Gregory Dennis: No exit from the healthcare maze

Journey with me now to the mysterious world of healthcare — where nothing costs what they say it does, and no one can figure out what it really costs, anyway.
Where you’re never quite sure of the differences between your premium, deductible, co-pay, coinsurance and out-of-pocket maximum.
Where your health history is now available through an online patient portal — but you can’t remember the password. Where the doctor will see you in a few minutes, but you’re just as likely to end up seeing a physician assistant.
Where no one — not even the smartest doctor or healthcare economist — really understands what’s going on.
The journey won’t hurt. Well, maybe a slight pinch at the start. But by the time we’re done, you will be so anesthetized by the mind-numbing complexity of the entire deal that you won’t feel a thing.
Let’s start with the obvious: Pretty much every discussion about healthcare is a complicated one.
Healthcare begins with the incredibly complex human body and all that can go wrong with it.
Then add compassionate nurses and doctors, the profit motive, health insurance, government regulations, the ever-evolving state of medical science — and pretty soon you’ve got an incomprehensible, highly unsystematic “system.”
I should note that I make most of my living by providing marketing and public relations for healthcare. I like the work, but there are times when the vagaries of healthcare just leave me shaking my head.
For example: A recent article by the excellent VTDigger.org reports that State Sen. Tim Ashe wants the state of Vermont to require that physicians are paid the same for a service — whether it’s done in an independently owned medical practice or an academic medical center. Right now, payment is higher when a procedure is done at UVM, compared to when it’s done in an independent MD’s office.
Ashe’s bill has certain logic to it, but it may soon be a moot point. Independent physicians are an increasingly endangered species. They’re being gobbled up by hospitals and multi-hospital healthcare systems.
Another example: What’s paid for a procedure also varies according to how much an insurer has agreed to pay a particular facility. Down the street, the insurer may well pay a different amount for the same procedure.
Is there a one-size-fits-all solution? Probably not.
At this point we’ve got a hot mess on our hands. The alternatives are not simple ones.
Vermonters were astounded when Gov. Peter Shumlin abandoned his lengthy quest for single-payer healthcare in Vermont. He did it at the 11th hour, having “suddenly” discovered it would cost too much.
That decision, announced near Christmas after Shumlin had barely survived an election, prompted many of us to don our Cynic’s Coats.
Either the governor and his team knew it would cost too much and didn’t want to say so before the election, or they simply hadn’t given enough consideration to the actual dollars and cents.
Or maybe healthcare really is so complex as to defy human understanding.
Vermont Health Connect, the state-run insurance exchange, has certainly proven to be a monster.
I’m one of thousands who gave up on VHC’s inadequately programmed website. So to figure out what’s wrong with my monthly health-insurance bill, I’ve repeatedly resorted to the telephone help line.
Health Connect has finally managed to connect me to my actual mailing address. But the status of my monthly invoice is a still-evolving mystery.
My problems seem simple, however, compared to Elizabeth Rosenthal’s.
She is a writer for The New York Times and is therefore, by definition, supersmart. But even she can’t figure out her recent medical bill.
As Rosenthal reported in last Sunday’s paper, the bill itself was for just $225 of lab tests. But it was so loaded with codes, adjustments, “miscellaneous” and other arcana that she couldn’t decipher it.
Consumers are carrying more of the cost burden in healthcare. But figuring out the price of a particular procedure is so complicated that it’s pretty much impossible to be a well-informed consumer.
On the macro level, everybody talks a good game about paying for value and good outcomes, instead of simply paying for more healthcare procedures.
But we’ve heard that line for years.
Health insurance companies are inefficient beasts that often do selfish and illogical things. But the poor launch of Vermont Health Connect and other statewide exchanges has soured many people on a greater role for government.
And we’ve yet to figure out how to consistently define “value and good outcomes.”
My guess is that the system is essentially unfixable.
We keep trying to cut costs, but that hasn’t happened in decades. The best we’ve been able to do is occasionally slow down the rate at which healthcare costs are increasing.
Among the cost-cutting efforts have been HMOs, which are giving way to affordable care organizations and other catchphrases.
But as soon as insurers and government get serious about cutting costs, patients start to scream about their cruel failure to pay for life-saving procedures. Rational decisions about not paying for exorbitantly expensive drugs are met with cries of rationing and death panels.
As Americans, whatever the cost, it seems we want our healthcare and we want it now.
Gregory Dennis’s column appears here every other Thursday and is archived on his blog at www.GregDennis.WordPress.com. Email: [email protected]. Twitter:@GreenGregDennis.

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