So it would appear that I’m not the only one less than thrilled about the balance billing practices of some hospitals:

Here’s what the WSJ had to say.

In an unexpected move, we are closing 600 of our satellite offices throughout the country. While there will be no impact on our top line, we should see a significant improvement in our bottom line as there will be far fewer Starbucks out there where we can abuse our expense accounts.

Please bear with us during this difficult time and hope for the best as we deal with Christopher’s withdrawals.

So the Mass. attempt at “socialized” healthcare turned one year old today. CONGRATS!

Our resident Bostonians on staff @ change:healthcare, George and Vic, must be so proud. Oh wait, they’ve already fled the state to be here.

Nevertheless the plan seems to be working well according to Julie Appleby of USAToday – residents are getting better coverage…and premium rate increases of 5.1 to 9.4% unless you take the person profiled in the article who got a 45.7% increase in premium over the first year’s premium. Wow! Even the private insurance industry is hard pressed to pull that one off!

An excerpt from the article: “I almost fell on the floor,” says Pelletier, 55, of Newbury. “Costs are getting out of control.”

No kidding.

People will eventually make the connection. The decisions you make regarding their healthcare – when to go, whom to see, and what to pay – are what ultimately determines the premium. The premium is an effect, not a cause.

Happy Birthday!

The best thing about this job is that we get to meet some really great people. Today we met some outstanding folks who are going to make a difference.

Cover America made a stop right here in Nashville today and a few of the change:healthcare team had a chance to catch up with them. The cross country trek to capture stories of consumers’ difficulties with the healthcare system is part of a Consumer Reports effort on the healthcare front.

We really enjoyed meeting Meg, Blake, Pauline and Liz. Even got our photo with the RV in Centennial Park, in the shadow of Hospital Corporation of America (oh, how we love the irony of that one). Many thanks to these folks for what they are doing – fighting for the healthcare consumer.

Meg is getting a much deserved break after three weeks on the road, and we wish her a happy mini-vacation.

The rest of the crew is headed on to eastern Kentucky before hitting Virginia. We are going to try and hook them up with our favorite West Virginian, Bob Coffield of the Health Care Law Blog when they hit Charleston.

Let’s be emphatic. Government will not help the country’s healthcare crisis in the least by nationalizing healthcare. However, there are some things they CAN do that will probably ease our pain.

1. Repeal HIPAA

Let’s start with a big one right off of the bat. HIPAA regulations guarantee privacy of medical information. That’s a good thing. Personal privacy is the highest priority we have. But the legislation allows self-serving insurance companies and providers to act in their own best interests and block access to data the very data that is most valuable to healthcare consumers.

2. Outlaw Balance Billing

The practice of balance billing is a disgraceful tactic employed by disreputable healthcare providers. It occurs when a provider bills a patient for the part of a bill that was negotiated as a discount under contract with the insurer! The balance billing comes enough after the fact that the patient, confused by an already arcane system and intimidated by aggressive collections practices, pays the bill thinking it is their portion of the bill.

3. Cut the Employer Tax Break

Cut out the tax break for companies that pay their employee’s healthcare and give it to the employee by increasing their pay to cover the increase. This would push the real cost of premiums down to employees and have the net affect of letting people see more of the true costs of healthcare. Then employee decisions about how they would handle their own care would truly be more informed. Imagine if we treated healthcare insurance like car insurance. Hmm. I have a little ding in the car. Do I call it in and pay the deductible and have it drive my rates up or just cover it with some of that chip paint? Hmm. I have a splinter. Do I go to the ER for $500 or go to the local clinic in the drugstore for $49? Sweet.

4. Cap Malpractice Suits

The multi-million dollar lawsuits against healthcare providers have to stop. They drive up costs astronomically. I understand that there is pain that comes with loss and poor care, but we have become far too litigious a society with too many of us looking for a lottery payout at the end of a lawsuit. It’s becoming increasingly difficult for physicians to afford malpractice insurance. And they pass on its cost to you and me. Docs are also picking up and moving practices from states where they simply cannot afford the rates.

