Why we can’t have nice things…

Hopefully everyone saw the announcement last week that business titans Amazon, Berkshire Hathaway and JP Morgan Chase were teaming up to tackle the rising costs of healthcare. This announcement noted that this was solely to benefit the collective one million U.S. employees of the combined organizations; but many of us dreamed that they would disrupt the whole healthcare industry and solve the general healthcare cost crisis in which we appear to be stuck.

That is, we were hoping until everyone in the healthcare sectors started complaining to JP Morgan’s bankers.

Wait, what??? Well, I guess that is why we won’t see any healthcare disruption anytime soon. Or, as I tell my kids, here’s why we can’t have nice things…

The reality is that way too many players in healthcare today are making a lot of money (from insurance companies to physicians). So much money that they hire lobbyists, call their investment bankers at JP Morgan and otherwise make every effort to keep their income growing. Wouldn’t you?

One key component of why we pay so much for healthcare in the US is the lack of transparency and payment integrity issues (i.e., overcharging), resulting in large profits for many in the market. We are also so emotionally connected to our healthcare in the U.S., we have a hard time becoming a consumer when our own health is involved (especially on the pre-care/emotionally gut-wrenching side of healthcare decision-making).

In Texas, the Department of Insurance launched a mediation program to assist patients with large “surprise” bills ($500 or more). With this program in 2017, the mediation only paid the providers 14% of the charges they were billing ($1 M was paid out of $7 M in disputed charges). Keep in mind that this total is only limited to:

  • People who knew about and who took the time to use the program.
  • The provider did not have them sign a document that estimated the cost of the services, or where the actual cost actually exceeded the documented amount.
  • You were treated by a non-network Radiologist, Anesthesiologist, Pathologist, Emergency Department Physician, Neonatologist or Assistant Surgeon in a network hospital.

Imagine the numbers outside of that subset in Texas alone!

So, the lesson here is that we can all hope and dream that healthcare can be “fixed.” However, until we are all aligned and agree that there will be some losers in the new equation (including insurers, PBMs and even physicians), we’re still stuck with rising costs as long as we can continue to pay. I keep thinking that we’ll hit the spending limit some time soon, but it seems to just keep rising. Maybe someday we’ll find a reason to have nice things.

 

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