Deck Chairs

When the great boat was going down and an iceberg was ripping a hole in its new metal skin, I imagine those deck chairs, the ones that would have been wooden and heavy. Or perhaps there were none there on the deck of the Titanic because this was the North Atlantic and there was ice in the water and surely in the air.

In Health & Welfare Committee last week, we were visited by Blue Cross, one of our state's two largest insurers, in fact it is now the one the state now contracts with to provide insurance to most of Idaho's 17,000 or so state employees.

Blue Cross went to great lengths to show that spending more money on health care did not produce better quality health care. It is a point I would have appreciated coming from them had they bothered to mention how a health care system run by insurance companies creates a level of unpredictability and complexity never seen in the history of medicine world-wide.

Daily, the cost of American health increases because we as a nation and state government allow insurance companies to set their own rates. We let them decide what gets covered and what does not. We let these companies control and then change randomly who may treat whom and how much will be paid to those who provide care, based on who they are providing it to and whether that person is newly sick or has been sick with this same condition for a long time.

Imagine being a doctor and trying to figure out who and how much to bill for a colonoscopy. If the patient has insurance you get paid X. If they do not it is more. If the condition was pre-existing the insurance company might not pay, so you bill and work to get payment from the patient. Not only do you have to know the rules for every insurer, but you have to know that the rules can change at any time. So you may suddenly be designated as an out-of-network doctor or the procedure may no longer be covered so the company won't pay you and your patient, not knowing this, doesn't have the money to pay, so you don't get paid at all. Maybe, just maybe if you fight the insurance company you can get payment for the colonoscopy, or, if you use a different code on the paperwork, you will avoid the fight. In any case, before each procedure you need to make sure that the company will let you do what your patient needs. They may decide to pay for a lesser procedure or to make you wait until the problem is more severe, or until the person has moved to someone else's health plan.

Clearly you would never have time to see patients if you had to do all this yourself, so you hire one or two people to help with the paperwork. That is part of what makes what your colonoscopy (and your patient's insurance) cost more because not only do you have more staff to deal with the complexity, but all the insurance companies hire more staff to manage the complexity too.

So the Titanic screams ahead.

In the Senate Commerce Committee this week, Bill Deal, Director of the Department of Insurance, brought a rule, which is kind of like a law, to limit "discretionary clauses" in insurance plans. It is a modest change that means more than you might think. Read your policy sometime, if you have one (and I understand that one out of four of you have no insurance policy.) You will find statements something like this:

We agree to cover these things, but at our discretion we actually might not.

We promise to pay for this, but at our discretion we might choose not to.

We will cover medical care that costs this much unless, at our discretion, we decide we won't.

Bill's rule says you can't do this, at least not to ordinary people with individual plans who have no way to negotiate those bombs out of their policies. Small businesses beware you still have discretionary clauses in your policies.

The rule is progress. It is one deck chair a few feet to the left as the metal tears and the ship pitches starboard.

Like many, I've been spending a lot of time assessing what made our economy collapse. You can look back at reasons why wages are low and why still American companies could not survive manufacturing anything in the U.S. The cost of health care is clearly a factor.  U.S. companies have to pay for it while companies from countries with national health plans do not. It still weighs heavily on businesses trying to hang on while, all around them, businesses close and people lose incomes, buying slows and the chill sets in.

The icy waters froth and lap. Brilliant blue ice glows in darkness.

I plan this year to propose a bill to make companies tell small businesses the details of their health plans BEFORE the business signs on the dotted line. It says the insurance company can not change the plan in the middle of the contract.

Wooden legs scrape on a painted metal deck.

I look to President Obama to do this one thing for American business. Simplify this mess. Make it so no American family ever goes bankrupt or into deep debt to pay for needed medical care, ever again.