I was employed for 20 years as an anesthetist in a metropolitan hospital with an upscale clientele. We worked closely with our department’s anesthesiologists to provide the required anesthetics for surgical patients and others. As interesting as the practice, the staff and the patients were, it was a challenge from the “back office” that more and more frequently caught my attention.
The calculation of hospital charges and individual provider fees for an anesthesia department is a convoluted and confusing process. It was made more so by the differing “requirements” our patients’ various insurance carriers demanded. At the time there was no computer software to process the data. Thanks to a manic nature I successfully wrote our department’s first program. I had thus, for years, been in the trenches of medical billing and its interface with insurance carriers.
Our current national movement toward health-care reform is long overdue. A few observations from a participant might be useful.
I’ve found patients and their providers to rather quickly develop a trust, a personal bond. In fact, the treatment of patient life-long medical needs is not infrequently described as an art. It is also the business of health-care providers — i.e., physicians, nurses, technicians, and the institutions where they practice. This is the fundamental health-care transaction: “doctor / patient.”
Insurance carrier is a facilitator
Neither patient nor provider is dispensable. Comparatively, the role of the insurance carrier is only one of facilitation. Doubt that? Sum doctor plus insurance carrier, or patient plus insurance carrier. Neither adds up to anything of function or meaning.
The purpose of our health-care system is to keep our public as healthy and productive as is reasonable. The purpose is not to provide a means to riches for insurance carriers, nor even frankly, to provide the business setting for their existence.
We need to be certain our health providers and their infrastructure are adequately funded, now and into the future, by providing incentive to attract future expertise. Dollars are needed to maintain and modernize hospitals. It is, in my view, manifestly irresponsible to suggest that helping an insurance company meet its non-care expenses is in any way of the same consequence as ensuring we 1) conserve patient dollars and 2) have world-class providers. If a patient must spend a health-care dollar, let it flow to the providers who earned it.
Government has shown efficiency
There is, of course, a need for the insurance “function.” Our government, though, in its administration of the successful Medicare and VA programs, is already demonstrating its efficiency in providing that service. Inclusion of a robust public option within the congressional reform package extends this efficiency to the populace at large. Robust means immediate, available to all, accountable to the government and blessed with the ability to negotiate rates with providers and drug firms.
The least essential segment of the patient/carrier/provider system is the carrier. The fewer dollars insurance companies take out of the system the more we can lower patient costs — and the more dollars we can invest in those who actually do the work, our nation’s providers.
Robert Gratz lives in Minneapolis.