5 bullshit things about health care and the reasons behind them

health careDo you find the health care system in America baffling? Me too. But industries work the way they do for a reason.

With help from independent health care analyst Skip Snow, I did my best to reveal the perverse logic of American health care.

It all comes down to one thing: when the people who use a service aren’t the ones who pay for it, the whole system functions chaotically. Here are #5BullshitThings:

Nothing has a fixed price tag.

How are we supposed to make smart health care choices when you can’t tell what things actually cost? This leads to absurdities like this $153,000 bill for a snakebite treatment. Go ahead, ask that hospital what it’s going to cost you to get that dailysis treatment or hip replacement. Just don’t expect a straight answer.

What’s really going on. You’re under a misconception. You think that you, the patient, are the customer for health care. You’re not. Your insurance company is the customer, because they’re the ones paying most of the bill.

Your insurance company has negotiated rates with suppliers like hospitals and doctor’s offices. Those rates are a lot less than the “rack rates,” which very few people ever end up paying. Since the negotiated rates aren’t public, you don’t see them. If you did, you’d see that the rate varies according to the agreement, which is why there is no fixed cost.

You need to fill out the same paperwork in every doctor’s office.

You go to a doctor. You go to a specialist. You go to a hospital. Everybody gives you a form on a clipboard. Every form asks for your medical history. This is bullshit. Why can’t you just fill this out once and make it available to everybody?

What’s really going on. There are two kinds of medical information. There is self-reported information, which are you are free to share with anyone, but which providers don’t necessarily trust. And there is your health record (things like test results and doctors’ notes), which is protected by HIPAA. HIPAA allows health care providers to share information when needed, but there’s no easy way to do it.

There are plenty of people trying to fix this, like Medicare’s “Blue Button” initiative, the electronic health records company EPIC, and initiatives from Microsoft and Google. But so far they’ve failed to make sharing and privacy easy. So we have to fill out the same paperwork over and over again.

The Affordable Care Act (Obamacare) isn’t actually about insurance.

The backers of Obamacare would like you to focus on the number of people who are insured now. The ranks of the uninsured have decreased from 15% of the population to 11%. But that’s just the opening salvo in the transformation that Obamacare is trying to create.

What’s really going on. Right now, your insurance pays for things medical providers do, like tests, exams, and procedures. But what we as patients really want is to be well. The Deloitte Center for Health Solutions says we’re at the beginning of a transformation where insurers will pay for value provided, not just for tasks. According to Skip Snow, “The ACA moves the system to deliver care based on value. Providers will get paid when they do good job managing a person and a population’s health state.” That would be a complete transformation in the payment models for health care.

As you might expect, those measures of value are controversial. For example, Dr. Wayne Altman** is part of a group called Care That Matters, studying quality measures designed to incent physicians to provide better care, not just save costs. Don’t expect this fight to settle down any time soon.

Our healthcare system is the most expensive, but not the best.

The Commonwealth Fund ranked America’s healthcare system last of 11 developed nations, even though, at $8,500 per person per year, it is by far the most expensive.

universal health careWhy it happens. As shown on this map, most western countries provide health insurance for all citizens. This is the “single-payer” system. The system is overall more efficient. On the other hand, it means that, at least in theory, everyone gets the same basic level of care; it’s hard to turn being rich into better treatment.

Skip Snow points out that although the US system based on insurance companies is more expensive, it has a benefit: it makes it easier for medical entrepreneurs and pharmaceutical companies to create breakthrough treatments and profit from the results. Much of the medical innovation happens right here in the U.S. And if it succeeds, we end up paying quite a bit for it. That’s capitalism in health care.

You can’t get help by email.

Or apps. Or videoconference. It’s 2015 — we’ve got any number of ways to communicate. I can get a notification when my flight is late and an email when my car repair is done. Why can’t I ask my doctor a question that way?

Why it happens: Nobody can figure out how to reimburse doctors appropriately for electronic communication. There’s the liability issue, as well: who’s responsible if you read the doctor’s email and interpret it incorrectly? We’re all suffering because the incentives in the system don’t allow for technology. Yet.

** Disclosure: Dr. Wayne Altman is my partner in the non-profit WellnessCampaign.org.

Photo: 401kcalculator.org via Flickr.

