By Hedda Haning, M.D.
Daily Mail (Charleston, W.Va.), March 12, 2013
What’s the matter with our health care?
For the vast majority of docs, their primary concern is to take good care of their patients. But the fact is they also have to pay their expenses and earn a living.
The way things stand now, providers carry much uncompensated care on their books. Their administrative overhead — for pre-approving procedures, re-submitting denied requests, appealing, billing and collecting payments — is huge.
Let me explain about usual and customary fees.
That is the fee the doctor “usually” charges for a given procedure. Insurance companies say they want to pay the doctor’s “usual and customary fees,” but doctors have learned from experience that private insurance companies will pay about half of what the doctor bills.
Doctors solve the problem by billing double what they know will really cover their costs so as to overcome the insurance company scam. This is an old game.
The big problem is that patients suffer, because uninsured patients are responsible for the entire “usual and customary” fee, proving it is usual and customary. They aren’t allowed to scam the billing numbers as the insurance companies do.
Uninsured patients always pay more if they can afford to pay anything.
Also, in the United States, private insurance overhead is at least 30 percent, a cost passed onto the payer. To clarify: the 30 percent does not pay for care.
In the private setting, overhead pays for administration (including repeatedly denying care), advertising and profit.
Medicare has a 3 percent overhead. It’s not Medicare that will bankrupt us; it is private insurance.
Around the world, advanced countries, all having some variation of a Medicare-like system, pay half of what we do and get better care.
Some suggest that employment will suffer in the United States if numbers of administrative personnel and costs drop because we switch to Medicare for All.
Actually we need more nurses taking care of patients in offices, hospitals, nursing homes, and helping students in school. We just have to prioritize and pay for their employment.
We need more primary care physicians. We need more mental health professionals, including school counselors. Employment will not be seriously at risk.
And just FYI, most medical providers in national health programs overseas have approximately the same income as docs do here. That is true even though we spend twice as much on health care in this country than any other developed country does.
Money wouldn’t seem to be a major issue for doctors, and most of them, particularly in primary care, want out of the “free” market.
Again, what most doctors want is to take good care of their patients; therefore, most doctors want single-payer health care or Medicare for All, as do most Americans when polled.
That means a system in which tests and treatments are not profit-driven, but rather depend on studies that show the best way to care for patients, and then provide the needed care for everyone.
I emphasize: While I am talking about public payment, the care is private. You would choose your own provider, doc or hospital.
Many folks don’t realize that the cost of drugs are tightly regulated elsewhere. Pharmaceuticals in all other advanced countries are as good as ours, but cost a fraction of those on our market.
Somehow the pharmaceutical companies manage to make a really healthy profit even overseas. They don’t have to bankrupt Americans to make money.
By the way, our Veterans Administration system, in recent years considered the model health care provider in our country according to outcomes and patient satisfaction, bargains drug costs way down.
Can the rest of us learn something here?
Did you know that employer-sponsored health care began during World War II to make up for the wartime wage freeze? That approach was useful then, but doesn’t work for us now.
More than 46 million people are uninsured or under-insured in our country even though most of them are currently employed.
Nearly 50 percent of personal bankruptcies are related to medical expenses even though more than 50 percent of the bankrupt had medical insurance at the time the illness began.
Unfortunately, we have even heard – including in West Virginia – of corporations declaring bankruptcy primarily so they can dump employee benefits, including health care.
Contrary to all rumors, according to rankings on every health care outcome from infant mortality to life expectancy to availability of high-tech equipment, our medical care is mediocre at best. We spend much more per capita than any other developed country and our costs are rising faster.
Let me repeat: Our health care is not the best in any way!
So our current health care system is not the best for patients or doctors, and it is not good for the economy either. Health costs weigh on employers.
Few small businesses can afford to pay for health insurance for their employees these days. Even large corporations feel the sting.
A few years back, it cost at least $1,500 per car for GM to cover health care for employees. It has to be higher now. Is it any wonder that more cars are currently made in Canada than in Michigan or the entire United States?
And from the workers’ point of view, if they do have health insurance, they feel unable to risk it by changing jobs. They can’t take that chance either to climb the skills or wage ladder.
Our national medical bill is well over a trillion dollars and climbing.
Health care the way we do it now, private and profit driven, is what threatens our future financial stability.
And that is in spite of the fact that millions of Americans don’t have any health insurance at all.
We can simultaneously make our health care system and our economy better by changing from private health administration to Medicare for All. We have to stop being gullible, and we have to stand for care before profit.
Learn more, and help us work for change. Please join us at 7 p.m. April 25 at the University of Charleston for an open public forum on Single Payer Health Care (and a comparison with the Affordable Care Act).
Haning, a retired physician, lives in Charleston.