Happy Blizzard Week! I hope everyone on the East Coast is enjoying the snow and that no one has been in an accident while driving, fallen down on the ice, or gotten stuck in the snow while trying to get to the mailbox (OK, yes, I got stuck in waist deep snow on my way to the mailbox... I didn't even make it down the steps. Phil very carefully pulled me out; luckily, no harm done!).
If you've been following me on Facebook, you know I've had a very "medically eventful" autumn. I'll ramble about that drama in my next post, but in this one I wanted to share a very concise solution to a number of issues related to "health care reform" (HCR). I have finally taken a stand on the topic, and I've discussed my personal experience and opinions below.
The following is taken from my LLMD's website. Read it and ponder on it. It's what inspired my position on HCR and I hope it will get you thinking, too.
"Philosophy for a Distinctive, Compassionate, and Sustainable Medical Practice
In the typical primary care medical practice the physician contracts with one or more
insurance companies. The insurance company and the contracting physician negotiate
set rates for each type of visit, diagnostic test and medical procedure. This guarantees
the insurance company a cap on costs and allows the physician access to the insurance
company's patients. However, insurance reimbursement rates leave little or no room for
a profit. If the primary care physician is to keep afloat they must have a high turnover of
patients. This usually entails strategies like double-booking time slots in the schedule,
and limiting patient visits to 15 minutes or less. Further, the schedule is booked weeks
in advance causing patients to face long delays in getting appointments. Physicians
don't like it. Patients don't like it. The quality of care sometimes suffers, and nobody is
happy.
The solution is to avoid these inefficient contracts. This has two effects. The first is that
the physician sets the price for each service and is paid directly by the patient. If the
prices are too high or too low, the business is not viable. The market guides the price,
not some third party insurance company whose primary obligation is to the bottom line,
not the patient. Secondly, the physician can dramatically cut overhead costs by
eliminating the need to staff and equip a billing and collections department. With
reduced overhead, the physician can spend more time with each patient for a
reasonable price. This is not a new idea. In fact, this is how medical practices
functioned prior to the HMO revolution in the mid 1980's. It does not mean that the
patient is necessarily responsible for the entire bill. Depending on the patient's
insurance coverage, the patient can submit the amount paid for reimbursement from
the insurance company. If the patient has an HMO or Medicare, the patient may not get
reimbursed. If a patient has insurance, blood tests, x-rays, and hospitalizations will
likely be covered. We recommend checking with your insurance to verify coverage
issues and reimbursement procedures." -CMW, M.D., Virginia
It's the simplest solution to the issue that I have ever read -- it takes power out of the hands of insurance companies and puts it in the hands of the patients and doctors. It even allows the uninsured to get qualified medical care without going to the ER. You see, hospitals can't turn anyone away, so lots of uninsured people go there for common acute illnesses like strep throat, where it costs exponentially more to treat them than at a PCP's office. The bill usually ends up being swallowed by the hospital or government, raising health care costs across the board. That's a huge part of the current campaign in Congress to "reform" health care.
Consider the way my doctor's philosophy contrasts with the current federal majority party's approach to HCR. Personally, when I read it her philosophy for the first time, I had an "AHA!" moment. I'd been ambivalent about reform because while I didn't really like the plans being discussed in the House and Senate, I didn't have a better idea. Well, I do now. It's a real, compassionate, free-market solution. There has been criticism about letting health care exist in a free-market environment (like with HSAs). But this idea is different; powerfully simple, straightforward, and accessible.
I was working for Congress when Medicare Part D was passed, so I know a lot about the way government run health care works after the legislation is implemented. I fielded hundreds (no joke) of calls from senior citizens who didn't understand this latest addition to their coverage. Somehow, the federal government often manages to complicate social programs to the point that the people they're intended to help can't understand them. I had a manual explaining the program and a college education, and still had trouble figuring it out!
That said, the idea of improving and expanding coverage as simply as possible appeals to me.
The following is an anecdotal, but expansive, recent history of my health care coverage:
At present, the only way I am able to get health insurance is through a law in Virginia that states that insurance companies must insure any individual seeking coverage, regardless of their health grade (1-4, one being perfectly healthy and four being chronically ill, or having ever taken an anti-depressant... I kid you not). However, the insurer is allowed to charge the patient the highest possible premium. People who are 1-3 on the scale usually won't be refused coverage, and therefore wouldn't pay the maximum premium; it's just people like me -- the 4s -- who are too sick to work and therefore can't get employer health insurance.
