Monday’s posting about doctor’s salaries received great responses. Most were in agreement that they feel doctors are paid a fair wage based on the service they provide. Not surprisingly, folks couldn’t help but mention some of the other things they view as issues in the healthcare system. Since my last post did not stir up a lot of controversy, I will try again with some of my views and questions about the upcoming reform.
Admittedly, this will be stream-of-conscious, but the underlying theme is focusing on applying logic from my experiences to what I currently understand the changes to be. This site is meant to help people think about their personal finances and I think that, when dealing with political discussions, it is helpful to draw on your personal experiences to extrapolate where you stand and what you predict will happen. Again, my main concern is to point out what people might expect as a change to their personal financial situation. That said here are one man’s (me) questions.
What is Insurance?
I will start with what I think might be the most controversial. Very few people will argue against dropping the insurance practice of denying coverage due to pre-existing conditions. But, the very basic premise of insurance is underwriting for risk of payout. If you insure people who are recognized as requiring more to take care of than their premium will cover, where is that money coming from? I read an article about the NFL being approached to advertise to young people to enter the exchanges to mitigate the cost of sick and elderly people. According to this article, the NFL declined and now actors and actresses are being approached. This makes me sad that 1. young people would not be interested in understanding what is happening unless an athlete or actor told them it was important and 2. that they are being asked to foot the bill for the older population. Sound a bit like social security?
Back to insurance, should safe drivers pay higher premiums to offset the cost of insuring accident-prone drivers? Granted, the ability to drive vs. being healthy are two different things and certain illnesses cannot be helped. Should there be any consideration to health issues caused by voluntary decisions (overweight, risk- takers, or smokers for example) vs. involuntary? In the current system, insurance companies play the role of the bad guy, but I often wonder how that will play out if the government becomes that bad guy deciding what is and is not covered. Bottom line, no one ever wants to be the person to say that nothing more can be done for a sick person but, unfortunately, that sentiment does not coincide with the insurance model.
One of the most interesting moves I have seen in the early stages of healthcare reform was in response to the requirement that 85% of premium dollars must be spent on healthcare. In response, the company planned to approach doctors with the incentive that instead of reimbursing members this money, they would give it to them as a bonus for controlling the member’s cost. This sounds a lot like what insurance tries to do to begin with – make a profit by limiting the member’s benefits. This also shows how, no matter what the law, people are always going to look for and find ways around it.
One commenter from Monday mentioned that teachers, like doctors, are underappreciated and that it is unfair that their wages come into question. I agree with the sentiment that teacher’s salaries are low. While on the topic, one of the prime complaints from teachers unions is that they cannot be rated based on standardized tests because inner-city schools have less motivated students and it is not a fair rating for those teachers. Is it just me, or is this same logic being applied to doctors? Why is it their fault if someone abuses the ER or does not follow direction given from the physician? Perhaps doctors will need to form a union soon.
What is Driving Up the Costs?
Anyone who has looked at a medical bill can see how expensive hospital visits, procedures, and drugs are. As one commenter noted on Monday, it would be nice to see these costs up front and not a surprise on the back-end. This would certainly help consumers make more informed decisions. Working in health insurance, one of the biggest shocks to me was the disparity between what is billed and how much an insurance company actually pays. Why bill so much when you will accept so much less for the service? One reason is, just like other businesses, providers pass on costs of lost revenue (via low Medicaid reimbursements and uninsured patients) to the other customers. The ER is not going to refuse a patient that is not insured, but they expect to make it up somewhere else.
To me, one of the biggest offenders are drug companies. I understand that, like doctors, they offer a valuable product but when there are instances of companies trying to change certain drugs just enough to avoid generic alternatives being made or the endless ads trying to get people to ask their doctors for brand name drugs, I get pretty irritated. Personally, I have not met a doctor that has recommended a brand name over a generic for anything.
The part that I really question in regards to what will occur with healthcare reform is malpractice and overall regulations for billing and tracking. There are plenty of administrative needs in a provider’s practice to keep up with regulations and these folks must be paid. I imagine this will only get worse with new regulations. One example is the requirement for providers to use electronic systems for notes and records. Is this a good use of an older doctor’s time who can see many patients a day because they are well-versed in their field, but now have to mess with a computer system that they never had to before? And then there is the issue of malpractice. It is very expensive and is the reason for excessive tests. Doctors must protect themselves from lawsuits and they have to make up the cost somewhere.
Can there be Patient Preference?
One thing that I have struggled to find clarification on is any requirement of providers to see certain patients with certain coverages. What I mean is many people are concerned that with lower reimbursements and more regulation, less people will want to become doctors. That, combined with more people being insured, means a high risk of longer waits. What is to stop a provider from excluding certain plans with lower reimbursements or offering priority visits for people that pay an additional fee? I understand that this sounds like a terrible concept but the point is that people will do what they need to so as to maintain their quality of life. If the above scenario is not possible, then how many hours are required for a physician to see insured patients and could they do that minimum amount and devote the rest of the time to fee for service scenarios outside of healthcare reform? Finally, my biggest (and saddest) question is will providers devote more time to things like cosmetics to supplement their income because it will not be regulated?
I need to do more research on these items and I do not know the answers of how much wiggle room providers have to be selective about who they see. I came upon an interesting blog called Doc For Change. The author is a physician from New York who is posting about his progress as he reads the entire bill. I will stay tuned for that and likely pass some of the above questions his way.
What About the Morals?
Another troubling point for me is deciding what is covered. Abortion comes to mind. There are people that are morally opposed to abortion. If you Google “does Obamacare cover abortion”, you will see articles from both sides of the coin. One side argues that because some plans will cover it and others not, that those morally opposed can prevent their money from helping fund abortion. The other side argues that plans do not readily disclose if they cover abortion or not and, they will have a decision to make if the overall plan with abortion included is better for them than the plan without. Again, this is a slippery slope of the government being part of moral questions. It is one thing to discuss legality, it is another to help fund it.
Is Anything Positive at This Point?
There are the obvious things to point to that should be good for people. More patients ensured and the allowance of dependents to stay on their parents’ policy up to age 26 come to mind. Forbes wrote this piece showing that it appears some of the inflation in healthcare is leveling off and they will continue to monitor for trends. I certainly hope to see some of the positives and that I will be able to report a help rather than hindrance to people’s financial outlooks.
With every post I write, I continue to be impressed with the knowledge and reasoning of people that visit. This is certainly one of the most emotionally charged and relevant topics of the day. It is my intent to simply continue raising questions and keep people engaged rather than sway opinion. Right now, I am very nervous about what the changes will mean to my financial bottom line, but I want to be fair and continue revisiting the topic to see if any changes to my outlook come about and I can share any tips I’ve found.
How are you feeling about healthcare reform? Are you preparing in any way?