emergency room bill. He eventually pays $4,000 after negotiating with the hospital.
So what do these emergency room visits really cost the hospital? Is there a markup in the "retail" bill to compensate for reduced payments by insurance companies and/or for people who are billed by do not pay at all?
Approximately 80% of Americans have health insurance either via their employment or via government (Medicare, Medicaid, etc.). Another 16% are uninsured, while about 5% have private insurance.
For too long now, the costs of medicare care has been "masked" from most who receive it. But as costs have escalated without much of any controls to the point where the rate of increasing costs are unsustainable, something has to be done.
It's all about accessibility, affordability, quality and accountability. We can make huge leaps forward in 2009!