One of the steadfast hallmarks of capitalism has been the all-mighty price tag.
Businesses have thrived in part by providing the best price. Companies that can't show value are quickly overshadowed and eventually eliminated by the competition.
Yet, when it comes to the American health care system, common practice and common sense are both thrown out the window.
Patients are quick to purchase medical procedures and supplies without knowing the cost, stemming from years of using employer-sponsored health insurance plans. People don't commonly shop around; they have no idea if the doctor they are choosing is providing the best service for a fair price.
When the bill can quickly escalate into thousands of dollars, it is simply amazing that prospective patients don't routinely ask: "Hey, what's this all going to cost?"
This historically backward approach to health care is of growing concern to the New Jersey Association of Health Underwriters (NJAHU). No one, it seems, is well served with mystery pricing:
- Consumers have become hesitant to seek medical attention because of the added potential stress of a large medical bill for which they do not have adequate coverage.
- Insurance carriers often reluctantly pay a percentage of dubious bills after services are rendered, when it's too late to ask questions. They also deny claims because of repetitive procedures with incorrect coding.
- Providers often feel the insurance company is not paying enough and invoke the practice of "balance billing" on a regular basis.
Providers have claimed they cannot reveal reimbursement amounts from the insurance carrier, as it affects their competitiveness in the marketplace. NJAHU vehemently disagrees with this approach.
The medical community needs to be properly and expeditiously paid for the often life saving expertise they deliver. But these professionals also need to remember their Hippocratic Oath did not include a clause to put a person in collections for an unpaid bill for services that were not previously disclosed.
Our association members – advocates for hundreds of thousands of insured and uninsured people in New Jersey – believe it is high time for providers of healthcare in New Jersey to disclose the cost of medical products and services to patients up front.
Transparency is a win-win, as patients could become more comfortable with the process, providers could receive fair and equitable payment without administrative delay and, we can assume, costs would be cheaper to carriers as patients shop around.
In a recent survey by the Society of Actuaries, healthcare actuaries believe that creating more transparency between doctors and patients, as well as between the provider community and patients, could be at least somewhat effective in reducing healthcare costs.
For New Jerseyans fortunate enough to have health insurance, each procedure and diagnosis they receive has a billing code that carriers use to determine payment. Depending on the insurance carrier and its contract with the provider, rates for the same procedure can vary dramatically.
Patients need to know the costs beforehand to determine if they should be getting the procedure done elsewhere to maximize their insurance coverage.
For the uninsured, which comprise about 1.4 million people in New Jersey, most are feeling the economic squeeze of everyday life. When it comes to their health, a person's most precious commodity, the cost of treatment should be detailed right down to a reasonable payment plan if necessary.
Perhaps New Jersey can build a search engine for health care prices, as is being done in San Francisco by Castlight Health. Patients could search for doctors that offer a service nearby and find out how much they will charge that patient, depending on their insurance coverage, for such procedures as colonoscopies, CT scans and blood tests.
Information for the website can be gleaned from the explanation-of-benefits forms that patients receive after a doctor visit.
As the new federal health reform law takes effect, transparent pricing will become a greater issue. Around America, 30-40 million people are expected to join health insurance exchanges, which encourage comparison shopping.
New Jersey should take the lead now. When we demystify what it costs to provide health care, we give people the ability to make informed choices for themselves and their loved ones.
Dave Mordo, a resident of Middletown, is the Legislative Chair of the New Jersey Association of Health Underwriters and a broker at Walsh Benefits in Fair Haven, NJ.
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written by ecco shoes, August 16, 2010
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And then, after diagnosis of a (human) vehicle problem, we can maybe put the repair up for auction, and see which 'garage' will give us the cheapest (medical) repairs. We might need a tow to a different 'garage'.
Our insurance companies will require that we get estimates. Do we get to see video tapes of previous 'procedures' performed by bidding-for-your-repair garages? Do we get to see how clean their tools are, how modern their equipment? And what about labor? Will immigrant doctors and mechanics work cheaper than natives? Off-brand and generic medical equipment is a-ok? Whatever the market will bear? Don't take it personally, its just busyness? There's nothing wrong with making a good profit?
Rich people will get the high-end procedures and poor get cut-corner procedures? Allow slimy earn'n'deserve systems into the 'take it VERY personally" world of medicine, shall we? NOT a good idea. 'Affording' (monetary discrimination) needs to be REMOVED COMPLETELY from the medical industries, and every other industry, crack, and crevice, for that matter.
Do you see the pyramid scheme symbol on the back of the USA dollar? Need we say more? Capitalism is a pyramid scheme. Get rid of economies and ownership (monetary discrimination) and you've fixed the health care system. Before health care can get fixed, capitalism must be fixed. (Its a pyramid, so it will eventually get top-heavy and flop on 'its own'... just like servitude-infested childhood playground pyramids did/do.)
Rat-racing up the sides of pyramid schemes... everyone trying to 'get a leg up' on each other and everything, is NOT the way to run a society. Try cooperating, not competing. Competition is NOT healthy and never was. There's lovers and fighters. the fighters have flopped at running a sane society. Now hand it over to the lovers/cooperators/Christians, eh? Try things like the military survival/supply system and the USA public library system... both discriminationless... because both are commune/socialist which are NOT economic systems in the pure use of those terms. It is the practice of NOT using economies/ownership.
So, first, notice the massive inequality and servitude infestation in capitalism. Notice how its a pyramid scheme. Notice that its a Columbian Freemason pyramid symbol on the back of the USA dollar and notice that the USA gov is in a district of Columbia and not part of the USA. Notice that the 'fed' runs a con/sham felony pyramid scheme called the free marketeers... and that it forces 18 year olds to JOIN OR STARVE. They have to join (get a job aboard the competer's church)... OR ELSE! Notice the parental policy reversal from share share share... into fight fight fight when USA kids turn 18. Notice the widespread "pay up or lose your wellbeing" Chicago mob-like felony extortion in capitalism.
Fix the foundation before remodeling the house atop, huh?
Larry "Wingnut" Wendlandt
MaStars - Mothers Against Stuff That Ain't Right
(anti-capitalism-ists) (system fighters, not role-playing people fighters)
Bessemer MI USA