Wednesday, February 01, 2006

Why Dede should wait before jumping off the Beverly Bridge.

I spent Halloween weekend living in my own private hell. I’m allergic to penicillin. That’s something I’ve known since I was a child. So my dentist gave me clindamycin for some problems I’ve been having with my teeth. Thursday before Halloween I broke out from head to toe in hives and a full body rash. I was a mess. I spent the next four days going from salt baths to calamine lotion. At one point my joints locked up and I couldn’t move without extreme arthritic pain. I wished I was dead. I couldn’t go to the hospital because I am without health insurance right now. For all the pain and discomfort I was in I was more afraid of the staggering bills I would be faced with if I saw a doctor. I did the only thing I could do in my situation. I suffered in ways no person should so that I wouldn’t burden my wife and our family budget with thousands of dollars in medical bills. I’ve heard that the average hospital inpatient is charged close to $5000 per day. I also knew that for all the bills I would generate the hospital would do exactly what I was doing. They’d take me off the antibiotics that caused the problem. They’d bathe me and cover me in lotion. They’d put me in a bed for observation and give me advil for the pain. That all comes after an uncomfortably long wait in an emergency room before you can be admitted. I know the triage mentality those weasels have. A rash gets ignored for hours if there’s a broken bone or other high dollar injury. It was four days before I could stand to put clothes on. It would have been about that long before I could leave the hospital.

This is in stark contrast to the treatment one can expect in veterinary medicine. New patient Barney was in the waiting room for barely ten minutes. He saw the vet tech as soon as we entered the exam room. The vet gave him a thorough exam and even educated us on preventative care procedures. He gave us medicine for Barney’s illness and treatments for fleas and hairballs, neither of which he suffers from but an ounce of prevention beats a stomach operation. The vet tech showed us how to give Barney his medicine and use the other treatments. We were in and out of there in a half hour, one stop shopping. We didn’t have to rush to make it to CVS to fill a prescription like we do when we see our own doctors. Total cost for a sick cat? $135 I’d say 100 times cheaper then similar treatment for a sick person.

I know you can’t compare people to pets but I will say this. Veterinary medicine is a bargain when you compare it to human medicine. Veterinary medicine is also much more streamlined and customer focused then the care people can expect to receive. In fact, right now we have a 2 tiered health care system. Those with insurance get crazy expensive procedures and those that don't get "Self Pay" on their charts and kicked out the door as soon as possible. Insurance has fostered a culture of consumer apathy on the part of the insured that has allowed the health care industry to jack up prices in this country far beyond what comparable care goes for in other industrialized countries. The procedures that the consumer can't get covered are very reasonably priced. Laser eye surgery for one. Claritin when it went OTC for another. The day insurance stopped paying for Claritin it went from $80 a month to $20 or roughly the equivalent of the out of pocket co-pay ie what the consumer and the market would bear.

Now I’m seeing rich weasels like Steve Forbes on TV pitching Health Savings Accounts in place of employer pays health insurance. I have to say given the current business climate that it sounds like and attractive offer. Basically instead of paying $8000 for my share of a pooled risk policy my employer deposits the money in an IRA style account. I’m free to use the money on any health care procedure or let it sit and compound interest tax free. When I was at Kidder, Peabody they paid close to $40,000 for an HMO plan that I didn’t use for 5 years. What I wouldn’t do for 40 grand so I can see a doctor today. That’s the beauty of this kind of plan, it doesn’t disappear if your employment changes. Use it now and lose it or let it sit and compound until you are older and will need it. It’s an instant incentive to take care of yourself as you’ll want to nest egg as much as possible rather then spend away. Do I need that cheesburger and carton of Lucky’s? Should I walk to work?

It also is an incentive to keep an eye on the medical bills you are racking up. Does that doctor really have to order all those tests or is he trying to get the insurance company to pay for his new MRI facility? When the consumer starts seeing the bills and prices you’ll see the free market spring into action to lower the price. Does junior really need all that Ritalin just because the teachers don’t know how to engage boys and interest them in the learning process? Not if it means I have to park in the city lot and walk through snow instead of parking in the company garage. Again, if the patient knows how much money is changing hands in the health care industry I'm certain prices would come down. Look at laser eye surgery. No insurance covers it so it's very affordable. Viagra is $10 a pill because it's covered on insurance. If it wasn't covered no one would pay $10 just to fuck their wife. Orthonovum or “the pill” would no longer be an additional expense. In fact I think it should be an acceptable expense out of any males health savings account too. I would gladly throw in on something that I may not be taking but am benefiting from.

The downside to this is that it will destroy the insurance industry overnight. How many employees would opt to stay in the old HMO Insurance racket knowing that they are likely to not stay at the job very long and would rather bank their healthcare spending for when they are out of work. Any employee who expects lifelong employment and retirement care at this point is deluded. I believe most employees will opt for a form of healthcare that will not leave them defenseless when they get laid off.

I believe only the currently sick or those taking care of dependents who need constant medical care will stay with the old system. The old system will crush under it's own weight rather quickly if they're no longer pooling risk with younger healthy employees who just want health insurance in case something bad goes wrong but generally never use their policy.

In any event, none of this stops people from purchasing insurance out of their HSA individually. It doesn't stop the insurance companies from selling policies. It might however bring the price of that policy down to where the many millions of uninsured Americans can afford it. In my case, my wife is an independent contractor in her field. We pay for her policy out of pocket so that we don't have to pay for the staggering cost of fertility treatments. I don't have insurance because the medical care I need monthly is less then the cost of a policy for me.

Now for the good news. Let the free market and the consumer take control of their healthcare spending and you’ll see a boom in cottage industries offering simple testing. Imagine the mall MRI and Sonogram facility where they do volume business in just taking the tests and having physicians in some boiler room interpret the tests. A quick $50 and you get a full body checkup that's just as good as sitting on that paper in the doctors office and being poked. Get an MRI every year and if something new starts to grow it shows up faster then a doctor would catch in his office with a flashlight and a stethoscope. Hey that spot wasn't on her MRI last year. Maybe she should go for further testing.

You'll see a new middle tier of healthcare technicians who are trained much like a pharmacist or dental hygienist to know what types of tests to recommend to certain types of people. I need a physical, I don't really need to pay a physician to run the tests. Tests interpretted as negative, no problem. Tests unclear or positive then it's off to see a physician. This means jobs, fulfilling and well paying jobs that don’t require 8 years and a quarter million dollars worth of tuition.

Is this the perfect solution? No but it’s a damn good place to start. Will there be some growing pains involved in rolling out this kind of plan? Yes. I’m willing to see public funding to start accounts for those most at risk of facing financial ruin while the economics are ironed out. Will this ever happen? Probably not. The Insurance Lobby will never roll over and let this one through.

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