This week’s Health Wonk Review includes a thought-provoking article by Dr. Doug Perednia, written in response to Paul Krugman’s “Patients Are Not Consumers“. Dr. Perednia makes some excellent points about the inability of patients to be true “consumers”, even in cases where they have their own money on the line. He notes that if you call your doctor’s office to find out the price of a procedure, they won’t be able to tell you because there are too many complexities in the health insurance system for the doctor to give you an accurate idea of what the cost will be. And if you call your health insurance carrier directly, you won’t get a clear answer either. We’ve found that even if you know that a procedure isn’t going to be covered by your health insurance, and try to shop around for a price as a patient paying cash, it’s still next to impossible to get an accurate idea of what the cost of a procedure will be until the actual bill arrives. And even if a patient is a diligent “consumer” – asking question, pre-authorizing everything with their health insurance carrier in advance, making sure that all of the providers are in-network – there are still surprises that can pop up, thanks to the convoluted nature of our health care system and health insurance networks. Our family has had an HSA-qualified health insurance policy for several years, and we’ve tried to the best of our ability to be conscious consumers when it comes to our health care. But it’s not an easy task, even if you think you know all the right questions to ask.
Dr. Perednia also makes a very good point about the illegality of “balance billing”, and the fact that if Medicare’s reimbursement for a particular service is too low to make it financially worthwhile for the provider, a Medicare patient cannot simply pay out-of-pocket for the procedure. However, patients are free to go to a doctor who doesn’t take Medicare and pay out-of-pocket for any procedure the doctor offers. And my understanding is that if a particular service isn’t covered at all by Medicare, patients can go to a doctor who does take Medicare and pay cash for the procedure. So there’s truth to the statements made by both Krugman (“we’re not talking about limits on what healthcare you’re allowed to buy with your own money”) and by Perednia.
I liked the point Dr. Perednia made about how prices for elective and cosmetic procedures have declined over the past decade. Procedures such as laser vision correction – paid for by the patients themselves, with little or no reimbursement coming from third parties – have gotten less expensive over the years. We often hear that one of the reasons healthcare keeps getting more expensive is because we keep upgrading the technology being used. And yet the technology used in today’s Lasik procedures is far more sophisticated than what they were using ten years ago. In fact, technology in general keeps getting better and more advanced, while also getting less expensive as time goes by. Cameras, computers, memory cards, phones… they all keep getting more powerful and faster, and in general, we continue to be able to get more for our money with each passing year. Why then, is it so much different in the world of traditional health care? Interesting points to ponder, and Dr. Perednia points out that what’s missing in the traditional health care model is the ability for patients to truly be “consumers” the way they can with elective health care.