Thursday, August 09, 2007

Consumer Reports on health insurance

The September 2007 issue of Consumer Reports has a major story on health insurance in the United States: “Are You Really Covered: Why 4 in 10 Americans can’t depend on their health insurance,” starting on p 16. The story is the first in a planned series. The story traces the history of managed care back to the early 1990s, which seemed to work for a while; then state laws started mandating coverages that have political sympathy, such as bone marrow transplants for some breast cancer patients, but that have poor medical utility. The story claims that doctors have interfered with discounts, but in my own experience (with United Health Care) I have found that in network discounts are very large (about 65%) even before deductibles are met. The story encourages consumers to do their own math, and make sure that every physician treating them is in their company’s network. Consumers constantly have to battle with insurers to prove that proper referrals were obtained or that services were in network. Insurances companies have a fiduciary incentive to deny claims or reduce payouts, as Michael Moore pointed out in “Sicko”.

The article did not go into single payer arguments, but at least one obvious question comes up. What if routine screenings (like colonoscopies, mammographies, etc) and follow-ups could be put on a single payer plan, as well as children’s care?

We still don’t have consistent information on how well single payer works in other countries, Michael Moore notwithstanding. Salaries in Britain are lower, and Britain, as we know, had a recent security issue importing doctors. Information on other systems seems fragmented, as think tanks earn money for churning out biased reports, and even the major media outlets, with all their journalistic fact-checking, don’t have a real good objective handle on it.

The article mentions the 2002 film "John Q" but John Grisham's "Rainmaker" is also worthy of note.

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