Universal health care” map by NuclearVacuum, Obi-wan Kenobi, Apatens – This file was derived from: BlankMap-World6.svg. Licensed under CC BY-SA 3.0 via Wikimedia Commons

13 responses to “5 bullshit things about health care and the reasons behind them

  1. If prices are not published and known, then there can be no price competition in the healthcare market. This is the key to competition lowering market prices. This healthcare system will never lower costs without pricing becoming transparent.

    1. Monopolies generally become byzantine and ubiquitous. The ‘medical establishment’ is rather monolithic and sort of sets the tone of what medicine even is, don’t you think? I’m not saying that, for brevity, I’ll call ‘western medicine’ doesn’t often do wondrous things at whatever price. But for instance… Im no longer sure if I can trust the food at the grocery store as to what’s been sprayed on the produce or the effects of ingredients in the food. The same folks own big pharma also make pesticides and vaccines and cereal and nearly all the seeds. I guess what I’m wondering is if we should look into the bullshit that causes the need for health care and whether or not some of the medicine they’re selling us for what ever price is bullshit. After that one might look into the bullshit the governmental medical agricultural folks have suppressed or outright lied about (pot is being worked on so maybe see what else or was cannabis the only fib). Then we might be able to lower the cost of health care in many ways. Regardless of who pays.

  2. Many doctors now use email. Some use secure systems, some just use plain old insecure email. This may be geographically driven, like many healthcare decisions.

  3. “Much of the medical innovation happens right here in the U.S. ”

    Yet, according to the OECD the average life expectancy in the US is 79 years; in the UK it is 81 years, Japan – 83 years, Canada – 82 years, Germany – 81 years, France – 82 years and so on.

    Co-incidentally, a lower and falling life expectancy works in favor of health insurance companies as there is less expense to pay out for.

  4. We’re playing a shell game. I am forced to switch insurance @12/1. The new company, Aetna, can’t tell me if an ultra sound is covered without my new insurance being effective. I know the policy “name”, “level”, & premium but there’s no way to get an answer.

    It’s like buying auto insurance & then finding out you don’t have collision. WTF!?!? Plus it took 4 phone calls to actually speak to a human being.

    SOOOO FRUSTRATED!!!

    Thanks Obamacare, another feather in the cap.

  5. The cost of healthcare is outrageous! I have to pay $1,675 a MONTH for bloody healthcare! My wife and I both work so we make more than 100k but less than 125k, so we don’t receive any help/tax credit on healthcare. Our employers do not subsidize healthcare so the full weight is on us. I really hate obama for forcing us to have insurance. If I could just insure my kids I would do that instead. The problem is that only certain people are helped while others are royally screwed over. It makes me mad that some burger flipper gets free healthcare and I have to pay extra so that bum can have free healthcare. Go to hell obama.

  6. i’m so friggin pissed off. have spent all night looking for new insurance and it is more than 3 times what i have been HAPPILY paying. so, in order to afford insurance, i have to stop contributing as much into my retirement. my husband and i are both self employed, so we don’t receive any match from an employer. f off obama!

  7. The biggest piece of bullshit is that America has a healthcare system at all. In a place where health care is provided by thousands of competing businesses, we don’t have a healthcare system any more than we have a restaurant system.

    As soon as we stop pretending we have a system at all, we can begin to have the conversation about whether we need one and what the design should be.

  8. So my toddler woke up with a fever of 103f and no other symptoms. Of course my wife and I were concerned when nothing we did would lower his temperature. So we did what any scared parents would do. Yup, a quick trip to the ER. Our visit was surprisingly short, about 30 minutes total. During that time a nurse gave him a dose of Motrin, the doctor came in and announced that he did not know what was wrong, and another nurse screened him for strep and flu. Fortunately the tests were negative. A few weeks later I received a charge from the hospitals lab requesting $78.00 for the two screenings. Not bad. Then one from the hospital ER requesting $2,000.00. Then one from the doctor requesting an additional $1,400.00. Why should I pay the ER or the doctor all that money if they didn’t do anything for my son? It’s like paying a mechanic to fix your car but he couldn’t find the problem. They didn’t charge me for the Motrin, the most beneficial part of the visit. I’m confused and supremely irritated. I thought highway robbery was a crime?

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