Richard's Common Sense: Medical care

Showing posts with label Medical care. Show all posts

Monday, July 2, 2012

When ideological purity trumps common sense

Republicans’ repeal push: Is it the right move? - The Washington Post:

“I will act to repeal Obamacare,” said former Massachusetts governor Mitt Romney on Friday.

“We will not flinch from our resolve to make sure this law is repealed in its entirety,” House Speaker John Boehner said Sunday on CBS’ “Face the Nation”.

“If I’m the leader of the majority next year, I commit to the American people that the repeal of Obamacare will be job one,” said Senate Minority Leader Mitch McConnell (Ky.) on “Fox News Sunday”.

Florida says no to two U.S. healthcare law features | Reuters:

(Reuters) - Florida will not implement two provisions of the U.S. healthcare law involving an expansion of Medicaid for the poor and creation of a private insurance exchange, Governor Rick Scott said on Sunday.

Two other states with Republican governors, Wisconsin and Louisiana, opted out of the two provisions last week in the wake of the Supreme Court decision upholding the Patient Protection and Affordable Care Act.

And so the games begin. Lets try some common sense.

Mitt Romney, the man who would be president, who believed in the principal provisions of the Affordable Care Act when he was governor of Massachusetts, now believes that these are, and here I'll quote Mr. Romney, "bad law." Curious that and certainly not common sense.

John Boehner and Mitch McConnell want to repeal the law in its entirety. Thus it follows that they object to elements of the law that prohibit insurance company abuses involving preexisting conditions, insurance cancellation if you become sick, extended coverage for minors, insurance exchanges so those who must buy their own insurance can get a better price. Clearly the ideology of the radical right trumps what is good for United States citizens. Certainly not common sense.

Radical right wing ideology extends to governor's offices, at least in Florida, Wisconsin, and Louisiana all of whom object to extending medical care for the poor and setting up insurance exchanges.

In the matter of Medicare the choice is simple, we can provide Medicare insurance to the poor so they are less sick less often or, as the governors seem to believe, we can allow them to become more sick, more often, and then go to Hospitals, the most expensive form of medical care where the cost is ultimately covered by the cost of insurance on everyone else. Certainly not common sense.

The nonsense with insurance exchanges is equally wrong headed, aka just plain dumb. By not setting up exchanges these governors require citizens without employer provided insurance to buy as individuals. Such insurance is, and here I speak from my own experience, much more expensive and consequentially leads many to become uninsured. The result is as above, more sick, more often, care in much more expensive hospital settings, cost born by everyone else. Certainly not common sense.

Ideological purity leads to bad government. It's time for Congress and Governors alike to look to the "general welfare" of United States citizens. That's one of the principals of our form of government. That's just common sense.

Friday, June 29, 2012

Supreme Court & Affordable Care Act

The Supreme Court has ruled on the Affordable Care Act, upholding the requirement that almost all citizens must purchase health insurance or pay a penalty. The court upheld the Act on the argument that the penalty is a tax thus the Act is a proper exercise in Congresses power to tax.

While Common Sense has reluctantly favored the Act I am troubled about the entire matter. The Act will result in more citizens having health care insurance and corrects some of the most egregious health insurance abuses. These are clearly improvements to health care in the United States.

Yet the Act does not effectively address the central issue of health care cost. In the United States we spend roughly twice as much money per individual as other post industrialized nations yet our health results on many metrics are relatively poor ranking 37 according to the World Health Organization. While the ranking is debatable, it is clearly true that the United States health care system is over priced and that it under performs. The Act contains some provisions designed to address cost but, significantly, does not address any of the fundamental issues that drive excessive health care cost. It address principally who pays, insurance companies, not how much is paid, cost. It does nothing to address the disparity is drug cost between the United States and other nations such as Canada. Likewise, it does nothing to address excessive health apparatus cost. It does nothing to address malpractice insurance cost. It does nothing to address the very real 10 to 20 to one cost differences for identical procedures in the United States and Europe or Asia or Central America. Thus while the act unequivocally does some good it simply doesn't effectively engage the issue of cost.

