[culture] A small Gedankenexperiment on healthcare

My experience of being deeply enmeshed in the healthcare system is that a majority of my non-billing paperwork (and a meaningful percentage of my billing paperwork) is intended to ensure that I am qualified to receive certain benefits, and to check my continuing eligibility. Another way to put this is that a majority of the patient-facing overhead of healthcare delivery costs, meaning costs exclusive of actual medical expenses, is about compliance.

A simpler way to put this is that we spend a lot of money making sure only those judged deserving are helped.

From my perspective, the only three things I’ve done in my life that were more paperwork intensive than being a patient in the American healthcare system were to apply for a security clearance, buy real estate, and adopt [info]the_child. I did all of those things successfully while in good health and of sound mind.

Being very ill in America invokes a messy, complex, internally inconsistent system that requires a lot of focus and precision at a time in most people’s lives when they are least equipped to provide those things. If indeed, ever they were. Not everyone is good at paperwork. And this is me, who is not dealing with public benefits and all their myriad oversight requirements, but rather a relatively sane and generous employer and employer-sponsored private benefits plan.

So let’s assume a certain number of claimants are fraudulent. That’s true in every walk of life with every kind of benefit — someone will always be trying to figure out a way to get something for nothing.

What would happen if we simply let those people into the system? If, instead of spending money on compliance we spent that same money on delivery? Would net costs go up or down?

We’d certainly have a system that is much kinder and more supportive to the overwhelming majority of users, its legitimate patients. Instead of punishing the users along with the fraudsters, let’s keep things simple for the people in most desperate need.

Would that cost more or less? I have no idea. But it would be the mark of a compassionate society that values life, liberty and the pursuit of happiness over punishing the undeserving and deserving alike.

7 thoughts on “[culture] A small Gedankenexperiment on healthcare

  1. Mike says:

    Right now, it’s not the claimants that drive up the cost, it’s the 20% overhead needed to sustain our insurance system. Read “The Healing of America” (https://en.wikipedia.org/wiki/The_Healing_of_America) for details. It’s a short, well-written comparison of health care systems. By switching to single-payer model, we could pay for basic health care for *everyone* without any overall increase in cost.

    I firmly believe that health care should never be a for-profit industry. Making money off the sick and injured is morally repugnant.

  2. pelican says:

    I’d also add that in a universal health care system, it is not the patients (or, at least not the patients alone) who can game the system to get “something for nothing.”

    I can spend my days bopping around Vancouver, getting my blood drawn and worked up for non-existent abdominal pain, but why would I? What’s in it for me? If health care is available when I need it, why would I use it when I don’t?

    For fraud to occur- “something for nothing”- it would require the collusion of providers and patients- you will say you worked up my abdominal pain and bill the province for for it, but you actually didn’t.

    Of course, that kind of fraud occasionally happens in the US, too, but in both countries, fraud is going to be detected by auditing providers, not patients.

    “Rice” indeed.

  3. Rachel Sinclair Hunt says:

    For some reason I take slight issue with your reference to insurers making value judgements about whether patients are deserving of care in this sentence: “A simpler way to put this is that we spend a lot of money making sure only those judged deserving are helped.” I work in the insurance industry – though not in the medical portion – and I don’t think anyone is making that kind of value judgement. They are just determining whether a claimant is eligible for the care being requested. Maybe it’s just semantics and I’m splitting hairs. I think our healthcare system is definitely broken, but I dislike the demonizing of the insurance industry.
    I completely sympathize with the rest of your comments, however. I find it really frustrating to have to fill out leave paperwork for each absence due to chemo (a requirement of my employer) and repeatedly fax requests for medical information to my healthcare provider. Why should I be responsible for doing these things when I am the sick person? At my healthcare provider there is a nurse coordinator who handles all the scheduling of chemo patients and makes sure that we see our doctors before our chemo sessions and get our labs done at the right time. I can’t help feeling that there should be a coordinator who takes care of all my paperwork as well.
    But hey, we live in a country where the government expects citizens who know nothing about tax laws (or math, in some cases) to calculate how much they owe in taxes. Why should it surprise me that our healthcare system expects the patient to be responsible for making sure all the paperwork gets done?

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