OK..Some of you all have been trying to coax me into addressing the ongoing controversy between President Obama and the Roman Catholic Church over a new federal mandate requiring all employers to include health insurance coverage for contraception, sterilization and abortion. If your views have been shaped by corporate media, you probably believe that this is a straightforward, deontological dilemma between "religious rights" and "reproductive rights." Sorry...but I won't address that issue! Why not? Well...it's NOT because I teach at a Roman Catholic college and it's NOT because most of my friends and colleagues are liberal women. The reason that I refuse to address that debate is that it's not the ultimate source of the conflict and therefore, to do so would be tantamount to a physician treating the symptoms of the disease rather than the underlying disease.
So what's the disease? Well, it's President Obama's decision to "reform" the U.S. health care system by expanding and revising employment-based health insurance. Kronke and I have already dealt with the various problems associated with employment-based health insurance in our essay: The Modern Health Care Maze. So in this use blog I'll try to explain how and why this mindless system inevitably alienates not only religious employers like the Roman Catholic Church, but also their employees. Ultimately, I might even question why an otherwise saavy politician like Obama failed to "anticipate" the consequences of this policy.
First of all, let's ask the most basic question. Why would I want my employer, the federal government, and/or the state of Ohio to choose my health insurance coverage for me? Do these governmental entities or my employer know something that I don't know about what I need in terms of coverage? President Obama sent me an e-mail message the other day. It said: "Sorry Ron, but even though you and your wife are well beyond your reproductive years, I decided that you really NEED health insurance coverage for contraception, sterlization, and abortion?" Then the bishop sent me an e-mail that said: "Sorry Ron, but the Roman Catholic Church won't pay for that mandated coverage because we believe that contraception, sterilization, and abortion are immoral." Note that both the President and the Bishop believe that they are acting in good conscience on my on my behalf. But the fact of the matter is that I really don't need contraception, sterilization, or abortion coverage. I also don't need in vitro fertilization coverage. If I did, I guess it's good to know that if my wife and I end up with octuplets, my health insurance will cover up to $1,000,000. per child toward treatment in a neonatal intensive care unit. The government and my employer might also decide that we also need insurance coverage for mamograms, a hair transplant, cosmetic surgery, and/or a sex change operation. I know that pharmaceutical companies believe that I need insurance coverage for a test Low T (low testosterone), and for the expensive, patent-protected drug that cures it. That's why their lobbyists are are swarming state governments hoping to force insurance companies to cover those tests and drugs.
Now if the health insurance offered to me by my employers was offered as a gift, I wouldn't be so critical. But the fact is that I pay for that insurance via diminished salary and co-pays. Moreover, although the President and the Bishop are willing to force me to pay for insurance coverage that I mostly don't need, neither of them are anxious to provide me with reasonable coverage that I really might need someday: dental care, eye care, or long-term nursing care. So one of the unanticipated consequences of employment based health insurance is that I'm stuck paying for health insurance that I wouldn't otherwise purchase. And of course, over time, the quality of that insurance coverage has decreased, while the costs have increased. So as a result, every year I pay more for my health insurance and more out-of-pocket for my uncovered health care. Now I can't blame the Bishop for my lousy health insurance. There are only a few health insurance companies licensed in the state of Ohio, and they all are well-represented by powerful lobbies. But I do blame President Obama for attempting to recussitate such an irrational, convoluted health care system.
Now let's look at another related issue. Why do we continue to support a tradition whereby access to some birth control methods requires a prescription from a physician; a stranger that probably doesn't know much about you, or the drug being prescribed? Moreover, that same physician is financially motivated to prescribe expensive, recently patented new drugs and devices (whose safety and effectiveness are not well known), rather than prescribe generic old drugs and devices (whose safety and effectiveness are well known)? As a result of this wacky system, every few years these new drugs and devices, whose safety and effectiveness were initially declared by the Food and Drug Administration, turn out to be unsafe and/or ineffective. Then, we have those highly paid lawyers, specializing in "class-action lawsuits," taking pharmaceutical companies to court. When the pharmaceutical companies lose those class-action lawsuits and are ordered to pay out huge settlements to the victims, those payoffs are either covered by their own liability insurance and/or passed onto consumers in the form of higher prices. Do you got all that?
