Tuesday, January 18, 2011

The real health care reform issue

Now that the Republican-controlled House is voting symbolically to repeal the health care reform act signed into law last year, it is time to revisit what is truly wrong with health care reform.

The single greatest problem in health care is health insurance or what is referred to in the business as "denial of claim."

Huge profits are made and executives are rewarded millions in bonuses by how much an insurance company refuses to pay for legitimate medical expenses by its subscribers.

For example, I need to have surgery on my foot. ODS, my health insurance provider, will pay 80/20 for the surgery whether it's done at the doctor's office or as an outpatient at a hospital.

But, ODS will not pay for a facility charge from the doctor, which means it would cost me between $1,000 and $1,200 out of pocket on top of the doctor's fee.

ODS will pay the facility charge at St. Charles Medical Center in Bend, but the procedure there costs between $8,000 and $10,000, which would cost me about $2,000 out of pocket. The insurance company would be on the hook for roughly $6,000 to $8,000.

So, ODS will gladly pay 6 to 8 times what is necessary in order to not pay my doctor a facility fee, which is a legitimate expense.

To put it mildly, this is counter-intuitive.

It is the No. 1 reason why our health care system is worse than much of the developed world. We pay more and get less health care.

For-profit insurance companies wrote much of the health care reform legislation and they protected their turf.

Until we have a non-profit, single-payer insurance system in our country we will never have true health care reform.

This won't solve all the problems associated with health care, but it will go a long way to making it better.

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