Julie Sneider
View from the Waiting Room

Where’s the consumer’s voice in health care?

By - Feb 22nd, 2010 04:00 am
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hospitalconsumer“Consumer-driven health care” is a phrase often tossed about in the debate over how to fix the nation’s ailing health system. The gist of the argument goes something like this:

Let’s unleash the power of consumers to drive down costs by making doctors, hospitals, insurance plans and drug companies compete for consumers’ business. Just give consumers — including those covered by Medicare — big tax breaks or vouchers to buy their health care plans in the private market, and they’ll shop and barter for medical care and insurance the way they shop and barter for cars, furniture and other goods and services.

It sounds like a great idea, but Andy Serio isn’t buying it.

Serio has spent decades in the trenches of southeastern Wisconsin’s health insurance and employee benefits business, helping both public and private sector employers cobble together their workers’ benefit plans. As a result, he’s seen, heard and lived through a lot of health reform ideas from every different political viewpoint, and he’s known for having strong opinions about what he thinks works and doesn’t work from a business perspective.

Of all the reform proposals floated over the years, nothing seems to exasperate Serio more than “consumer-driven health care.”

“Consumerism is a good idea,” he says. “It just doesn’t work in health care.”

The reality is that individual consumers have limited choices in the health care system. If they’re lucky enough to get insurance through their jobs, they get a choice of one, maybe two, plans. They have no control over what the insurance companies charge, and they have no control over what doctors, clinics or hospitals charge, especially for big-ticket items like cancer treatment or cardiac surgery. To put it simply, consumers have no power to negotiate anything in health care.

“The trouble with consumerism in health care is this,” Serio explains. “When there’s a big sale on furniture at Steinhafels, you’ve got the user — the consumer — who’s the payer. Then, there’s the supplier, which is Steinhafels. It’s a two-part system. But in health care, the payer is not the consumer; the payer is the consumer’s employer or insurance carrier. So right there, it debunks consumerism because you, the consumer, are not in charge of your choices, your employer is.”

To be clear, Serio isn’t blaming employers or insurance companies for skyrocketing health care costs. He’s just saying it’s naïve to think that giving consumers vouchers or tax breaks or making them pay thousands more in deductibles provides enough momentum — enough “competition” — to fix a broken system.

And, he’s right. Nothing short of a major, national overhaul will effectively lower costs, improve quality and extend health insurance coverage to millions of uninsured Americans. Tinkering around the edges isn’t enough when there are so many factors that add up to the United States spending $2.5 trillion on health care last year. Consumer lifestyles and the aging population are to blame, as are the profit-driven goals of the insurance industry, drug companies, medical device businesses and hospital systems.

Perhaps the biggest cost driver of all is American consumers’ unrealistic expectation that the U.S. health system can and should deliver the very best medical care without limitations.

So, while we wait for Washington politicians facing reelection to muster enough courage to pass dramatic changes to an industry that accounts for 17.3 percent of the U.S. economy, what — if anything — can we consumers do?

It sounds trite, but Serio suggests that if we can help it, don’t get sick.

“Consumerism in health care can work when it’s directed toward wellness and prevention,” he says. “Take care of your health. If you don’t, it will cost you more.”

There are many ways to encourage wellness and prevent sickness. We can exercise more and eat healthier diets to control our weight so that we don’t develop diseases such as diabetes. We can get immunized against the flu. If we have a chronic condition like high blood pressure, we can follow our doctor’s advice to manage it so that it doesn’t mushroom into something much more serious — and expensive.

We can also get educated and stay informed, which is what I hope this new column, “View from the Waiting Room,” will do for ThirdCoast Digest readers. Over the coming weeks and months, the column’s purpose is to provide news and views on national and state politics, business trends, wellness and other issues that impact the health and well-being of the people who live and work in southeastern Wisconsin. If you have a comment or idea to share for a future column, I’d love to hear from you.

