Friday, November 10, 2017

Affordable Care, Accessible Care, or Amazing Care - Pick Two, or Maybe Just One

There's an interesting article over how on Doctor found out how insurance preauthorization requests for medicine are dealt with, and to someone with no idea of economics, nor of the messed-up state of our health system it seems shocking.

Medpage Today: Who Actually Is Reviewing All Those Preauthorization Requests?

While it is on the Internet, there's no reason to disbelieve the veracity of the account. Some Facebook friends were in high dudgeon over how dare an insurance company deny requests due to cost, after all how dare they?

As explained in the account, if they approve every expensive treatment to everyone who requests it the system goes broke - and fast.

Obamacare isn't making it any better and if anything is making it worse combining even more byzantine regulations, taxes, and fees that serve to subsidize one portion of the population at the expense of everyone else.

While some people demand we adopt the Canadian health care system, that system scores high on affordable (to the patients if not the government and overall payers) but low on accessibility due to wait times and low on amazing as many treatments are withheld or denied due to lack of resources as everyone is scrambling for all of it. You'll get access to care all right, in a few months or years, eventually, if you don't die first. Canada while excellent for access to emergency medicine is pretty lousy for access to non-emergency issues - average time in Ontario for an MRI for example is 101 days. Depending on the situation, you may not have that time to wait, not to mention waiting possibly in pain for 100 days to get whatever is wrong diagnosed. Looking over that site, while they often claim they're close to hitting their targeted date, the date itself for many procedures is set pretty darn far out beyond what would be acceptable to people in the USA to make it an achievable goal with the resources they have, and they often can't hit it even after they set it up with that in mind.

Yes, the US Healthcare system is a complete mess, so much so that it's hard to tell what the cost for a procedure even is before you have it, and depending on the insurance you have, you might pay for some, all, or none of it. Even the amount actually paid for the procedure after it is billed can also vary dramatically.

Adding to the fun the US Pharmaceutical market subsidizes the world market in pharmaceuticals as the same drug s sold cheaper elsewhere due to either government purchases and formularies or because the company knows that Americans can be made to pay more. Since people in other countries can't, the companies decide to make less overall profit in those countries but maintain some volume there and make at least something for their drugs and they then makeup the profit margins back in the US.

No easy answers to the problem, and anyone who tells you they can get you Affordable Care, Accessible Care, and Amazing Care all together just by adopting their genius plan to revise the American healthcare system is lying to you.

2 comments:

Scott said...

From how you describe it, having Blue Care Network here in Michigan is like having Canadian socialized medicine. Waiting 90 days for an MRI is normal, as I have had to do for chronic knee and low back pain.

I eventually got the MRI's, but had to jump through multiple hoops with multiple interim treatments (PT, epidural injections, spinal steroid injections, etc) before they would even consider it.

And after all that hoop jumping I did eventually get my knee scoped, but I'm no closer to getting the back pain fixed.

Michael Carrell said...

Thier is no way to control cost without market competition and market pricing.
Karl Denninger outlines an approach which would accomplish this at fixhc.org, many of these ideas should be included in a reform of the healthcare mess.