5. Make Docs and Hospitals Post Rates

To me, this is a no brainer. Require doctors and hospitals to post what they charge for treatments and services, which is easy information to access. Government should mandate that rates be posted. I do not care if providers post their billed rate (that’s the rate they charge you before the insurance company gets hold of them and adjusts it down) or the amount they’re ultimately reimbursed. But I think the providers will sort that out pretty quickly once one of them starts undercutting the others by posting their reimbursable rate. Why do you think prices in most commodities come down when competitors start advertising their prices? Because most consumers like value.

6. Disallow Flat Rate Co-Pays

This puts the government in the insurance company’s business, but flat rate co-pays simply keep consumers from knowing what the true cost is. Again, one of the problems with our current system. Consumers are unable to make an informed decision because they don’t have an accurate idea of what the product really costs. Switch to a percentage of cost co-pay system. Some employers and insurance companies have already done this. It gives a consumer an easier way to move into truly understanding the costs without dumping them in cold-turkey like an HSA does, asking them pay the full amount until the deductible is met.

7. Create Competition among Insurance Companies

Insurance companies are licensed on a state-by-state basis as a result of ERISA. The government should centralize this process to create competition. Going state by state effectively holds down competition by limiting the number of choices. There are a few national insurance companies that have gone through the trouble of getting licensing in each state or built partnerships to use networks in other states, but not nearly enough.

8. Monitor Insurance Companies More Closely

It’s unbelievable that my large not-for-profit insurer can build lavish new offices, pay exorbitant salaries and go out and purchase for-profit wellness and disease management companies and other businesses with their excess cash. The government agency responsible for the oversight of this not-for-profit entity is asleep at the wheel. Some customer-friendly insurers return a portion of that excess to their members through premium rebates or reductions, which is smart business in a competitive marketplace. By at least making the general public aware of how companies use their excess, consumers could be mobilized to exert more pressure on insurance companies to keep their costs – and their ostentatious ness — low.

9. Create Incentives for Careers in Healthcare

Wake up Washington! We’re getting older as a whole and needing more care. So help incentivize more people to enter med school. More docs mean more ability for people to get access to healthcare. Usually at a cheaper price. It decreases the demand on the docs’ time which allows them to concentrate and focus on providing high-quality care versus pushing through yet another patient. Also, create more programs to help with med student loans. Perhaps urge more fellowships. Whatever it takes to keep docs from being $250,000 in debt upon leaving school and being in a spot where they HAVE to charge some outrageous amount to cover their malpractice insurance and student loans.

10. Pay for Performance

And we might as well go there. Establish scores for high quality care – the quality of care Americans should come to expect from this country’s healthcare practitioners – and use pay to incentivize physicians to meet and surpass those standards. Make it easy for patients to report who does quality work.

There are many other ways that government could be helpful in healthcare other than socializing it. We’d love to hear your ideas.

Got some nice ink today from our friends over at The Tennessean in the Healthcare section. Thanks to Getahn Ward there.

And double congrats to our friends at Data Advantage who got some in the same article. They have a nice new web site, too.

Be sure to check out what Data Advantage is doing with their Hospital Value Index.

And don’t miss their article in the WSJ!

Congrats!

We are sooooo excited! We are down to the final edits on our upcoming book, My Healthcare is Killing Me.

I know. I hear you Steven Krein, that’s not the name you wanted (congrats on the funding announcement BTW!). Don’t worry change:healthcare will be prominently featured on the cover.

Looks like we are about 3-4 weeks away from having it out in the public eye.

So start lining up for your autographed copies today!

Maybe Steven or our buddy Jay Parkinson and his Hello Health project will set up a book signing for us in NYC!

I guess I’m a little confused with all of this concern over socialized healthcare. Seems like we’ve already got it . So what’s the big fuss?

