Healthcare and Capitalism- YOUR MONEY, YOUR HEALTH, YOUR CHOICE?
Your Money: My opinions on this topic should be a book and it has been the subject of many. I mentioned the history of healthcare in my book BridgeIT: The Integrative Approach to the Healthcare Crisis in the United States. My son, who is in college, had to read The American Healthcare Paradox by Elizabeth H. Bradley and Lauren A. Taylor. He knew I should read it, too. They did an amazing job summarizing the history of healthcare and how it is different than Scandinavian countries, who spend less in healthcare and more in social services to support overall wellness.
The staff of BridgeIT have a motto: YOUR MONEY, YOUR HEALTH, YOUR CHOICE. That is not just a motto to us, we believe it! We believe it so much, we scrapped our idea and are bringing the conversation to you. What is your choice? What do you want your healthcare to look like? It’s your money, how do you want to spend it?
So, let’s start there. It’s your money. If you haven’t read my book, there is a chapter called Healthcare Math, where I explain the confusing model of the corporate provided healthcare as a benefit, and your actual costs. It’s a grand illusion that you make what you think you make and most of us in the U.S. don’t realize what our employers cover or how much it costs.
So, let’s look at basic capitalism. You want to buy a new television. At first you have some idea of what you might want. You want it to stream Netflix and be able to see every scale in the dragon on Game of Thrones. You go to your local Walmart and start to look at the prices. Do you want LED? 5 series or 7 series? 50” or 60”? What is the difference between the $249 model vs. the one for $349. You may get someone helpful at Walmart, but you feel like you should shop around. So, you go to Best Buy and ask them all the same questions. Maybe now you are looking online and asking your friends. “Jack, you have a nice one…What do you have?” What is clear is you get to choose who you buy your tv from, what kind you get, and pay for it with your hard-earned money. (I’m curious, did you charge it to a store credit card to get a discount? This may apply to our conversation later). This is capitalism at its best, right? Your money, Your TV, Your Choice.
Now let’s say you have a job at a local factory making widgets. When you hired in, they offered you full benefits including healthcare. Cool! Do you get to choose which healthcare plan? Not usually, they have met with the insurance company to find the best price for their factory as a group. So, the factory does have a choice. Factory’s money, Factory’s choice. The insurance company create plans for the corporations to get a group rate. The cost is still very high, let’s say $700 a month for you and your family. You may get an option to choose a managed care plan with a lower deductible of $1,000 and a 20% co-pay, but you are limited in what doctors you can see. Or you can get the everything is covered plan for $700 and a $2,000 deductible and 50% copays but you can choose your own doctors. (Confused yet?) Now let’s say you hurt your shoulder moving the widget’s at work.
If you have the managed care plan, you have to see the doctor’s that are covered, so it’s like saying you can’t go to Best Buy, you have to shop at Walmart. And you are told by the doctor, who is paid by the insurance company, that you need a shoulder surgery. His cost is $5,000, but your insurance pays $3,500 for it, so that is the new cost. You have to pay $1,000 up front and then pay $500 in copays also. If you have the everything insurance plan. Your cost would be $2,000 up front and $750 in copays but you can go to Best Buy and get it there for $2,000 and $525. Does that feel like you are the customer and are getting the best price for the product?
No? Well maybe we have to look at the hospitals and doctors to lower the price there. Does the doctor say, “my cost is $300” and you say, “I will give you $175” and they say-SOLD! The doctors and hospitals have a cost to their services, but it is difficult to pin down a comprehensive cost for a “shoulder surgery”. There are many factors to consider, such as equipment cost, multiple providers, cleaning the operating room, medications, support staff, and unknown complications. So, insurance companies created DRG’s (Diagnosis Related Group) and they collected data of thousands of shoulder surgeries and decided the average cost should be $3,500. Hospitals are dependent on insurance reimbursement and government reimbursement, so they are forced to accept this amount. If it is more than that, they may have to write it off.