Common Sense continues to believe that we deserve much better law from our elected representatives. A health care law modeled after other countries such as Canada where cost are roughly half the United States is one clearly effective alternative.

This Supreme Court decision establishes a new federal power that troubles Common Sense. The decision's rational establishes the principal that Government can use tax to coerce an individual citizen to engage in a commercial transaction. While it is true that tax policy has long been used to shape commercial activity the Court's reasoning extends government's use of the power to tax to a level that is coercive.

There are significant differences between previous tax policies that apply to individuals to shape behavior and the Act's use of a tax penalty. For example a tax policy that gives individuals favorable tax treatment for a home purchase as we have today is clearly different than a tax policy that would increase taxes on renters since they do not purchase a home. The first kind of tax policy has long been accepted. Home ownership is widely viewed as a societal good and thus deserving of favorable tax treatment. The second kind of tax policy would doubtless generate enormous resistance just as the Act has done. It is interesting no note that while a tax credit or deduction for those with insurance is certainly conceivable Congress chose instead to impose a coercive penalty tax.

While Common Sense reluctantly favors the Affordable Care Act as a flawed improvement to a clearly broken health care system, I am very troubled by the Supreme Court's reasoning. Common Sense believes both that United States citizens deserve much better health care reform likely based on the single payer systems that have demonstrably better results, and that this Supreme Court reasoning is both flawed and ultimately dangerous.

Ranking 37th — Measuring the Performance of the U.S. Health Care System

Friday, April 13, 2012

US Supreme Court and Health Care

The Affordable Care Act aka Obamacare is under review by the US Supreme Court. The case was brought by 26 states and a number of private parties. While the challenges vary in detail, the central issue is the law's provision that requires individuals to purchase health insurance. The say the least, the law is controversial. Herewith some facts and common sense.

What is the law

Herewith the principal provisions of the law from Wikipedia:

Guaranteed issue and partial community rating will require insurers to offer the same premium to all applicants of the same age and geographical location without regard to most pre-existing conditions (excluding tobacco use).^[18]

A shared responsibility requirement, commonly called an individual mandate,^[19] requires that all persons not covered by anemployer sponsored health plan, Medicaid, Medicare or other public insurance programs, purchase and comply with an approved private insurance policy or pay a penalty, unless the applicable individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship.^[20]

Medicaid eligibility is expanded to include all individuals and families with incomes up to 133% of the poverty level along with a simplified CHIP enrollment process.^[21]^[22]

Health insurance exchanges will commence operation in each state, offering a marketplace where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible).^[23]

Low income persons and families above the Medicaid level and up to 400% of the federal poverty level will receive federal subsidies^[24] on a sliding scale if they choose to purchase insurance via an exchange (persons at 150% of the poverty level would be subsidized such that their premium cost would be of 2% of income or $50 a month for a family of 4).^[25]

Minimum standards for health insurance policies are to be established and annual and lifetime coverage caps will be banned.^[26]

Firms employing 50 or more people but not offering health insurance will also pay a shared responsibility requirement if the government has had to subsidize an employee's health care.^[27]

Very small businesses will be able to get subsidies if they purchase insurance through an exchange.^[28]

Co-payments, co-insurance, and deductibles are to be eliminated for select health care insurance benefits considered to be part of an "essential benefits package"^[29] for Level A or Level B preventive care.^[30]

Changes are enacted that allow a restructuring of Medicare reimbursement from "fee-for-service" to "bundled payments."^[31]^[32]

Additional support is provided for medical research and the National Institutes of Health.^[33]

Common Sense wonders if those making the most noise about this law actually know what it provides.

Why health care reform

Any rational consideration of health care reform needs to address the base issue of why should the government get involved in health care. There are several reasons supporting this involvement.

