January 2010
Ken Schields
Health Care Change 2010 - It’s Time to Think Cost
The emerging second decade of the second millennium is poised to present a plethora of challenges to the American public. Arguably, the one area that holds the most mystery has to be the two-plus “millennia” page health care legislation that will undoubtedly have a major impact on everyone. Not all good! Exactly who the winners may be is still anyone’s guess. The big issue at stake is if the American health care consumer will continue to be the loser. There has been very little concrete discussion about cost reduction. What strategies are going to be included in the final bill that will truly lower cost? Expanding the insurance pool? Decreasing Medicare payments? Eliminating overuse and abuse of expensive technology? Tort reform? Decreasing drug costs? Fighting fraud? Placing limits on the administrative costs of insurance companies? A public option for medical insurance coverage? What is going to work? Then again, what is the role of the American health care consumer?
Will we continue to be spectators or are we going to take an active part in our health care? It is well beyond taking control of our personal heath. Health care is a business and must be approached the same way we buy a car, cell phone, house, groceries and essentially any other consumer product. Although most of us are obscured from actual medical costs by our insurance coverage, we must take a broad look at what we are paying. Hopefully our eyes and minds have been opened by the wide spread economic malice of the past few years. It’s been a very rude awakening for all too many unfortunate Americans. The greed fueled abuses of our financial sector are also rampant in our health care industry. Unfortunately, much of it is legal and/or flies below the radar of the impotent watchdogs and regulators. What can we do?
First, do the numbers - or “metrics,” which seems to be the new euphemism. Answer a few questions?
How much are you paying for health insurance?
How much is your annual deductible?
How much are your co-pays and co-insurances?
Do you know what each of those terms mean – and the ramifications of each on
your checkbook or credit card statement?
Have you ever forgone a treatment, procedure or ancillary care due to the above?
Do you review the EOBs (Explanation of Benefits) that you receive from your doctor, hospital, other health care provider AND insurance company or Medicare?
Do you compare them? Do you follow up if (when!) you find discrepancies?
Other questions for consideration:
Do you ever ask your doctor why is that MRI, CT scan, or other expensive test
necessary? Or, why is it needed at all? Then again, if you have a good
relationship with you doc, ask why they spent so many years in medical school if
all they do is order MRIs, etc?
When you are prescribed or referred to any additional or ancillary services by the
doctor do you ask if they have any financial interest or actual ownership in the
business to which you are being referred.
Did you ever question why many hospitals (both for profit and non-profit) own
physician practices and limit or prevent referrals outside the hospital system?
(Truth be told… That’s an answer you will never get in writing.)
Did you ever look at the web site taf.org and review the top 20 or 30 False Claims
actions against the health care industry during the last decade? (At last count 19
of the last 25 are in health care and resulted in billions of dollars in settlements.
The key word here is SETTLEMENT. Just try to find out who, if any, went to jail)
This is just the tip of the iceberg. Do your homework or pay the price!
