It seems in the past an insurance company role was to assess risk and based on the results, established policy coverage terms, set prices and issue policies. This resulted in the insurance company receiving premiums and making payments, as required, to the policy holder. Insurance companies weren't seen as 'the' most important player in 'minimizing' the policy holder risks....nope...the policy holder was held accountable for minimizing risk.
Today the health care discussions are focused on what is wrong with health insurance companies. These companies are, and should be, criticized for their policies on 'pre-existing conditions' and always pushing back on claims before making payments. I also wonder when they became the experts on our health care experience so that we hold them responsible for correcting the inefficiencies? It is bewildering to me how they ended up in this role and whether they should have the role, I think not. Heck, when it come to health care reform I'd just like to get a consolidated bill from the labs, doctors, technicians etc. for diagnosis and treatment for a health issue.
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Okay, so the insurance industry is motivated to lower claims by educating their policy holders. That seems like a good strategy. But it costs money to do that potentially putting upward momentum on pricing.
ReplyDeleteIn healthcare, it appears insurance companies are using a hammer to keep costs lower. Either not reimbursing at 100% of clinician/hospital fees or not covering a procedure at all. The Medicare program seems even worse, discussions of 20% cuts to doctors, where is the justification for this?...how does this make sense for improved healthcare? Lowers cost but also would have a significant impact on
a. type of person who wants to begin a career in the field of medicine and
b. lowers the amount of time doctors spend with a patient....
either case doesn't seem like a positive outcome.
Why don't we find a way to motivate (read as tax incentives, federal funding, establishing standards, etc.) the health care industry to lower costs through integrated health care record keeping, fewer low value maybe unneeded procedures, adding health care patient advocates that can assist in making sense out of a treatment series.
Bottom line, I don't hold the insurance companies responsible for making this happen. Yes, they probably do have a role but the real issue is the patient demands and doctor/clinician inefficiencies.
Walmart and Government Health Care
ReplyDeleteThe proposed Government run health insurance option reminds me a lot of Walmart coming into an area once with many small businesses. In the short term, both Walmart / government can reduce the consumer/patient prices. In the longer term you have to wonder about what the implications are. For Walmart, the method of lowering cost to the consumer rides on the back of the suppliers. What I mean by this, because of their overwhelming buying power with most suppliers they can demand an arbitrary lower price. This most often means a loss of supplier employment levels, lowers existing US employee wages or off-shores production in countries with lower wages. All of which have occurred on a regular basis. The government will fundamentally do the same thing. Sitting in Washington they will mandate that hospitals, doctors, pharmas lower their costs by some arbitrary amount which will have the same effect as the Walmart example. The hospitals/doctors/pharmas will attempt to cut their SG&A costs but if unable to realize the savings there are only a couple of options. One, they won't accept patients with the government insurance including Medicare or they have to lower staffing levels or wages.
In both cases the US middle class wage earner base shrinks some more resulting in either more un-employment or lower overall living standards. Why don't we address lowering health care costs through real reforms and efficiencies, not slam an arbitrary reimbursement rate on the industry?