A colleague of mine experienced our health care system at its best over the last couple of days. In light of the coming Supreme Court decision on the efficacy of Obamacare, it is instrumental to relate his experience, since if Obamacare were to be upheld, the experiences we have with our health insurance companies will surely not match that which my colleague experienced. My colleague’s child required emergency services, and the initial request for payment was denied since sinus infection leading to bronchitis and shortness of breath in the middle of the night is a preexisting condition. Health insurance companies need to protect against individuals gaming the system if they are to provide effective services to their customers. In this case, even though this insurance company had no record of it, it could reasonably be assumed that the patient had in fact had a sinus infection at some point in their childhood, and therefore this incident of a sinus infection is reliably a preexisting condition.
The health provider system in this case was efficiently organized to provide highest quality of service at least cost. While the patient had health insurance from a national insurer, a third party was selected to process the claims. When a bill for emergency services arrived at my colleague’s house, noting the insurance company on the bill but indicating no insurer payment, a call was made to the third-party processor who, it turns out, had no record of the bill. A further call to the insurance company itself (well, several calls, but that’s beside the point) indicated that the bill had been charged against an account with this insurer which had expired 6 years previously, explaining why the insurance company declined payment. A further call to the service provider itself, the hospital which delivered the care, pointed my colleague to the company which provides their billing services. It turns out that a reasonable error had occurred. Even though the patient’s card indicated the insurance ID, the billing company’s practice is to enter the name and the insurer into their computers, and rather than match to the patient’s insurance ID, merely bill to the first entry which pops up, which turned out to be the former policy now lapsed these 6 years. When asked to make an indication on the patient’s records to enter the proper insurance policy for any subsequent visits, the billing agent told my colleague that it would be entered, but not to expect that it would make a difference, since checking such things was not the usual procedure.
My colleague has nothing but praise for the efficiency and efficacy of our health care systems, the best on the planet. There were only four parties which had to be contacted to insure the matter was dealt with, the hospital, its billing company, the insurer, and the company handling the insurer’s claims. It only took about 4 hours on the phone to straighten out the matter, all of which revealed the competence and professionalism of all parties involved, and the efficiency of the system as a whole. My colleague is rightly curious about how passage of Obamacare might impact our current, well-oiled health care system.
All of which became even more interesting on the publishing of two articles recently in the New York Times. One, Getting Lost in the Labyrinth of Medical Bills, exclaims the benefits of capitalism and the free market in the health care system, noting that the price that two patients pay for the same services can vary dramatically based on the market power of the health insurance companies covering the two patients. This free-market interaction between health care providers and health care insurers leads to benefits for both; by providing lower rates to insurers who direct patients their way, both the hospital and the insurer benefit, just as capitalist theory predicts.
This does bring up a minor issue addressed in the article, that patients are often confused by the system; but this, too, results in an efficient free-market solution, that of health care advocates, who help patients navigate the system, providing extra employment in the health care field as a further benefit.
If the previously cited article shows the value of the free market in our health care system, a further article, E-Tailer Customization: Convenient or Creepy?, reinforces the notion. The article notes the mutually-beneficial effects to the customer and retailers like Amazon of the retailers’ ability to use information about the customer to tailor the information and coupons for savings the retailer presents. Just as each customer can have a better experience when retailers like Amazon present them items and costs different from what they might present to the next customer, so health care consumers get the benefit of being charged differently for similar services, based on the company they have chosen to provide them health care insurance.
There is significant concern that Obamacare might upset this efficiency of our health care system; will the Supreme Court see the light?