In conclusion, the debate over contraceptive covereage is really a sideshow; a byproduct of a woefully convoluted health care system. As much as I'd like to write a convincing deontological argument reconciling religious freedom with reproductive freedom, it's really not the real issue. I thought Kroncke and I articulated the problem pretty well! "In hindsight, did it ever really make sense to set up a health care system whereby fourth-party corporate employers purchase health care insurance for their first-party employees from third-party corporations, which in turn pay second-party providers for health care products and services? Does any other industry insulate buyers from sellers in this way?" So, the conflict between religious rights and reproductive rights disappears if we just dump employment-based health insurance, and replace it with a system where we buy our own health insurance (and health care). Unfortunately, insurance companies, physicians, pharmaceutical companies, and hospitals won't like that new system. They all want us to buy more health care than we really need.
Finally, we must ask the question: Why would President Obama risk politically alienating Catholics, Evangelical Protestants, Jews, and Muslims in an election year in order preserve such an irrational, ill-conceived, and convoluted health care system? God only knows!
Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts
Monday, February 13, 2012
Tuesday, June 9, 2009
Access to Health Care
In the United States, the stated goal of health care reform debate has been to provide universal access to high quality health care at a reasonable cost. However, most of the rhetoric has focused myopically of universal access. Unfortunately, in the real world proponents of universal access must also take into account the quality and cost of that health care. After all, no one aspires to provide universal access to low quality health care or universal access to high quality health care that no one can afford. Unfortunately, any reasonable account of access, quality, and cost of health care generates mind-boggling complexity. Let’s start with access.
Today, about 55% of all Americans gain access to health care via private health insurance purchased through their employers, while 45% gain access to public insurance via Medicaid, Medicare, Veterans Medicine, and SCHIP. (poor, elderly, veterans, and children). In 2005, the Census Bureau reported that at least 44.8 million Americans were without either private or public health insurance coverage. By 2006, that number rose to 47 million: a 15% increase. Since, 2000 the number of uninsured Americans has grown by 8.6 million: an increase of about 22 percent. The largest segments of uninsured are employed young adults 19-29 and older adults 45-64. The uninsured rate among young adults, signals a corresponding rise in the number of uninsured young children; which has led to the recent reauthorization of SCHIP. Due to the ongoing economic recession the number of privately-insured Americans has decreased and the number of publically insured has increased. Although the public policy goal has been to increase the ranks of the insured, what is the precise relationship between “access to health insurance” and “access to health care? That answer is hardly straightforward.
When reformers call for universal access to health insurance, presumably they mean “good health insurance.” In an ideal world, “good insurance” is “comprehensive insurance” that covers every possible health care need (or want). Conversely, “bad insurance” covers nothing. So in the real world, the mere fact that you have health insurance does not necessarily guarantee that you have access to the health care products and services that you may need or want. Therefore, what most of us really want is universal access to comprehensive health insurance. But in the context of health care what does “comprehensive” mean? Does it include “all health care” or just “basic health care?”
Well, what precisely is this alleged distinction between “comprehensive” and “basic” health care and who decides? Does “basic” include access to all known preventive care, including: annual physicals, vitamins, and all known tests, imaging technologies (eye exams, hearing exams, MRIs, mammograms etc.), and vaccines? Does it include access to all known treatments, including: laser surgery, stem cell therapy, and genetic therapy? How about doctor’s office visits for minor illnesses such as colds and flu? Should everyone have equal access to: state-of-the-art trauma centers, organ transplants, hip replacement surgery, physical therapy, fertility treatment, psychiatric treatment, eye glasses, vision correction surgery and cosmetic surgery? Should all Americans have access to both new and old drugs, including: AIDS drugs, and diabetic drugs? How about access to weight loss therapy (including surgery), smoking cessation programs, and mental health treatment? Does basic insurance cover Tommy John’s surgery for 53 year old beer-league baseball pitchers, motorized scooters for the morbidly obese, or psychiatric drugs for children diagnosed with Attention Deficit Disorder or depression, erectile dysfunction drugs for old men, or chemo and radiation therapy for all cancer patients (including for ninety year-olds)? In Vitro Fertilization, abortions, or birth control pills for the poor? Does basic health insurance include unimpeded access to experimental, futile, and/or low-quality treatments (that are less-than safe, or less-than effective)?
Therefore, it seems obvious that the distinction between “basic” and “comprehensive” insurance is far from clear. Even if you are a member of congress that has the most comprehensive health insurance coverage in the world, there is still wide variability in access to specialists and state-of-the-art technology. That’s because access to health care products and services depends largely upon where you live. Our current health care system has evolved to serve major urban populations. Therefore, even insured congressmen from rural districts may not have access to the health care they need or want. Other rural patients have “access” to specialists and state-of-the-art technology, but only to the extent that they are willing (and/or able) to wait for an appointment and/or travel to a distant urban area. And, of course, rural patients that are uninsured (or under-insured) have access to health care to the extent that they are willing or able to pay for both the trip and the treatment. So one might argue that rural patients in the United States have “access” to a vast market of health care products and services, but only to the extent that they are willing (and/or able) to overcome geographical and financial barriers. Now is that really “universal access to health care?” If not, how would congress go about addressing this alleged injustice?
