Tuesday, April 15, 2008

Costs, Health Plans - Two Pretty Kettles of Fish

The phrase :pretty kettles of fish" comes from a custom along the Scottish border during the salmon run – eating hot, boiled salmon with your fingers from a huge pot in a catch-as-catch can fashion. A pretty kettle of fish has long been synonymous with confusion, muddle, and mess.

The April 14 New York Times and Wall Street Journal contains two pretty kettles of fish boiling health plans.

• The NYT’s three lead titles say it plainly 1) “Co-Payments Go Way Up for Drugs with High Costs; 2) Insurers Shift Burden; 3) Fees for Most Expensive Class of Drugs Soar Ten Fold or More.” Not a pretty kettle of fish if you have cancer, rheumatoid arthritis, multiple sclerosis, or some other dread disease requiring drugs costing $100, 000 or more a year. Insurers, including Medicare., are abandoning the traditional practice of paying $10, $20, or $30 for a co-pay for a prescription and going to 20% to 30% of the total cost. Patients are forced to pay the price or go without. When patients go to the pharmacy, they may suddenly be surprised with a bill of $5, 000 to $10,000 or more, something they overlooked in the fine print of their health plan contract or missed in a letter from the their health plan. As one might expect, the Times editorial page followed with “When Drug Costs Soar Beyond Reach.” Its writer blamed drug companies, employers, government, and health plans for cruelty to patients.

• The WSJ op-ed column, by Dr. Jonathon Kellerman, novelist and clinical professor of psychology and pediatrics at USC’s Keck School of Medicine, paints an even less pretty picture in “The Health Insurance Mafia.”

“Most discussion about the rising cost of health care emphasizes the need to get more people insured. The assumption seems to that insurance – rather thanthe service delivered by doctor to patient is the important commodity.”

“But perhaps the solution to much of what currently plagues us in health care – rising costs and bureaucracy, diminishing levels of service – rests on a radically different approach: fewer people insured.”

“Physicians and other providers need to liberate themselves from the Faustian bargain they’ve cut with the Mephistophelian suits who now run their professional lives.”

“If substantial number of health-care providers shook off the insurance monkey off their back, en masse, and the supply of providers was substantially increased by opening more medical schools, the result would be more honest, cost-effective system benefiting everybody. Except the insurance companies.

How’s that for two pretty kettles of health plan fish?

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