Response to the North Coast Journal article on health care reform
I am a local pediatrician and I really enjoyed reading Alan Sanborn's salient and entertaining article in favor of health reform. I, too, am an advocate of a single payer system because I can see no other way to improve care and contain costs. There is fat in the system, but it belongs to: INSURANCE COMPANIES (most of these companies keep about 20% of the premiums thay take in for themselves in the form of administartive costs and profit), MALPRACTICE LAWYERS and PHARMACUETICAL COMPANIES. Without fundamental reform, including tort reform, much of the money put into the system will not go towards health care essentials.
To rebut Ron Ross, the comparison between running health care and running a company is not a comparison that works, because there are fundamental differences between some one with cancer who needs treatment, and some one who would like to mail a package (i.e. the Fed Ex example). Health care is not an optional service, but a necessary one. Patients should not be expected to choose between having their breast cancer treated or dying. However, it is not unreasonable for a customer to choose between sending a package or spending that money on something else. Besides, how many of us have the $60,000 in our bank accounts so that we can shop around to see which cardiologist we like for our angioplasty? The idea that medical services are in some way consumer-driven is ridiculous. And even if we did have that 60 grand to spend on our angioplasty, which one of us would be in a position to accurately judge the quality difference between one cardiologist and next? Even as a doctor, I would have no way to assess anything outside of my field. Supposing you could judge the quality, no one would be able to tell you what the angioplasty would cost. Besides, who cares what these things cost if your insurance company is going to pay for it? Thus the so-called consumers of health care have no way to judge the service they are getting, they can't find out what the cost is prior to accepting the service, and many don't pay the bill themselves anyway. All the principles that operate to make business lean, efficient organizations do not apply.
Realistically, patients have limited or no options when it comes to health care coverage. In fact, many of those uninsured have NO options. Even when the consumer does have options and can choose an insurance policy, it is impossible to understand what you are purchasing. (Find me one person who understands the coverage that their insurance policy provides with all the deductables, co-pays, caps, exclusions, preferred providers, in-network requirements, reccisions, authorizations, pre-authorizations, prior authorizations, covered prescriptions, etc., and I'll hire them immediately to work in my billing office). I still can't figure out what my insurance will and won't cover. I called Blue Cross today and I got the following message: "Verification of benefits or coverage is not a guarantee of eligibility or payment. Actual payment is based on the terms and conditions of the plan." What the heck does that mean?
As for the argument that government does not run things efficiently, if that is so, then let's improve our government. If you have a child who is not doing his homework, do you adopt him out? No, you work on the problem in order to improve it. There are goverment programs that work well to werve as models, too often they get ignored. Take for example, the Rural Health Clinic program. This is a government program that helps fund rural clinics that care for the indigent. I think the government has done a great job of balancing oversight while allowing the clinics to function independently, in providing incentives to function efficiently while but not interfereing with effectiveness. More information is available at: http://www.raconline.org/info_guides/clinics/rhcfaq.php#whatis
Another great federal program is the Vaccine For Children or VFC. They provide free vaccine to clincs and doctor's offices for low income children. For our, office, they have been great to work with. They oversee vaccine distribution and they help us to maintain the proper quality and care of those vaccines. Again, here is a program that provides a great balance of support and oversight while encouraging independence and efficiency. http://www.cdc.gov/vaccines/programs/vfc/default.htm
We should meditate on the disclaimer given to all subscribers of Blue Cross: "Verification of benefits or coverage is not a guarantee of eligibility or payment. Actual payment is based on the terms and conditions of the plan."
I am a local pediatrician and I really enjoyed reading Alan Sanborn's salient and entertaining article in favor of health reform. I, too, am an advocate of a single payer system because I can see no other way to improve care and contain costs. There is fat in the system, but it belongs to: INSURANCE COMPANIES (most of these companies keep about 20% of the premiums thay take in for themselves in the form of administartive costs and profit), MALPRACTICE LAWYERS and PHARMACUETICAL COMPANIES. Without fundamental reform, including tort reform, much of the money put into the system will not go towards health care essentials.
To rebut Ron Ross, the comparison between running health care and running a company is not a comparison that works, because there are fundamental differences between some one with cancer who needs treatment, and some one who would like to mail a package (i.e. the Fed Ex example). Health care is not an optional service, but a necessary one. Patients should not be expected to choose between having their breast cancer treated or dying. However, it is not unreasonable for a customer to choose between sending a package or spending that money on something else. Besides, how many of us have the $60,000 in our bank accounts so that we can shop around to see which cardiologist we like for our angioplasty? The idea that medical services are in some way consumer-driven is ridiculous. And even if we did have that 60 grand to spend on our angioplasty, which one of us would be in a position to accurately judge the quality difference between one cardiologist and next? Even as a doctor, I would have no way to assess anything outside of my field. Supposing you could judge the quality, no one would be able to tell you what the angioplasty would cost. Besides, who cares what these things cost if your insurance company is going to pay for it? Thus the so-called consumers of health care have no way to judge the service they are getting, they can't find out what the cost is prior to accepting the service, and many don't pay the bill themselves anyway. All the principles that operate to make business lean, efficient organizations do not apply.
Realistically, patients have limited or no options when it comes to health care coverage. In fact, many of those uninsured have NO options. Even when the consumer does have options and can choose an insurance policy, it is impossible to understand what you are purchasing. (Find me one person who understands the coverage that their insurance policy provides with all the deductables, co-pays, caps, exclusions, preferred providers, in-network requirements, reccisions, authorizations, pre-authorizations, prior authorizations, covered prescriptions, etc., and I'll hire them immediately to work in my billing office). I still can't figure out what my insurance will and won't cover. I called Blue Cross today and I got the following message: "Verification of benefits or coverage is not a guarantee of eligibility or payment. Actual payment is based on the terms and conditions of the plan." What the heck does that mean?
As for the argument that government does not run things efficiently, if that is so, then let's improve our government. If you have a child who is not doing his homework, do you adopt him out? No, you work on the problem in order to improve it. There are goverment programs that work well to werve as models, too often they get ignored. Take for example, the Rural Health Clinic program. This is a government program that helps fund rural clinics that care for the indigent. I think the government has done a great job of balancing oversight while allowing the clinics to function independently, in providing incentives to function efficiently while but not interfereing with effectiveness. More information is available at: http://www.raconline.org/info_guides/clinics/rhcfaq.php#whatis
Another great federal program is the Vaccine For Children or VFC. They provide free vaccine to clincs and doctor's offices for low income children. For our, office, they have been great to work with. They oversee vaccine distribution and they help us to maintain the proper quality and care of those vaccines. Again, here is a program that provides a great balance of support and oversight while encouraging independence and efficiency. http://www.cdc.gov/vaccines/programs/vfc/default.htm
We should meditate on the disclaimer given to all subscribers of Blue Cross: "Verification of benefits or coverage is not a guarantee of eligibility or payment. Actual payment is based on the terms and conditions of the plan."
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