You go to a restaurant, peruse the menu, take your waiter’s suggestions, and order a meal. But there is something odd: the menu has no prices and you have no idea what you will be required to pay until a few weeks later when the bill arrives in the mail.
That, it turns out, is analogous to what goes on in health care, where fees are hidden at the time of service. Making matters even worse, patients often are seeking care when they are frightened and vulnerable, in no position to ask about prices or haggle.
This is the lead to a good NYT story today about the hidden nature of health care costs, but it leaves readers believing that visiting an out-of-network provider and paying their often exorbitant and surprising costs is the choice of the patient or the result of patients’ oversight…
Even well-insured and sophisticated health economists, like Dr. Garber, an adviser to Dr. Colella’s company, can be hit by unexpected fees. When his wife had a baby, an anesthesiologist spent a few minutes administering an epidural anesthetic. Dr. Garber assumed the doctor was part of his insurance plan—the hospital participated in the plan and the doctor had not said he did not. But then the bill came for a few thousand dollars, and it was up to Dr. Garber and his wife to pay it.
That same out-of-network epidural thing happened to me nine years ago, which is partly why I’m now so cautious about checking health care costs.
But then last year I had a weird, possibly cancerous tumor in my leg and there were no in-network doctors who dealt with such things. Since all the in-network doctors agreed that he was the only one I could see, you might assume (as I did) that my insurance would cover him as a network provider.
Instead, I discovered that my typical employer-provided insurance plan had a contingent for such cases: they’d only cover 50 percent—even though I had no in-network option.
One solution proposed by the Obama administration—improving networks so that patients can stay in-network—is, sadly, another recipe for wasting health care doctors. Why should every network have a specialist to deal with every rare medical condition? Wouldn’t it make more sense to make insurance cover what doctors think a patient needs, regardless of arbitrary networks? Of course it would.
This is only one example of how what’s being argued about currently isn’t really giving anyone much to feel hopeful about.
“One solution proposed by the Obama administration—improving networks so that patients can stay in-network—is, sadly, another recipe for wasting health care doctors.”
Do you mean “health care dollars” ?
And I agree with your last point. Maybe Democrats will come back to Congress and start health care reform over again from scratch.
What Obama and the Dems are really proposing is simply a new billing system. Sure, we’ll cover more people–by making them buy insurance from private companies that they can’t afford in the first place.
Medicare for all–now!
DOCTORS determining what kind of care patients should receive? That’s crazy talk. Surely insurance companies have a better grasp of what services are most appropriate in a given situation.
Arg. This is one of the reasons that the very concept of for-profit health insurance drives me nut.
“Arg, it’s drivin’ me nut” = What the single-scrotumed Cockney pirate responded when asked why he keeps a steering wheel in his trousers.
Sigh. We’re still going to be paying 25% of our income on health care in a few years. If we’re lucky. $1,000 a month? Someday we’ll look back on that with nostalgia.
Yet another reason for a true and robust public option.
Firedoglake led a whipcount to find which members of Congress would support the Public Option.
It worked: 60 members of the House made it clear they won’t vote for a bill without a public option.
Yesterday alone, FDL and partners raised nearly $100,000 for progressive members of Congress who agree to draw a line in the sand over a public plan:
http://campaignsilo.firedoglake.com/2009…
You, too, can offer carrots to these progressive politicians at ACT Blue:
http://secure.actblue.com/contribute/pag…
It’s time we beat the lobbyists at their own game.
Figures. An in-network doctor should be able to give a referral to an out-of-network specialist and that should be enough to cover things fully.
“Why should every network have a specialist to deal with every rare medical condition?”
This is an odd question. A doctor doesn’t “belong” to a network — that’s just the terminology for things — a doctor can contract with many, many networks. The doctor has a contract written up that defines how much the insurance company will pay for things. Without that contract, there’s no real way to determine the cost of a procedure. Some insurance companies won’t cover a penny.
In terms of, “Wouldn’t it make more sense to make insurance cover what doctors think a patient needs, regardless of arbitrary networks?” This is basically what happens. Insurance company draw up more contracts to cover more procedures. That does not waste health care dollars. In fact, by contracts bring down health care costs because doctors charge less when dealing with a pool (insurance) than an individual.
Obama’s plan limits out-of-pocket costs. And that includes for doctors and hospitals not covered by your insurance.
Finally, it is easy for us who aren’t the 40 million without insurance to pounce on the many imperfections of this plan. Medicare for all does not have the votes for pass. Not even close. We can wait a decade for the tides to change (or not, given that democrats will suffer in the next election if the fail to pass health reform), and we might get a better health care bill as a result. But this plan is worse than Clinton’s plan. Clinton’s plans were worse than Nixon and Truman’s plans. And while we wait for a better plan to earn votes, against the lessons of history, millions more will go without health care.
I’ve been blogging about some personal experiences with our local system (between the Ballard Emergency Physicians, the contracted ER docs for Swedish Ballard and Premera).
http://www.quasilaur.net
One of many problems with health care aside from just insurance.
See folks, UHC is not that simple, and it certainly isn’t cheap.