The first and arguably most compelling from a cost point of view is that the government is already the dominant health care payer. US health care spending in 2010 was some $2.6 trillion, 17.9% of the US GDP. In 2011 federal spending on Medicare, Medicaid, and Children's Health Insurance Program (CHIP) was 21% of federal spending, some $769 billion. Wikipedia says that 60-65% of all health care spending is government funded. Absent effective reform future government health care spending will increase and continue to be a major contributor to federal deficits.

In addition various federal and state laws require certain health care providers, notably hospitals, to provide health care services independent of the recipients ability to pay. Other government programs regulate drugs, treatment technology, and services. In addition to being the largest payer for health care, government is the principal health care regulator.

US per-capita health care spending is over twice that of other first world nations yet key measures of health in the US are lower, often far lower than other nations. The WHO ranks the US health care system as 37th in overall performance despite being highest in cost.

Clearly, the current US health care system is seriously broken. Common Sense believes that notwithstanding any arguments of private sector v. public sector efficiency, the current system's inability to deliver reasonable health care results at a reasonable cost is undeniable.

Issues before the Supreme Court

The Court has scheduled an unusual three days of hearings on the law addressing the following issues:

Does the Tax Anti-Injunction Act apply to that portion of the law requiring all consumers to buy health insurance or pay a fine. If it's a fine then the Court can rule on the law soon. If it's a tax, then the court must wait until 2015 this portion of the law.
Did Congress overstep its bounds by including the individual mandate itself in the law. This question hinges on the Commerce Clause of the constitution.
Can the rest of the law stand if the individual mandate is deemed unconstitutional. Many argue that the premise of the law rest on requiring all consumers to buy health insurance to pay for the other previsions of the law.

Common Sense notes that only one provision of the law proper is before the court, the individual mandate. Other provisions of the law are only at issue as a consequence of the severability argument.

Support for the law

Much, most of it stunningly self serving and distorted, has been said about support for the law. The facts are that general support and opposition are fairly evenly divided with significant numbers of Americans undecided.

Other polls vary.

Interestingly, support for most provisions of the law is generally high with the individual mandate/penalty the notable exception.

Clearly, the central support issue is the individual mandate/penalty. Just as clearly support is sharply divided along political parties.

Conservative principles and health care

Conservative principles would argue for a free market approach to health care. Historically, the US has had a free market health care system with a mix of profit and not-for-profit hospitals and for-profit insurers. Obamacare preserves this system. It does have provisions that regulate insurers. These provisions have broad support. To fund these provisions it establishes an individual mandate/penalty.

Common Sense notes that this is, in fact, a generally conservative approach, at least in so far as profit making hospitals and insurers remain at the heart of the system. This is in sharp contrast to single payer models common in much of the industrialized world.

Where conservatives find issue is the individual mandate/penalty. They see it as an intrusion by the federal government in individual rights and a violation of the Constitution's Commerce Clause.

Common Sense notes that an alternative would be a single payer system. Such a system would be based on existing principles that allow medicare/medicaid and the federal government's ability to tax. Of course, the history of Obamacare and other health care reforms strongly suggests that conservatives would find this equally unacceptable. The US would be forced to continue using a health care system that is both expensive and ineffective to the point of jeopardize the entire economy.

The commerce clause

At the heart of the constitutional questions before the court is the commerce clause as interpreted by the courts. The commerce clause is one of the enumerated powers in the constitution. It states simply

[The Congress shall have Power] To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes;

The clause has been the subject of at least 46 historic supreme court cases and as interpreted by the courts has served as the legal basis for among other things

federal regulation of in-state industrial production,
federal regulation of worker hours and wages
federal regulation of state activity when it has a "substantial economic effect" on interstate commerce or if the "cumulative effect" could have such an effect
federal Civil Rights acts outlawing segregation and prohibited discrimination

There are some noteworthy limits on what is permissible under the Commerce Clause. In particular Lopez v. United States. 514 U.S. 549 (1995) that struck down the federal Gun Free School Zones Act of 1990 and Morrison v. United States which overturned the Violence Against Women Act. Taken together, Lopez and Morrison have made clear that while the Court is still willing to recognize a broad interpretation of the Commerce Clause, if it does not find activity substantial enough to constitute interstate commerce it will not accept Congress's stated reason for federal regulation.

