11-28 Guest Column

There is no free market when it comes to health care

  • Published: 11/27/2009 11:47:43 AM
  • Last Updated: 11/27/2009 11:49:43 AM
   Hello? Is anybody out there? I want affordable, quality health care!
   Not to worry, they say. Competition will bring down the cost of care.
   Huh? The only competition I see is between insurance companies vying to attract new members to their risk pool.  Even the public option, as written today, can only compete when the applicant is unable to get other insurance.
   Then they say: not to worry, the free market will bring prices down. As if that has worked over the past 20 years.
   So I have waited ... a life time, and now I am of an age when I know I will need health care, but if the insurance prices keep going up 20 percent every year, I probably cannot afford it even if I am on Medicare. Not to mention that cutting costs seems to mean lowering the service level from doctors to a physician assistant and below that a nurse practitioner or a nurse at the same office visit price as for a doctor.
   When I ask, “how much?” they ask me what insurance I have — to answer a question with a question is never a good thing.
   I say, “I want to know how much it will cost to have my hip replaced?”
   “Well, it depends on what your insurance has set for their  payout and then you pay the difference.”
   Okay, so what is the difference? When you get your bills it will give you the amount? “Isn’t that like buying a pig in a poke,” I reply.
   At this point I am doubting my intelligence. When I got the hospital bill, the physician bill, the surgeon bill, the diagnostic tech bill and the drug bill — followed by the Medicare review of what’s owed and finally the explanation of benefits, the only thing they had in common was the date of service. No wonder there is a raft of Medicare fraud. The buyer of the service, me, never knows if the price is right.
   Now, it dawns on me what might be a problem: the insurance companies have negotiated a deal with the hospital and the doctors on my behalf.
   The charge is determined by what the insurance companies are willing to pay and what the health care system is willing to accept. What they accept of course will also cover the indigent costs for those who did not or could not pay their healthcare bills plus, of course, the costs of the middle men’s outlandish CEO salaries.
   There are as many prices for any given treatment as there are insurance policies. I think, this is the juncture where the “free market” competition is supposed to take place.
   Whoa now! The free market works when the seller and the buyer negotiate a deal. Right? They bargain. The health care system is the seller of services and I am the buyer — not a middle man. So how is their bargain going to bring down the cost of health care for me or for my small business?
The other part of the problem is that with the life or death issue of health care, I do not always have the choice to refuse care while looking for a better price or better care while I am having a heart attack, for example.
   I don’t understand why an insurance company is the decider and not me. If I have to have car insurance which costs too much, I can sell the car and take a bus. Not so with health insurance. Taking the risk of not having health insurance may mean bankruptcy or death if I have a catastrophic injury or chronic disease.
   I do, however, understand that I probably cannot bargain with a health system all by myself. A much larger group is needed for the bargaining power equal to the monopolistic health care systems. So who is the power broker? I don’t know at the moment, but I am darn sure I want a broker who cares more about my life, my costs than they care about profits.
   My final question, not yet answered, is where in the legislation now being discussed are the incentives to cut health care costs? It sure isn’t in the free market.
   For anyone who wishes to be better informed about health care issues, I recommend a newly published book, “50 Meds for a Sick Health System” by Oregon author Randy Stapilus. Stapilus is a research journalist who has firsthand experience with the system. It’s a quick read of 163 pages.

Marni Haley is a resident of rural Yamhill County

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dmbprogsv from newberg
11/27/2009 10:17:09 PM

now the rest of the story...when you only have about 5 companies that the atate of oregon ALLOWs to compete against each other,,and the state SETS the rates by the way,,,whio is the compitition?,.... the state...welcome to progressive way of faking you out...its done it's duty hasnt it... why not this novel idea..OPEN the state up to ALL and evry insurance comany...then you will see capitalism at its finest...it will force down the prices...guarenteed...when you keep voitng for progressives you are voting for socialistand commiunist ideas..dont be fooled...like you have been for 20 years

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