Posted on 07/18/2012 2:54:32 PM PDT by NYer
I have waited a bit till the dust settled on the Supreme Court decision of last month to ask some questions of about healthcare, and more specifically Health Insurance. I waited because this is neither a political blog, nor a legal blog. I want to leave the political commentary and questions to others, and let the legal types parse the Constitutional questions.
My questions are more personal and directed to us who are consumers of health care, especially about Insurance and how we pay for healthcare than healthcare itself. It is also about the high costs of healthcare.
While we may all wish to blame others (HMOs, hospitals, doctors, government et al.) is it not also possible that we all share some of the blame for the “off the hook” costs of medical care and for the Insurance debacle we in?
I would like to state a few questions and ask your feedback because a lot of the Health Insurance landscape is puzzling to me.
1. Let’s start with the concept of insurance. Most of us have several kinds of insurance: Car insurance, homeowners insurance and medical insurance. And yet the word “insurance” with reference to healthcare has taken on a vastly different meaning than any other kind of insurance.
Insurance is normally used to cover catastrophic, or at least significant costs. When I need new tires, I do not call my car insurance company. When I need an oil change or a 30,ooo mile checkup I pay for these things out of pocket. Same with homeowners insurance. We do not ask or demand our insurer to pay for new light bulbs, or even more expensive things like a new roof or HVAC system. No, Insurance is for catastrophic losses.
So why, when it comes to medical “Insurance” do we demand that every little pill, every doctor’s visit, every medical device be almost wholly paid by “insurers?” How did this system evolve? Is it necessarily reasonable for us to expect third parties to pay for everything when it comes to healthcare?
2. You may say, “But Father, if money were a consideration, many might neglect their health.” And this may be true. Although many do that now. But this leads to my next question.
3. Are Medical prices artificially high because third parties pay the bills? On the patient side there is inelastic demand. We run to the doctor with almost no thought to the cost. But on the supplier side why should an x-ray cost $1,100? Why should a night in the hospital cost thousands? Why should a 15 minute office visit to the doctor or specialist be $90-180? I wonder if market forces had predominated all along, would prices would be this high?
4. When did prices start going out of range? I vaguely remember as a child in the early 1960s that my mother paid the doctor cash when we visited. Only later did insurance start picking up the tab. At one time a doctor visit was considered affordable. My Grandfather, who was a doctor, surely did have some patients who could not pay, and I know he still saw them, but most could afford a visit a few times a year.
5. What role does technology play in costs? I realize that in the old days there was far less expensive equipment either available or used. Technology is expensive to be sure, but in other areas where market forces predominate, technology is still affordable. Very sophisticated computers, TVs and electronic devices that start out expensive, become affordable to the average person quickly, when market forces kick in. Is medical technology really all that different? Has the lack of a natural market due to third party payers meant that things have remained overpriced?
6. Malpractice Insurance is surely a huge factor. Is there anything we can do to limit frivolous lawsuits or limit the damages that must be paid? Can we stop suing each other so much?
7. What part has insisting that employers and government (more third parties) cover healthcare insurance played in driving up costs? Would insurance be more affordable if we all had to personally write the check every month? Would insurance companies compete more for our business? Would they have more incentive to help keep costs low?
8. I am personally happy to see “urgent care centers” beginning to spring up. So many these days run to hospital emergency rooms for what is not really an emergency, it is just urgent. They are not bleeding out, having a heart attack, or trouble breathing. They are not unconscious. They just have a headache that won’t quit, or have turned their ankle and fear it may be broken, or have a severe cold. Perhaps their doctor is away or it is a weekend or holiday. Urgent care centers perhaps with a doctor and several trained nurses may be a less expensive alternative. Can we develop more creative solutions like this?
Please understand these are real questions I am asking, not rhetorical points.
At the moral level I do think it is important for all of us to ask if we have not personally contributed to the high cost and increasingly unmanageable nature of the healthcare system. We don’t care what it costs, we don’t even ask what it costs. Our demand for unlimited care seems itself to be unlimited. We are part of the forces that have driven costs up.
I realize that healthcare decisions can get complicated. How long should I wait before I see the doctor? Is my ankle just twisted or is it broken and do I risk permanent injury if I don’t attend to it? These are not always easy things to answer, and most of us err on the side of caution. Maybe we should. But is cost never to be a factor?
