Our Crazy Health-Insurance System
First off, I can't say I disagree with it.
There are more factors involved though. I personally feel the quality of health care has gone down. One factor I witnessed first hand was litigation. When my wife had our last child she was told by her first doctor that she was a perfect candidate for a VBAC. That said, the doctor would not go to the hospital my wife wanted to go to (we had medical outcome reasons) so we changed doctors. Keep in mind we read the ACOG position paper on it and were well aware of the risks and the competency of my wife to deliver a 10 lb baby VBAC. We even had a second opinion from a trusted friend who happens to be an OB. From that point it went down hill as doctors fought tooth and nail to convince us that VBAC was a bad decision and having a repeat section is a GOOD decision. Every shred of medical evidence we can find argues EXACTLY the opposite point. During my wifes delivery the doctor on call came in and literally chewed me and my wife out because he said we were taking a big risk. My wife was in transition at the time. Why was he upset? He was afraid of something going wrong and us suing him. He was very honest in giving that assessment. Now, why does he want to intervene? Because despite the increased risk of intervention, when he goes to court there is more paperwork and more "stuff" done by the doctor. "I did all I could" sounds much better than "I just wanted to let the labor progress naturally (or I did nothing)".
Insurance companies do not put pressure on doctors to reduce the number of C-sections in this country. This would reduce cost. Insurance companies are not lining up to support free-standing birth centers across the street from major hospitals. This would reduce cost. They typically do not offer a reduction in premiums for people who choose that route. MOST of my insurance cost is maternity so I presume that a substantial amount paid out by insurers is towards delivering babies. If the birth-center movement had some traction insurance companies would pay out far less because, for one thing, every 3rd delivery would not be a section. Sections cost significantly more than a vaginal birth. A visit to a free-standing birth center costs literally thousands less than a hospital visit. The majority of healthy low-risk women are capable of delivering a baby naturally making a birth-center a great option both for cost and safety.
Now, lets consider this a little further outside of the scope of maternity. What incentives are insurers giving me to shop for price when I am ill? I cannot think of many. I get a list of nearly every doctor and town and am told "Go to any of them and we will pay 90 percent". In my own interests I am likely going to choose the BEST doctor and often times that is the most expensive doctor. It kind of makes me wonder if they are not all that upset with the way things work. After all, the more money they dole out, the more they can legitimately charge us and the more money they TAKE-IN. More money exchanging hands certainly is a good thing for them. Its how low margin, big-box retailers make a living.
Finally, I want to include one more aside on this whole mess. I am an asthmatic whose asthma has been reduced to a single mild attack every 6 months or so. When I was a kid and had it worse I could get an inhaler for $10 and it would last me several months. If I could buy one today it would last me years. The deal is, I cannot buy one over the counter any more. They have been pulled off the market because 1) doctors claim they do not want people self-diagnosing asthma and 2) they supposedly infect the atmosphere with CFC's. I can however, see a doctor and get a more expensive inhaler which, of course, still impacts the environment. I could get on Singulair and take one pill a day for the rest of my life. No asthma for me. Yay! But at what cost am I taking that route? My solution now is to deal with it naturally. My cases are mild and simply calming down and drinking caffeine tends to solve the problem. Its the right solution for me in this day and age. Still, I wish I could buy my old inhaler. I am willing to pay $10. I am not willing to ensure about $400 changes hands on my behalf and put myself at a risk for future higher premiums.
Who really wants to think about all of this though? If your employer is paying for your insurance all you care is what your co-pay is. Its exactly how I was until I spent time paying for my own insurance. If you want to know the truth I wish my employer would ditch my health care benefits and increase my pay by the amount they are paying for me. Then I could get an HSA and a qualifying high deductible policy. This would encourage me to be more responsible with my health care choices and if I remain in good health for a few years the money I won't have to save in subsequent years will result in a raise.
As it is, we have gone down this path for way too long and it isn't going to be corrected overnight.
