Republicans have long asserted that the solution to solving America’s health care crisis is to give greater power to the consumer to make her own health care choices. Republicans view high deductible plans and electronic medical records as tools that will give consumers greater control over their health care. It sounds good conceptually, but reality has proven time and again that these ideas don’t currently work.
Photo: Massdistraction, Creative Commons, Flickr
Medical providers are the first major obstacle. Most health insurance plans today have a deductible that must be met each calendar year before insurance covers their medical care. Deductibles typically range from $500 to $2,500, but a $5,000 deductible is not uncommon. Paying for medical expenses out of pocket until a deductible is met encourages consumers to be more selective in medical care, avoiding excessive testing and treatment. It is also supposed to encourage consumers to shop around for non-emergency care.
Unfortunately, most medical providers have shown their disdain for these plans in their refusal to operate their practices like businesses. Most doctors refuse to even provide a ballpark range cost estimate for an office visit in advance even though they know what the insurers’ reimbursement rates are. Once a consumer visits a provider to treat a specific situation, the doctor might embark on a “fishing expedition” into other non-related issues, along with ordering lots of tests. If the consumer begins to ask questions or insists on limiting the visit to the issue at hand, the doctor may become impatient. In some cases, such “defiance” by the consumer results in doctors issuing them certified letters informing them not to return to their practice.
Doctors may be frustrated by the departure from the halcyon HMO days of the consumer $5.00 co-pay. They don’t realize that consumers are financially strapped. But what they really fail to grasp is that beyond cost, a consumer might disagree with certain treatments and medications the doctor wants. In consumer driven health care, consumers are supposed to question their medical providers, but doctors don’t always understand that consumers are not only concerned about their money, but also about their bodies. There have been too many instances over the last few years where treatments and medications have turned out to be, not only of no medical benefit, but actually detrimental.
There are several reasons doctors have concerns about a consumer refusing a recommended treatment:
- The doctor sincerely believes the treatment will benefit the consumer.
- The doctor financially benefits from additional treatment: additional consumer visits bring additional revenue. The doctor may also have a financial incentive in ordering tests.
- The doctor orders excessive testing as a legal protection. For all the Republican rhetoric over the years about curbing frivolous lawsuits, the Administration has done nothing. The amount of legitimate medical malpractice lawsuits is minuscule.
Beyond convenience and extended hours, consumers are visiting medical clinics inside drug and discount stores, along with physician-staffed medical clinics, because these places address the consumers’ ailments without pushing additional treatments.
And then there’s billing and pricing. Most medical providers are demanding payment up front, even if an insurance policy states that payment is not due until the claim has been processed and the payment owed the provider calculated ($0 if the visit is over the deductible). Failure to do what the provider’s billing department wants will result in a certified letter denying future treatment.
Then there’s lack of pricing parity. Your visit could have been for the exact same thing as the person sitting next to you in the waiting room. But the provider will accept $60 for a visit from that person because she is on Medicare. For you, it’s $130. Clearly, this has not been a trip to the supermarket.
Electronic medical records require universal health care, and yet politicians on both sides of the aisle pontificate about the efficiencies of converting to electronic medical records. Without universal healthcare first in place for every American, electronic medical records will make life easier for insurance companies to reject more people from obtaining health insurance. Google ($551,24 GOOG), Intel ($22.25 INTC), Microsoft ($27,84 MSFT), and Steve Case’s Revolution Health should be publicly lobbying for nothing short of universal health care if they want to profit from electronic medical records. To tell consumers that electronic records could save their lives is not convincing when the bigger issue is living day to day.
Universal health care is consumer-driven health care, and the only way to take consumer driven health care beyond the rhetoric is to, at a minimum, enact a federal law requiring insurance companies to offer guaranteed issue community-rated policies to consumers. Tuesday’s Wall Street Journal article “Anxiety Over Health Insurance Shapes Life Choices” describes the various choices people make to get or keep health insurance. From couples not divorcing, to people living in a certain state, it is truly a sad state of affairs for more and more consumers.
You might have noticed the use of the word "consumer" instead of "patient." Consumers should be able to make choices in the same manner they approach any other product and service purchasing decision. Numerous federal consumer protection laws successfully exist in our capitalist system. In order for consumers to be productive in society and pursue “life, liberty, and the pursuit of happiness,” they need to have consumer-driven health care that is real rather than rhetoric.
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