Health Care: My Take

I've sat back and watched the health care reform debate with bemused resignation.  It seems to me that everyone thinks healthcare costs are the dragon that is going to eat us up, but no one, at least no one in politics, is discussing how to slay the dragon; rather, they are arguing about who should have the job of feeding the dragon.  I say that if we slay the dragon, or at least put him on a diet, then the feeding schedule would take care of itself.

There was a huge outcry recently when Blue Cross in California raised the rates on its individual polices by 30%.  Obviously, 30% is far higher than our current inflation rate, but most stories I read vilified Blue Cross without really examining the cause of the increase.  According to Blue Cross, there are two main reasons for the increase.  First, as the economy worsens more people become unemployed or have their wages cut.  Those people look for ways to economize, and if they are young and healthy, health insurance is more apt to end up on the chopping block than it is if they have an on-going illness.  In short, Blue Cross said that the pool of people buying individual coverage has more sick people and less well people in it than it did a year ago; therefore the average cost has increased.  Secondly, physicians have learned to band together to act as one big bargaining unit to force higher rates from insurance companies.

We have a system where most people have little incentive to pay attention to the cost of medical care.  The amounts charged for care are unknown to most patients until they appear on an EOB, and generally the "costs" shown are subject to discounts given to insurance companies.  Many physicians say that Medicare and Medicaid do not pay enough for services, and that costs are shifted to those with insurance, or even more so to those without it, but with the ability to pay medical bills.  Somehow, we have to get the consumer a direct interest in his/her medical bills.  We need to allow alternative providers some latitude to provide services in more cost-effective ways and to give consumers a reason to use lower-priced services.

About the time my son was born, many insurance companies were requiring what the press called "drive-through deliveries", meaning that mom only stayed in the hospital 24 hours after a normal delivery.  Insurance company data showed little health benefit to staying longer.  Doctors, hospital and patients screamed, and laws were passed requiring insurance companies to pay for a 48 hour stay after a vaginal delivery.  I had two vaginal deliveries, and I have to say that I don't know what was done for me during the second 24 hours that would have made it worth any great amount of money to me to be allowed to stay, had my insurance not picked up the bill.  In other words, if leaving after 24 hours would have saved me $200, I would have left.  For that matter, did I really need an OB, a physician,  to deliver the baby?  Could a midwife have done it?  Rather than have my OB interrupt his office hours or time off to deliver the baby, would it have been cheaper if a doctor employed by the hospital, whose job it was to deliver all the babies born while she was on duty, did it?  Again, neither I nor the doctors in question have any financial incentive to explore the possibilities.

Health insurance costs ARE high, but they are high because health care costs are high.  Providing universal insurance at government expense (or with government subsidies) is going to make the problem worse, not better. It is going to produce even more people who want healthcare and have no financial incentive not to use it.  Any effective healthcare reform is going to have to make more people pay more directly for their own care.  Someone has to say "No, it isn't worth the cost".  Personally, I'd rather be the one to say that for myself and my family than to have some government functionary say it.