Health Care Consumers

As many readers know, I've been a big consumer of medical care during my lifetime. So I may be biased.

But, as I've sat around numerous waiting rooms at various hospitals and doctors' offices, one thing I haven't noticed is a lot of people who go there for fun. I've never met anyone who, while sitting around the living room bored, said "I know! I'll drop by the doctor, that's always a good time!" I know people who plan weekend getaways to Vegas, but none who plan weekend getaways to the oncology ward. (Take it from me, it's not a fun place.)

So I'm bewildered by the people out there who seem to think that the best way to address the explosion in the cost of health care is to get people to stop spending so much on it. Medical care just doesn't seem like a big way for people to blow their discretionary income, you know what I mean? I can't imagine that's really a big driver of costs in the system.

Me, I think I'd look into the byzantine system of multiple payers and coverages. There's a huge industry that seems to be involved in making sure that getting your medical bills paid is as complicated and painful as possible. I think there might be some dollars to be saved by firing all those people who have the job of trying to get some other insurance company to pay the bill. I might also look into the marketing practices of pharmaceutical companies. Individuals spending wastefully? I'd save that for last. But then, I'm not a Republican.

Since it's well-proven that detecting disease early and managing it before it become serious is far more economical than waiting, I'd also try to give people an incentive for early care, instead of one that works against it. But then, I'm trying to imagine a practical system that takes good care of people. Silly me.

Still, there are people out there who are seriously suggesting that medical decisions, like whether to order an MRI or and X-ray, should be made by wallet-conscious laymen and not by doctors, and that we all need empowerment to question the amount of money being used to restore our health. In their market-driven reality, it makes good sense to encourage people to save money by taking their medication every other day, instead of every day as prescribed.

Why not stop taking antibiotics when you start to feel better, and save the last few days worth of pills for the future? Then you could save a few bucks. You don't want to be a spendthrift, do you? (Maybe antibiotic resistance isn't a problem if you don't believe that bacteria evolve.)

As a veteran of medical billing, I'm also wondering where these people live, the ones who think that I have the ability to choose a doctor by price. My experience is that there are no fixed prices for any medical procedure. Rather, there is a complex set of differing fees and "discounts" that each doctor has negotiated with each insurer. I can't just ask at the front desk "How much is this going to cost?" and get an answer. You thought going to the auto mechanic was frustrating? Imagine trying to get an estimate from a doctor's office.

Even if I could manage to choose "economical" Doctor A, and "good value for the money" Hospital X, it turns out that I can't have that combination, since Doctor A only has privileges at Hospital Y, and besides, I also want to splurge on specialist Q, who's done a thousand of these procedures, and he works somewhere else. Even if there were "perfect information", the system isn't built to allow rational economic decisions based on price. Assuming you agreed that, when you are sick, price should be the criterion for decision-making, of course.

NPR had a good story on this element of the Bush healthcare proposal this morning, providing some useful background, worth checking out before the President's speech tonight.

That probably helps explain a survey conducted last year, which found those with HSAs and other consumer-directed plans are less satisfied than those with more traditional types of insurance coverage.

"People are very frustrated by the amount of -- or lack of -- information on cost and quality, and that certainly shapes their opinion about these plans," Fronstin says. "To the degree that these plans may be providing information, people don't see it yet."

Those in consumer-driven plans also say they're not yet experiencing the promised savings, according to the survey. In fact, people are finding exactly the opposite. Says Fronstin, "We do find that people in these plans are spending a higher percentage of their incomes on out-of-pocket expenses and premiums than people with comprehensive plans, and that finding is exacerbated for people that are less healthy and lower income."

As I say, I may be biased. But it seems to me that what the President is about to propose combines all the best features of last year's Social Security plan with his Medicare drug program. Watch out.