Do you think that getting healthcare is similar to buying a commodity like, say, a couch? You shop around, comparing options and costs. Cloth? Leather? Sectional? Chesterfield? And then you buy one?
Does this really happen with healthcare? In my experience, no. There are lots of reasons why we can’t choose our health care the same way we would choose a couch. For one thing, when we need care, we’re pretty vulnerable. We’re either sick or we’ve been in an accident. We’re not in a great position to compare Emergency Room doctors to find the best value!
For another, most of us have private health insurance – either through our jobs, or Covered California, or individually – and private health insurance limits our choice of doctors. They do this because it’s part of their strategy to spend as little as possible on our care, so they can be more profitable.
You can buy just about any couch you want (except maybe designer couches or couches that are too big, or that your significant other really hates). But in most cases, you can’t go to any doctor you want because insurance companies negotiate low reimbursement rates with certain medical groups and limit your choice to those medical providers. Like my friend –
Right after she had her daughter, my friend was diagnosed with melanoma. As a young mom in her early 30’s, she wanted to live to see her baby grow up! My friend is very smart. She decided her best bet was to find the nearest oncologist with the highest success rate against melanoma. And she did. She found a world-class melanoma specialist about 30 minutes from her home in Encino. Fantastic!
Not quite. When she checked into it, that oncologist was not in her insurance company’s provider network. She could consult with him, but she would be responsible for the “full retail” cost of her treatment as it would be out of network.
The good news is, she lived. And with her daughter in kindergarten, she’s now more than 5 years past her diagnosis with no sign of cancer. The bad news is, she went through months of battling with her health insurance company over coverage.
Many people might conclude, oh well, if she won, then anybody could win. But mostly, that’s not true. The vast majority of people simply accept that they can’t see the doctor they prefer, and they don’t even try to fight the insurer. If they are ill, they may not have the energy for all the letters and phone calls and follow-ups.
Or if they do try, they don’t know how to go about it and so they lose. (If you’re facing a similar problem, see below for an article with tips on how to get your health insurer to cover out of network provider charges. And good luck!)
But there is one major exception to insurer limitations on a patient’s freedom to consult the doctor of their choice.
That exception is straight Medicare. If you have straight Medicare (not Medicare Advantage, which is Medicare delivered through private health insurance), you can go to any doctor who accepts Medicare. Over 90% of physicians accept Medicare.
When I was taking care of my 85-year-old dad, his geriatrician thought he had some kind of cancer in his blood. He referred us to a hematologist-oncologist for an assessment. I was frankly very worried about the costs, because I had heard all the criticisms of Medicare and thought it must be terrible insurance. Dad had straight Medicare and an inexpensive supplemental “Medi-Gap” policy.
When I got the bill, I was pleasantly surprised to see that everything was covered, no questions asked. This is how insurance is supposed to work! You pay your premium, you visit the doctor, and show your card. You pay nothing at the doctor’s office, nothing at the lab. You get a bill and it says, “You Pay This Amount: $0.”
Guess what kind of insurance Medicare is? It’s single payer healthcare for people aged 65 or older. It’s terrific coverage and it doesn’t limit your choice of physicians.
We know it’s not perfect – it would be better if it included dental and optometry – but compared to private health insurance with its limited doctor networks and sneaky little charges, Medicare is a dream come true for older Americans.
If the healthcare security Medicare brings is good enough for our grandparents, it’s good enough for everyone. A bill to improve Medicare and expand it to everyone has been introduced in Congress by Senator John Conyers (MI). It’s called HR676.
And check out the link (below) to see the video created by Robert Reich and Move-On about how expanding Medicare to everyone could help save our economy!
Learn more:
http://www.newsweek.com/myth-health-cares-free-market-244994
http://www.pnhp.org/publications/united-states-national-health-care-act-hr-676
Robert Reich & MoveOn