Congratulations to Congress on passing a bill that slaps a band-aid on the health care problem in the United States. Most would agree that more than a band-aid is needed to cure something that is hemorrhaging money, but everyone can pat themselves on the back for applying a few stitches and gauze when a tourniquet was needed. Forcing people to get health insurance or they’ll pay a fine, forcing companies to provide health insurance or they’ll pay a fine, and providing health insurance to people who can’t afford it might lead to a greater number of insured, but it does nothing to address the biggest problem facing healthcare worldwide; cost.
Healthcare premiums for most people and companies have risen to astronomical levels, with some paying double and triple what they did even a few years ago. It is easy to blame the health insurance companies for this but the problem is more pervasive. Unfortunately many health insurance companies are publicly traded (including the one I work for). As anyone who works for a public company knows, Wall Street forces the hand of companies to increase their profits and margins and revenues or risk a crumbling stock and worthless company. Shareholders demand that health insurance companies make money. So yes, insurers are in the business of making money, but for most the margin is a measly 4% (as opposed to most industries who are well over 30% profit margins). Many argue that health care should not be a for-profit business and some states have made it mandatory for certain plans to run as not-for-profits. Perhaps more research should be done on how making health insurance (as well as hospital systems) non-profits could lower the overall cost of healthcare (but after I liquidate all my stock, thankyouverymuch).
Doctors in the US are in business of making money just as health insurance companies are. Doctors have offices to keep open, malpractice insurance to pay for, and medical school loans that rival many of our mortgages. Many countries with socialized medicine also subsidize Med School for their best and brightest. Those governments cover malpractice issues and provide the facilities which the doctor’s practice from. Until we can provide the same for doctors in our country they will continue to charge high amounts to cover their start-up and continued costs.
Health insurance is responding to the ever rising cost of healthcare. Healthcare costs rise faster than inflation because each year new treatments, new drugs, and new procedures are added to what is available. It is not the same gallon of milk costing 3% more each year. It is as if the milk changes every year, tasting better and better, providing more vitamins, and curing diseases. Doctors use to advise to “take two aspirin and call me in the morning.” A single aspirin is about a nickel each as opposed to many of the pills used for treatments these days that cost hundreds to thousands times more than the 5 cent aspirin. Then there are the host of issues that are now treatable with expensive therapies, surgeries, and drugs that used to cost the system nothing as little as 5, 10, and 15 years ago. People with restless leg syndrome used to just live with it (frankly, they probably didn’t even know they had anything until they saw a commercial for a drug). Now they can take a $5 pill every day to keep the twitch away. People who couldn’t have children were told to adopt or find other things in life to do besides have children. Now infertility treatments are readily available and very expensive (which insurance sometimes pays for directly but always indirectly through the complications of multiple births, high-risk ob/gyn visits, etc.). People with bum knees were resigned to be in a walker even as little as 30 years ago. Now people replace their knees like it was as common as having a cavity filled. Men who couldn’t "get it up" were told that was a normal part of old age. Now they have an expensive little blue pill. This list could go on and on and grows with each year. Advances in medical science are both a blessing and a cost-curse. It is great that we can treat so many awful diseases, rid people’s bodies of cancer, treat high blood-pressure, and make sure men can have sex well into their 80s, but better living through science and technology is costly.
Our system is broken because we have a payment system that encourages doctors to do more then they need to do and not tell you how much it’s going to cost. Doctors don’t have a menu of services. You can’t easily find out or see how much a visit for a sore throat will be. I bet if you visited a doctor for a sore throat 3 times in the same year it would cost 3 different amounts based upon what their medical billing department decided.
I recently had an issue with a bill from my doctor. In addition to my $181 well-visit charge I also had a $130 asthma visit charge on the bill. Actually, I had to call my insurance company to see what the two office visit charges were for since the bill didn’t say and I knew I only had one office visit that day. My doctor’s billing department charged me $130 for an asthma visit because I asked for a refill for my inhaler during the course of my well visit. I fought the charge and it was waived but how many people would just say "meh, insurance paid for it so why should I care that the doctor charged me for $130 of services she didn't do on me." And what if my doctor told me I needed a whole host of tests and maybe a small procedure because I mentioned my knees hurt me a little when I run? Would I question these expensive items or just let her go ahead and do them. Insurance has allowed us to take an inactive role in our healthcare. We don’t have to think of the cost of something and whether it is necessary or not. We let our doctors, those same doctors who make more money the more they do, make those decisions for us.
No one likes the finger pointed at them, but we are a collective citizenry who takes better care of their cars than their bodies. People are more apt to remember their oil change than their yearly mammogram or prostate examination. People would never put sugar in their car's gas tank but smoke, eat, and drink to their heart’s content without thinking of the impact those decisions make on the cost of their health. If we kept crashing our car into a tree on purpose we wouldn't expect our car insurance company to keep covering us (or to give us insurance a week after we wrapped the car around the tree) yet we keep wrapping our bodies around trees through unhealthy habits and expect to be taken care of.
Beyond not taking care of ourselves we are a nation of consumers who demands the very newest and very best and this is also true for healthcare. We want the newest iPod, the latest model car, and the recently released drug. The difference between the iPod and the drug is people with health insurance rarely pay attention to how much money that drug, or procedures, actually costs since many only see their co-pay. How many people are guilty of demanding a doctor fill out a prescription? How many people unnecessarily go to the doctor or ER for the sniffles? Every decision we make on how we take care of ourselves and when we take care of ourselves drives the cost of healthcare. Technically losing weight or taking pills are both treatments for pre-diabetes, exercising or taking blood pressure medication are both treatments for hypertension. Too many people take the “easy” way out, taking the pills rather than cutting back the cheeseburgers, which is also the more expensive way out.
Every country, even those who have a century of socialized medicine under their belts, are feeling the pain of healthcare cost increases. They have to make tough decisions on what things they are going to treat and what they aren’t, what drugs they are going to cover and what they won’t. As Americans we are used to getting what we want, when we want it and if we have to put it on credit we will and health care is no exception. We’ve run ourselves in the red and forcing people to carry health insurance isn’t the answer. The answer is addressing the rising costs by educating people on how to be better and more frugal health care consumers, to pay doctors based on outcomes rather than ala carte delivery, to explore ways to make the health care industry not-for-profit, and to take better care of ourselves. Until we solve the rising cost of delivery, something this week’s “monumental” bill did nothing to address, we will continue to have rising cost of healthcare and therefore insurance.