Health care reformers are passionate on all sides. Each side commissions studies that support their point, and another side fires back with their own study conflicting the first. The message is lost, and average Americans are struggling to make sense of it all. There’s finger-pointing, placing the blame on someone else, when instead we shouldn’t be worried about who is right, but rather what is right.
Blaming opposing political parties, government, or single industries isn’t going to address what’s really bringing down health care costs. So yesterday both parties came together to address Obama’s health care plan at a White House health care summit.
After watching the coverage last night, my mom called and went off about the health care debate. She said she just felt confused and didn’t understand who was right and who she should believe. She was hearing from Republicans, Democrats, even her health insurance company - all with differing messages on what reform should look like. And she wondered who to believe.
I told her – what does it matter? What matters is, were in this mess together. So let’s fix it together. Stop the blame game, and let’s come up with a real solution to address rising health care costs. I think we’re all for the same thing: a sustainable system that Americans can afford.
If you want to talk to your Congressperson about curbing health care costs you can send them a message through Regence’s Issues and Action center. Or if you just want to learn more, here are some resources you can visit:
http://americanhealthsolution.org/fact-check-what-causes-premiums-to-increase/
Top 10 Health Care Cost Drivers
More on health insurer competition
http://www.aarpmagazine.org/health/health_care_costs.html
Friday, February 26, 2010
Thursday, February 4, 2010
The Reimbursement Riddle
Do you pay the same for your McDonald’s meal as the guy behind you in line at the drive thru? Or better yet, should you? That’s the type of question the Massachusetts Attorney General (AG) is asking after a statewide investigation of health care costs.
The results of the investigation indicate that various insurers and consumers were paying different rates for the same care in the same hospitals. It turns out that the hospitals negotiated different paying agreements with each party. And this drove up health care prices – for one major insurer in Mass., provider price increases accounted for 80 percent of total medical growth – according to a recent article in the Boston Globe.
Don’t get me wrong, I like it that my insurer (and employer) Regence, negotiates good discounts for me. That’s part of the advantage of belonging to a group. But negotiating is a two-way proposition. Like in Massachusetts where the AG found that some providers negotiated higher prices for themselves, even though their outcomes (the outcome of the treatment or procedure) weren’t any better.
This all reminds me of the time my daughter was in the hospital. Every single day the case manager visited us and asked when we were leaving. Turns out my insurance coverage paid one flat fee for service, regardless of the time we spent there. In turn, the hospital wanted us out of there to open the bed to someone else.
Meanwhile, there was a child in the same room as my baby, with the same condition – and no one hassled those parents about discharge – they had different insurance coverage. So was that provider treating my daughter differently because of the way the reimbursement model was structured?
Which opens us up to ask – should negotiating these prices be allowed? Or should providers just post their prices, and insurers just set the prices they will pay – and let consumers sort out the difference with the providers? Are any of us ready for a system that operates this way? I’m not faulting the hospitals – they have staff to pay, technologies to keep up, and more. And I’m not faulting Regence or Tricare for their position, but I am faulting the system for allowing this type of reimbursement model to exist.
Maybe we should focus on other ways to curb costs – like incentives that make us stop and think about the resources we’re using, and that others are sharing the cost of. Incentives like discounts on coverage for extreme weight loss, or smoking cessation. I’m sure there are numerous ideas out there t hat would work, and I would like to hear yours.
The results of the investigation indicate that various insurers and consumers were paying different rates for the same care in the same hospitals. It turns out that the hospitals negotiated different paying agreements with each party. And this drove up health care prices – for one major insurer in Mass., provider price increases accounted for 80 percent of total medical growth – according to a recent article in the Boston Globe.
Don’t get me wrong, I like it that my insurer (and employer) Regence, negotiates good discounts for me. That’s part of the advantage of belonging to a group. But negotiating is a two-way proposition. Like in Massachusetts where the AG found that some providers negotiated higher prices for themselves, even though their outcomes (the outcome of the treatment or procedure) weren’t any better.
This all reminds me of the time my daughter was in the hospital. Every single day the case manager visited us and asked when we were leaving. Turns out my insurance coverage paid one flat fee for service, regardless of the time we spent there. In turn, the hospital wanted us out of there to open the bed to someone else.
Meanwhile, there was a child in the same room as my baby, with the same condition – and no one hassled those parents about discharge – they had different insurance coverage. So was that provider treating my daughter differently because of the way the reimbursement model was structured?
Which opens us up to ask – should negotiating these prices be allowed? Or should providers just post their prices, and insurers just set the prices they will pay – and let consumers sort out the difference with the providers? Are any of us ready for a system that operates this way? I’m not faulting the hospitals – they have staff to pay, technologies to keep up, and more. And I’m not faulting Regence or Tricare for their position, but I am faulting the system for allowing this type of reimbursement model to exist.
Maybe we should focus on other ways to curb costs – like incentives that make us stop and think about the resources we’re using, and that others are sharing the cost of. Incentives like discounts on coverage for extreme weight loss, or smoking cessation. I’m sure there are numerous ideas out there t hat would work, and I would like to hear yours.
Subscribe to:
Posts (Atom)