is there health care crisis in us

Is there a health-care crisis in the US? The averages may say no... but the

stories say yes

I've been drawn to write about the health-care situation in the US for

some time. There have been very powerful proposals, such as this one

by Michael Porter and Elizabeth Teisberg a few years ago, that I

thought deserved advocating (link - $$).

In addition, for the past year I have bought my own health insurance

(instead of having it provided by an employer) and with my wife

managed the resulting insurer/caregiver/patient relationships. And,

let me tell you, doing it yourself opens up a whole new window onto

the health-care world. Buying your own insurance and managing your own

care allows you to see deep into the sausage factory that is today's

US health-care ecosystem.

Nonetheless, I held back. Perhaps our situation and experience were

unique. Perhaps struggles and issues we had were due to our own

mistakes. (We made some, perhaps many.) I also resisted the overheated

rhetoric and drastic solutions proposed by some politicians. In

addition, economists like Greg Mankiw provided analysis showing public

concern about the issue is overblown.

The I read the front-page story in yesterday's Wall Street Journal by

John Carreyrou (link - $$). It was horrifying to read about the

gentleman who, despite better-than-average health-care coverage, ended

up owing more than $1 million to hospitals, doctors, etc. And while

the dollar figure was astonishing, more intriguing to me were the

problems and issues he and his wife ran into while trying to

understand and manage the bills. These problems and issues were very

similar (though larger, of course) than issues my wife and I have run

into in trying to manage health-care for our healthy family.

Typical issues include:

1. Difficulty in getting billing and reimbursement details from

caregivers and insurers

2. Coding of invoices to maximize caregiver insurance

reimbursement--not always accurately reflecting what was done

3. Frequent rejection of charges by insurers, causing the patient to

intervene to try to not pay more than is appropriate (a difficult

task--see issue #1)

4. Onerous collections procedures (at my former company, we used more

care and respect in trying to collect a $10 phone bill than many

caregivers and hospitals use in trying to collect bills amounting

to hundreds or thousands of dollars--bills which are usually in

dispute)

5. 200-300% price differences between insurer-negotiated prices and

those consumers must pay for the same product or service

In the Journal article, there is a happy ending--sort of.

Earlier this week, Mrs. Dawson was contacted by a CPMC official

with surprising news. The hospital said Mr. Dawson had qualified

for financial assistance under its charity-care policy and wrote

off his entire bill. Asked why the Dawsons hadn't been told they

could qualify for charity care before a reporter contacted the

hospital, CPMC said Mrs. Dawson never gave it the opportunity to

explain its policy to her.

Of course, blame the customer. That is an old strategy which my wife

and I have encountered often in working with the health-care system.

So while I can't argue with Prof. Mankiw's math, his figures reflect

broad averages which bleach out the real pain and injustice suffered

by many. (Prof. Mankiw has been fortunate enough to have two of the

world's great health-insurance providers--the Federal Government and

Harvard University--as employers.) And, I would wager, given that

companies are pulling back more and more on their health-insurance

benefits, more people are becoming responsible for management of their

own health care--meaning an increasing number of people will get to

experience that pain and injustice, unless the system gets some real

reform. (Politicians, please read the Porter/Teisberg paper!)

The averages say the situation is fine. The stories paint a very

different picture.

We expect from the health-care system compassion, fairness, respect

and dignity. Often, in the doctor's office or the hospital, we get

them. Once the subject shifts to money and payment, however, they

vanish into the air like smoke.

healthcare, health care, insurance, reform, customer service, Wall

Street Journal

Posted by John Caddell at 9:22 AM