Editor’s Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Anish Koka, a cardiologist in private practice in Philadelphia. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
The House of Representatives vote to pass the American Health Care Act—the Republican attempt to replace the Affordable Care Act--has received much attention. The coverage has focused on technical details of projections from healthcare analysts regarding the number of people that would lose insurance coverage with any attempted changes to the status quo. While I am sympathetic to the plight of those who benefited greatly from the Affordable Care Act, I remain unconvinced that the current conversation does anything to reach the goal shared by the vast majority of Americans regardless of political party affiliation: Make basic healthcare affordable to the maximum number of Americans.
Further reading: House Obamacare bill won't fix healthcare system, doctors say
The current conversation fails because it does not address the fundamental barrier to healthcare access - which is not insurance coverage, but rather the cost of healthcare coverage.
Consider the bill a friend of mine who has health insurance through her employer recently received after her daughter had an echocardiogram and an ECG done - $4800 for the echocardiogram, $1200 for the ECG. Last I looked, Medicare pays about $12 for an ECG, and about $140 for an echocardiogram. The facility was out of network, so the insurance company paid about 80%, leaving the remainder of approximately $1000 as the patient's balance.
This raises the interesting question: Are insurance companies forced to pay what hospitals charge, or do hospitals charge what insurance companies will pay?
The truth is somewhere in between: both parties are complicit. Insurance companies turn out to be very poor stewards of your money. Hospitals, emboldened and strengthened by consolidation that reduces competition, are more than happy to set outlandish charges that insurance companies will pay. It is a cruel irony lost on most that the Democrats, who were supposed to be the party of 'adults', the party of technocrats, the party that traditionally speaks for the common man has a platform built on an individual mandate to buy health insurance and support this hospital-insurance nexus.