When the Obama Administration announced that it was going to attempt to reform the health care system in this country, it sounded good to me for about half a minute. But almost immediately it became apparent that we weren't on our way to anything all that good, because the goal morphed from "health care for all Americans" into "health insurance for most Americans."
I think everybody (except maybe the very rich) understands the difference between "all" and "most," so I'm not going to go into that. But it's worth pausing to contemplate the difference between health care and health insurance.
Health care means you go to the doctor when you need to, and he or she provides you with the treatment that, in his or her medical judgment, is necessary. Of course, medical treatment costs something, and so to provide health care for all, there would have to be some agreement as to how much health care everybody was entitled to and some arrangement for paying that cost. Apparently, that problem was too tough for those people in Washington to tackle.
Instead, we've gotten a mandate to purchase health insurance. Everybody... well, almost everybody... is supposed to buy it now. And insurance companies are supposed to sell it to everybody, too... as long as they can pay the premiums. If you don't buy health insurance like you're supposed to, you're permitted to pay a fine, instead... which in fact will be a lot less than the cost of a health insurance premium in most cases, and you can still go to the emergency room if you need to, anyway, and the taxpayers will foot the bill if you can't, so why bother buying the insurance if you're a risk-taker?
Obamacare, as some people label the new program, is supposed to help keep the costs of health care down, so that should be good, right? Well, insurance companies are in the business to make money, which means that they've got to charge you for their profit and overhead on top of whatever payment is allowed to the provider. They're supposed to police the greedy providers (your doctor, e.g.) who provide "unnecessary" treatment, and discourage patients (like you) who like to go to the doctor for fun, even when they don't need to. If the insurance companies can prevent enough "unnecessary" care from taking place, and restrict the costs for the rest, they should "save" enough to pay for themselves and the "cost of health care" should go down eventually, right? Then maybe it won't be necessary for them to raise your premiums twice a year any more.
The uncomfortable truth is that the mandate that everyone buy health insurance is no guarantee that anyone can buy the coverage they need at a price they can afford, because there has been no agreement on what "basic health care" is, or how much it should cost. (Just in case somebody decides to tackle those issues in the future, though, the insurance companies have been jacking up their rates at a furious pace so as to have a little "wiggle room" for a "compromise" on rates.) And as for the idea that increased insurance company rigmarole will lower the cost of health care, just ask your doctor what percentage of his or her overhead already involves dealing with their crazy paperwork.
There's a good case to be made that the insurance industry is actually the cause of the spiraling cost of health services, as opposed to a cure. I'm undergoing some interaction with the health care system right now, and so I have a handy anecdote on point. My doctor recommended that I have an angiogram, which traditionally is a pretty gross, intrusive procedure with a significant risk of complications that I didn't want. But my doctor said that in my case he'd be able to get all the information he needed with a procedure called a "CT angiogram," which is a non-intrusive procedure designed to accomplish the same end, or at least enough of the same end for my doctor's purposes. He warned me, however, that my insurance wasn't likely to pay for the CT angiogram, allegedly because it is still "experimental," (it's not) but actually because the insurers are afraid that more people will get the test if it's not so gross and intrusive. I thought this was B.S., but it turned out to be true. The insurance company was willing to pay for a test that posed a far greater risk of complications for me, and was at least as expensive, but refused to pay for the non-intrusive test recommended by my doctor.
What did I do? Well, on my doctor's advice, I called the hospital and told them I wanted to pay for the test myself, and asked them for their best price. Turns out their best price was 20% of what they would have charged the insurer. I got my test, with a free life lesson thrown in.
Why does the hospital charge the insurance company more for the same work? Well, it isn't just greed, despite what the seven-figure-compensated CEO's of the health insurance companies might tell you. The price differential reflects the cost of paying a full-time staff of medical billers, etc. for hassling the insurance company's paperwork, and delays for six months to a year before payment would arrive by that route. The insurance company's objective in "adjusting" the bills is, of course, to shave enough off the bill to pay both its overhead for all the adjusters who are hassling with its own paperwork, plus the profit that allows it to pay seven-figure salaries to its top executives. Is it really the cost of health care that's going up, or just the cost of insurance?
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