When the great boat was going down and an iceberg was ripping a hole
in its new metal skin, I imagine those deck chairs, the ones that would
have been wooden and heavy. Or perhaps there were none there on the
deck of the Titanic because this was the North Atlantic and there was
ice in the water and surely in the air.
In Health & Welfare
Committee last week, we were visited by Blue Cross, one of our state's
two largest insurers, in fact it is now the one the state now contracts
with to provide insurance to most of Idaho's 17,000 or so state
employees.
Blue Cross went to great lengths to show that
spending more money on health care did not produce better quality
health care. It is a point I would have appreciated coming from them
had they bothered to mention how a health care system run by insurance
companies creates a level of unpredictability and complexity never seen
in the history of medicine world-wide.
Daily, the cost of
American health increases because we as a nation and state government
allow insurance companies to set their own rates. We let them decide
what gets covered and what does not. We let these companies control and
then change randomly who may treat whom and how much will be paid to
those who provide care, based on who they are providing it to and
whether that person is newly sick or has been sick with this same
condition for a long time.
Imagine being a doctor and trying to
figure out who and how much to bill for a colonoscopy. If the patient
has insurance you get paid X. If they do not it is more. If the
condition was pre-existing the insurance company might not pay, so you
bill and work to get payment from the patient. Not only do you have to
know the rules for every insurer, but you have to know that the rules
can change at any time. So you may suddenly be designated as an
out-of-network doctor or the procedure may no longer be covered so the
company won't pay you and your patient, not knowing this, doesn't have
the money to pay, so you don't get paid at all. Maybe, just maybe if
you fight the insurance company you can get payment for the
colonoscopy, or, if you use a different code on the paperwork, you will
avoid the fight. In any case, before each procedure you need to make
sure that the company will let you do what your patient needs. They may
decide to pay for a lesser procedure or to make you wait until the
problem is more severe, or until the person has moved to someone else's
health plan.
Clearly you would never have time to see patients
if you had to do all this yourself, so you hire one or two people to
help with the paperwork. That is part of what makes what your
colonoscopy (and your patient's insurance) cost more because not only
do you have more staff to deal with the complexity, but all the
insurance companies hire more staff to manage the complexity too.
So the Titanic screams ahead.
In
the Senate Commerce Committee this week, Bill Deal, Director of the
Department of Insurance, brought a rule, which is kind of like a law,
to limit "discretionary clauses" in insurance plans. It is a modest
change that means more than you might think. Read your policy sometime,
if you have one (and I understand that one out of four of you have no
insurance policy.) You will find statements something like this:
We agree to cover these things, but at our discretion we actually might not.
We promise to pay for this, but at our discretion we might choose not to.
We will cover medical care that costs this much unless, at our discretion, we decide we won't.
Bill's
rule says you can't do this, at least not to ordinary people with
individual plans who have no way to negotiate those bombs out of their
policies. Small businesses beware you still have discretionary clauses
in your policies.
The rule is progress. It is one deck chair a few feet to the left as the metal tears and the ship pitches starboard.
Like
many, I've been spending a lot of time assessing what made our economy
collapse. You can look back at reasons why wages are low and why still
American companies could not survive manufacturing anything in the U.S.
The cost of health care is clearly a factor. U.S. companies have to
pay for it while companies from countries with national health plans do
not. It still weighs heavily on businesses trying to hang on while, all
around them, businesses close and people lose incomes, buying slows and
the chill sets in.
The icy waters froth and lap. Brilliant blue ice glows in darkness.
I
plan this year to propose a bill to make companies tell small
businesses the details of their health plans BEFORE the business signs
on the dotted line. It says the insurance company can not change the
plan in the middle of the contract.
Wooden legs scrape on a painted metal deck.
I
look to President Obama to do this one thing for American business.
Simplify this mess. Make it so no American family ever goes bankrupt or
into deep debt to pay for needed medical care, ever again.