First off, I can't say I disagree with it.
There are more factors involved though. I personally feel the quality of health care has gone down. One factor I witnessed first hand was litigation. When my wife had our last child she was told by her first doctor that she was a perfect candidate for a VBAC. That said, the doctor would not go to the hospital my wife wanted to go to (we had medical outcome reasons) so we changed doctors. Keep in mind we read the ACOG position paper on it and were well aware of the risks and the competency of my wife to deliver a 10 lb baby VBAC. We even had a second opinion from a trusted friend who happens to be an OB. From that point it went down hill as doctors fought tooth and nail to convince us that VBAC was a bad decision and having a repeat section is a GOOD decision. Every shred of medical evidence we can find argues EXACTLY the opposite point. During my wifes delivery the doctor on call came in and literally chewed me and my wife out because he said we were taking a big risk. My wife was in transition at the time. Why was he upset? He was afraid of something going wrong and us suing him. He was very honest in giving that assessment. Now, why does he want to intervene? Because despite the increased risk of intervention, when he goes to court there is more paperwork and more "stuff" done by the doctor. "I did all I could" sounds much better than "I just wanted to let the labor progress naturally (or I did nothing)".
Insurance companies do not put pressure on doctors to reduce the number of C-sections in this country. This would reduce cost. Insurance companies are not lining up to support free-standing birth centers across the street from major hospitals. This would reduce cost. They typically do not offer a reduction in premiums for people who choose that route. MOST of my insurance cost is maternity so I presume that a substantial amount paid out by insurers is towards delivering babies. If the birth-center movement had some traction insurance companies would pay out far less because, for one thing, every 3rd delivery would not be a section. Sections cost significantly more than a vaginal birth. A visit to a free-standing birth center costs literally thousands less than a hospital visit. The majority of healthy low-risk women are capable of delivering a baby naturally making a birth-center a great option both for cost and safety.
Now, lets consider this a little further outside of the scope of maternity. What incentives are insurers giving me to shop for price when I am ill? I cannot think of many. I get a list of nearly every doctor and town and am told "Go to any of them and we will pay 90 percent". In my own interests I am likely going to choose the BEST doctor and often times that is the most expensive doctor. It kind of makes me wonder if they are not all that upset with the way things work. After all, the more money they dole out, the more they can legitimately charge us and the more money they TAKE-IN. More money exchanging hands certainly is a good thing for them. Its how low margin, big-box retailers make a living.
Finally, I want to include one more aside on this whole mess. I am an asthmatic whose asthma has been reduced to a single mild attack every 6 months or so. When I was a kid and had it worse I could get an inhaler for $10 and it would last me several months. If I could buy one today it would last me years. The deal is, I cannot buy one over the counter any more. They have been pulled off the market because 1) doctors claim they do not want people self-diagnosing asthma and 2) they supposedly infect the atmosphere with CFC's. I can however, see a doctor and get a more expensive inhaler which, of course, still impacts the environment. I could get on Singulair and take one pill a day for the rest of my life. No asthma for me. Yay! But at what cost am I taking that route? My solution now is to deal with it naturally. My cases are mild and simply calming down and drinking caffeine tends to solve the problem. Its the right solution for me in this day and age. Still, I wish I could buy my old inhaler. I am willing to pay $10. I am not willing to ensure about $400 changes hands on my behalf and put myself at a risk for future higher premiums.
Who really wants to think about all of this though? If your employer is paying for your insurance all you care is what your co-pay is. Its exactly how I was until I spent time paying for my own insurance. If you want to know the truth I wish my employer would ditch my health care benefits and increase my pay by the amount they are paying for me. Then I could get an HSA and a qualifying high deductible policy. This would encourage me to be more responsible with my health care choices and if I remain in good health for a few years the money I won't have to save in subsequent years will result in a raise.
As it is, we have gone down this path for way too long and it isn't going to be corrected overnight.
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