Insurance = Socialism

Insurance is based on the concept of socialism.  Assemble a group and they all contribute to the group for the better of the whole to protect the individual. That’s what insurance is. We all pay in. Some really need it and use it and benefit from the group spread of the risk. Others don’t need it as much and they help cover the others who do with an eye toward having their future needs covered. Insurance is based on the most core principles of socialism.

Medicare = Socialism

Medicare is socialized healthcare. The government groups all people over 65 into a single pool. Everyone paid in with taxes and the government covers the majority of costs. So Medicare is already socialized. Ask anyone using it what they think of it. Most will say they are thankful that it is there, but that it does not do it all.

Medicare = Private Healthcare

Private healthcare rates are generally set based on Medicare rates. There are so many services and procedures that it would be terribly time-consuming and inefficient for an insurance company to negotiate each batch of services with a provider on a case by case basis. So they set most of the rates based on a percentage above what Medicare would pay. In essence, they let Medicare lead as the largest insurer in the market (a socialized one at that) and then just follow their lead. The larger an insurer’s group, the closer their reimbursements are to Medicare’s. The small the group, the more they pay.

Insurance = Socialism = Medicare = Private Insurance

So following through the equation, it’s pretty obvious that we already have socialized healthcare. Getting it more socialized will not solve the problems we have – overuse of the system, high costs, quality of care, and inaccessibility to care.

With fully socialized medicine, anyone can go any time is the idea people have. That will not breed discretion, it will only create more overuse as an “all you can buffet.”

The governement is inefficient and overpays at every turn for things. Costs will not be held in check.

Quality – controlled by the government? Oh my. Anyone ever heard the phrase “Close enough for government work? Look at the VA and its recent struggles.

And where are the additional doctors to address this new open buffet? I see nothing where the effort is being made to bring in more physicians to help address what will be an increased demand.

Does everyone deserve healthcare? Absolutely.

Do we want the governement running it? Absolutely not.

There is much the governement could do to improve healthcare, but taking it over is not part of it. Look for some ideas on where they might be able to help in  the next post.

Just caught a USA Today article that ran today on California health insurere Health Net being fined $9 million for dropping a patient going through treatment for breast cancer. I applaud the court for having the gumption to take a stand against an insurer engaging in such an unfair practice.

One can only assume that the intent was to punish the insurer and make an example of them so that other insurers would think twice about such a practice in the future. However, there is a side effect to this remedy. That cost will have to be made up somewhere and at someone’s expense. The somewhere will be in the form of increased premiums at the expense of Health Net’s insured.

With insurance, it seems that even when we win, we still lose.

People love the Apple Store. It has all of the elements that people look for in making a purchase these days. So it’s no small wonder that they are rapidly cornering the high tech market. Their approach is simple, straightforward, here’s your options. Here’s the cost. They can now check you out with a handheld device instead of having you stand in line at the cash register. “Can I e-mail you the receipt instead of printing it out or do you need a printed out receipt?”

That rocks! That is exactly what the healthcare industry needs to aspire to.

So to that end, I ran across this in my own back yard from Nashville General Hospital:

The global fee for uninsured patients with an uncomplicated vaginal delivery is $1600+ $200 paid at the first visit for ultrasound service. Total =  $1800..

Medicos offers unlimited ultrasound services for an additional $200

Nashville General faces some stiff competition in town. This is a city with Vanderbilt University Hospital, St. Thomas (part of Ascension Health), Baptist and even the flagship facility for HCA located literally across the street from their corporate offices. Nashville General gets a lot of the low cost and uninsured in town, so it’s interesting to see such cost transparency coming from them instead of these big name market and industry leaders.

Now I’m going to guess they haven’t got the whole handheld device checkout thing down, but this is a nice start. I’m sure that Michele whose blog I pointed out earlier this week might have really enjoyed having this sort of information before the birth of her child.