Our even recent ancestors suffered through things we barely tolerate for a minute. In the old days when you went to the doctor with bad knees he’d hand you a cane and say “No more tennis for you.” We on the other hand demand knee replacement surgery and that others pay for it. Perhaps that is OK, but are there no limits? What part have we played in driving up costs by insisting that everything has to be fixed with no share in the cost other than our premium? And when the premium or co-pay goes up, we nearly hit the roof and scoff at the high price of medical care.
I want to say that decent healthcare available for all is certainly a pillar of Catholic Social teaching. But are there no limits to be accepted? Is it never legitimate to try and reign in the costs? Are there any limits of what others owe me in terms of medical care or at least in what I expect them to pay?
And a final bevy of questions:
Again, I am interested in your thoughts. I am not writing this post as an expert of any sort. I am asking questions as I try to formulate a moral point of view on the need to provide healthcare coverage to all but also to recognize necessary and reasonable limits.
I am also trying to start a discussion around the idea that we may have ALL had a role to play in driving up costs, and thus may have a role to play in bringing those costs down.
This video illustrates how third-party payments relate to escalating costs:
John Stossel: Insurance Makes Healthcare Far More Expensive
I am harboring a wish that Msgr. Pope will be named to replace Bishop Hubbard :-) ... Please!
I am also an Albany Diocese resident and I harbor the same wish!! Is it possible that it could ever happen?
The article is very well thought out and makes excellent points - Thanks for posting!!
Why has Lasik and cosmetic surgery costs dropped steadily in price?Could it be because insurance doesn’t cover it?
Why can’t veterans go to a local hospital or doctor rather than traveling 100s of miles to got to the Veterans clinic or hospital?
Why don’t we require hospitals and doctors to post an estimate for procedure if paid in cash. And a list of possible complications along with the estimate of handling those costs?
Indeed why don’t we require or set up a rating and comment system for all medical suppliers, so we can choose based on price plus independent comments by consumers?
Why don’t medicare and other government programs pay their fair share. At least an 95% of the average for the region?
more good questions.
Pope Pope I.
With all due respect to Msgr. Pope, there isn't a one of these problems, or its potential answer, that is not "political." Therein lies the problem.
However, his only staff was a receptionist. He did all his own basic lab work and never had an X-ray or EKG machine. The tools of his practice were only the most basic and he referred patients to specialists who needed care beyond what he could provide. He also filed all of the insurance, Medicare and Medicaid clams himself. In later years he often said he spent more time on the paperwork than he did seeing patients.
Today even the smallest medical practice has nurses and technicians to aid in patient care, EKG and X-ray machines, automated lab equipment and at least one person just to file the insurance, Medicare and Medicaid claims. My father, even with his most basic level of medical practice, paid about $3,000 a year for malpractice insurance, a rate that would seem ridiculously cheap by today’s standards. All of these costs must be reflected in what the patient is charged. In addition reimbursement from Medicare and Medicaid has been cut in recent years often to below the cost of providing the care. These costs then have to be shifted to other patients. My physician charges about $100 for a basic office call and allowing for inflation from my father’s day and the added costs for today’s medical practice that would seem pretty reasonable. In comparison, an electrician installing a ceiling fan in my home charges $200 and I pay $70 per hour for computer repair and at least $35 per hour to have a mechanic look at my car.
This fellow will probably never be named a bishop. He is neither a socialist nor a denizen of the left side of the bell curve.
I think that Pope Benedict has been names more and more Bishops from the right side, however.
Dear Salvation,
These things are, to a degree, relative. So, the new head of the CDF isn’t COMPLETELY sold on liberation theology, but he’s hardly “to the right.”
There are a few US bishops who are politically and economically not very liberal, but even someone like Dolan would be okay with DeathCare by Obama, if it were adjusted a little here and there.
That’s indecent and immoral.
sitetest
Great article.
A new urgent care just opened in my area. I haven’t been yet but I might.
Since I am a senior and have Kaiser, I am supposed to go to them. But I recently got new glasses and just didn’t claim any insurance at all.
They gave me a deal. I’ll take that, thanks. Look at all the paperwork time I saved them.
I’m pondering your answer. ALL the bishops came out with statements AGAINST Obamacare.
They came out against DeathCare by Obama because it includes abortion funding, contraceptive services, etc. (and that's not just the HHS mandate for “private” insurance).
They don't oppose the idea of government-run “universal” health insurance as generally envisioned by DeathCare.
sitetest
Marking
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.