June 27, 2009 - Healthcare Reform

Why don't they get it?

The problems with healthcare are obviously a very complex; however, there are a few things that are at the heart of many of the issues.

It is time that the payers are removed from the beds of the hospitals and providers. Competition is stymied because providers are not forced to compete with one another, but instead they complete for the best contract with the insurers.

In addition to the issues created when competition is stymied, costs soar when the complexity of the payment system requires entire departments to manage. In the new healthcare model (the efficient model), the cost of care should be the cheapest for the person that has cash up front at the door and most expensive for the person with insurance that has very complex payment requirements.

Note that my push to change the model of payment does not mean that I do not support improvements in quality. Pay for performance and other concepts to force providers to have excellent outcomes and practice evidence based care. These are good things.

What I am really suggesting is that we must overhaul the system such that receiving payment for services provider as suggested by your physician should not be a complex issue. Submit the claim, get the payment, close the case.

So, how do we manage utilization in a system like this? That should be the responsibility of the individual insured party. When they contract with the insurer to provide coverage, information should be provided showing clearly what is covered and what the max payments for these services are. While I do not believe that insurers should contract with providers, it would be fine for insurers to note that a specific provider has a charge structure that is approved. This, however, should never be a negotiation. In the event the insured chooses to seek services which exceed the cost of their insurance coverage, the provider can agree to accept the insurance coverage as payment in full or the insured will be responsible for the balance of the bill.

I sincerely hope that we focus on FIXING healthcare rather than simply adjusting a few statements and increasing the complexity of the system. We aren't going to have a cheaper healthcare system by simply leveraging more technology.