Additionally, I do not qualify for Social Security Disability (which would help defray costs) because I haven't worked for five consecutive years and therefore hadn't "paid in" enough money. The reason? I went away to college when I was 17 instead of getting a job straight out of high school (I even skipped my senior year of HS, for the record). I graduated at 22, and got two job offers before I even took my exams. I accepted the one with the better health plan, which I felt was the responsible course of action, and started work three weeks later. Two days after I started my job, I had to be admitted to the hospital. It was the beginning of the end. I worked for six months before my 5'6, 92 lb body became so frail that I could no longer stand without falling. I was fired because of my health at age 23.
Because I had only been employed for six months, I only got 30 days of COBRA. I had to get an individual policy fast. My father paid for it, since I had absolutely no assets and certainly couldn't work. He chose a high-deductible Health Savings Account (HSA). The premium was initially $450/month, with a $3,000 deductible and a $5,000 cap on prescriptions. During the diagnostic phase of my illness, that worked well enough, but once I was diagnosed (with neuro-Lyme) and started treatment, the policy became virtually useless -- just a fallback in case I got cancer or fell and broke my neck.
You would think the situation couldn't get much worse, but two years later I'm still fighting that disease (and about four others, as you all know), and as of last month (11/2009) my monthly premium was raised to $772/month from $537/month -- a 43% increase from the previous year.
Were you able to follow that web of information? It's not "simple," that's for sure.
My coverage history raises many questions about what's needed in health care reform. Should we be giving insurance companies a break, or putting regulations on them? Should we add new programs, expand old ones, and create new departments for oversight, or should we simplify the doctor-patient-insurer (whether the insurer is private, Medicare, or Medicaid) relationship? Do we put health care in the hands of the government and insurance companies, or in the hands of doctors and patients?
Personally, I am no longer a patient of any doctors who participate with insurance companies. We have put my care -- my life -- in the hands of doctors who don't double book, who treat as they see fit (without having to worry about intimidation or threats from the insurance companies), and who keep their practices small enough to know every patient's case by heart. I no longer dread doctor visits, knowing I'll have to sit in noisy, crowded waiting rooms just to get 10 minutes of face time with the doctor after waiting for an hour. Now the "waiting rooms" I sit in are more like meditation rooms -- places of peace and quiet -- and I'm never in them for long.
I don't have to deal with a billing department, talk to a physician's assistant, or tell a nurse why I'm there and then repeat everything to the doctor -- wasting time. I'm not rushed in and out the door. A standard office visit is 30 minutes long and every single minute is spent with the doctor: no nurses, receptionists, or other staffers. An extended visit is usually about an hour: again, every minute spent with an MD.
All of my doctors have degrees from Ivy League medical schools; they are outstanding experts in their specialties. And all of them have opted out of the insurance run-around in order to take the best possible care of their patients. Shockingly, they charge very little money, especially considering the time and expertise they provide. They are available twenty-four hours a day, seven days a week, and they don't charge for after hours calls. My PCP even makes house calls for established patients -- for no extra charge other than travel expenses.
There was a time when doctors like mine were the rule, not the exception. Wouldn't it be nice if everyone could have that level of care? Guess what: everyone could. Most people don't need to see their doctors very often, so it's not like paying the doctor and then waiting to be reimbursed by the insurance company would be an unbearable financial hardship for most. The government could legislate reimbursement for those people who need Medicaid/Medicare from providers who don't participate with Medicare/Medicaid (something they don't currently provide). People wouldn't be running to the ER for a sinus infection because that's the only place they can get free treatment. They could get regular check-ups and preventative care, saving billions by stopping problems before they start. And, as the philosophy above states, the market sets the price: if the cost is too high, the doctor's practice will not survive. That's what keeps costs reasonable.
If every doctor stopped participating with insurance companies, and patients started filing claims themselves, the doctors could afford to support themselves without overbooking. Insurance companies would be background noise in the medical community, instead of stomping around and brandishing big sticks, using their money and influence to create policy.
To be fair, universal coverage is what Congress is trying to accomplish. However, they're pushing quantity and ignoring quality; treating doctors like the greedy bad guys, and rewarding insurance companies -- which are businesses run for profit -- BIG profits! What good is it for everyone to have coverage if the care is going to be sub-par?
There's a lot of controversy surrounding this, but I've finally found where I stand. I don't need 2,100 pages of text to outline health care reform and expand coverage. Two paragraphs are enough for me. It seems to me that sometimes, when you least expect it to be true, less is more.
**For the record, I know some of this might be tough to swallow, but I didn't make it up. There are some great books and documentaries on corruption in the health care system. I highly recommend the documentary Under Our Skin (recently short listed for an Academy Award Nomination): it discusses the corrupt relationship between insurance companies and the doctors on their payroll -- it focuses on Lyme disease, but as you can imagine, the type of activity they uncover is widespread. The film is two hours well spent, I promise!**
NC Lyme Advocacy Financial Support
11 years ago