It is reasonable to say that the commerce clause is one of the most hotly debated clauses in the constitution.

The Commerce Clause and the Individual Mandate

The Individual Mandate provision is the commerce clause issue before the court. Various lower federal courts have either dodged the issue or decided differently from one another. While much has been written about the issue at root the central question is does an individual decision to NOT purchase health insurance constitute commerce. The federal government argues that it does. Opponents argue that it doesn't. Intimately connected to this issue is the question of what limits the scope of the commerce clause. Given the history of the Commerce Clause litigation it is nearly impossible to predict what the Supreme Court will decide.

Severability

Obamacare contains many provisions beyond the individual mandate. Opponents of the law argue that absent the individual mandate the other provisions must fall. Proponents argue that they should stand. Common Sense notes that where similar laws exist without an individual mandate health insurance premiums have skyrocketed largely because of preexisting condition provision.

Common Sense and Obamacare

Common Sense believes unequivocally that health care reform is necessary. Further that absent such reform health care cost are likely unsustainable. That is not to say that Obamacare is good law. Common Sense believes that it is not on the argument that it does not in fact address the issue of health care cost or does it do much to address the issue of health care results. What it does do is address the issue of mandated treatment v. cost by the individual mandate and to address some of the most egregious health insurance practices.

Tuesday, February 14, 2012

An argument for social justice

Common Sense has a cousin with a decidedly off center sense of humor. From time to time he sends interesting and humorous emails around. Now, before getting upset, take a moment to think about if/why this might be funny or perhaps sad.

You're a sick senior citizen and the government says there is no nursing home available for you. So what do you do?

Our plan gives anyone 65 years or older a gun and 4 bullets. You are allowed to shoot four Politicians.

Of course, this means you will be sent to prison where you will get three meals a day, a roof over your head, central heating, air conditioning and all the health care you need!

Need new teeth? No problem. Need glasses? That's great. Need a new hip, knees, kidney, lungs or heart? They're all covered.

As an added bonus, your kids can come and visit you as often as they do now.

And who will be paying for all of this? It's the same government that just told you that they cannot afford for you to go into a home.

Plus, and because you are a prisoner, you don't have to pay any income taxes anymore.
Is this a great country or what?

Thursday, January 5, 2012

TED Talks: Some common sense on health care

Image via Wikipedia

If you are not familiar with TED talks take a look at the listing site. One recent posting is of a common sense idea to reduce the cost of medicine by creating an alternative market mechanism, a Health Impact Fund, that would compensate pharmaceutical companies based on the impact of a drug on health. The basic notion is that a pharma company could enroll a drug in a Health Impact Fund. Such drugs would be sold at cost and the Pharma company receive a portion of the Health Impact Fund tied to the impact the drug has on overall health. Worth listening to.

Wednesday, April 27, 2011

Supreme Court skeptical that prescription data laws don’t violate free speech - The Washington Post

Supreme Court skeptical that prescription data laws don’t violate free speech - The Washington Post

Yet another example of no common sense being driven by big business.

Here's how it works. You're ill. You go see your doctor. Your doctor prescribes medicine. Now the prescription goes to your pharmacy. The pharmacy fills the prescription. Now here's where it gets interesting. The pharmacy sells the prescription data to drug companies. It strips out your identity but leaves in the doctor's identity. The drug company, now armed with the prescription history of your doctor, knows whether your doctor uses less expensive drugs or generics or the drug companies' branded drug. Thus armed the drug company can focus their marketing to promote their drug.

The case if being litigated as a business free speech case. Common Sense wonders, to what degree is business marketing that potentially increases medical cost "free speech" under law? Does business have a "free speech" interest in what doctors prescribe for their patients? Common Sense thinks not.

