Consumer Driven Health Care

I’ve been writing a lot about patients and doctors wresting away the management of health care from the dreaded insurance companies and government. In order for this to happen, the currently extant payment system must radically change. How do we accomplish this? It will not be an easy task, but as more influential people recognize the need, which seems to be happening, we can return to sanity.

A blog called Driving in Traffic contains an informative article entitled The Economics of the US Health System: Part of the Problem. This is must reading to get up to speed in this area.

I found another interesting article advocating a grass roots movement similar to the recent protests by illegal immigrants. Entitled MAY DAY! MAY DAY! MY health DAY! A Cry for Help or Time to Act was posted on the Medical Blog Network.

We should not consider Consumer Driven Health Care (CDHC) synonymous with a combination of Health Saving Account (HSA) and high-deductible insurance, as many insurance companies are now doing as a marketing ploy. Government mandates that move in that direction are mere bandages that do not treat the underlying infection. CDHC means far more than just another insurance scheme. It means putting the decisions back into the hands of the patients with counsel from their physicians.

I don’t have all the answers. In fact, I don’t have any. The reformation task is so huge as to be daunting. But how can we continue to accept increases in healthcare costs of 10-20% annually while quality of services declines?

HSAs might be a step in the right direction. Indeed, if an individual feels that it is his own money he is spending, he is more likely to be prudent. One of the knocks on the current system is that people take advantage of the healthcare system because somebody else is paying for it. Thus, they think nothing of going to the Emergency Room if their allergies act up.

On the other side of the coin, providers are being squeezed, so they must treat greater numbers of patients, spending less time with each one. A visit to the family doctor typically involves seven minutes of “face time” with the doc, whereas many doctors feel that closer to 40 minutes would be appropriate. Their third-party payers put them in a bad position in three ways: by paying them on a fixed fee schedule, by “managing” the relationship, scolding docs who spend too much time with patients, and by imposing onerous paperwork demands on practices.

The purpose of the great paperwork burden, of course, is to avert payment rather than facilitate it. Once again, from a consumer perspective, this is ass-backward. Wasted money due to administrative inefficiency has been estimated as high as 40 percent of the total health care bill.

Given the squeeze by insurance companies, the stifling and costly legislation (HIPAA), and the profusion of malpractice suits at the behest of the plaintiff’s bar, it is a wonder that anyone wants to be a doctor in this country these days.

A couple of health insurance bills have been hanging around congress for about a year. These bills are a step in the right direction in that they would allow interstate commerce in the health insurance industry. Right now, if you live in New Jersey (perhaps the state where health insurance is most expensive), you cannot buy health insurance issued in, say, Pennsylvania. These bills would allow individuals to purchase health insurance across state lines, introducing competition and theoretically lowering prices. This Turkey does not see a downside. The two bills are HR 2355, sponsored by John Shadegg (R-AZ) and S 1015, sponsored by Jim DeMint (R-SC). You can call or write your congresspeople about them.

But don’t rely on Congress to straighten out the mess. Individual awareness and activism are keys to getting something done.

I’ll wrap up this meandering rant with a gem of a health care anecdote I found in The Examining Room of Dr. Charles blog. Entitled There’s No More Cherry Cola, it serves as a reminder that the big, corporate approach to medicine is the wrong kind of progress.