Our health care system is built on the “fee for service” model – meaning that for each test or procedure that a doctor orders, an insurance billing is generated. This billing model, coupled with their need to defend against lawsuits, leads Doctors to duplicate orders, and to “over-test.”
In the last year I have had some dental work to correct a problem with my bite. This has involved seeing my Dentist, an Orthodontist, and a Periodontist, often all three of them on the same day. On multiple occasions they all ordered exactly the same x-rays, at $35 per film, on the same day. This quickly racked up to $250 – $350 in unnecessary billings
in each office.
I protested, and asked why they couldn’t share the x-rays that had been taken earlier in the day. This was met with vague mutterings as to how “they needed different views of my teeth.” I observed that the bitewing sets were a perfectly standard view, and that they were identical to the x-rays taken that morning. This was met with more mutterings about “copies for their records” and other important sounding doctoral bluster. The evasion continued until I confronted the extremely wasteful procedure head on: “It’s really so you can generate billings to my insurance isn’t it?” Two of them stammered and stuttered, murmured something about how they “weren’t setup to share x-rays.” and quickly changed the subject. The third (and by far my favorite Doc) laughed, and said, “You know, you’re absolutely right, it’s really wasteful isn’t it?” I explained that my insurance company had canceled my dental coverage without warning or explanation. I told him was paying out of pocket for the x-rays. He sent me off to the next appointment with my x-rays in an envelope.
My Sister in Law is Taiwanese, and when I visited there two years ago she described their system to me. They have a very efficient (single payer) health insurance system. In Taiwan, my x-rays would be encrypted for privacy, and loaded onto a microchip embedded in my health insurance card. When I went to the next office they would pop my card into a scanner, and boom, there are my x-rays, saving everyone hundreds of dollars and reducing the potential for error. This is a prime example of how better electronic recordkeeping saves everyone money.
It also protects against malpractice, as each Doctor in Taiwan instantly knows the patient's allergies, medications, and has easy, legible and secure access to all of the health records.
What is tragic about the current healthcare debate is that both the Republicans and Democrats have valid points, and good ideas to reduce costs and increase coverage. Both sides are so locked into their ideological positions that honest discussion becomes nearly impossible. As long as the screaming continues, we all lose.
The Republicans are right about tort reform: Doctors perform gobs of un-needed and vastly expensive testing all the time to defend against possible lawsuits. Have you ever asked a Doctor what a test they are ordering costs? They generally have no idea. If the burden of defending against malpractice were made less onerous they would have to carry less liability insurance, and the cost of medical care might eventually fall. *
Democrats are right about the fee for service model being problematic, and about the rationing imposed by abusive underwriting procedures that make it nearly impossible for many people to get or afford private coverage.
A simple, yet damming truth: the way we do health insurance and deliver care now is the least cost-effective and most wasteful way to deliver medical services on the planet. We are the only major developed economy in the world that operates on this model, and our healthcare outcomes are ranked 37th among developed nations, behind the economic powerhouses of Dominica, Croatia, and Cyprus. The good news: our system does outrank such paragons of enlightened public policy as Angola, Ethiopia, and Myanmar. (Source:
http://www.photius.com/rankings/who_world_health_ranks.html )
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* I say “might” because the virtual monopolies of our vast industrial complexes are very quick to raise consumer prices in reaction to market forces, but very slow to lower them. One look at gas pricing over the last decade makes this abundantly clear.
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