Real Health Care Reform, and it isn't Obamacare

It's allergy season, and over-the-counter medications aren't relieving me of my itching and sneezing. I need a prescription, in addition to the Zyrtec and Benadryl I already take. My prescription is for Veramyst, a nasal spray that is not available over-the-counter or in a generic form. Cost: $120 for a one month supply. This is too pricey.

I don't have health insurance. I can't afford it.

Enter Obamacare? I don't think so.

Have you read the recent decision by the 6th Circuit Court of Appeals? I'm not referring to the decision itself, but take a look at why the government wants to mandate all individuals purchase health insurance. . . cost shifting which causes higher costs.

Congress’s findings identify a multi-step process that starts with consumption of health care: (1) some uninsured persons consume health care; (2)some fail to pay the full costs; (3) in turn the unpaid costs of that health care—$43 billion in 2008—are shifted to and spread among medical providers; (4) thereafter medical providers, by imposing higher charges, spread and shift the unpaid costs to private insurance companies; (5) then private insurance companies raise premiums for health policies and shift and spread the unpaid costs to already-insured persons; and (6) consequently already-insured persons suffer higher  premiums.§ 18091(a)(2). Also, some uninsured persons continue not to buy coverage because of higher premiums.

Bingo.  But exactly when did cost shifting start?

With Medicare.

The Medicaid/Medicare program doesn't pay the doctor's or lab's or hospital's full price for covered patients. So, when it was instituted, doctors who took Medicare/Medicaid (MM) shifted the costs to non-MM patients to make up for the loss in treating MM patients.

The insurance companies don't pay full price, either. They negotiate the amount they will pay for their insured, which is far less than the going rate for the same service on the open market. The medical providers accept the discounted rate as payment in full.

For example: I must have a certain blood test done annually before the doctor with write a prescription to treat the chronic condition.

I pay for my office visit, which is between $70 - $100. I pay for the blood draw and lab work - $200.

If I were insured, I'd make a co-pay for the office visit of $10 - $20 or so. The Insurance company would pay about another $10 to $20 for the insured patient's visit to the doctor's office.

So, by accepting insurance, the Dr.'s office is paid $40 max for a service they charge over $70 for. They don't take responsibility for their choice to accept less than the full amount due, they cost-shift the other half of the fee to non-insured people like me.

The insurance company has contracted with the lab to pay $30 for the blood draw and lab work, the patient pays nothing. The lab only makes 15% of it's usual fee for my blood draw and lab work, and must, therefore cost-shift the other 85% to non-insured people like me. But wait, I finally found a local health care provider who has contracted with a local lab to let their uninsured patients have blood draw and lab for $14 (for my test).  So why must I pay $200 for the same service just because I'm uninsured?

Does this make sense?

I could pay for my own health care without too much trouble if I was allowed to pay the same amount for my health care as any health insurance company gets to pay.

This isn't about deadbeats and poor people skipping out on their medical bills, it's about big business i.e. insurance and big Pharma getting rich on the backs of working folk by shifting the losses from their poor business decisions to the uninsured public.

Cost shifting makes the cost of health care too high across the board. The solution to the high cost of health care isn't to force the uninsured to buy insurance, that only serves to treat the symptom and protect the insurance industry.

The solution is to stop the damned cost shifting. Make it a crime to charge one class of patients more for their health care than another class of patients. If insurance can pay a flat $30 for a lab test or office visit, so should the uninsured.

Either that, or let's start using cost shifting to make sure poor people can buy a car, or to subsidize food purchases, or better yet, vacations.

Or, let's pass a law mandating that consumers must purchase my products and services, so that I can be sure my business is protected from those cheap bastards who don't buy the products and services I offer to the public.

That makes about as much sense as shifting the high cost of health care from the insured to the uninsured.