18 February 2010

Why the HealthCare system doesn't work.

I remember when I was a kid, very few people had HMO's. Most had what was called "Indemnity Insurance". Basically the way it worked was very simple. You went to the Doctor, and you paid his fee.

The End.

What? You don't get it? Think of it this way. You have Auto Insurance. Do they pay for Oil changes? No? Why Not, it's Auto Care isn't it? You're right, it's not, it's Auto Insurance. Auto Care probably wouldn't work, because then EVERYONE would start taking their cars to get oil changes 4X a year, just as the Dealers all say we should, then what would happen. There would be an Oil Change Shortage wouldn't there? Prices would go up, but what would we care, we're not paying for it, the Auto Care takes care of that.

Sound ridiculous doesn't it?

Well that's is the problem with the Whole HealthCare system. Where once they used to get involved MAYBE once every 5 to 10 years, when there was some sort of an emergency, the $250.00 to $500.00 deductibles that most policies had, insured that the vast majority of people never used their insurance, which kept the price very, very inexpensive. Now they get involved not only with every Dr. visit, but also every prescription that is filled. Health Insurance companies went from having just a few hundred employees to deal with the occasional claim, to having to hire hundreds of thousands of employees to deal with every single instance of your Medical life. Does that sound cheap to you?

Additionally, how has the health insurance industry impacted the Dr.s Office? Let's compare.

Before, your average Doctor was housed in about a 1000 Sq. Ft. office with a Nurse that doubled as a secretary. In today's dollars, he only had a payroll of maybe $200K Total. If we were to suppose that the good Doctor had a total of about 240 business days in a year doing about 16 appointments per day. Charging around $50.00 a visit would cover his payroll, and he would only need to add in another 10 to 20 bucks or so to pay the Rent and Electric bills and other expenses.

Today your average Doctor needs a couple of Billing Agents to take care of the HMO and PPO Claims, they also need collections people, plus an accountant to keep track of where the money is coming from. Keep in mind that an average Dr. might take about 3 different insurance policies. Additionally, they need a secretary to co-ordinate the calls all these people are getting, plus an office Manager to keep all the employees in line. And let's not forget there's still him and his nurse. Now take a look at Payroll. It has swelled to about $500,000.00! Let's say this doctor had the same number of days, about 240, and does about 16 Appointments per day, one every half hour. Now he needs to charge over $130.00 per visit, JUST to cover the Salaries. Additionally, since he needs a larger space, more phone lines, electricity, computers, repair expenses... you now see why the good Doctor needs to charge around $240.00 for an office visit. How did your health improve?

America has traded the freedom of the medical system for a centrally run insurance conglomerate handling your day to day Medical needs for what? So we would be free of Paperwork? Someone STILL has to do the paperwork, but the Doctor's were NEVER going to do the paperwork for free. It's precisely this system of our NOT wanting to take personal responsibility that took us down this road. Only us taking back our personal responsibility will bring us back from this nightmare.

Before my wife went back to work, I had a Catastrophic Health Policy. It had a very high deductible, I NEVER used it, but it was there to cover JUST THAT, a Catastrophe. If everyone purchased Catastrophic insurance you would not only save THOUSANDS of dollars a year in premiums, but you could demand and get discounts from your Doctors, because you don't NEED the system that he has in place. You are paying him directly, not going through a front group of insurance companies and ultimately that saves him money.

The only reason we went back to an HMO is because the company pays for it. In all honesty if we were given a choice, to have the Cash in our pockets (a Catastrophic Policy with a $5000.00 deductible can be about $10,000.00 a year LESS than an HMO), we would take the Cash and go back to having a $5000.00 a year deductible. Truth is we still have to pay a $25.00 Co-Pay, so really what do we save? $50.00 to $100.00 an office visit? (When I had the Catastrophic Policy, I would negotiate with all the Doctors to let me skate on paying between $75.00 to $125.00 Cash).

HMO's and PPO's place the burden of the Paperwork on the Doctor. The Doctor then has to hire people not only to deal with the Paperwork, but also to collect money from the Companies, for something that the VAST Majority of Americans can afford to pay. He then has to raise his rates accordingly to pay for the expanded payroll. To top it off, we haven't' even talked about the number of people that Insurance Companies have had to hire to go from only occasionally dealing with someone filing a claim going over their deductible to dealing with EVERY SINGLE medical situation. All of these people are additional salaries that have to be paid for, when you pay your insurance premiums and the truth is that it is NOT sustainable. Considering the fact that Government tends to over-regulate things, I don't see them reducing the burden placed on Doctor's that would allow them to reduce staff. We should as a country reconsider the role of HMO's and PPO's in the Health Care debate as a way of curtailing the boom in health care expenditures. While it's clear that the bottom 10% can't afford paying $75.00 for an office visit, we shouldn't design a system with the bottom 10% in mind, that should be a supplemental system put in place AFTER the main system has been fixed.

We need to figure out a system that works for the top 90% of Americans, that lowers costs, keeps Medical inflation in check and gives us the freedom to choose who we want to take care of us. As I've said before, once we've fixed that problem, then we should design a supplemental system to take care of the poor.

1 comment:

  1. Why are we surprised that Health Care is so expensive in the U.S. When we went from paying our own Doctors Office visits, to having an HMO pay them for us, did we think that service was going to be inexpensive? The HMO has to hire thousand of people to deal with every office visit, and prescription filled. The Doctor's have to increase staff to deal the the HMO's, and their paperwork, it's a never ending cycle, where the HMO's put up more barriers and paperwork to pay out, so Dr's respond by hiring more people to deal with the additional paperwork. This will only get worse with more and more Government regulations. We need to go back to the old indemnity system, where the Insurance companies ONLY get involved when something happens that we can't afford. If Dr.'s can get rid of their Bloated staff, they can go back to charging $100.00 or less for an office visit. To say that we can't afford a $200.00 annual office visit, but we CAN afford an $1000.00 a month insurance premium is absolutely ridiculous. If EVERYONE eliminated their HMO's and went back to an indemnity system, Inflation in the Health Care system would come to an end, and then we can deal with real reform in the system.


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