While marketing may well be speech, free speech does not include an inherent right to know what a doctor prescribes. Quite the contrary, Common Sense thinks that doctors have a privacy interest in their prescription practices every bit as much as patients have a privacy interest in their drug use.

In addition all of us, government included, have an interest in the cost of medical care. It doesn't make any sense, never mind common sense, to appeal to "free speech" when trying to justify a business practice that is clearly intended to increase drug profits by favoring branded drugs over generic and simply increases drug costs and the cost of medical care.

Why do Americans spend more for and get less medical care? Common Sense thinks that this bit of foolishness is part of the problem.

Sunday, April 24, 2011

Comparing Ryan's Medicare Plan to What Congress Gets - Uwe E. Reinhardt - NYTimes.com

Comparing Ryan's Medicare Plan to What Congress Gets - Uwe E. Reinhardt - NYTimes.com

Of particular note to Common Sense in this interesting article is the central notion that in the US medical cost consistently grow much faster than the consumer price index. Certainly medical care is expensive, particularly for cutting edge procedures. But why should it's cost grow two or three times faster than the CPI?

The cost growth of health care is particularly hard to justify given its performance. Consider that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. Clearly the US health care system is hardly one where costs and results are not reasonably related! Clearly it is one that is simply not competitive!

Common Sense thinks that health care is one of those things where free market principles simply don't work. Consider that in New Hampshire the cost of a routine office visit varies by a factor of 4 between $49 and $200 with the majority of providers charging in the neighborhood of $100. There is such a dramatic cost difference for medical services between the US and other countries that there is now a "medical tourism" industry!

Common Sense thinks that we should focus much more attention on why medical care in the US cost so much and rather less on how we pay an essentially unreasonable bill for services that are not effective when judged by world standards!

Tuesday, April 19, 2011

PolitiFact | President Obama says Republican Medicare plan would cost people $6,400 more in 10 years

Interesting piece on Medicare and the current debate. Common Sense believes that the proposed voucher 'solution' is just a way of stepping away from insuring that elders and the poor actually have reasonable health care. Many many of us have relatives and friends that use these programs. For my part both my parents' lives were extended and dramatically enhanced through Medicare. I've friends and relatives that depend on Medicaid to help them deal with long term debilitating illnesses.

Controlling the cost of medical services and thus Medicare and Medicaid expenses is clearly needed. Here it's worth noting that medical cost vary widely across treatment locations, often by factors of four or more. Indeed, Common Sense has relatives that travel to Mexico for some medical services. They note that they receive treatment by doctors trained in the US using US and EU manufactured equipment at costs a small fraction of US costs! Common Sense thinks that much of the problem with Medicare and Medicaid expenses is rooted in the US medical delivery system and its unreasonable cost structure.

Sunday, January 9, 2011

Health care reform

The Republican House wants to make a show of trying to repeal health care reform knowing full well that it won't pass the Senate. Common Sense thinks that political theater is not a substitute for real governance.

The original so called health care reform bill is certainly flawed in that it principally reforms heal insurance not health care. Consider the altogether typical and mindlessly wrong quote from one of our Democratic Representatives that people die because they don't have health insurance. Think about that for a moment. Common Sense thinks that people die because they don't have health care. Health insurance is simply the way we deal with payment.

That brings the issue into some better focus. Consider that we regard education through high school as a "general welfare" on the theory that an educated populace is good for all Americans. We regard the interstate highway system as a "general welfare" issue on the theory that rapid, convenient, low cost transportation is good for all Americans. Likewise many other benefits.

What then of health care? Is a healthy populace good for us all?

Common Sense says so. An unhealthy population is an enormous risk to society as a whole. It is an enormous drag on the overall economy. Why then is the issue of universal health care so contentious? As many western nations have already discovered, universal health care is practical. It improves health. Live expectancy is longer. Quality of life is better. And health care cost are LOWER!

