Health Plan Consumer

By Jan Greene

Wasn't that some culture's curse — may you live in interesting times? Well, in healthcare we're smack in the middle of interesting times, and they don't want to let up.

I've been busy with work (a good thing for a freelance writer! A bad thing for a blogger!) so I've been remiss in posting. Meanwhile, lots of action to be noted:

–AHIP, the trade association for health plans, is meeting just across the bay from me this coming weekend, and proponents of single payer (government-sponsored) health coverage will be outside promoting their cause. That should be interesting…a little street theater at San Francisco's Moscone Center usually jazzes up a slow summer news day. And maybe that's the kind of energy it will take to get some kind of reform happening somewhere, somehow.

–Yet another Commonwealth Fund report following the experiences of the underinsured finds that their ranks have grown from 16 million to 25 million since 2003 — a 60 percent increase! This is interesting because people with inadequate health insurance tend to get ignored in policy discussions focused on covering more people with no insurance at all. But these folks are often employed, maybe work for themselves, are paying an insurer for "coverage" and yet face big out-of-pocket expenses anyway. The Commonwealth Fund found that 45 percent of these people have an outstanding medical debt and 53 percent of them went without needed care because of costs.

The other interesting piece of this study is its mention of the various ways that health plans are being winnowed away and not just with high deductibles (the dollars you pay before coverage kicks in). Health plan designers are finding creative ways to cut costs, and in ways that the average consumer might not notice until she trips on them — limiting the total amount the plan will pay for medical care, limiting the number of physician visits.

–The wordplay around "consumer-directed" continues to be an interesting topic of discussion. It's the flavor of the month in the healthcare industry but some consumer advocates believe the term is a palatable-sounding shield for making individuals pay more out of pocket for their care. Writing on the Health Affairs blog, Ron Cunningham, an editor at the journal, makes the the point nicely:

But the policy community understands, and pardons with an ironic wink,
the gamesmanship involved in labeling as “consumer-directed health
care” those recent insurance benefit redesigns that increase
deductibles and patient cost sharing. When did consumers ever stand up
and demand that they be allowed to pay more when they are sick?

Meanwhile, back at the ranch (we'll see how many of you young'uns catch that reference), I'm checking out a redesigned medical price information service provided by an outfit called change:healthcare. Its Medstimate is supposed to be new and improved and based on a wide variety of sources. We'll see if it measures up and I'll report back next time.

By Jan Greene

There's a really interesting column in the Wall Street Journal this week by Dr. Benjamin Brewer, who writes regularly about his experiences in the American health system. He talks about taking his daughter to an emergency room for stitches and getting a surprisingly high bill. His comments address what this blog is all about:

Nobody I know would be willing to buy gas at an unknown price, only to
find out the damage when the tab comes a month and a half later. But
between the mind-numbing complexity of health-care charges and the
reluctance of many in the health system to reveal their prices up
front, you don't have much of a choice.

Yeah, exactly. He goes on to talk about being on the other side of the billing process:

Some patients with big deductibles or health savings accounts try to
negotiate fees with me. I'm not offended, but as a family doctor in
Illinois my margins aren't that high to start with. A $65 to $85 office
call carries $45 to $50 in overhead.

This is instructive because it goes to one of my main pieces of advice: Know which medical services have a high profit margin and negotiate harder on those. It's pretty well known that primary care doctors such as family physicians aren't making a lot of money on office visits, so there's not much point in dickering their prices down much (though it's always worth asking). I'll be devoting future posts to the profitability of other common medical services.

There's an interesting string of comments after Dr. Brewer's column in the WSJ that get into a debate about how much medical services cost and what should be done about it. If you have a subscription to the WSJ you can read all about it (though someday soon the journal is rumored to become free of charge).

Some of the comments were from consumers who had tried to get pricing information before they had a medical service and were told that information is confidential. That's ridiculous. We should all ask and keep asking until hospitals, doctors' offices, labs, imaging centers and all the other parts of the system get the message that they need to evolve with the times just like consumers, whether we like it or not. It's ludicrous to think that consumers have to take the brunt of paying for more of their care without giving them the information and skills to do so. That's what we'll try to remedy, in some small way, on this blog.

By Jan Greene

Greetings. There's an interesting chicken-or-egg thing that goes into starting a blog. Do you just start writing even if nobody's out there? Or do you put together a comprehensive package and then start publicizing?

I'm guessing this is a little of both. I'm going to keep commenting on what's going on and keep adding resources to this page and keep publicizing to reach a wider audience. It'll be the chicken AND the egg approach.

Meanwhile, anybody here but us chickens?

by Jan Greene

OK, let’s get things rolling here. How about some dialog about how insurance is changing these days. Many people have told me about shrinking benefits, higher deductibles and certainly higher premiums over the past few years.

I’m self-employed and buy an individual, high-deductible policy. I pay the first $2,500 of most things, though a certain amount of preventive care is exempted from that (the first several doctor visits of the year, for example.) My premium has gone from about $150 to $330 in the past two years.

How has your insurance changed?