Cooperating for better care.

Vatsal G. Thakkar

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The monetary pleasures of insiders in America’s corrupt health-insurance system

This piece by Vatsal G. Thakkar, M.D., should be required reading for  healthcare-sector executives, clinicians and federal policymakers. It details how well-connected people, including physicians, can pull strings to get insurance coverage that ordinary people cannot.

He tells stories that “reveal an uncomfortable truth: Our health-insurance system is so broken that pulling strings — or rank — is sometimes the only way to get the coverage you think you’ve paid for.”

He continues:

“These workarounds are necessary because the healthcare system doesn’t follow any rational rules of economics, where the customer should be king.

“Economies of scale are supposed to bring costs down. But in healthcare, large hospitals are often more expensive than smaller ones because they can demand higher payments from insurance companies, which are then passed down to patients.

“In most realms, those with the least ability to pay should receive the biggest discounts. In healthcare, it is often the uninsured and indigent who receive bills with the full ‘chargemaster’ fee — the wildly inflated prices that nobody really pays — while large insurance companies get the biggest breaks.”

He discusses eloquently the lack of transparency in pricing —  an opaqueness that’s highly profitable for providers and insurers and so is likely to continue indefinitely — but bad for patients and their families. He notes:

“In a battle of dueling bureaucracies, the Supreme Court recently dealt a blow to price transparency in Vermont, where the state wished to publish a database of fees and other information. An insurance company, Liberty Mutual, objected to turning over the data on what it paid doctors and hospitals, and the Supreme Court agreed. The justices argued that, according to the ACA {Affordable Care Act} only the Department of Labor, and not individual states, had the right to collect this data. The ruling affects almost a dozen states that are pursuing similar initiatives.”

To read Dr. Thakkar’s essay, please hit this link.

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