The health policy wonks and those who purport to “reform” the U.S. health care system may be long on academic and other fancy credentials. But they also persist in demonstrating they can be short on old-fashioned common sense, especially about the way most of us lead our lives.
That’s a point emphasized in a recent column in the evidence-based “Upshot” feature of the New York Times, written by Austin Frakt. He directs the Partnered Evidence-Based Policy Resource Center at the VA Boston Healthcare System and is an associate professor with Boston University’s School of Public Health and an adjunct associate professor with the Harvard T.H. Chan School of Public Health.
Frakt looked at some recent research to dissect a question that occupies many experts: Could Americans cut their health care costs by shopping around more for medical services? This is a fond notion held by a slice of health care “reformers,” whom Frankt proceeds to disabuse.
He notes that it’s “ludicrous” to expect medical service shopping from patients suffering a heart attack or parents dealing with a feverish kid in the middle of the night. But even with the estimated third of instances that are non-emergency and even elective, is it plausible to think health care shopping makes sense?
Nope, he answers, pointing to a recent study examining patients’ payment possibilities with imaging (MRIs) for lower limbs (knees, feet, ankles). In many areas, not only are there many options to get an MRI nearby (15 sites on average within 30-minutes’ drive), they vary widely in cost, from as little as $280 to $2,100. Controlling so it’s the same type and quality MRI, patients — if they hunted around and traveled a bit — could save anywhere from 36 to 55 percent on the procedure, researchers found in their study of records on 50,000 consumers, ages 19 to 64.
But here, as Homer Simpson would say, is the “Doh!” factor emphasized in this work: Patients find it too complex and daunting to shop for medical services — they instead rely on doctors’ recommendations. If their MDs practice in a big, shiny hospital where MRIs will hit the max price and that’s what the doc promotes, well, that’s where patients end up.
Frakt gamely suggests that instead of targeting patients, cost-control advocates might stand doctors up with broader, deeper information on lower-cost services and providers near them, so they could suggest them to their patients. That does, however, ignore “facts on the ground” — the clubby practice of medicine, in which referrals are like gold, not to mention that many practitioners benefit financially by recommending expensive tests and services because they get a piece of the payments, say, as hospital or practice partners.
In my practice, I see not only the harms that patients suffer while seeking medical services but also their struggles to access and afford safe, efficient, and even excellent medical care. As anyone who deals with doctors, hospitals, insurers, and medical costs and bills knows, the system seems set up to be a byzantine and confusing as possible. What working person has the time or patience to wade through the thicket of esoteric jargon, tiny print, and bumpf that’s a routine part of US health care? Where are the clear, simple, transparent price lists and other comparative tools to make it easy and simple for consumers to understand and “shop” for better, cheaper medical care? Why does our health care system fob the burden of hunting for good and affordable treatment onto patients?
The absence or dearth of such patient-friendly resources is also why, on another account, it is shameful and unacceptable that President Trump and his administration have decided to promote so-called association and “STLDI” coverages, blessing them in newly issued regulations. That last acronym is officials’ way to describe, in redundant fashion, health policies dubbed both short-term and limited duration. They’re neither, actually, since they can be written for terms of three years. And others, appropriately, have dubbed these offerings as being skinny or junk.
STLDI policies, if they survive court and state regulatory challenges, resurrect an unhappy, unsuccessful coverage targeting younger, healthier Americans, offering them low or lower premium in exchange for — well, who knows what. Experience has shown that companies offering the policies write them with a torrent of fine print, exempting from coverage such items as pre-existing condition protections, prescription drug payments, and maternal care.
As Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services in the Obama Administration, described the coverage this way on Twitter: “You will never know what’s in a Trumpcare Insurance plan for the simple reason that: You will never be as good at reading fine print as insurance companies will be at writing it.”
Many policy-holders, if they fall ill and need health insurance, will find they, essentially, have none, critics say. Who are they? As Noam Levey, the seasoned health care reporter for the Los Angeles Times, reminded on his social media account: 98 percent — or 335 of 340 — of healthcare groups criticized them.
Trump officials promote this coverage, however, as offering consumers new options. Advocates don’t even try to disguise that they’re an attack on health insurance offered through markets established under the Affordable Care Act, aka Obamacare.
STLDI coverage will be accompanied, if the administration has its way, by other alternative policies to be issued and promoted by like-minded groups, including small businesses and associations of interest. Business leaders, angry with Obamacare, insisted for years that associations would leap into the fray, offering cheaper, better health coverages, if allowed. Funny thing, a leading small-business group advocating these plans for decades, has gone quiet but has acknowledged that, no, it won’t offer its own plan.
To those who wish to shop around, study well, bonne chance — and caveat emptor.
For the rest of us, might think again and ensure you’re registered to vote, as we’re less than 100 days from crucial midterms. We need to let our elected officials know what we think of their efforts to make our lives harder, more complicated, and potentially costlier by pushing more and more of health care’s burdens on us.