Categories: News & Views

0 thoughts on “View from the Waiting Room: Where’s the consumer’s voice in health care?”

  1. Anonymous says:

    Welcome to TCD, Julie. “Don’t get sick” is certainly good advice and to the extent that we have control over our health, we should do the best we can. But try visiting an emergency room, as I did recently, and tell me how useful consumer choice is to someone comparing the relative merits of Xrays vs. MRIs or drug therapy vs. surgery. It’s nonsense and its proponents like Paul Ryan should know better.

  2. Anonymous says:

    I agree with Ted, “don’t get sick” is good advice, but how do you prevent a brain tumor, bone cancer, or any other debliating illness that is out of our control? For the time being we do need to cover those without healthcare, for those of us who have it, leave it be until these “politicians” can agree across the aisle what will be good for the country. They’ll also have to stand firm to keep the lobbyists out of their decision.

  3. Anonymous says:

    Maybe we should get back to a time when insurance was for the catastrophic conditions and not just a trip to the emergency room for a sniffle or cut. My mother was a nurse and it was instilled in me that you don’t run to a doctor or hospital for every little bump, scrape and boo-boo. I’ve been to the hospital four times in my life and three of those were for deliveries. My kids, twice – a broken arm and a gushing gash in the head that would not stop bleeding without sutures. Everything else, good genes, good living and a lot of basic first aid. Plus learning to live with a very high deductible (by choice) that forces us to make wise choices with our doctor visits.

  4. Anonymous says:

    Good article – and I agree with Mr. Bobrow that Paul Ryan should know better and he should read this article.

  5. Anonymous says:

    I look forward to future articles in View from the Waiting Room, an important, as well as appealing, new column. These are critical times in the process of healthcare reform. This column will keep me paying attention.

  6. Anonymous says:

    Don’t get old!!!!!

  7. Anonymous says:

    Well said! I’m glad to see someone cutting through all the red tape and politics to tell the truth about health care. I look forward to your next column!

  8. Anonymous says:

    Wow! After all these years of ignoring the health-care debate because it never made sense, I think I finally have a grip on the issue. Perhaps your next column could touch on quantum theory as it relates (or not) to health care.

  9. Anonymous says:

    this is spot on thanks for the clear and understandable report
    here’s the other worrisome part: “big tax breaks or vouchers to buy their health care plans in the private market” – our healthcare system is so bad that the govt has to chip and pay for it with vouchers & tax breaks! – why not just medicare for all?
    and yer right: “Consumer lifestyles and the aging population are to blame, as are the profit-driven goals of the insurance industry, drug companies, medical device businesses and hospital systems.” This is why it has to be a complete overhaul (like a “medicare for all”) versus having have to fix it by “tinkering around the edges” …so true …so true
    i agree consumerism doesn’t work in health care – similar to how it doesnt work in public schools…

  10. Anonymous says:

    I think some will say for me to stay out of the local debate there, but since I was invited in to this community I feel my opinion may be respected by the publishers.
    I live in Northern California, in a relatively small county. In the last few years we’ve seen a disturbing trend in our doctors’ offices and clinics.
    It basically goes something like this. “Due to the reluctance of Anthem Blue Cross to pay contract rates in line with our fees, we no longer accept Blue Cross for payment.” There are other insurers on the list as well, but I used BC because they’re the current poster child for greedy insurance companies.
    This is Dr. speak for “your insurance company wants to pay usual and customary fees for the region, but we want more.”
    Most of our older local docs do charge fees in line with the local economy, but many of the younger want San Francisco fees for rural living. These tend to be the docs who have been in practice for 5-10 years. You know, the ones that grew up believing greed is good?
    My thought is that they chose to leave the big city to live in a small community where salaries don’t approach those in the metro areas, so they should adapt to their environment. If they want rural quality of life, good schools for their kids, low crime rates and other percs that come with this lifestyle they need to adapt.

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