Just some common sense.

Saturday, December 25, 2010

Stupid ways to increase health care cost. A true story.

Health care is expensive. It is arguably much to expensive. Here's a true story showing some of the foolish reasons it to expensive.

Day 1 - Call pharmacy to get prescription refilled. CVS has a generally good prescription refill automated system. Unfortunately, after asking for a refill I pressed 2 instead of 1 and got an IVR script to refill another prescription. No way out of IVR script except 3, talk to a pharmacist. Choose 3, talk to pharmacist who gladly helps. Dear CVS Common Sense thinks it's DUMB not to have a go back option on your IVR menus. Extra cost of prescription refill, one pharmacist conversation.

Day 1, later - Go to CVS to pick up prescription. Not there. Talk to pharmacist again. Pharmacist says insurance won't cover until tomorrow. Prescription has 1 refill every 30 days. Prescription dated 24th of last month. It's now 24th of this month. That's actually 31 days since November has 31 days. Pharmacist agrees but it seems that prescription wasn't picked up until 25th of November, never mind that it's still been 30 days, insurance says no. Pharmacist says phone it in on the 25th. Dear insurance company, Blue Cross Blue Shield Ma, days are days not dates. BTW, what does the pickup date have to do with the prescription date. Dumb to reduce your cost at the expense of system cost. Extra cost of prescription refill, another pharmacist conversation.

Day 2 - Phone CVS and order prescription again. Manage to hit 2 not 1. Extra cost of prescription refill, additional IVR interaction.

Day 2 later - Pick up prescription interacting again with pharmacist.

So the insurance company optimized their cost by screwing me, happily I don't take the med every day so days vs date not an issue. Along the way, the insurance companies inflexible policy, we're talking 24 hours here folks, actually since it was 4PM when I went to pick up the prescription we're really talking 12 hours, lead to 1 additional lengthy human interaction, 1 additional IVR interaction, and 1 short human interaction.

This is NOT efficient. It's a case study in how one parties optimization actually increases cost. Dumb, just plain dumb. So thinks Common Sense.

Monday, October 4, 2010

More health care cost

About 6 or so weeks ago my wife and I were out sailing with friends. The boat hit an unexpected wave and I lost my balance landing bum first on a piece of 3/4" wide cockpit coming. It hurt and I doubtless bruised my bum or damaged my coccyx. It's been very painful to sit and especially to drive the car. Naturally, when I went to the doctor I inquired about the injury as I was concerned about how much longer this was going to hurt. Understand, I've had similar injuries in the past and I know they take a long long time to resolve and there isn't much that can be done about them. Even so after six weeks I was starting to wonder how much longer.

Now here's the interesting part. When I asked the doctor, she said at least another 6 weeks, perhaps longer. Not the answer I was looking for, but an answer and helpful in setting my expectations. Then somewhat to my surprise the doctor suggested that perhaps a pelvic x-ray was in order. I asked her if that would change anything and she indicated that it wouldn't but might provide some reassurance and a better idea of healing time. I don't know what a pelvic x-ray cost but at a guess I'd expect some hundreds of dollars.

Think about it for a bit. The injury is over 6 weeks old. I'm healing slowly but definitely healing. There isn't any real treatment. The x-ray won't change anything physically but might make me feel better emotionally. Common sense suggests that it's not worth the cost. Indeed, common sense suggests that it should never have been on offer. That raises the interesting question of how much heal care is consumed not because it's medically necessary but because it might improve someone's emotional state. I'll concede that there are certainly times when someone's emotional state is such that a medical procedure that doesn't really treat the underlying condition is justified. But how ofter are we doing things just because we can or because the patient is a bit whinny?

Common sense says that we should remove the whinny factor from medical care.

Sunday, October 3, 2010

Health care cost

We've now had health care reform a la fed. Read insurance company entitlement program in trade for sensible industry practices restrictions. But it's something, never mind that it did little to actually reduce health care cost.

