Insurance Anyone?

I just heard Iowa Insurance Commissioner Nick Gerhart’s interview with NPR on the potential effects of the proposed repeal of Obamacare. Because he was summarizing a LinkedIn blog post he wrote about a week ago, I read that as well. His post is very well-thought out, as you would expect. I have a lot to learn about the healthcare insurance system which has a high impact on patient care at my level. One of the solutions proposed by the President Elect is that the solution would involve allowing private insurance companies to compete for business by selling insurance across state lines.

Commissioner Gerhart doesn’t think that would be a major driver for lowering costs. The reasons? The insurers would have to comply with state mandates, and would still need to assemble a physician network for competitive pricing. He also pointed out that many companies already sell in multiple states, and there are apparently no barriers to new companies entering different states. The important factor is the cost of contracting with physicians in those states. If the carriers can’t grow big enough to get competitive pricing arrangements with doctors, they can be priced out of the market.

I don’t pretend to understand that and several of the other points he made, although they sounded practical. I tweeted the entire post although I’m not sure it’ll be accessible to everyone unless you have access to LinkedIn.

There were a several comments, mainly from insurance executives. I thought it might be helpful if a rank-and-file doctor piped up. My modest contribution is below.

“…I need all the education I can get about this situation. I’m a consulting psychiatrist on faculty at The University of Iowa Hospitals & Clinics and often one of the first questions I have looking over the shoulders of the residents who are skimming the electronic health records of a patient we’re asked to see is, “Does the patient have health insurance?” And “Does the patient’s insurance offer mental health and substance use benefits?” Access is hard enough without insurance cost barriers. What do you think about single-payer systems? The Physicians For A National Health Program (PHNP) website says “Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. As a result, administration consumes one-third (31 percent) of Americans’ health dollars, most of which is waste.”

Some people probably gamble on the risk of getting sick and needing health insurance, and the rising cost of Obamacare probably feeds that strategy. This reminds me. Occasionally I play a video Blackjack game–no real money, you understand, and not on line, just chatty comic characters. When the dealer shows an ace, he asks, “Insurance anyone?” This is to help you cut your loss in case the dealer has Blackjack. I always decline it, betting against the chance the dealer has Blackjack.

Sometimes I get burned.

But don’t burn the turkey and have a Happy Thanksgiving!