At the core of our medical problems, the too many layers and not enough common sense...

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Summary: Though insured, I choose to be fairly open-eyed when it comes to medical conundrums. The following short account shows several indications of the lose-win nature of our current medical system.

Monday, 22 February 2010

(13:11:58 CST)

At the core of our medical problems, the too many layers and not enough common sense...

Like the majority of Americans, I have health insurance. Like at least the stereotypical majority of males from television, I am not a fan of any sort of medical procedure; meaning that most weeks insurance is paid so I can still avoid going to the doctor. This is ok. Insurance, much like a gun in a nightstand table, is mostly there for when things go awry.

Recently, though, at the behest of the Wife person; I went to get my yearly physical. It went well, I had no inherent problems outside of a low HDL and my weight being too high. Then, you know, came the billing process.

Being insured, I assume that the $50 spent in copay (for three visits) will cover everything I owe; but two glitches got me two bills to at look at. In the first, I found that per doctor's visit is $160. Of which, the insurance pays about half and my copay pays about a sixth. The remaining third or so is "written off" according to the bill. In the second, I found that the blood-work portion of my physical cost about $400. This will presumably be covered shortly, but looking at Sarah's nearly identical bill, insurance is going to pay off about $80 of it, and the rest will be written off by the hospital. For those keeping tabs, we are talking about something on the order of $400 in write offs between the two agencies with about $300 paid by insurance and $50 paid by me.

I think this underlines four of the biggest problems facing our health care, today:

  • Rapid Inflation of Medical Costs: Around the year 2002, most doctors charged about $75 per visit. Co-pays were likewise about $10-$20. Now I am regularly seeing greater than 200% increases in less than 10 years. Using this tool it turns out that $75 should have turned into round-about $90 if it matched other forms of inflation.
  • Opaqueness of Costs: Had the bills not went wrong, how would I have known how much my insurance paid? Most of us go to the doctor, pay our $20 copay, and go away. Do we know whether or not that $500 or $800 or $100 is being charged behind the scenes? Do we care?
  • The Insured Pay a Different Amount than the Uninsured: Perhaps the biggest issue I see, here, is that had I not had insurance; this physical (over three visits) would have cost me around $700 dollars. Because I have insurance, then the physical will cost me about $50 and the insurance company about $300. I presume the other $400 goes on a tax form at the end of the year as "underpaid" or something. The upshot of the whole thing is that the ones with the least ability to pay for medical costs get the roughest medical costs because they have no proper representation. From my time spent working as a CSR with an insurance company, I know that elderly without full Medicare benefits can get bills on the order of 10x what those with Medicare benefits get. How is this possibly justified? Even if you say "Ok, costs are sort of intangible and inflation is going to happen," how can you say that it is proper that paying for insurance means that you get charged a different amount to begin with? Or, at least, your insurance company is allowed to not pay for the majority of costs and the doctors are ok with that?
  • Too Many Layers: Why was I even getting a separate bill for the blood work? Why was this not handled in-office by my doctor? His office sent my paperwork off to a third party without my permission, and that third party tried to recoup the costs with me. Wouldn't it have been vastly more sensible had either (a) he sent me to the third party to begin with or (b) he paid the third-party for the services and then I paid him?

Keep in mind that most of the issues I am pointing out are not necessarily in line with the current health care reforms floating around. I also know that any sort of regulation of pricing will probably just lead to issues as 2010 locked-in costs become outdated a few years down the road and we end up with something like a medical bankruptcy. I personally think if you could make medical costs more open, get rid of the one-price for the insured and one-price for the non-insured, and come up with a way to simplify the layers; then you would go a long way to fixing the inflation issue outright. Insurance companies, for instance, could offer bonuses to those who go to lower-cost doctors and doctors should be fully required to get permission for contracting out part of your work to third parties. In both cases, it keeps the paperwork and cost down, which should benefit everyone. The fact that we usually don't know how much is really being paid, nor know where all it is getting sent to or who all it is being seen by...well, that's a troubling fact, to me.

Si Vales, Valeo


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