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12/3/2009
How is a doctor visit like the grocery store?

You’ve heard me rail over and over about the critical importance of lowering health care costs – and that lowering costs must come not through government mandates but rather through the power of consumers and the market. Period. Period. Yes, some reforms to our insurance and delivery systems are needed, but NOT 2,000 or 3,000 pages worth of government directives.

Over and over I’ve said it. Many, many others have said it. Just for drill, here’s a quick sampling.

Various health bills contain no provisions to substantively control the growth of costs, Jeffrey Flier
Any solution must bend down the health care cost curve, David Walker
Controlling costs must be part of a federal health care solution, Tom Still
Contain health care costs with three strategies, John Torinus
I dare you, just ask “How much will it cost? FoxPolitics

So up pops this NY Times article over the weekend that laid out the specifics of we consumers taking the cost of health care into our own hands. I know I’ve shared it a several times, but my husband and I have a high ($8,000) deductible policy, so we essentially pay for all of our health care out of pocket (plus insurance premiums that aren’t cheap) except for annual physicals and associated blood tests. Do I need even to state that we work hard to pay the lowest possible price for all services? – which is not so very easy to do, as anyone out there who’s tried it knows.

The Times article is chocked full of great stuff. Really cool. The health care pricing websites referenced are really usable. Check them out.

Also,

CHECK WITH YOUR INSURER Many insurance companies have begun posting provider prices on their Web sites so enrollees can access cost information. These tools allow you to compare prices among network doctors (not all network doctors are paid the same) and check on the price of diagnostic tests and other treatments.

“This is especially helpful if you’re in a high-deductible plan,” said Ms. Tu, “because you can see how much you’ll pay out of pocket.”

Blue Cross Blue Shield does that here in northeast Wisconsin - it’s our insurance carrier, so I’ve tried it. Clunky. A start, which is great, but not much more than that at the moment.

Wisconsin PricePoint System – powered by Wisconsin Hospital Association – is another good start. Ok, but not near complete. Still, a great start that I won’t complain about.

And the Wisconsin Collaborative for Healthcare Quality is doing good work on the quality and cost fronts.

The point is, being a responsible health care consumer is just like going to the grocery store to find the best pasta for your needs and your wallet. The day is coming. Neither the government nor our employer need be fighting against the traffic to try to save money for you and me. It’s up to us – you and me. Empower yourself!

Jo Egelhoff, FoxPolitics.net

COMMENTS

Jo, indeed you and your husband are very smart and hard workers. And you or he (or both) must have a job, making it a bit easier to afford a high-deductible insurance plan. But you've obviously made the right choices in life or been in the right place at the right time.

But not everybody is in your position, and we have a lot of people not so lucky and not so hard-working. In some cases $8000 per year represents 25-50% of their total pay and putting food on the table for their kids tends to take priority.

As well, seeking out the lowest bidder is not smart, no matter how smart you think you are.

That we are wasting 31% of our healthcare costs on the insurance bureaucracy and another 20% on over-use, duplications, fraud and malpractice is absolutely stupid.

And the only ones who scoff at fixing it correctly (with a Medicare-for-all system) are those who have insurance (at the moment) and a job (at the moment).

Jack Lohman (Thu Dec 03 07:57:22 2009)

Once again Jack you're 1) off message and 2) completely out in LEFT field.

This is not a discussion of affordability - it's another whole subject. Very important, yes, but another whole subject. How much should a household be responsible for health care? A household earning $25,000; $50,000?; $150,000? Should the household earning $50,000 be expected to budget $10,000 in insurance and/or medical costs? $5,000? $7,792? Probably something close to that. Health care costs money. Period. And for those families earning below certain limits, yes, subsidies must be made available. That is not the issue referenced in my piece.

I'm tired of your arguments about how great a job the government can do providing health care for me, with the consumer and markets completely left out of it. Much of that overuse is coming from those "insured" by Medicare and high-premium employer-paid insurance products. Eliminating deductibility is one solution. Now how are you and your buddies in the government going to control Medicare overutilization and fraud?

Jo (Thu Dec 03 10:36:45 2009)

Jack says a "Medicare-for-all system" is the correct fix. Medicare as currently constituted is doomed to bankruptcy in a handful of years and, in addition, is underpaying doctors and hospitals. Load the program with millions more clients, and the bankruptcy date will move up. Let's do this "correct fix" fast so that we can enjoy at least a few years of coverage before the end. Of course, an obvious question arises: What then?

Ron Zahn (Thu Dec 03 10:44:23 2009)

Call it what you wish, Jo, but to ignore the problem of waste and efficiency and concentrate only on consumer-driven health care is a disservice. Price-shopping health care is not like visiting the grocery store.

Competition in health care is a red herring that the insurance industry has very successfully promoted, but when it comes to the health care of a loved one, most people are not going to check prices. And if they do they will most likely will go to higher priced doctor/specialist because, presumably, they are the best. And most people don’t know that older and less expensive 24-slice scanners are inferior to newer and more expensive 64-slice scanners, so to drive people in that direction is a disservice.

