Sad but accurate
An economist by the name Uwe E. Reinhardt published a very nice article in Health Aff. 2006;25(1):57-69
One specific paragraph summarized our current healthcare pricing as follows:
Until now, the U.S. health care "market" has been analogous to an imaginary world in which, say, employers offered to reimburse their employees 80 percent of the "reasonable cost" of all attire deemed "necessary" and "appropriate" on the job but, under the contracts negotiated with department stores by the fiscal intermediaries administering this "Clothes Benefit Program," employees had to enter department stores blindfolded. Only months after a shopping trip would the employee receive from the fiscal intermediary a so-called Explanation of Benefits (EOB) statement, explaining how much the employee had to pay for whatever he or she had stuffed, blindfolded, into the shopping cart on that shopping trip. Framed in bright red on that EOB would be the statement: "Pay X amount." X would represent 20 percent of what the intermediary would have judged, ex post, to be "reasonable prices" for those garments in the shopping cart deemed by that intermediary, ex post, to have been "appropriate" attire for the particular employee's circumstances. It also would include 100 percent of the prices charged by the stores for items in the cart that were deemed by the intermediary, ex post, as "not necessary" or "inappropriate" and that were therefore not covered by the Clothes Benefit Program.
Ridiculous though it sounds, such an arrangement closely resembles the current payment system for U.S. health care. It is difficult to reconcile this picture with increasing demands by employers, insurers, and policymakers that patients be forced to act as more responsible "consumers" of health care, a movement now gathering force under the banner of consumer-directed health care.
This scenario is very accurate as to how things occur every day in our current healthcare system. The time for change is here and we as consumers, patients, and providers need to start directing the changes rather than allowing politicians and third parties to dictate them.
One specific paragraph summarized our current healthcare pricing as follows:
Until now, the U.S. health care "market" has been analogous to an imaginary world in which, say, employers offered to reimburse their employees 80 percent of the "reasonable cost" of all attire deemed "necessary" and "appropriate" on the job but, under the contracts negotiated with department stores by the fiscal intermediaries administering this "Clothes Benefit Program," employees had to enter department stores blindfolded. Only months after a shopping trip would the employee receive from the fiscal intermediary a so-called Explanation of Benefits (EOB) statement, explaining how much the employee had to pay for whatever he or she had stuffed, blindfolded, into the shopping cart on that shopping trip. Framed in bright red on that EOB would be the statement: "Pay X amount." X would represent 20 percent of what the intermediary would have judged, ex post, to be "reasonable prices" for those garments in the shopping cart deemed by that intermediary, ex post, to have been "appropriate" attire for the particular employee's circumstances. It also would include 100 percent of the prices charged by the stores for items in the cart that were deemed by the intermediary, ex post, as "not necessary" or "inappropriate" and that were therefore not covered by the Clothes Benefit Program.
Ridiculous though it sounds, such an arrangement closely resembles the current payment system for U.S. health care. It is difficult to reconcile this picture with increasing demands by employers, insurers, and policymakers that patients be forced to act as more responsible "consumers" of health care, a movement now gathering force under the banner of consumer-directed health care.
This scenario is very accurate as to how things occur every day in our current healthcare system. The time for change is here and we as consumers, patients, and providers need to start directing the changes rather than allowing politicians and third parties to dictate them.
posted by Anonymous at 6:08 AM
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