| SUBSCRIBE | | Why we charge |
|
|
|
Front Page 
opinion guest_columns
Wednesday, September 02, 2009
Reforming Health Care Takes Smart Shoppers
By Dr. Barry Krakow
Albuquerque Physician
“Are you a good shopper?” Most people spend years honing marketplace skills, shopping for everyday fare and bargaining for big-ticket items.
But if asked, “Are you a good shopper of health-care services?” the answer is different. Not only are medical bills or insurance claims unreadable, it's challenging to obtain the price beforehand for services from a doctor, hospital or lab. Muddling past co-pays, deductibles and insurance coverage questions yields a guesstimate, but it's nothing like shopping. It's something different, something rarely discussed in health-care reform debates.
Paul Gessing of the Rio Grande Foundation mentioned this distinction at the town hall admirably sponsored by Rep. Martin Heinrich. Modern health insurance is not really insurance; it's often prepaid health care — a down payment on future service costs.
Some of us, including doctors who provide these services, may forget health care is a service with a cost, a profit margin and a price to pay. Politicians and others imagine insurance as a right or benefit owed to citizens. Only politicians can enact such legislation, but the fact remains — health care is first and always a service.
Unlike health-care services, the real world marketplace suffers no confusion about costs, profits and sale prices. You pay for food at a grocery that stocks the food you want and can afford; you don't ask the cashier “what's my copay?” or “will my deductible cover it?”
This act of paying embodies the something missing in health-care exchanges. By your actions, you gain knowledge that you carry around in your wallet, in your mind and in your relationships.
This wondrous act of paying so profoundly impacts your thinking and behavior to use money wisely; its absence leaves a vacuum into which many politicians and citizens are drawn. Regrettably, time spent in this void leads people to say funny things about health-care reform.
My sides split whenever I hear a politician say “government” and “savings” in the same breath. Heinrich pressed this point, but too few people laughed at the joke. How can we honestly believe a public option can be financed by a government more adept at spending than saving?
Another side splitter from our congressman: Let's attack “waste, fraud, and abuse.” Since that clarion call echoes from every candidate in the last umpteen elections, why have we yet to cut waste, fraud and abuse? Or, why does Medicare, a government program, suffer more waste, fraud and abuse than private insurers?
A brief disclosure: By treating patients' sleep disorders, my goal is to wake them up. May I suggest we need a wake-up call to get at the heart of the problems in our health-care system?
By distorting our usual act-of -paying experiences, we no longer utilize our immense power to restrain costs. Instead, we continue to engage in a perverse system that minimizes our obligation to assess the costs of these services as with normal shopping experiences. In contrast to the spirit that founded our unique country, we handed over too much responsibility for the management of health-care costs to the government, insurance companies, lawyers, doctors and the workplace. The public option can only increase the perversity of this system.
As Pogo once said, “We have met the enemy and he is us.” Because we as health consumers do not or will not regularly or directly contemplate the costs of our personal health care, we distance ourselves from the economic facts for any and all health-care services. When more serious health-care problems arise, we feel entitled to care, because the system fosters entitlement. Eventually, some need a rescue (a bailout) because the system never encouraged saving for a rainy day for 10, 20…or 50 years.
If this debate were honest, it would be crystal clear there is no conceivable way to pay for health-care reform proposals that only emphasize expansion of the government.
I forgive politicians for trying to disinform constituents; they have a long tradition of crafting pleasant sounding oxymorons like “government savings” that pacify and eventually sedate. But in this age of information combined with current economic turmoil, it's perplexing that many people swallow these bromides. If you fantasize about fiscally responsible and sustainable public options, dream on.
Will we accept this wakeup call? Doubtful. Too many prefer the snooze button. Nowadays, life is supposed to be a low-deductible, zero co-pay experience. Still, as Medicare, Medicaid, and Social Security slide deeper into their sinkholes, perhaps we can break the spell that sustains a dreamy belief in the public option.
Do we need health-care reform? Unequivocally. Should the safety net be more effective? Absolutely. Can we hope to change health care by responsibly cutting costs, improving outcomes and expanding access without handing over one-sixth of the economy to the government? Yes, we can!
You also can send comments via our comment form
|
|
E-mail Story
Print Friendly
