Friday, November 30, 2007

Is there a health-care crisis in the US? The averages may say no... but the stories say yes

I've been drawn to write about the health-care situation in the US for some time. There have been very powerful proposals, such as this one by Michael Porter and Elizabeth Teisberg a few years ago, that I thought deserved advocating (link - $$).

In addition, for the past year I have bought my own health insurance (instead of having it provided by an employer) and with my wife managed the resulting insurer/caregiver/patient relationships. And, let me tell you, doing it yourself opens up a whole new window onto the health-care world. Buying your own insurance and managing your own care allows you to see deep into the sausage factory that is today's US health-care ecosystem.

Nonetheless, I held back. Perhaps our situation and experience were unique. Perhaps struggles and issues we had were due to our own mistakes. (We made some, perhaps many.) I also resisted the overheated rhetoric and drastic solutions proposed by some politicians. In addition, economists like Greg Mankiw provided analysis showing public concern about the issue is overblown.

The I read the front-page story in yesterday's Wall Street Journal by John Carreyrou (link - $$). It was horrifying to read about the gentleman who, despite better-than-average health-care coverage, ended up owing more than $1 million to hospitals, doctors, etc. And while the dollar figure was astonishing, more intriguing to me were the problems and issues he and his wife ran into while trying to understand and manage the bills. These problems and issues were very similar (though larger, of course) than issues my wife and I have run into in trying to manage health-care for our healthy family.

Typical issues include:

  1. Difficulty in getting billing and reimbursement details from caregivers and insurers
  2. Coding of invoices to maximize caregiver insurance reimbursement--not always accurately reflecting what was done
  3. Frequent rejection of charges by insurers, causing the patient to intervene to try to not pay more than is appropriate (a difficult task--see issue #1)
  4. Onerous collections procedures (at my former company, we used more care and respect in trying to collect a $10 phone bill than many caregivers and hospitals use in trying to collect bills amounting to hundreds or thousands of dollars--bills which are usually in dispute)
  5. 200-300% price differences between insurer-negotiated prices and those consumers must pay for the same product or service
In the Journal article, there is a happy ending--sort of.
Earlier this week, Mrs. Dawson was contacted by a CPMC official with surprising news. The hospital said Mr. Dawson had qualified for financial assistance under its charity-care policy and wrote off his entire bill. Asked why the Dawsons hadn't been told they could qualify for charity care before a reporter contacted the hospital, CPMC said Mrs. Dawson never gave it the opportunity to explain its policy to her.
Of course, blame the customer. That is an old strategy which my wife and I have encountered often in working with the health-care system.

So while I can't argue with Prof. Mankiw's math, his figures reflect broad averages which bleach out the real pain and injustice suffered by many. (Prof. Mankiw has been fortunate enough to have two of the world's great health-insurance providers--the Federal Government and Harvard University--as employers.) And, I would wager, given that companies are pulling back more and more on their health-insurance benefits, more people are becoming responsible for management of their own health care--meaning an increasing number of people will get to experience that pain and injustice, unless the system gets some real reform. (Politicians, please read the Porter/Teisberg paper!)

The averages say the situation is fine. The stories paint a very different picture.

We expect from the health-care system compassion, fairness, respect and dignity. Often, in the doctor's office or the hospital, we get them. Once the subject shifts to money and payment, however, they vanish into the air like smoke.

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Melissa said...

It seems that people either think that our healthcare system is one of the best, and some who think it needs astonishing reformation. I, myself, am the latter; Even with programs like Medicare, it seems people aren't getting enough help. That's why I'm working to support AARP in their petition to reform Medicare; go to and you can see videos and sign the petition. They even make it easy to write your Congressman and let him know how you feel. It's time we are listened to!!