Thursday, August 20, 2009

(mis)Understanding health care reform

As much as I love President Obama, I don't think health care reform is going to happen this summer. It's just too complicated. I consider myself an intelligent person, and I really don't understand it. So I imagine that most other intelligent people (and maybe some less intelligent people) don't understand it either.

To make it even worse, the right wingers have used some pretty annoying tactics to try to derail Obama. Focusing on several issues that are hot-button issues to many, such as abortion (i.e. saying that abortion "on demand" will be paid for by the new health care plans) and "death panels" (i.e. saying that elders will be unable to receive life supporting care at the end of life). And finally, sending disruptive people to town hall meetings all over the country. Here is an example of one, and Barney Frank's amazing response.

This is what I do understand.

Under the new plan, you will probably still get health insurance through your work, if you do so now. But if you don't get health insurance through your work, there will be a different way to get it: through the government plan. That plan will guarantee everyone basic health insurance. This sounds good to me. But I don't understand exactly how it will work.

I've tried to understand, I really have. I've even looked up information on other country's health care systems, like France and Israel. It's been interesting, but I'm still confused.

Speaking from my experience of this past year, while I'm grateful for my health insurance and health care, I'm pretty confused by it. Every time a procedure was submitted to the insurance company, the hospital or physician received approximately half of what they asked for (or sometimes less). Does this mean that the price they asked was inflated intentionally? Or has my health insurer negotiated a lower rate with them? And either way, what is the ACTUAL WORTH of the procedure? Or is there no such thing?

Here's an example: for my lumpectomy this winter, the surgeon charged $3056. She received in payment $1038.52. This is about a third of what she charged. What does this mean? The hospital fees for the surgery were $9519. They were paid $4890. So that was about 50% of what they charged. Again, what was the actual worth of the services? $9500? $4800? Or something in between?

Apparently I'm not the only one who is confused, as there isn article about this very topic in the NYTimes today.

If any of my readers can shed light on health care reform for me, please do so in the comments. Thanks!


D said...

Hi Adena,

Dorothea from the Spa. Insurance companies pay what they call reasonable and customary. It does not matter what the dr. or hospital charges. Insurance payments are negotiated by the employer, that is why two people may have the same insurance company, but they have different co-pays. One person may not have to pay anything for insurance, while someone else may have to pay a monthly fee to the inurance company or the employer. The employer decides as they are the one who contracts with an insurer.
I am sure that you dr/hospital charges what they consider the service to be worth, but your dr. knows just what percentage of the fee they will be paid. I will send you a separate email with my email address as I am not sure how blogs work. Had a great time with you and the other women at the spa. Keep in touch!

adena said...

wow, Dorothea, great to see you here on my blog! and thanks for the great explanation! that weekend was fantastic - thank you!

Anonymous said...

The ability to understand our health care system might get easier with reform. It is hard to understand for a reason and that is that it is not a market driven economy or system. There are not educated consumers (there are only the sick and those in need of care - how can that lend itself to "price shopping?"), and there is a disparity of knowledge and skill between those who need services, and those who purchase them and those who give them.

So, we need an umpire in the game.