raystone
05-13-2009, 06:58 AM
This was a blog response on Daily Paul. One of the best pieces I've seen written on the issue. Edited slightly to allow stand alone posting and emailing.
I am a private practice anesthesiologist. The AMA and our professional organizations are not responsive to those of us who desire free market solutions. If I ran health care: we'd all have bare-bones catastrophic health care insurance with high deductibles and contribute monthly to an HSA so that the deductible can be met with those saved funds when the need arises. Those funds are tax-deductible and carry over year to year.
This is the true purpose of insurance - to meet unexpected needs. We don't file on our car insurance for each oil change or homeowner's when we replace a ceiling fan - the costs would be outrageous. Similarly, I don't think that in-vitro fertilization and the most recent expensive drugs should necessarily be covered under a basic plan - this is expensive. I also don't want to pay for the country's obstetric care. That is a service that I would choose to exclude from my plan and pay for myself. My wife and I have such a plan through Assurant Health, and we pay about $150/month, then contribute $400/month to our HSA (which is our money to keep).
The result would be that we'd all pay out of pocket for routine care, but we wouldn't be paying $500+ (employee/employer contribution) to an insurance company's bureaucracy and CEO. Private payments would introduce competition among physicians. I would be very amenable to altering fees had I control of them. Not only that, but having personal financial responsibility for our health care would lead us all to have healthier behaviors and to use that care as wisely as possible.
Personally, as a physician, I would love to be able to discuss a payment schedule with my patients, and to offer charity care to those that I feel merit my charity. As I understand it, I AM NOT ALLOWED! If I offer a deal to a patient that is lower than Medicare's reimbursement, then I am guilty of Medicare fraud by overcharging the gov't what I accept from another patient. (Gov't reimbursement, BTW, is often as low as 30% of the billed amount which leads to overcharging of private patients by hospitals and doctors to compensate.) Likewise, the insurance companies control my reimbursement. As a member of a group of physicians, I never see the final outcome of an individual's bills that may or may not be paid in full over the course of the 90+ day reimbursement process. I am very removed from the entire process as it takes teams of accountants and office staff to deal with the complexities of coding and billing.
Insurance companies, IMO, are as much of the problem as the government. I don't know what the administrative portion of our health care premiums is, but it must be huge. When I provide the actual physician service, but the insurance company paper-pushing CEO makes 10-100 times that of any of my colleagues, there is a problem. Cut out the middle man, and imagine what could happen if we returned to an actual doctor/patient relationship.
Also, imagine this: when the government becomes my employer, I am no longer your physician. I also, am no longer a professional - my autonomy will have been stripped from me. I become a resentful, underpaid technician trapped in a bureaucratic hell. I've worked in the VA system. I know what it will be like. I just want to be left the hell alone to practice my profession and offer my services at a price that a patient and I can agree on. Just like I call on my plumber or mechanic to offer me services that I cannot provide well for myself. It isn't always cheap, but it is a free market. And I can pick up the phone book and compare prices.
The more we can minimize government and third-party intervention, the more competition will be allowed to exist for market-driven, productivity based health care between a doctor and patient.
This is an opinion from the inside of health care. Give these things some thought.
I am a private practice anesthesiologist. The AMA and our professional organizations are not responsive to those of us who desire free market solutions. If I ran health care: we'd all have bare-bones catastrophic health care insurance with high deductibles and contribute monthly to an HSA so that the deductible can be met with those saved funds when the need arises. Those funds are tax-deductible and carry over year to year.
This is the true purpose of insurance - to meet unexpected needs. We don't file on our car insurance for each oil change or homeowner's when we replace a ceiling fan - the costs would be outrageous. Similarly, I don't think that in-vitro fertilization and the most recent expensive drugs should necessarily be covered under a basic plan - this is expensive. I also don't want to pay for the country's obstetric care. That is a service that I would choose to exclude from my plan and pay for myself. My wife and I have such a plan through Assurant Health, and we pay about $150/month, then contribute $400/month to our HSA (which is our money to keep).
The result would be that we'd all pay out of pocket for routine care, but we wouldn't be paying $500+ (employee/employer contribution) to an insurance company's bureaucracy and CEO. Private payments would introduce competition among physicians. I would be very amenable to altering fees had I control of them. Not only that, but having personal financial responsibility for our health care would lead us all to have healthier behaviors and to use that care as wisely as possible.
Personally, as a physician, I would love to be able to discuss a payment schedule with my patients, and to offer charity care to those that I feel merit my charity. As I understand it, I AM NOT ALLOWED! If I offer a deal to a patient that is lower than Medicare's reimbursement, then I am guilty of Medicare fraud by overcharging the gov't what I accept from another patient. (Gov't reimbursement, BTW, is often as low as 30% of the billed amount which leads to overcharging of private patients by hospitals and doctors to compensate.) Likewise, the insurance companies control my reimbursement. As a member of a group of physicians, I never see the final outcome of an individual's bills that may or may not be paid in full over the course of the 90+ day reimbursement process. I am very removed from the entire process as it takes teams of accountants and office staff to deal with the complexities of coding and billing.
Insurance companies, IMO, are as much of the problem as the government. I don't know what the administrative portion of our health care premiums is, but it must be huge. When I provide the actual physician service, but the insurance company paper-pushing CEO makes 10-100 times that of any of my colleagues, there is a problem. Cut out the middle man, and imagine what could happen if we returned to an actual doctor/patient relationship.
Also, imagine this: when the government becomes my employer, I am no longer your physician. I also, am no longer a professional - my autonomy will have been stripped from me. I become a resentful, underpaid technician trapped in a bureaucratic hell. I've worked in the VA system. I know what it will be like. I just want to be left the hell alone to practice my profession and offer my services at a price that a patient and I can agree on. Just like I call on my plumber or mechanic to offer me services that I cannot provide well for myself. It isn't always cheap, but it is a free market. And I can pick up the phone book and compare prices.
The more we can minimize government and third-party intervention, the more competition will be allowed to exist for market-driven, productivity based health care between a doctor and patient.
This is an opinion from the inside of health care. Give these things some thought.