Subverting Competition in Healthcare May Force Price Controls

ruralhealthclinic-jeuaNew Orleans   There are obvious glitches in the Affordable Care Act that the politicians will handle.

One of them, as I’ve argued before, is going to be extending the deadline for enrollment to escape penalties past March 31, 2014, and that assumes that the government doesn’t waive the penalties entirely for the first year, which will more likely be the action taken if there continue to be huge systemic problems in enrollment.  The reasons are simple.   Politicians won’t take the heat from something that is obviously not fair to their citizens.   It is equally obvious as President Obama has argued that come hell or high water, they will fix the online process.   This is his legacy program and he does not want the enrollment problems to be in his official biography and eventual obituary.

Interestingly, there is another huge political problem looming in the Senate that perhaps was not as anticipated, but may have been the most effective obstacle created by the continued Republican rearguard actions, especially at the state level where half of the governors and their state legislatures have blocked Medicaid expansion and state managed marketplace exchanges. That problem, as a recent New York Times article indicated, lies in the widely disparate pricing for policies in rural areas, where healthcare is scarcer anyway.   No matter how urban the country is now, we have become no small number of Tea Party Congresspeople coming from areas where rural interests still dominate, and the weight of more rural states is still strong in the Senate where population is irrelevant to voting strength.

Talk about the irony of being hoisted by your own petard!  We have a private insurance company dominated healthcare model in the Affordable Care Act, because ideologically the notion of government managed and run healthcare like Britain or Canada was past the pale.  Our system would privilege private insurers and get the job done through the almighty power of free competition, by God!  Well, it turns out, not surprisingly, when politicians refuse to expand the insured base through Medicaid expansion and delay the marketplaces, then private insurers don’t want to come into those states, and these same market forces leave one or two companies in those situations with a virtual monopoly for providing the coverage, and prices do not go down, but in fact even in some situations increase.  So from place to place in rural areas, rates for the same coverage may be three and four times higher.   You can feel the political heat from here!

The solution would be that the government caps prices, but price controls might even be more inflammatory for the real conservatives than the problem they have now created, probably inadvertently given the low level of economic education even by supposed free market advocates.   As conservatives get over the fact that they can kill Obamacare and are forced to reckon with the ongoing reality of its impact in their districts, this will be a problem they will not be able to avoid.   It’s going to be interesting to hear the contorted arguments and watch the policy gyrations as they argue against price controls that would balance the cost for all Americans, and try to figure out a way to put the government’s finger, if not whole fist, on the scale to get some cost balance, since that’s only fair and their constituents are going to be calling for it, and loudly.


We All Need Health Advocates and Advisors

healthNew Orleans   The more I get my arms around the current American health system, the more I’m convinced we all need real help and representation and need it badly.  

            Two hugely disturbing cases of predatory abuse in the current health care system underscore my concerns.   One was a story as old as usurious interest rates about how some professions including dentists are offering patients special credit cards at shamefully high interest to pay for procedures they need but can’t afford.  Another was robbery not at the point of a drill but hidden behind the mountains of bills from hospitals involving so-called network versus non-network billing practices for doctors, anesthesiologists, and the swarms of others that a patient and family can’t possibly sort out in the throes of a health care crisis.

            This network non-network thing is too wild.   When you go to a doc or a hospital within your insurance network, you’re solid, but once they pull the curtain and put you in a standard issue hospital gown, you may assume everyone you are dealing with is Blue Cross or whatever kosher, but that’s definitely not the way the game is played.   Other docs might be called in for consults or anesthesia or whatever by your doc, but they may be out of your insurance network, and you won’t know until you get the mountains of multi-paged bills later and find literally thousands of dollars of charges your insurance company will refuse to pay but that are building a small and desperate mountain on your dining room table.   A heart rending story in the Times by Tara Siegel Bernard brought this home for a young couple with a baby who had to have heart surgery.   Luckily, the grandmother was a bear and quit her job to become the hospital bill wrangler for the young parents and after herculean effort managed to jawbone most of the bloodsuckers down to the “network” rate so that they were only stuck with an extra $10000 in bills.   Did I just say, “only?”  My point exactly!

            This is not a comment about the complexities of the Affordable Care Act, but ACA is in the mix because although Obamacare caps consumers’ out-of-pocket costs within network, this out-of-network mess is all Wild West still.   I actually think there’s a recognition embedded in the ACA that we all need help or at the least that we will be fortunate if can find a grandmother, a wrangler, or an advocate.    At the end of the ACA application there is a space to designate a healthcare “representative” in filing for Obamacare.   They are onto something here.

            The point hit home with me the other night when I was at a meeting at Fair Grinds Coffeehouse where people were coming into the Common Space to ask questions about health insurance and how ACA worked.   The last two people I visited with at nearly nine o’clock were two healthcare professionals, one who worked in physical plant issues at LSU and the other who was a doctor working at both LSU and Tulane hospitals.   Interestingly, the doctor didn’t have insurance.   Both were deeply skeptical of health insurance and in some ways their own institutions, and each had a million different questions about what might be best for them and their dependents under ACA and, frankly, in general.   One really wanted to know where it was possible to get real advice even if it meant an accountant or CPA?  The other was basing a lot of what he thought he knew on a random conversation with a friend in New York State where the marketplace is completely different from Louisiana.   I don’t think these conversations are unusual.

When even healthcare professionals are lost in the dark forest of health care and insurance complexity, grasping any twig they can find and crying in the wilderness, it is hard to avoid the conclusion that we all need real help in finding open, solid ground to make good decisions.  Given the dollars involved and the predatory, game-the-system strategies at play by big institutions, reliable advice, reasonably priced, might save us all thousands today and in the future.