| Imagine that you and I are standing in line at a fast food chain. You order first: a 16 ounce soda off the 99 cent menu. You are charged 99 cents. Then, I order a 16 ounce soda off the 99 cent menu, and I am charged 20 cents. I don't have a coupon, I'm not the surprise millionth customer, I just always get my purchases at the fast food joint for 80% off. How would you feel about that? Would you think it unfair? Same soda, same cup, same lid, same straw. President Obama has thrust himself into the health care debate, along with the Senators and Representatives charged with coming up with some legislation. Answering to the plaintive screams of the stakeholders: drug companies, hospitals, insurance purchasers, medical device makers, home health aids, unions: but not patients. They're all talking about what services to provide to which patients for how much money and how to pay for it. They're all missing an incredibly important point. A few months ago, I sat down with Tom Knox, candidate for Pennsylvania Governor. We talked health care, amoung other things, and we've spoken since. He is the ONLY politician I've ever spoken with who understood one of the most fundamental issues in health care. And that is the issue of service cost parity. No one else is talking about it, even in a roundabout manner. And if we don't answer to it, any reform (except for Single Payer Universal Care) is doomed to failure. Here we go: you go to the hospital for an appendectomy and pay for it yourself. You are charged $10,000. You go to the hospital for an appendectomy and your insurance company pays for it: if it is the one favoured insurance company in any geographic area, they pay $2,000 - $3,500. Any other insurance company would be billed the $10,000. (In both cases, less deductibles and co-pays.) Same operation, same doctor, same hospital. No matter what kind of health "reform" they come up with, whether or not there is a public option, if this fundamental disparity is not fixed, health insurance becomes even more monopolistic than it is now. In America, excluding government insurance, there is only one dominant insurance company per geographic area. If they get appreciably better deals than anyone else, no other insurance company can compete on rates. This becomes more true if people make their own choices: they'll pick on price, and the non-dominant carriers will be out of business. And then it will just be mud wrestling for who can scam more: the hospitals or the insurance companies. |
