|
medpundit |
||
 |
 |
|
Tuesday, November 26, 2002As South Knox Bubba has argued before, linking our healthcare insurance to employment is one of the key problems with our system. It’s very difficult to find an insurance company that will offer an individual policy. They’d rather negotiate with businesses, and the bigger the better. In fact, their risk pools are the businesses, rather than general population. One of my patients, a union rep, recently told me how difficult it is for his company to find affordable healthcare insurance. He represents about fifty workers at a small manufacturing plant. They have several people who are in their late fifties, and a couple of people who had some serious health problems this past year - cancer, heart attacks, etc. Because of those sicker employees, they had trouble finding affordable health insurance for the entire company. They ended up settling for one with fewer benefits than they would have liked. It’s no wonder that companies are loathe to hire older workers. They make their health insurance risk pools worse. I’ve said this before, but I’ll say it again. A better system would be one similar to car insurance, home owner insurance, and life insurance. Policies should be individual, the risk pools should be the general population, and insurance should kick in only after a certain amount of costs have been exceeded. Then, companies wouldn’t be taking on so much financial risk by hiring older workers, people wouldn’t have to worry about losing their insurance when they lose their jobs, and employers would be more willing to hire the disabled or welcome back the injured. Even more importantly, it would give the self-employed a fighting chance to obtain insurance. Health Bought: There was something else in that New York Times piece that was very disturbing. It’s the description of how one of the families felt when they had to go to the doctor without insurance coverage: Then their daughter came down with strep throat. "That was rather humiliating, being in the doctor's office without insurance," Ms. MacPherson said. "You become very obvious to everyone." This is from the family that has a $75,000 a year income. Surely, they could afford the $50 to $70 office visit for strep throat and the ten dollars for penicillin. But it isn’t the cost she’s talking about, it’s the shame. Why should anyone feel ashamed for not having insurance? Yet, I know what she means. The first question out of any receptionist’s mouth at a physician’s office is, “What type of insurance do you have?” It’s asked so often that people have come to believe that insurance coverage is a requirement for a visit to the doctor. A negative answer is heard so rarely, that the receptionist is likely to raise her eyebrows if the answer is “none.” I’ve often been vaguely aware of this sense of shame in patient’s I’ve seen without insurance coverage. I experienced it myself when I opted to go to an urgent care without my HMO’s permission and told them I was paying cash. We’ve come to think of complete and full health insurance coverage as the norm. Anything less is a sign of failure. Let me disabuse everyone of that notion right now. Doctors prefer cash-paying patients to insurance companies. For proof, consider this Mississippi doctor who dropped all insurance plans and began charging everyone a flat $40 fee: Determined not to hang up his stethoscope, Dr. Todd Coulter is trying an experiment of his own. At his small family practice in Ocean Springs, he has also sworn off insurance and charges $40 dollars cash per visit. "When we stopped taking insurance our overhead dropped immediately by $2,800 a month. Just dropped." This is my fantasy. Cut out all the middle men and deal only with the patient. It doesn’t get more efficient than that. And consider this, the patient and the doctor have a relationship. If there are extenuating circumstances, the doctor can cut the patient some slack in the payments. This could work everywhere. Health insurance for the big expenses. Individual responsibility for the small ones. It would be more humane than our current system. (Thanks to Jim Miller for pointing me to the Mississippi doctor. DB also has more on this, and on the insurance crisis in general.) posted by Sydney on 11/26/2002 07:30:00 AM 0 comments 0 Comments: |
|