Although most patients with health insurance believe that they have access to health care, most policies cover much less than they think. That’s because, “good insurance,” which is comprehensive is very expensive and difficult to sell employers, especially to small businesses. Therefore insurance companies adapted by devising innovative marketing strategies that help them sell that “bad health insurance.” Their solution: disguise the quality of their insurance policies behind a veil of complex, obscure jargon that only insurance adjusters can decipher. Systemic obscurantism has no doubt contributed to the growing number of uninsured and under-insured patients. Why buy expensive health insurance, if you don’t know what it will cover? Therefore, one area more than ripe for reform is the restoration of transparency in health insurance.
In conclusion the single-minded pursuit of universal access to health insurance is really an overly-simplistic basis for health care reform. We must also take into account quality and cost of that insurance and the actual health care covered by those policies.
Today, about 55% of all Americans gain access to health care via private health insurance purchased through their employers, while 45% gain access to public insurance via Medicaid, Medicare, Veterans Medicine, and SCHIP. (poor, elderly, veterans, and children). In 2005, the Census Bureau reported that at least 44.8 million Americans were without either private or public health insurance coverage. By 2006, that number rose to 47 million: a 15% increase. Since, 2000 the number of uninsured Americans has grown by 8.6 million: an increase of about 22 percent. The largest segments of uninsured are employed young adults 19-29 and older adults 45-64. The uninsured rate among young adults, signals a corresponding rise in the number of uninsured young children; which has led to the recent reauthorization of SCHIP. Due to the ongoing economic recession the number of privately-insured Americans has decreased and the number of publically insured has increased. Although the public policy goal has been to increase the ranks of the insured, what is the precise relationship between “access to health insurance” and “access to health care? That answer is hardly straightforward.
When reformers call for universal access to health insurance, presumably they mean “good health insurance.” In an ideal world, “good insurance” is “comprehensive insurance” that covers every possible health care need (or want). Conversely, “bad insurance” covers nothing. So in the real world, the mere fact that you have health insurance does not necessarily guarantee that you have access to the health care products and services that you may need or want. Therefore, what most of us really want is universal access to comprehensive health insurance. But in the context of health care what does “comprehensive” mean? Does it include “all health care” or just “basic health care?”
Well, what precisely is this alleged distinction between “comprehensive” and “basic” health care and who decides? Does “basic” include access to all known preventive care, including: annual physicals, vitamins, and all known tests, imaging technologies (eye exams, hearing exams, MRIs, mammograms etc.), and vaccines? Does it include access to all known treatments, including: laser surgery, stem cell therapy, and genetic therapy? How about doctor’s office visits for minor illnesses such as colds and flu? Should everyone have equal access to: state-of-the-art trauma centers, organ transplants, hip replacement surgery, physical therapy, fertility treatment, psychiatric treatment, eye glasses, vision correction surgery and cosmetic surgery? Should all Americans have access to both new and old drugs, including: AIDS drugs, and diabetic drugs? How about access to weight loss therapy (including surgery), smoking cessation programs, and mental health treatment? Does basic insurance cover Tommy John’s surgery for 53 year old beer-league baseball pitchers, motorized scooters for the morbidly obese, or psychiatric drugs for children diagnosed with Attention Deficit Disorder or depression, erectile dysfunction drugs for old men, or chemo and radiation therapy for all cancer patients (including for ninety year-olds)? In Vitro Fertilization, abortions, or birth control pills for the poor? Does basic health insurance include unimpeded access to experimental, futile, and/or low-quality treatments (that are less-than safe, or less-than effective)?
Therefore, it seems obvious that the distinction between “basic” and “comprehensive” insurance is far from clear. Even if you are a member of congress that has the most comprehensive health insurance coverage in the world, there is still wide variability in access to specialists and state-of-the-art technology. That’s because access to health care products and services depends largely upon where you live. Our current health care system has evolved to serve major urban populations. Therefore, even insured congressmen from rural districts may not have access to the health care they need or want. Other rural patients have “access” to specialists and state-of-the-art technology, but only to the extent that they are willing (and/or able) to wait for an appointment and/or travel to a distant urban area. And, of course, rural patients that are uninsured (or under-insured) have access to health care to the extent that they are willing or able to pay for both the trip and the treatment. So one might argue that rural patients in the United States have “access” to a vast market of health care products and services, but only to the extent that they are willing (and/or able) to overcome geographical and financial barriers. Now is that really “universal access to health care?” If not, how would congress go about addressing this alleged injustice?
