Comment on Drug Firms Paying Doctors by Debbie Abrams Kaplan

Debbie Abrams Kaplan — Tue, 16 Nov 2010 01:32:36 +0000

Ken – in fact I’ve looked at a lot of EOBs lately, and it’s crazy how high my out of pocket costs would be if I had to pay the entire thing myself. There’s not much “explanation” of the benefits or payments on those EOBs, just some numbers and a few words.

Comment on Drug Firms Paying Doctors by Ken Ricci

Ken Ricci — Tue, 16 Nov 2010 01:04:15 +0000

Thank you, D. Kaplan, for pointing out one of the major conflicts of interest in the medical business today. There are many others. One of the consequences of the current so-called health “insurance” industry is that the prices are set by negotiation between health care companies and doctors–but patients generally do not even know how much each medical procedure costs, nor is there any clear way to find out. (Have you read an EOB form lately? I get a headache just thinking about one.) All we know as patients is what the health insurance company charges us, or our employer, each month, and we are told “medicine is expensive, and getting better all the time–so it gets more expensive too.” We are told, essentially, “trust us, we your health care company know what medicine costs, and you don’t, so take our word for it.” But of course the health insurance companies do NOT have an incentive to get the right amount of medicine for the right price. No, from the point of view of the doctor and the industry, the more medicine that gets used, the better. Without knowing how much each piece costs, we the consumer are not able to exert any competitive price pressure. And we pay the same monthly premium whether we use too much medical intervention or not enough. So the incentives are skewed in favor of using too much, on all sides: doctor, patient, & health care company. The only possible outcome of this conflict of interest is that medical costs will continue to rise faster than inflation, faster than wages, and faster than the cost of living. –until we realize that we don’t have “competitive” health service pricing anymore, and try to impose some sound economic principles on a system that long ago abandoned them. But that would require separating the “routine health care” plans from the “catastrophic insurance” plans from the “chronic care” plans. Only the catastrophic care is properly called “insurance.” The other two types of care should be called collective bargaining plans rather than insurance plans, and should be handled by a separate company under a separate plan.
If that seems too complicated, go back to your last Explanation Of Benefits (EOB) form and see if that’s really the system you want setting the prices for us.

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Comment on Drug Firms Paying Doctors by Debbie Abrams Kaplan

Comment on Drug Firms Paying Doctors by Ken Ricci