Thursday, May 29, 2008

Healthcare Reform

Last night an enterprising group of folks were going door-to-door in our neighborhood polling people on their thoughts about topics for the upcoming election. At first, I thought it was generic, but it became obvious that they were pushing for health care reform to be the top priority (I rated other things like the economy higher). It got me to thinking.

Health care reform - what would I like to see change (in order).

1. Wait times for the doctor to go from several hours to my appointment time.
As we waited today in a doctors office, I became amused at one of their signs. "If you are over 30 minutes late...your appointment will be cancelled...and you will be charged". As I looked at my watch, we were well over 30 minutes past our appointment time. We went back, the nurse did her things, and we were sent back to the waiting room to wait for the doctor to get back from rounds at the Hospital.
Now I know emergencies come up, and I know this is a good doctor who likes to spend time with patients. However, the last time were at this doctor's office we were there 4 hours from start to finish. Most of that time was blown waiting for the doctor. I've dropped my family practice doc for less. Unfortunately in this particular case it's a specialist, and they have a virtual monopoly here in the area.
There are stories of doctors showing up to work an hour after the first patient appointment (this is NOT a story from the hospital). I encourage everyone to make note of your value of time, remind the office of this, and if there is equal competition, this should take care of itself.
Where are the people protesting the need for a patients' bill of rights that include wait time like they are for the airlines.

2. One bill.
For those that don't know, my wife is in health care management, so she likes to give me a hard time about why this can't happen. When I go to a doctor, I pay that office. I don't care what lab that doc uses, I don't care what other specialist he/she has to call in to assist with whatever I'm having done (think anesthesiologist). As far as I'm concerned, these are subcontracted parties, that are working at this one doctor's request. When I purchase a service (the doctor's visit), I want to write one check to one person, and have them take care of everything. This thing about receiving a separate bill from everyone that stuck, drew, rolled or touched me is ridiculous. No other business would be able to get away with this. How would you like it if the next time you got on an airplane, you received a bill the next week from the caterer for the # of soft drinks you had while on the flight? Subcontracted labor should be treated as such.
And while we're on the topic of bills, I really don't need a statement saying "This is not a bill" when they send something to insurance. Lately I'm seeing fewer and fewer of these, the cost of paper must be going up.

3. More businesses should offer medical savings accounts, along with high deductible insurance.
Until this type of plan reaches a critical mass, we won't be able to tell if this is a valuable type of insurance or not. Detractors will talk about how this takes low risk contributors away from group health care, but are there really enough examples out there to show this impact on a reasonable scale? There have been detractors of HMOs and PPOs, yet those plans have succeeded in providing health care to massive portions of the population. I've noticed that over the last few years the popularity of non-referral specialist co-pays has increased dramatically, so the idea of a traditional HMO is gradually dieing away.

4. Finally lets address health care reform in the traditional sense. Does this mean national health care? Maybe, I'm not completely sold on a requirement to provide it, maybe some incentives would be good, or an optional national group plan. Wouldn't that be one of the largest group health care plans ever created, they should get major discounts from the provider company. I do feel that all children should be covered somehow, whether through parents or medicaid. Someone is picking up the costs, some schools are even tasked with providing eye care/eye glasses to those in need. So for those readers that stick to 'we don't need any more welfare in this country', I would state that you're paying for it in one place or another right now. So lets make it official so that it can be tracked, expended, and made efficient.

Many other articles are going to talk about the ever increasing costs of health care. Yes, I don't like it, but on the other hand I do like the fact that I can get services today that weren't available in years past. The chance of surviving major medical issues is much higher today, which comes at an increased cost. The population is lawsuit prone today, which is also driving up malpractice insurance costs. And like everything else, health care overhead costs are soaring. With two new hospitals opening (one new, one expansion), the competition for nursing and administrative staffs around the Fredericksburg area is only going to increase. Until the costs to do business start dropping for doctor's offices, the costs to the purchaser's aren't going to drop. In reality, until the nation as a whole become more healthy, requiring fewer or less costly visits, the rate to insure the populous isn't going to drop.

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