Although most patients with health insurance believe that they have access to health care, most policies cover much less than they think. That’s because, “good insurance,” which is comprehensive is very expensive and difficult to sell employers, especially to small businesses. Therefore insurance companies adapted by devising innovative marketing strategies that help them sell that “bad health insurance.” Their solution: disguise the quality of their insurance policies behind a veil of complex, obscure jargon that only insurance adjusters can decipher. Systemic obscurantism has no doubt contributed to the growing number of uninsured and under-insured patients. Why buy expensive health insurance, if you don’t know what it will cover? Therefore, one area more than ripe for reform is the restoration of transparency in health insurance.
In conclusion the single-minded pursuit of universal access to health insurance is really an overly-simplistic basis for health care reform. We must also take into account quality and cost of that insurance and the actual health care covered by those policies.
Saturday, April 18, 2009
WARNING: OUR HEALTH CARE SYSTEM CAN BE HAZARDOUS TO YOUR HEALTH
Last January I finally got around to getting my annual physical. Same story…in terms of overall health, I’m among the top 5% of all men my age. Other than an occasional bout of labile, stress-related blood pressure, I am in great shape. That was good news, until I checked the mail in February and found a bill for $500 from the lab that processed the blood test that confirmed my excellent health. I immediately called Employee Benefits at my college to make sure that our new health insurance covers “blood tests.” She confirmed that lab tests are covered, and explained that there is often lag time in communication between the insurance companies and providers. In short: "not to worry!"So I ignored the bill. But I kept getting more of them. So I called our family doctor’s office and asked the receptionist what she thought had happened. She had no idea. But she was sure that she had forwarded my insurance information to the laboratory. Then a few days later, I received an automated phone message from a collection agency in regard to an overdue account that belonged to “Ronald Wade.” Of course, I am “Ronald White,” so I hung up. Then it called again, and, again, etc. So I called my insurance company to check up on the status of that mysterious bill. After waiting on hold for 10 minutes, I spoke to an agent that determined that the laboratory never submitted a $500 claim, but that my physician’s bill had already been paid-in-full. Then, I decided that I’d better contact the laboratory. The bill stated that I should use the company website. I quickly confirmed that I owed $500, and I was urged to pay off the account by credit card. After about 30 minutes of searching the website, I found a phone number. I called it and I was immediately captured by one of those endless option loops. Finally, after optioning for 20 minutes, I stumbled upon the option that I wanted: “speak to a customer service representative.” Elated, I pressed option #4 and hit the “pound key.” “We’re sorry, but all of our representatives are busy assisting other customers. Please wait for the next available representative.” Then I was treated to 30 minutes of soft rock, interrupted every 2 minutes by an automated female voice urging me to remain on the line. Finally, a company representative with an Indian accent asked me how he could assist me. I read off my 14 digit patient code and he pulled up my file. Sure enough, I owed $500 to the laboratory. I explained that I had health insurance and that the insurance company had no record of the lab submitting a claim and that my physician had forwarded the insurance information to the lab. Perplexed, he read off a 17 digit insurance number and asked me if it corresponded to the one on my insurance card. It didn’t match! It had two wrong digits. He immediately corrected the typos and told me that he would resubmit the claim with the correct number. Then I politely asked him why the laboratory didn’t contact the insurance company, or the doctor's office; and how the lab could reasonably expect me to figure out that someone at the lab miscopied a 17 digit insurance number? He couldn’t answer! Then, I respectfully complained to him about the endless loops on the website and phone system. He responded: “We’ve had many complaints about our website and phone systems.” So what’s wrong with our health care system? Well, we have a four-party system: first party patients, second party providers (physicians, labs, drug companies etc.), third party payers (private insurance companies, Medicare, Medicaid etc), and fourth party insurance payers (employers that purchase health insurance for their employees.) Can you imagine a more convoluted way to provide an annual physical? Wait a minute, I have to answer the phone…I’m back! That was that pesky collection agency again. Let’s make that a five-party system. Whew! I’m sure glad I’m healthy: even if my blood pressure is now 150/90. Check out my forthcoming essay (co-authored by Charles Kroncke) on our four-party health care system system. It will appear in the summer issue of the Independent Review.
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