Consumer-Driven Health Care

I've turned into all healthcare--all the time, but bear with me. The debate about this issue is so important, but most of the options aren't really on the table.

Here is an excellent article that discusses what we should be doing about health care reform. The bottom line: consumers should be responsible for their care. If you are poor, the government should be subsidizing it, but everyone else should be required to have health savings accounts and catastrophic health insurance.

It's ridiculous what insurance will and won't pay for these days. Why does an insurance plan pay for your office visits? Does your car insurance pay for your oil changes? Does your home insurance pay for mowing your grass?

It's inefficient the way we expect health costs to be free or nearly free, and it is part of the reason Americans expect the best health care on earth for a song. As the article notes, areas not covered by insurance, such as LASIK procedures or most plastic surgery, are consumer-driven and prices tend to drop over time as a procedure becomes more common. And doctors also add new "features" to attract customers and/or keep their prices up.

But with insurance, you don't know how much office visits, treatments and procedures cost. Often times, the facilities can't tell you, either. This was something that truly puzzled me about the way health care and insurance works in this country.

When my oldest daughter was born, the hospital had a "special" of sorts for people with our HMO. The total cost for labor and delivery was $25. But I got a bill for about $500 (I think; bear with me, it was a long time ago). I called the hospital to find out why my friends got the $25 deal but I was charged so much more. After much haggling, the clerk said, "Ok, just forget it. We won't charge you anything." So, I got my daughter for "free."

But how does that work? I mean, the insurance paid for most of it, obviously. But what about the $25 special? And why should I get my child for "free" just because I questioned my bill? What happened to the $475 that I wasn't expecting to pay?

Fast forward 16 years to this situation I discussed in a post last year, where my doctor waived his office fee for me out of compassion (I'd just lost my father and I was self-pay). As a self-pay, I usually paid $70 for an office visit. Who paid the 70 bucks for my doctor's compassion?

Then there was the $700 ultrasound I was supposed to get last year. I told the hospital "no," that I couldn't afford it. The clerk was stunned that anyone would simply refuse to get diagnostic treatment. But that was my choice, wasn't it? And why was the hospital quick to talk about payment plans or reducing the cost just to get me to get the procedure.

These are the sorts of questions we ask when we don't have insurance, but we should also be asking when we do. And it doesn't matter if you have private insurance or use Medicare or Medicaid. Medicare paid for my father to get his toenails clipped by a podiatrist every three months. Why is that?

If consumers were truly in charge of their health care decisions, like we make decisions about cars, houses, education, and so on, then they would probably opt not to have so many (unnecessary) tests and procedures. Or if they decided to get them done, then patients would be choosing how to spend their own dollars as opposed to someone else's. My fear is that most people advocating a new government system simply don't want to have to make those decisions, partly because it can be complicated and scary, but also because when someone else makes the decisions and you get stuck with something you didn't want, you can blame someone else. After all, who likes admitting that they bought a sucky car because they thought they were so smart? Most people just want to blame the salesman.

It seems to me that if consumers were responsible for their own care and providers were required to give the proper information, then many of the problems with our current system would be solved.