You'll get better health care when you foot your own bill

Andrew Carroll
The Arizona Republic

Family Medicine Specialist
Jan. 22, 2006 12:00 AM

Health insurance was invented as a health benefit that employers could offer employees as an incentive to hire on. The theory was that healthy employees would be consistent employees, and the health of their families would be ensured.

Much more today, we see health insurance as a burden, not only to employers but to employees, families, doctors and society.

The rise in health insurance premiums has far outpaced inflation, and yet the health care delivered is no more comprehensive, and likely less so, than even just a few years back.

 

General Motors used health insurance as a major bargaining chip with the United Auto Workers group recently in its contract negotiations. The union relented and allowed the sweeping changes. However, GM still will pink-slip 30,000 employees.

From a doctor's point of view, we could see it coming. The drive toward technological health care delivery and increased active longevity comes at a high price: research dollars for new scanners, new medications, new chemotherapy agents, and availability of highly subspecialized physicians.

And yet the obesity rate continues to rise and, subsequently, the rate of diabetes, hypertension and heart disease. Cigarette smoking is still at a 20 percent rate in the United States. As we move to being less of a manufacturing society and more of an information-based technological society, our sedentary lifestyles are becoming a huge burden on the system.

Insurance is the great equalizer for patients. For one co-payment, you can see a physician straight out of medical school or a university professor in practice 25 years with a stellar bedside manner. A physician who has been sued 20 times (though less likely to be credentialed with an insurer) with an awful bedside manner will make the same amount of money as a respected pediatric neurosurgeon for an evaluation and management visit. The insurance companies pay them both the same. A standard visit with those doctors will pay about $50 on average. How fair is that?

Patients will continue to see benefits decline for the benefit of insurance company shareholders. They profit at your loss. In my opinion, shareholder-owned for-profit health insurance runs counter to any notion that health care is a public good.

There's only one solution for the system, and that is coming slowly but surely. You will begin to spend your own money for health care.

Health Savings Accounts allow patients to store money, much like an IRA, for use in health care. To make this system work well, though, doctors and patients need to learn what health care really costs. And that's what makes this system much more viable in the long term.

I think the key to this change, though, will be balance billing, which will allow physicians and hospitals to bill above contract rates. This will allow the better and more patient-friendly doctors to bill what they're actually worth. Providers will compete for your business, both from a price and quality-of-care delivery standpoint.

Why is this better? For one, it will help reduce your or your company's premium. It will reduce intervention from the insurance company, like prior authorizations, because it's your money.

It will force doctors to become much more cognizant of the costs of health care because they will no longer be spending big corporation money in your workup, they will be spending yours.

And finally, you, the patient, will become much more involved in your health care because it's coming out of your pocket. Because it's your money, doctors will be much less likely to practice "defensive medicine" and more likely to discuss at length the merits of their workup plan and options.

You will become intimately involved in the decision-making about whether to have a CAT scan done, or an MRI, or a colonoscopy, or picking a brand name vs. a generic medication.

And when you become involved, you're more likely to demand better pricing, better evidence and better behavior from the people that deliver health care to you.

Including the doctors.



Dr. Andrew Carroll is a family medicine specialist in private practice in Chandler. He is also clinical assistant professor at the University of Arizona College of Medicine and a regular guest on "Sonoran Living Live."

 

 

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