Letter: Where were the “facts?”

By on October 1, 2009

I would like to know where Jeff MacKenzie got some of his “facts” for his long-winded article to Congressman Foster because some of his information is wrong or just bizarre.

I can’t attest to any agreements between Congress, insurance, AMA, etc., but that is certainly what lobbying is all about. You must contribute money and lobby to be heard.

It is certainly important to communicate either as an individual or an organization with Representatives and Senators in order for them to have facts on which to base decisions. Unfortunately too many of them are for sale and write or support legislation than enriches their campaign or helps them keeps their job rather than doing what they should be doing.

I think most of us who are savvy about health care pricing are aware of multiple tiers, not just three. Medicare and Medicaid tend to pay less than the cost of the value of what they receive. Insurance companies try to follow suit and negotiate to pay 40-60 cents on the dollar. The uninsured price is often negotiable with most providers if there is actual intent to pay. The goal of a government or public option is not, nor should it be, to pay less than the value of the care provided. Neither should the goal be to shift anyone into the public option from private insurance without some type of penalty.

There is plenty of competition in the health care industry. There isn’t much competition in the insurance industry. There is no price collusion between providers and insurers. That would be illegal. Providers are free to accept or decline any insurance they choose. Why should any provider accept payment from any insurer that pays less than the value of the services rendered? Unfortunately, with Medicare and Medicaid, there isn’t much choice. I think we’d all like to see the price structure simplified and all third party reimbursers forced to pay the same price. A big problem now is that you can’t even be sure insurance will cover a procedure after they have preapproved it.

The burden that the insurance industry has placed upon the user and the provider is untenable. Health care providers spend a small fortune employing people to deal with reimbursement and collections. Insurers make a game out of paying late because that extra day or two of interest is more money in their pocket. Insurers can be penalized for late reimbursement but the penalty is woefully inadequate.

Jeff stated that doctors need to be salaried but the question I have is, by whom? Since most doctors are self-employed, how would they be salaried? They have huge overhead with office expenses and staff. Doctors just don’t make that much money anymore. Consider that most go to school for 6-8 years. That’s followed by a residency and perhaps a fellowship. What salary would you think that would be worth, especially when you have to be on-call? Many doctors graduate with a debt in excess of $100,000. What incentive is there to work hard, perhaps 60 hours-per-week for a meager salary? Would you work long days and take call weekends and holidays?

I’m fascinated by the claim that doctors are taking kickbacks and rebates on drugs and services. What legitimate basis can you provide for these claims since these acts are illegal? There was much that went on years ago that never should have been allowed. I’m sure there are still some who take what they can get under the table, but to make a generalization that all doctors are on the take is just not true.

Jeff also doesn’t realize that continuing education is mandatory. What does he mean by “take place in Podunk, NJ or not at all?” Would you want a doctor caring for you who had no additional training in the 10 or 20 years since graduating from medical school? Health care is not static and new procedures, techniques and equipment are constantly being introduced. My mother received care (briefly) after a stroke from a marginally competent physician who was clueless about modern medicine and thought she had Parkinson’s. Fortunately she survived because of attentive family members. She’s doing well fifteen years later and does not have Parkinson’s.

The supply of doctors isn’t so much carefully controlled by the AMA as it is by the market and the desire of people to subject themselves to years of training for declining reimbursement. The government has increased the supply of qualified caregivers by expanding training programs for nurse practitioners, physician’s assistants, nurse anesthetists and nurse midwifes. The problem now is that with the tanking of the economy, the loss of jobs and benefits, it’s not so easy for some of these highly trained, skilled folks to even find a job after graduation.

I think we can all agree that pharmaceutical companies gouge us all. They spend a fortune on advertising trying to get people to believe they should take a pill for every ache or ailment. And of course it must be brand and not generic because drug companies want us to believe that the 3 cent pill is grossly inferior to the $3.50 pill even when made by the same company. The other farce is to combine two generic drugs to make a new “brand” drug and charge a huge markup. As for salespeople, some sales network is necessary as with any business. You can’t sell a product without educating people about its use, especially if it’s a drug.

I think some the biggest issues in health care fall into a number of categories:
1. Denial of insurance for pre-existing conditions.
2. Affordability of insurance.
3. Limits on deductibles.
4. Excessive profit margins by insurance companies and pharmaceutical companies and other products marketed for health care. Does a CEO really need to make $40-50 million or more in salary and benefits?
5. People needing care who opt not to carry insurance when they can afford it and opting not to pay for care received.
6. People who simply can’t afford insurance or health care.
7. Limited ability to get reasonable insurance as an individual.
8. Limited insurance options and portability of policies.
9. Too much red tape and decision-making power with insurance companies.
10. Transparency of actual costs vs. charges.

There are so many facets to the current health care dilemma. Any solution that mandates lower salaries for health care workers is going to result in fewer providers or providers of lower caliber. We are already expected to do too much with too little. How many other jobs demand absolute perfection but reimburse with the convoluted system that we use in health care?

Bob Morgan