Monday, May 11, 2009

Sick Joke and Obama's Not Laughing

My guess is that Obama kept a straight face today when he announced that health care leaders are committing to cut the growth rate of national health care spending. But, excuse me, is this some kind of sick joke? This is like the foxes saying they won't eat quite so many hens next year. Sen Ron Wyden even said so. This is no laughing matter, we need to be alarmed. The Department of Human Services estimates that health spending will grow an average of 6.2% a year. I've had enough. I call bull....!

My experiences with the health insurance system are probably much like yours. My first memory is attending a company staff meeting in which representatives from our HMO came in to describe how our premiums were going to increase 8% this year to 'cover rising costs'. We didn't really argue, we were lucky to have a company that provided health insurance. At the end of the meeting the HMO people let us reach into a basket and pick out a refrigerator magnet or children's toy with their logo on it. This was ten years ago. Hmmm, costs still going up?

Well sure they are. I thought HMOs were designed to hold costs down. I thought they were already doing everything they can do to be lean and mean and competitive against the other HMOs. Apparently not. Apparently they are busy committing fraud, collusion, and price fixing. Recently some of the very biggest HMOs have been under investigation in several states and paid fines to get investigations off their backs. I don't need an attorney general to tell me there's a racket here. All I have to do is take my kid to the doctor with a runny nose, fever, and tugging at his ear. I just need someone to look into his ear so they will write the prescription for the dang ear infection. A five minute doctor visit equals $220, HMO integrity- priceless.
And then there are the horror stories. An otherwise healthy college student has an episode of fainting. No insurance, no diagnosis, no recurrence. But for a couple of CAT scans and other tests the bill was $80,000. Really? How much can it really cost to go through that machine? $1,000? What do you need the other $79,000 for? I don't even want to get started on $10 aspirin.

It's the health insurers that are the sick joke here and, get real, electronic records ain't the answer. Here's what I think Obama ought to do. First off, HMOs should never be part of treatment decisions. If the doctor says you need a splint on your toe, it should not need approval by an HMO.

Next, what medical facilities charge for procedures should be made public. We should know how much an X ray, a saline IV, and yes an aspirin delivered by a nurse cost at hospital A vs. hospital B. Lets have medical facilities become transparent about their efficiencies and patient satisfaction surveys. For non-profits and publicly supported institutions this should be mandatory and available on the Internet.

Third, fixing prices for various insurances at differing levels is unfair. X procedure costs X amount for everyone. Back room deals to set 'discount rates' for 'preferred providers' are collusive and socially detrimental. No discount rates.
Fourth, make HMOs compete. These companies need to get lean and mean and fight for customers. HMOs ought to be in the vanguard of developing efficiencies in treatment and care and savings for their policy holders. Instead of denying claims they ought to push hospitals and doctors to improve health care. Think of all those clerical employees that could be hounding hospitals to keep staph off the floors and medical errors corrected.

When the first HMO fires half of it's administrative support staff, stops sending out forms in triplicate that say "this is not a bill", and actually tells hospitals to quit charging $40 for a gown that doesn't close in the back, then I'll start believing we're getting some real health care reform. Until then, no one's laughing at this sick joke.

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