There Has to Be a Better Way to Pay for Health Care

Townhall.com ^ | March 19, 2016 | Stephen Moore

[Kaslin]

Late last year, while playing tennis, I reached up to serve and felt a painful pop in my shoulder. The inflammation got worse over the next few months. Now anytime I try to put my arm above my head, pain shoots up my arm. I often wake up at night with an agonizing throb in my shoulder.

So I finally and reluctantly went to the orthopedic surgeon; he said that I had a rotator cuff tear and I would probably need surgery. Ugh! He scheduled me for an MRI, but the day I was set to go, the hospital called to tell me my insurance company declined to pay for the scans. The insurance company, Cigna, tersely sent me a note: "You will need to complete six weeks of conservative treatment, such as physical therapy and anti-inflammatory medication. Once that has been completed and you have been re-evaluated, we can try to have the MRI re-authorized." Gee, thanks. You guys are the best.

I've been doing therapy for many months already, with not much improvement. The doctor explained that the insurance companies want to make sure that physicians aren't padding bills with unnecessary procedures. Incidentally, I've paid for health insurance for 30 years and have almost never used the medical care system. I calculate the insurers have made well over $100,000 off of me.

But I am lost inside the bureaucratic maze. They don't want to pay for the MRI because they don't want to have to reimburse for rotator cuff surgery. So their hope is that I will just go away. Studies show these delay tactics and bureaucratic runarounds work to reduce insurance payouts.

Everyone has horror stories of insurance companies denying coverage for valid procedures. As an analysis in The Baltimore Sun recently put it: "Among insurance professionals, it is common knowledge that health insurers are denying claims for coverage with increasing frequency." This is what the health industry calls "cost control."

Look, I get it; the insurance companies are trying to root out fraud and abuse of excessive procedures, which drive up costs for everyone. But the insurance companies are becoming barriers to care even for legitimate and necessary procedures.

What's the root of the problem here?

First, the excess of health insurance actually drives up cost. The more insurance for a procedure, the more expensive it is. Health inflation and premiums has been rising by nearly double the consumer price index for at least the last decade. This is also why there are so many frivolous procedures performed. Patients have been removed from the decision-making process.

Second, Obamacare has increased demand for health care and is driving up costs, so insurers appear to be cutting their expenses by denying claims more often. By the way, the insurance lobby should take note that this sleazy practice only plays into the hands of Bernie Sanders and others who want a single-payer government system to take over health insurance.

That will make medical care worse -- and more expensive. Studies on Medicaid patients find little or no improvement in health outcomes compared to the uninsured population -- because the level of care is so lousy. Government health care will be Medicaid-type coverage for all. It will be "fair" because we will all get equally subpar medical care -- and I would never get my shoulder surgery under that system.

The health insurance scandal in America today argues not for a vast expansion of government-run health care; instead, it suggests the wisdom of the medical savings account approach, where people put money, tax-free, into an IRA account and draw it down to pay for their first few thousand dollars of coverage. That way it isn't an insurance company who makes the call as to whether I should get an MRI. I make the call with my own money. Is the pain in my shoulder so bad that I want to shell out $1,200 to have a scan? Right now, Cigna says I don't get to make that choice. So it's "free" but I can't get it. Wonderful.

The only people who know whether I need surgery are not the faceless, bean-counting claims adjusters living in Toledo, Ohio, but my doctor and me

[bert]

I frankly don’t give a damn about your posts.

they are totally irrelevant to me

[cableguymn]

make it yuge.. the best.. run by the very best people.. it’ll be spectacular, he has consulted with the very best (in his own mind..).. it’ll be great. I promise... I promise..

(I am non Donald Trump and I am not sure I’d support his message if it was from him)

[DoodleDawg]

I frankly don’t give a damn about your posts.

they are totally irrelevant to me

Because they do what Trump Chumps are either afraid to do or incapable of doing; asking "how"? I made several points on why I think Trump's plan won't work. Instead of showing me where I'm wrong you prefer to stick your fingers in your ears and say "Lalalala...I'm not hearing you."

[DoodleDawg]

Apparently you are too afraid to even read it. Sorry for you.

I read it...and raised some issues in reply 20. Care to address them?

[Alberta's Child]

The core problem is that what people want and what they are willing or able to pay for, when health, life, and death are involved, are radically different.

There -- I fixed it for you. It goes way beyond just these things.

[Liz]

What Trump plans for Obamacare (taken from his website):

1.Completely repeal Obamacare.

2. Modify existing law that inhibits the sale of health insurance across state lines.

3.Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system...

4.Allow individuals to use Health Savings Accounts (HSAs).

5.Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals.

6.Block-grant Medicaid to the states.

7.Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

(More details at Trump web site).

[cableguymn]

because as a cash customer the Dr only has to collect payment, with an insurance company he needs a small army of employees to deal with them and extract payment from them. I work with several dental clinics in my profession they LOVE cash, they give a price, collect payment, preform service, done deal.

With the insurance companies it can take hours of his staffs time to get paid for a service.

