The health care question

by Phil Stott

I've been thinking a lot about the state of the health care industry in this country of late-probably not entirely surprising, given the amount of attention it's been getting in the media.

Aside from the media coverage of the now-defunct deadline set by President Obama for Congress to deliver a reform bill, there are a few things that have set me to pondering the question. First up is an ongoing wrangle my wife and I are having with our insurance company over coverage for Maeve; they're maintaining that she's entitled to fewer visits in her second year of life than our pediatrician says she needs. Not that there's anything wrong with her-we're talking general wellness and progress visits-but it's extremely galling to be told by an insurance company that they won't cover check-ups recommended by a medical professional.*

Now, maybe the insurance company is right. Maybe the pediatrician's office we visit is unusual in the number of check-ups they request. Maybe they're engaged in the kind of cost-gouging that have prompted articles such as this one of late. They certainly aren't shy about billing for things; following Maeve's most recent visit-not the one that caused the dispute-we were sent an itemized bill that included charges for things such as ear cleaning ($70 for the two minutes it took to scoop the wax out). As outraged as I was by the charge, the insurance company ponied up the money for it and everything else on the bill short of our co-pay. All told, the fee for the visit-which lasted no more than 30 minutes, with the actual portion with a doctor lasting more like 15-was in excess of $800. Nice work if you can get it.

Looking over the bill, my wife felt so bad about some of the fees that she suggested vetoing them next time around-despite being discouraged by Maeve's pediatrician from cleaning her ears ourselves, she's pretty sure we could handle it. The point, though, is that there's no incentive for us to do that; it won't lower our premiums at all. The insurance company covered it, and probably still made a profit, the doctor's office got paid, and Maeve has clean ears. Everybody wins, right? Well, everybody except the people actually paying for the health insurance-namely my wife's employer and us. We're watching the cost of our premiums go up every single year.

I can think of no other profession where I can go in to visit a professional and not only have absolutely no control over the costs that professional charges, but so little incentive to even care about controlling the costs. I get no reward from the insurance company for refusing treatment, even if I know I don't need it. And, as with the ear cleaning example above, I know of no other private enterprise where you can levy charges for performing work that no-one asked for or was asked to approve. If I took my car in for a $30 oil change and was handed a bill for $500 of work done without my approval, I'd be kind of steamed. But if I take my kid in for a check up and the doctor decides to clean her ears without asking and then bill for it, well, that's just the way health care works.

However, I also know the flip side of the coin: a hernia sustained in Britain saw me wait a full year for the operation to repair it, as it wasn't a priority. And, moan as I might, I'm glad Maeve was born in a U.S. hospital than in an NHS equivalent in the U.K.-even the beds are nicer here.

Blending the best of both systems together seems to me to be the way forward-eliminating waste without curbing the incentive for innovation and achievement, providing health care for all without overloading the system or destroying the budget. I'm convinced that there must be a solution somewhere, and I'd like to think that it could happen in my lifetime. I won't be holding my breath though.

*For the record, I can't understand why examples like this aren't the instant rebuttal to claims that univeral healthcare provision would mean that a government bureaucrat will stand between you and healthcare. But maybe that's because I can't understand why bureaucrats are any less likely to approve treatment than employees of a for-profit insurance company with a vested interest in not spending money on treatment.