Friday, July 24, 2009

Sick and Tired

There's been a lot of noise lately about health care policy. Congress is liable to pass some form of health care reform, probably in the form of universal health insurance for all Americans. Which is a nice goal, although it kind of misses the point, in my opinion. To an extent, it matters that everyone should be covered such that they can have routine access to doctors, affordable medicines, and so forth. But simply addressing the issue of who pays won't fix the underlying problems. That's only one side of the equation. The other side also needs attention, otherwise overall costs will continue to soar out of sight.

To illustrate some of the problems, allow me to relate a recent experience. Over the last several years, I have been suffering from cataracts. Well, "suffering" is probably too strong a word. It was a nuisance more than anything else. But it was something that really had to be taken care of sooner rather than later, so my eye doctor and I scheduled lens replacement surgery for this last January.

The day rolls around, and I go to the hospital for my procedure. There's some paperwork to fill out, and I pay my share of the cost beforehand. Then, a few hours later, I went home with a bandage over my eye and a thundering headache. But a week later, I was seeing more clearly than, well, ever. I was, and still am, thoroughly happy with the result.

Then the bills started coming in. Apparently, everyone involved with the procedure is an independent contractor, and has to get paid separately ... complete nonsense, if you ask me. Anesthesiologists are the worst. Near as I can tell, they only do their books once a quarter. So here we are, six months later, and I still can't say with certainty that I'm free and clear.

Like I said, complete nonsense. And it's nonsense that drives up the overall cost of doing business, I'm sure.

So, changing who pays the bills won't make a bit of difference unless some other changes go through as well. Here's a short list of my suggestions:

(1) Coordinate record-keeping. For crying out loud, guys, this is the 21st Century, here! Why in the world can't you all get together beforehand, settle up charges ahead of time, and present the customer with a single bill at the point of sale? We have the technology to do this. It's not even particularly hard. The patient's privacy is never endangered. What's more, it saves everyone time and trouble -- doctors and hospitals get paid faster, not slower, and the customer is free and clear. This alone would save immense amounts of time and effort in paper-pushing, and time is money.

(2) Tort reform. A non-trivial fraction of that doctor bill goes towards paying malpractice insurance premiums. Lawyers bear part of the responsibility for the ballooning costs of health care. Now, if the doctor truly did screw up, he is and should be liable ... but on the other hand, if he followed best practices and used good judgement, he ought to be left alone. We've gotten too sue-happy, and that needs to be dialed back quite a bit.

(3) Prevention. A lot of the health problems we are seeing these days are, in fact, preventable. Mind you, we can't mandate diet and exercise, but we can do more to encourage them. Tax credits for gym memberships, for example. And reduced rates on health insurance if you actually go more than four times a week. Granted, it's hard for someone working two jobs to find the time, but most of us aren't in that position. Most of us can find the time, if we really want to, and at the end of the day, your health is ultimately your responsibility. With a real push for prevention, with incentives, future pay-outs for health care can be reduced substantially.

There are probably other items you could add to this list. But my point is that focusing on the front-end financial part only solves half of the problem. If you ignore the other half, the system as a whole stays broken, which makes all the hard work fixing the first half wasted effort.

And we don't really have that kind of time, or effort, to spare.

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