[bert]

you are irrelevant to the discussion

[DoodleDawg]

you are irrelevant to the discussionP> There is no discussion because there is no questioning. You are all swallowing everything that Trump says and believing it is the solution, regardless of how little sense it makes. You don't want debate or questioning or skepticism. You want blind loyalty.

[DoodleDawg]

I work with several dental clinics in my profession they LOVE cash, they give a price, collect payment, preform service, done deal.

And is what they charge you for the services the same price as they charge insurance companies?

[Liz]

Cruz campaigned for the Texas Senate seat on a promise to repeal RobertsCare (Texas version of Obamacre)

But Cruz had other things on his mind. He was in the US Senate for 10 months when he figured he was ready to run for president.

QUESTION: How many times did Cruz introduce a bill to repeal RobertsCare?

Is that why he called McConnel a liar?

[jetson]

We could go back to paying with a chicken or a jar of preserves.

[AndyJackson]

..I went out for a walk while my leashed dog went for a run

Been there!

[xzins]

I have always appreciated the Army health care process. First, the person goes to an aid station. If they need more help, then they are passed on to the clinic. If they need more care, then they go on to the hospital. If they need more care, then they’re sent to a specialty center.

Obviously, an emergency like a heart attack jumps to a hospital.

In the military, almost everything is solved at the aid station or clinic.

That said, this article echoes what’s been said now for at least a decade. The huge pool of “insurance money” drives up costs because all the providers know it’s there for the taking.

[DoodleDawg]

I have always appreciated the Army health care process. First, the person goes to an aid station. If they need more help, then they are passed on to the clinic. If they need more care, then they go on to the hospital. If they need more care, then they’re sent to a specialty center.

You've described today's healthcare system. I had a ingrown toenail and wanted to see a podiatrist for it. So I called my doctor and asked for a referral. But first I had to come in and see my physician so she could say, "Yep. That's an ingrown toenail alright" before referring be to the podiatrist associated with the practice. Then after making the call and waiting another week they were able to see me and say, "That is definitely an ingrown toenail." It needed surgery so I had to go to a surgical center for an outpatient procedure that finally fixed it. So in your analogy I went to the aid station, got passed along to the clinic before going to the hospital.

[mazda77]

Well now, apparently you did not make me part of that conversation but I’ll neuter your last point about HSA’s, just so you won’t feel like everybody is not salivating on your every argument.

So because I do not have a high deductible insurance policy, or none at all, I cannot engage in a HSA? Boy, that really works for one who has done my homework and can get cash coverage for far less than I can with ANY insurance policy. In many cases, what I pay for an office visit to my long standing GP is less than others pay with their co-pays.

For a hernia operation, with Insurance the billing to the insurance company would have been ~60K from the hospital that I received a predetermination of costs. The cash price would have been ~13K. I did some shopping around and found a private surgical center that eventually cost me $4200 cash total. Same surgeon network, same gas passer network. The insurance deductible would have been 6K.

So, tell me why I need to pay $700+ per month for insurance just to be able to have the luxury of paying $6000 deductible for a procedure that I paid $4200 for that a private, non-government controlled HSA would have allowed me to do? Just because I payed all of that money for insurance that essentially did me no good at all?

[xzins]

The aid station doesn’t have docs. Generally, it’s medics, and occasionally there might be a PA or a nurse present. (Obviously, it’s overseen by the medical system.)

The clinic is the first step with a doc.

Plus, the intent is triage and not to make sure each step gets a bite of the financial apple as is our current system.

Lots of folks get sent home with Tylenol from the aid station.

[ottbmare]

The best way to approach medical care is quite simple: Contract for services and pay for them yourself. It seems to work for almost everything else in our economy.

You're so right. So I'm assuming that if you need a CABG (cardiac catheterization and bypass graft, a rather common procedure for middle-aged people), you'll be able to afford to fork out $150000 for the diagnostics, procedure, inpatient admission, and follow-up care? Or half a million for cancer treatment? Because most of us can't, no matter if we have a health savings account or not.

[thirst4truth]

If the author wants to reduce health care costs, he should have dropped his insurance coverage and paid cash for his care.

You must not own real estate? If you own a home you have to have medical insurance. I am self employed and have to buy my own medical insurance, because I am not willing to take the risk of contracting cancer, it is in my family, to the tune of a $100,000 or $500,000 for treatment and loose my home to pay cash for that. So we got a major medical policy with a $7500 deductible. We have had it for over 20 years and it is not allowed by Obamacare. We were grandfathered in, thank you God!

Since Ocare was passed our premiums have rose over $200 a month, for a catastrophic policy, but it does not have to include maternity care, rehab care or mental care.

[yadent]

The Surgical Center of Oklahoma justifies Trump’s point #5 of his healthcare plan. Their prices for various procedures are around 80% LESS than traditional pricing. Considering the Federal government spends aprox. 25% of it’s budget on healthcare related, that’s over $1 Trillion per year, Trump’s ‘plan’ could result in ‘savings’ at just the Federal level of as much as $800 billion/yr......