Consumer Driven Healthcare: More Rhetoric Than Reality

Republicans have long asserted that the solution to solving America’s healthcare crisis is to give greater power to the consumer to make their own healthcare choices. Republicans view high deductible plans and electronic medical records as tools that will give consumers greater control over their healthcare. This sounds good conceptually, but reality has proven time and again that none of these ideas currently work.

Medical Providers: A Big Obstacle
Most health insurance plans today have a deductible that must be met each calendar year before their insurance covers their medical care. Deductibles typically range from $500 to $2,500 but a $5,000 deductible is not uncommon. Paying for medical expenses out of pocket until a deductible is met encourages consumers to be more selective in medical care, avoiding excessive testing and treatment. It is also supposed to encourage consumers to shop around for non-emergency care.

Unfortunately, most medical providers have shown their disdain for these plans in their refusal to operate their practice like a business. Most doctors refuse to even provide a ballpark range cost estimate for an office visit in advance even though they know what your insurer's reimbursement rate is. Once a consumer visits a provider to treat a specific situation, the doctor wants to embark on a “fishing expedition” into other non-related issues, along with ordering lots of tests. If consumers begin to ask questions and just want to treat the issue at hand, the doctor becomes angry. In some cases, such “defiance” by the consumer results in the doctor issuing a certified letter informing them not to return to their practice.

Doctors are angry as this is a departure from the halcyon HMO days of the consumer $5.00 co-pay. They cannot grasp that consumers are financially strapped. But what they really fail to grasp is that beyond cost, a consumer might disagree with certain treatments and medications the doctor wants. In consumer driven healthcare, consumers are supposed to question their medical provider, but doctors don’t like it. They have little to no regard that not only is it your money, but it’s your body. There have been too many instances over the last few years where treatments and medications have turned out to be of no medical benefit and actually detrimental.

There are several reasons doctors have concerns about a consumer refusing a recommended treatment:
  • The doctor sincerely believes the treatment will benefit the consumer.
  • The doctor financially benefits from additional treatment: additional consumer visits bring additional revenue. The doctor may also have a financial incentive in ordering tests.
  • The doctor wants treatment and orders excessive testing as a legal protection. For all the Republican rhetoric over the years about curbing frivolous lawsuits, the Administration has done nothing. The amount of legitimate medical malpractice lawsuits is miniscule.

Beyond convenience and extended hours, consumers are visiting medical clinics inside drug and discount stores, along with physician-staffed medical clinics, because these places address the consumer’s ailment without pushing additional treatments.

Billing and Pricing
We’re still not out of the medical provider’s office. Most medical providers are demanding payment up front, even if your insurance policy states that payment is not due until they have processed your claim and calculated the payment you owe the provider (or $0 if the visit put you over the deductible). Failure to do what the provider’s billing department wants will also result in a certified letter denying future treatment.

Then there’s lack of pricing parity. Your visit could have been for the exact same thing as the person sitting next to you in the waiting room. But the provider will accept $60 for a visit from that person because they’re on Medicare. For you, it’s $130. Clearly, this has not been a trip to the supermarket.

Electronic Medical Records Require Universal Healthcare
Politicians on both sides of the aisle pontificate about the efficiencies of converting to electronic medical records. Without universal healthcare first in place for every American, electronic medical records will make life easier for insurance companies to reject more people from obtaining health insurance. Google (GOOG), Intel (INTC), Microsoft (MSFT), and Steve Case’s Revolution Health should be publicly lobbying for nothing short of universal healthcare if they want to profit from electronic medical records. To tell consumers electronic records could save their life is not going to be convincing enough when the bigger issue is living day to day.

Universal Healthcare is Consumer-Driven Healthcare
The only way to take consumer driven healthcare beyond the rhetoric is to at a minimum enact a federal law requiring insurance companies to offer guaranteed issue community-rated policies to consumers. Today’s Wall Street Journal “Anxiety Over Health Insurance Shapes Life Choices” describes various choices people make to get or keep health insurance. From couples not divorcing, to people living in a certain state, it is truly a sad state of affairs for more and more consumers.

You might have noticed that throughout this post I have used the word consumer instead of patient. This is because I believe consumers should be able to make choices in the same manner they approach other product and service purchasing decisions. Numerous federal consumer protection laws successfully exist in our capitalist system. In order for consumers to be productive in society and pursue “life, liberty, and the pursuit of happiness,” they need to have consumer driven healthcare that is real rather than rhetoric.

1 comment:

JaaJoe said...

Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read.