A comment

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Category : General, Medical Rants

A reader tried to post a comment yesterday related to one of my “top 10”. My spam filter spit him out.

Unfortunately, spam has become a major issue for blogs. I have had as many as 300 comments to delete in a single day. I currently use a program called Spam Karma. You might get caught with “bad karma”, even if you are writing an intelligent comment.

I like this comment – so I will publish it here:

As one from the “payer” side, I’d recommend we take the argument on health care costs a step further. Like it or not, employers pay a significant portion of health care costs, both directly (premiums) and indirectly (cost-shifting for uninsured, FICA taxes, income taxes, etc.)

The real issue employers have with health care costs is they have NO sense for their return on the investment. And that is the fault of the medical and managed care communities. Employers carefully assess each investment into plant and equipment, personnel and training, investment options and new products. They calculate RoIs carefully, assess performance constantly, and get as comfortable as possible with an expenditure BEFORE they make the investment.

Think about health care – what do employers get? Happy employees? Rarely – health insurance is a terrible “good” – people only use it when they are ill or injured, it is convoluted and difficult to understand, and they have to
pay for part of it too!

Actually, what employers SHOULD be thinking about is the demonstrated ability of a health care provider to “deliver” healthy, fully functional employees and families, thereby enhancing productivity and, therefore RoI. Health insurance is an investment in productivity.

If we can evolve to this way of thinking, much of the present bickering about health care costs will end. Sure, there will be arguments about impact rates, who delivers what benefit, and what evaluation methodology makes the most sense, but that will signal we are talking about the right things.

So, the next time someone complains about charges, costs, or premiums, ask them how that “good” will help them function. They won’t know the answer, but perhaps they’ll start thinking about it.

I like this comment because it makes us think carefully about we we will do provide. How does one place a price on good health? I have some friends who have serious illnesses currently. Money is no object to them or their family at this time.

If you like the comment, you might want to check out the authors blog – Managed Care Matters

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Comments (4)

I see patients one person at a time. My duty is to the patient, not their company. The individual patient is the one who signs a form agreeing to accept the responsibilty for my bill. There are occasional exceptions (I recently did a Workers Comp Eval in which I received payment directly from Workers comp; before the eval I informed the patient that I was providing services to Workers Comp and not him and obtained informed consent before proceeding with the evaluation). In most cases, doctors have relationships with individual patients, not companies or businesses. Although businesses do pay for much of healthcare in this country through health insurance premiums, this is at the expense of higher wages. So ultimately, it is the worker who is paying.

Dr Rack is correct in the micro sense, and Mr Paduda is incorrect in the macro sense. I can’t imagine that Mr Paduda is unaware that the primary reason that employers pay for health insurance (as opposed to life, auto, homeowners) is the WWII wage freeze forced employers to compete for workers on the basis on tax-exempt fringe benefits. This led to the employers’ providing health insurance as a then-inexpensive benefit. Today it’s a very expensive benefit, and still untaxed. If it were made taxable, or if individuals could get the same tax benefit by buying it themselves, we would not be discussing this at all.

It’s a fallacy to analogize health insurance premiums to an investment in plant, equipment, or personnel. These premiums are paid in lieu of higher wages that would otherwise have to be paid to get the same compensation package for an individual worker if he had to buy his own coverage. It’s cheaper for the worker to have the employer pay for it, both because it’s tax free and because of group premiums. Employers buy insurance for their employees because the workers demand it, and are willing to accept lower wages if they get it; nobody ever seriously promises that they will have healthier, happier, more productive employees “delivered” to them. Health insurance is not an investment in productivity, as suggested. It’s a form of compensation. Physicians and the rest of the health care industry have enough on our plates without having to “deliver higher productivity” as well. Please!

I don’t look at financial status of the patient while treating him/her.

[…] In the US, most employers provide employees health insurance benefits. The reasons for this have to do with history and tax law. In World War II, because of wage controls, employers could not bid for scarce employees by offering higher salaries, so they offered other benefits, such as health insurance, instead. Furthermore, employers can deduct employees’ health care insurance from their income for tax purposes, while individuals cannot generally deduct what they pay for their own health insurance. This arrangement gives employers, rather than individuals, control over what health insurance options they can choose. It also can even further tilt the balance of power and control over health care to large organizations (large employers) and away from the individuals who actually need the care. Such large organizations may not always make decisions about health care that are best for their individual employees.One example is an argument that was distributed over two other health care blogs. Medical Rants included a post from Managed Care Matters which argued that “the real issue employers have with health care costs is they have NO sense for their return on the investment. ” Thus “what employers SHOULD be thinking about is the demonstrated ability of a health care provider to ‘deliver’ healthy, fully functional employees and families.” Of course, it really is the patient who should be concerned about his or her health care provider’s abilities. How a corporate benefits manager could figure out the performance of all employees’ health care providers, and then sensibly figure out how to improve them, is unclear. A few comments made this point more eloquently.A more fundamental confusion appears in a story out of Detroit. A local medical benefits administration company, Weyco, Inc. has apparently decided not to hire any new cigarette smokers, and to fire any current employees who refuse to quit. The rationale by the company president, “increasing health care costs were choking his business.” I am a strong advocate of quitting smoking, but as the Detroit News editorialist wrote, punishing smoking employees by firing them has surely “gone too far.” […]

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