Friday, June 29, 2012

The Affordable Care Act: Health Care Reform?

Photo: Wikipedia
No more suspense, folks!  The Supreme Court has upheld the Affordable Care Act.  My relief knows no bounds.  But there's still something that bothers me, and should bother you, too.  This law is not health care reform.  This law reforms and regulates how the insurance industry behaves toward customers and how it conducts business.  It also says that everyone is eligible for help in affording medical insurance.  I suppose it could be the first step in reforming health care...sort of.

What is health care?  As I see it, health care is what happens between you and your doctor, you and hospital staff, you and nurses, and you and any other type of medical personnel who provide medical services.  Is there really anything wrong with the medical care Americans receive?  The actual care, as long as it's provided by competent medical personnel, is some of the best in the world.  So what needs reforming?

The way the medical industry does business.  One of the huge changes that can be made is to stop the fee for service method for charging patients.  This encourages doctors to do more than is probably necessary in order to earn more money.  What if doctors were salaried workers?  Joe Klein, in the June 11, 2012 issue of Time magazine, wrote about finding the best care for his parents as they approached the end of their lives.  He found a facility that used the Giesinger model of care that included hiring doctors for the facility and paying them salaries instead of using the fee for service model.  The doctors focused on what the patient actually needed, and in some cases, it wasn't much.  This business model cuts costs and allows doctors to focus on the quality of care they provide a patient.

There also needs to be regulation and transparency of the contracts between insurance companies and medical providers (probably also between them and pharmacies, and pharmaceutical companies, if they have contracts with them).  It's understandable that these contracts establish the business relationship but what else do they do?  There is really no transparency.  Could I request and receive a copy of the contracts between my insurance company and my medical providers?  I doubt it.  And yet, I find on the Explanation of Benefits notifications "contractual codes" for allowable amounts as well as allowable procedures to bill.  The allowable dollar amount is usually smaller than the billed amount.  What happens to the difference?  I'm not billed for it.  I remember calling my insurance company about one of these codes and being told that it was "corporate" and "contractual."  What does that mean?  The customer service person could not tell me.  I don't even think she knew.  So my questions are: are these contracts really necessary and why are they such a secret?  Another question: what if doctors switch to salaries instead of a fee for service charge?  How would that affect the billing contracts between insurance companies and medical providers?

Pharmacies and pharmaceutical companies should also enjoy increased scrutiny.  I think they need to provide more transparency regarding any contracts they may have with insurance companies, and especially with the pharmas, more transparency regarding their accounting and budgets.  If the pharmas are going to use the costs of research and development to justify charging a high price for a drug, then I think the public has a right to see how much they spent on R&D.

I'm seeing a common denominator in all this, actually.  It's money.  The acquisition of it seems to take precedence over providing the services needed.  I've often wondered what the medical profession would be like if we took money out of it entirely.  Of course, how would the medical personnel pay their bills?  Would they have an incentive to do a good job for patients?  Of all professions, it just seems to me that medicine should be the one profession that offers their services to benefit the health of their patients and not their bank accounts.

We need to re-define value in this world -- how we value people and things, and why.  Money, as arbitrary a determinant of value as it is, has gained an amazing amount of power for something that's inanimate.  It exists way beyond an instrument of exchange.  What would a world without money look like?

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