To Make Health Insurance Work, let the Patient Decide

To make health insurance work, let the patient decide

By Marcy Zwelling-Aamot, M.D.
Posted: 04/12/2011 05:40:39 PM PDT
Updated: 04/12/2011 06:28:42 PM PDT

Americans' frustrations are increasing. While we were promised that the cost of health care would soon stop its upward trajectory, we have yet to see any evidence of anything of the sort. My individual premium is going up every year while my co-pays go up. Every business person with whom I speak complains about their health-care costs and that includes the deans of our university where their health care costs are consuming so many dollars, they are starting to cut classes and decrease opportunities for students.

The debate continues in Washington, D.C. and the promises are coming a mile a minute right along with the threat that we are all going to have to "take it in the shorts" one way or the other. I wonder if individual Americans wouldn't be better off managing our own health-care demands rather than leaving things in the hands of the government or the insurance companies that have not earned our trust or our respect. The latest budget debate and near closing down of the government assures me that things would be better in the hands of the average American. We seem to appreciate the value of a dollar and understand value much better than our elected officials.

The solution is really quite simple.

1) We need transparency in health care but not the kind of transparency that Congress dreams up. Just last week, Sen. Charles Grassley of Iowa decided to submit a bill that would have all of a doctor's Medicare billing data go online. How is that

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transparency? Does a restaurant owner have to tell the world what he pays for hamburger meat or how many customers he feeds daily? Invasion of privacy is not transparency. I would offer that transparency is more about revealing legitimate retail pricing. How can we even start to manage our dollars without knowing the cost of care? Every medical facility and establishment should be required to post their retail cash prices. This costs nothing and at least starts to bring some honesty to the discussion. We can start that today by asking our city councils to demand that every medical facility business license require the posting of retail prices. You may be surprised to find that a mammogram costs less than $100 and yearly lab tests can be purchased for less than $50 cash. Those who use their insurance and pay for their care through their deductible know that the cost goes up when the payment for services is made through circuitous means (our insurers or the government).
Moreover, insurance companies and the government should post what they pay for each procedure so that patients will understand their contribution to their health-care purchase. Finally, insurers and the government should post what they charge for insurance. Consumers are pretty smart shoppers when they have the information to explore.

2) Congress should require every insurer and itself (including Medicare) to sell a catastrophic-only health-care insurance plan that is actuarially based and open to all patients including those with pre-existing conditions. The premium for this policy would be affordable and available to all. Community rating does not apply. Patients must be charged the actuarial value of the policy but it should be available to all. Surely, that person with hypertension will pay some additional cost but smart insurers will find a way to attract those patients by offering them a reduced rate for proof of adequate medical treatment. This also puts the patient in charge of their own health care. As it is, there are many "pay for performance" opportunities for doctors. but they have all failed because they have not offered incentives to the right person. It is always the patient who should reap the benefit of his or her investment in their health.

A free market is the only way to bring competition back into the medical-care marketplace and healthy competition drives innovation and excellence. The current fixed pricing system offered by Medicare and health insurers has taken away opportunities afforded by human nature, our competitive spirit and drive. The cost drivers are all the middle men and regulations imposed on what should be a transparent and open marketplace.

In the end we want a health-care delivery system where the patients can be empowered to be responsible for their own health and life investments. Doctors need to direct our care to our patients specific individual needs and we must be answerable to that person in our exam room, not the government or an insurance company. History has taught us that with freedom of self determination, America will always find its way to excellence. Why can't we assume the same in the healthcare marketplace?

Marcy Zwelling-Aamot practices internal medicine is Los Alamitos.