Recently hospitals in our area have acquired 3D imaging equipment. 3D is reported to be about 40% more reliable than traditional imaging.Two friends have mentioned this to me, and their experiences are different in that one was offered the 3D for an amount paid out of pocket in addition to the insurance payment, and the other was told that 3D was only available if the entire cost were paid out of pocket, since their insurance policy did not cover that.
At the same time, President Trump is trying to get a replacement for Obamacare (ACA) that will fulfill his campaign promises of lower cost, better care, and more individual choice in the health care market. He is finding it complicated. It is complicated at a very personal level when a 3D machine is sitting there and one person can have a 40% advantage for additional cost because they have the money, and another person does not have the money and has to take second tier service, and yet another person has to find another insurer or a different plan that will pay for 3D or pay the entire cost out of pocket.
Choice of provider is the most touted and greatest benefit of President Trump’s still-nebulous proposal, but it is elusive. Insurers can drop providers, and when the contract between insurer and provider changes, people frequently lose their familiar providers. Your choice of a plan makes you – along with other enrollees in that plan or with that insurer – a bargaining wedge permitting the insurer to control billing by telling the provider what they will pay for each service. The insurer can write the ticket for both patient and provider, and leave both of them in the lurch in the interest of profit.
As to lower cost and better care, good health care costs a lot less than bad health care. Obamacare both reduced costs and improved care significantly by making preventive care free. You might skip a screening if the kids need shoes, but that choice is not necessary if the screening is free. You can get both shoes and the screening, problems can be diagnosed early, and treatment can be more successful and less costly.
Lower cost and better care both serve the interests of the actual payer for care and the actual recipient of care, and serve the provider better also, since providers work toward better health and better outcomes for patients. It is an often-obscured fact that your insurance company is neither payer nor recipient. You and/or your employer pay for your insurance and are beneficiaries. Insurance companies use the crystal ball of actuarial tables and the wedge of negotiation with all parties to make a nice profit for themselves. They raise the cost of insurance beyond the cost of care to maintain their profit margin. It is easy to see that their stock, their CEO salaries, and their contributions to legislators have all soared along with the premiums for their plans.
The methods by which President Trump expects to provide good health care for everyone are all guided by profit principles, and he has called the insurance companies together to advise him. Suggestions include health care savings accounts and refundable tax credits, useful to upper-middle and high income people, many of whom would still be unable to put aside money enough to comfortably pay for a bout with cancer or contracting a chronic condition. Even more onerous is the idea of high-risk pools. The whole idea of insurance is the distribution of risk, which widely distributed becomes manageable.
Savings accounts, higher cost based on age or risk, and subsidy in the form of refundable tax credits all suffer from the same flaw. They continue the situation we now have with 3D imaging – a tiered system that divides people into groups that receive a different level of care and pay a different cost, some able to afford what actually everyone needs, and some falling far short of adequate care. Since 1954 and Brown v Board of Education we have known that officially “separate but equal” is inherently not equal. We also know that everyone – rich or poor, young or old, male or female – has a continuing need for good health care. My friends all need the diagnostic tool that is 40% better. We can have these benefits at a reasonable cost only if we abandon the exploitation of illness for profit.