With that as background I recently had an interesting experience in health care cost.

Round 1 started innocently enough with a prescription. It was about to expire so I asked my doctor to renew it. Not a problem and she uses the laptop she now caries about thanks to computerization of the hospital to issue the reorder. Now this is meant to be simple, efficient, and, of course, save cost. Of course, when I go to pick up the prescription two weeks later I'm told that it's expired but not to worry the pharmacy will happily contact the doctor to reorder. Never mind that the reorder was issued two weeks prior. Looks like this computer stuff isn't working as well as it might. Not to worry, I'm about to see the doctor in a couple of days for a followup visit and I'll deal with it then.

Round 2 starts the following Thursday when I show up for my followup visit. Unfortunately, the scheduling computer thinks that my appointment was for the previous day. Never mind the appointment card that clearly says it's today. But not to worry, the doctor has a free appointment the following day. OK, drive home and try again tomorrow.

Round 3 starts when I arrive at the doctors office only to be asked to sign a financial responsibility document since the insurance company now says that my primary care provider is my previous doctor. Now I've been seeing my current doctor for over two years! Also never mind that the doctors are part of the same clinic and the clinic has a service agreement that lets me see any doctor in the clinic without a referral. Not to worry, sign the agreement and see my current doctor who happily tries to renew the original expired prescription again.

Round 4 begins when I contact my insurance company to deal with the primary care issue. After being subject to 4 IVR , keying in 29 digits, and spending 8 minutes of my life I get the an agent call queue. Two minutes later I get a really nice agent who seems surprised at the issue. Six minutes and considerable conversation later it seems that the insurance company was doing some sort of system maintenance and decided to change my PCP. The agent is apologetic and changes it back.

Now lest you think that I'm just upset about the inconvenience of this affair, I am, consider the cost. Round 1, my doctor, the most expensive agent in this little drama, does something but in round 3 has to do it again. That's waste. Also in round 1 the pharmacy does something that should never have been needed to be done to begin with. That's also waste. In round 2 the doctor has a no show patient, me, and non-billable time. That's waste. I show up the following day and talk to a clerk who has to reschedule. More waste and inconvenience. Then in round 3 the doctors office has to prepare a document for me to sign since the insurance company has made a mistake. Still more waste. Later in round 4 the insurance company waste still more of their time and mine undoing the effects of their mistake. Yet more waste.

Common sense suggests that this version of computerized medicine is certainly NOT more efficient or less costly. On the contrary, this experience suggests that it is much less convenient and significantly more expensive.

Monday, April 26, 2010

Medical Reform? It's NOT about insurance! It's about cost!

(CNN) -- When Godfrey Davies learned he needed surgery to remove polyps blocking his nasal airways, the self-described bargain shopper set out on a mission to find an affordable surgeon. He quickly learned a good deal is hard to find.

"The total numbers they were throwing at me were just incredible. I couldn't believe it," he says.
Davies, who is semiretired from his real estate business and uninsured, says he received estimates from two surgeons. When hospital, anesthesia and incidental fees were all tallied, the cheapest price he could find in Indianapolis, Indiana, was $33,127 -- which he would need to pay out of pocket.

"I was speechless." Davies recalls. "It was absolutely out of the question financially for me to have this done under those circumstances."

Frustrated that his bargain shopping saved him so little, Davies called on family in the United Kingdom for assistance. When they told him they had found a private hospital in Wales that would perform the surgery for $2,930 [or £1,897], Davies didn't think twice.

He purchased a $768 round-trip ticket, and on March 18, he boarded a flight to the UK to have his polyps removed there at a savings of nearly $30,000.

Common sense, it's NOT about insurance! It's about cost!

Davies, who is originally from Wales and has been a U.S. citizen since 2002, says he was disappointed about having to travel more than 4,200 miles for such a simple procedure. But ultimately money was the deciding factor.

"$33,000 versus $3,600 ... I can put up with a lot of inconvenience to save that kind of money."

Any questions?