The “captive market of health care” should not be entrusted to the “free-for-all capitalist market of CEOs.” Sorry. I don’t trust them and their profit motive that drives insurance CEOs to deny health care to increase profits. And I’m not alone; over 60% of the public supports Medicare-for-all. Yea, you are right. Right wingers are not in the 60%.

You are wrong on the over-use. More of it is in the private healthcare system because (a) it is more profitable and (b) it doesn’t result in jail time. But please to not let me confuse the discussion with facts.

Ron, I don’t know your background or biases, but with a Medicare-for-all system we could provide first-class Cheney-care to 100% or America for the same dollars we are spending today (16.5% of GDP). Not the $1 trillion Congress is now considering, but that system leaves the for-profit insurance industry in the loop.

We’d pay for it in taxes rather than wages, but it would use the same private doctors and hospitals we’ve always used. And Medicare doesn’t underpay doctors, it fairly pays them (at least if they repeal the proposed 20% cuts implemented by the Republican congress under Clinton). They pay about 10% over costs while I’ve seen private insurers charged 400% of a physician’s and hospital’s costs, and most of them blindly pay the price (it’s called “usual and customary”).

You are right when you say “as currently constituted.” There are many changes needed but none will occur under the current system.You can see more detail at Medicare-for-all. If you are a business leader this system would greatly benefit you.

Jack Lohman (Thu Dec 03 11:57:21 2009)

Jack, the fallacies and biases evident in a scan of the Medicare-for-all site would take hours to address. Permit me instead to affirm that I have definite biases. I am biased in favor of whatever it is that has made this country the greatest and most successful on earth. Where else do even the poor have TVs and cell phones?

I believe in free enterprise, private property, individual responsibility, free markets, the entrepreneurial spirit, limited government (as in The Constitution), and liberty.

If profits and competition in the food industry allow my wife and me to eat well on $150 a month, I believe profits and competition can serve me well in the area of health care. (Both, by the way, are essential to life. If the government must run health care because it is essential, it must also run the food industry, eye and dental care, and more.)

A major issue that cannot be overcome is that government everywhere is comprised of people, just as is industry. The same people who paid $300,000,000 to secure one vote in the Senate the other day will be running Medicare-for-all. Government is not by its nature benign and beneficent.

I am baffled why anybody would want health care run like Freddie and Fannie, the post office, Medicare and Medicaid, Social Security, and Government Motors.

Competition in a free market serves the customer most efficiently, though not perfectly. Perfection will await heaven.

Ron Zahn (Thu Dec 03 17:50:00 2009)

Would I want my healthcare run like Medicare? Ron, my healthcare *IS* Medicare, and it is great. I go to the same doctor and hospital as before, maybe even your doctor and hospital. They just send the bill in a different direction.

But when you reach 65, please opt out and continue with your private insurance.

Would I want my care run by a private insurance company that can cancel my policy at will, and refuse care when it becomes too expensive? NO! Remember the 17 year old girl that died because she was denied a kidney transplant (against her doctors orders)? That was Cigna, not Medicare.

Jack Lohman (Fri Dec 04 04:32:39 2009)

Jo,
You like to use anecdotes. So here's one from me. Last night I received a call from my wife's cousin. He has always been a real free market guy. Private enterprise uber alles. Well, he has a high deductible plan (single guy) . He had a bike accident over the Summer and just got the last of the bills for which he had to pay them all. $6000 for a 20 mile ambulance trip, CAT scan and emergency room treatment (no concussion or fractures). He now agrees with me that much health care can't be just shopped for like sausages. he now understands how someone can go bankrupt over healthcare. Sure, he didn't want to get in the accident but it happened. I also have a contractor who does some work for me. He had a mild heart attack. Called 911 when feeling chest pains. But, the ambulance took him to a Green bay hospital instead of the hospital that was in his plan. A $9,000 higher hit to his bank account. Was he supposed to ask 20 questions of the ambulance driver and his insurance company while in the ambulance? I have stated in this forum how difficult is is to get total costs on something as simple as a colonoscopy.
These problems will not be solved by the haphazard attempts by some well meaning (and some not so well meaning) insurers or other companies to try to post accurate prices. Not to mention that under fee for service a heart attack doesn't have a definable treatment or outcome. Only the government can do it byb leveling the playing field, much like only after the government got involved with auto safety did we get seat belts and air bags. How many hundreds of thousands died because the big 4 didn't want people to think that cars were dangerous. How many died because the big 4 said the customer will eventually figure out which cars are dangerous and the market won't buy those cars. How much more fiscal and physical carnage should our society accept under the "market knows best" philosophy.
You and many other in this forum have a deep seated philosophy that because it is privatized it must be better. That the Market is better at delivering services always better than the government. This is simply a false statement if applied to the overall concept of an effective healthcare system. Some things are better from a totally free market and some are not. I think it is time to get off the philosophical market high horse and look all around at the failures we endure that others do not and the high cost we pay for such failure. Oh, please, no blasting me for being a Liberal etc. I'm an independent business person who who work very hard and creates a few jobs here and there and I do my battles with government and regulation. I simply have the open mindedness to understand that results should come first and philosophy second.

dave allen (Fri Dec 04 07:49:54 2009)

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