Earlier today, I saw an intersting tweet on Twitter that I decided to reply to. (Yes, you can follow me on Twitter: swdowling). And, I received a public reply back from the other tweeter (aka tweep) – and I replied again, also publicly.
The tweep – I am using this reference to remain gender neutral here, since I won’t name names, either (See below) – is not receiving payment for a prescribed plan of treatment. The tweep is misconstruing the withholding of payment for the withholding of care.
As consumers, we need to change our perspective and actually act like consumers rather than entitled children who do not get their way. I know that sounds harsh, but it is the reality of the situation for which I don’t really have a better analogy. And know what you are buying when you purchase the insurance policy. If you don’t know or can’t figure it out on your own, ask for help! Ask a trusted broker that you know. Ask me. Just ask – and know what you are buying ahead of time of claim. Get engaged!
The initial comment that got my attention dealt with the tweep’s suggestion that the insurance company should not be practicing medicine – nor should the insurance company be telling the doctor what type of treatment to follow or questioning the doctor’s professional opinion. The tweep said, “the problem of insurance companies practicing medicine by preventing people in pain getting what the physician order.”
I have never heard of an insurance company practicing medicine – so I asked which one was, indeed, practicing medicine. Further, I asked what the doctor and pharma company were charging for the drug regimen. And, I asked why they charged what they charged.
The reply was of no help and included a comment that the tweep would not name names (ergo my use of gender neutral “tweep”). “My feeling is that any [insurance company] which override the doctor’s professional judgment are interfering in my healthcare. No names in public.”
If I was a fellow policyholder of this tweep’s insurance company, I would be happy that the insurance company did not just pay whatever the doctor and pharma company decided to charge. Eventually, I (and every other fellow policyholder) would be paying for this tweep’s doctor and pharma company charges at time of my/our renewal – by way of higher premiums – in order to cover the unreasonable and non-agreed to costs of the tweep’s care from the year before.
Until we collectively treat our health care providers like the car saleseman, home builder/seller, grocery store, or even insurance salesman, we will not reign in the rising cost of medical treatments and medical care.
Market forces and competition solve cost issues, not government regulation. The fact that Walgreen’s, Wal-Mart, Target and others are delivering remedial medical care – the highest volume of care and the same that you might receive in a doctor’s office visit – says that there is a profitable way to treat this segment of health care in a less expensive way. No Congressmen needed!
Changing you personal health care consumption habits will go a long way to solving our health care cost issues. Change your perspective. Act like a consumer, not an expecting and dependent child.
How might you change your perspective on consuming health care?
{ 3 comments… read them below or add one }
Scott,
I understand your point and can appreciate it. Most people don’t make an effort to understand what they are buying in terms of insurance coverage. But your Tweep’s conclusion, that insurance companies have a conflict of interest when paying out claims or approving procedures, drugs, etc is not unreasonable. Insurance companies are notorious for placing every single barrier possible to not payout claims. Their entire business model is based on paying the least amount of claims. And it is not uncommon for them to disregard a doctor’s recommendation despite what the policy says. They often change the rules, decide what is and isn’t appropriate level of care and for the most part are the complete antithesis of transparency. http://www.insurancecompanyrules.org/
Lastly, in terms of curbing health care cost I think there are many different ways we can reduce the cost of health care. I would start with removing the power insurance companies have over hospitals, providers and patients; and reforming the US’s legal system with respect to medical malpractice.
Once we address them both, we will be able to buy health care the way we buy a car, consult with an attorney or hire a contractor.
Well said, Brandon.
Insurance companies are not angels and certainly need reform. Transparency will solve all issues on both sides of the equation. See my post on Loss Ratios http://www.insuranceinthelight.com/?p=18. Insurance companies can certainly explain how pricing is created and remove the shroud of secrecy.
I do not see the insurance companies as wielding omnipotent power over providers. Before Medicare insurance companies had no power.
With the advent of Medicare, providers saw a profit center with no limits. By having patients sign assignment agreements, thereby claiming the legal rights to the insured's insurance benefits, providers knowingly put themselves at the discretion of the insurance company to pay them. This all worked well while Medicare paid whatever the market would bear. Now, it's a different story.
See Maggie Mahar's Health Beat Blog <a href=”http://www.healthbeatblog.org” target=”_blank”>www.healthbeatblog.org and read her book, "Money Driven Medicine". Medicine did not used to be a money making industry. Medicare was the goose that laid the golden egg.
When purchasing a car, we negotiate for the car first, then look to pay or finance it.
We can do the same with health care right now. We just have to choose to do it.
Thanks for your comment.
Keep them coming.
Scott, you very clearly make this point and I'm glad to find someone who does so! It frustrates me to watch the #HCR hash-tag on twitter and see so many people kicking and screaming for their slice of the "free" pie that the current administration is selling, somewhat deceptively I believe.
We *are* consumers and unfortunately there are those who think that is bad, who subscribe to Michael Moore's flawed assertion that capitalism is the root of all evil. Capitalist measures should be the reform we strive for, not government take-overs of our liberties.