Monthly Archives: May 2014

Problems and Solutions to the Broken Healthcare System

My wife and I recently had a little girl. Until that moment I had never been exposed to the healthcare and insurance ecosystem. I have been fortunate. I’ve never had an extended stay at the hospital, I’ve never been on prescription medication, and as an adult, I have never been to the doctor outside a checkup. Now I realize that the system is completely convoluted and non-transparent.

From what I can tell there are four major problems with the healthcare and insurance mechanisms.

1. Prices for healthcare services are unavailable, non-existent, or not published.
2. There is no crowd-sourced ratings system for hospitals (think yelp for hospitals).
3. Since everyone is insured no one cares about cost. This has resulted in higher prices.
4. The people have no power to control the quality or cost of the healthcare services.

These four problems ultimately result in a system that is too expensive, low quality, and where the people have no power to do anything about it.

Here are my proposed solutions:

1. Pricing for healthcare services are unavailable, non-existent, or not published.

Require all hospitals post itemized prices for their goods and services. Every procedure should have an itemized “menu” outlining what the procedure may cost. Since any given procedure is highly variable the menu should include “average cost”, “best case”, “most likely”, and “worst case” scenarios.

The menu should also include things like bandages, medication, and anything else a hospital could use to inadvertently pad the bill.  Great hospitals should even consider hiring a “budget specialist” who discusses costs and options with each patient.

These menus should be posted online and available before he procedure. This will allow individuals and insurance companies to shop around for a facility that meets the individuals’ need. This will also drive prices down since hospitals will be forced to compete based on price (or provide superior service to justify higher prices).

I would not eat at a restaurant that didn’t post prices so I should not have to receive healthcare services without prices either.

2. There is no crowd-sourced ratings system for hospitals (think yelp.com for hospitals).

There should be a crowd-sourced ratings system for hospitals. In my opinion this would have been a much better investment than healthcare.gov. When hospitals are forced to compete for business based on price and services the consumer benefits. Prices will ultimately fall and service will rise.

For example, in Atlanta there are several major hospitals in the metro area. For most procedures I have no idea what a service cost or who the best service provider may be. I usually just go to the closest major hospital. I imagine most people do the same thing.

A rating system would enable a consumer to quickly and easily search for a service provider based on thousands of consumer ratings. Ultimately a sick person cannot choose if they want to go to the hospital, but they can choose which hospital they visit. The power of consumer choice based on good information will ultimately force hospitals to compete.

3. Since everyone is insured no one cares about prices. This has resulted in higher prices.

The third major problem I see with the healthcare system are insurance companies.

Healthcare prices are so complex and expensive (for reason listed above) that no one can or wants to deal with it. We defer all responsibility to our insurers. Now, with the implementation of the Affordable Care Act (Obamacare) we have no choice anyways. Ultimately this leads to a system where no one cares about prices because they will be paying the same insurance premium regardless. But this is a false premise.

Because no one cares about prices and live under the illusion that their costs are the same there is no incentive to seek more cost effective solutions. People rarely look at their hospital bill and pay whatever the insurer requires. This ultimately leads to higher healthcare costs and higher healthcare insurance premiums.

Healthcare insurers should provide incentives (lower insurance premiums) to individuals who shop around for better prices and value. This would ultimately lower insurance prices and force hospitals to compete again.

4. The people have no power to control the quality or cost of the healthcare services they receive. 

The biggest problem with our healthcare system is that the people receiving the services have no power to control prices or the quality of service they receive. The appropriate infrastructure is not in place. All of the power resides with the insurance companies and healthcare providers.

Insurance companies operate as powerful unions who dictate what they will pay a hospital for a given good or service. Insurance companies have large staff who perform complex pricing studies so they understand what people are paying and how much a product SHOULD cost regardless what a hospital charges.

This results in hospitals charging several times market value for a given good or service because they fully expect the insurance company to pay only a small fraction of that amount. Meanwhile: the consumer is screwed, hospitals charge too much, and insurance companies reek most of the profits.

Obamacare:

Obamacare has only served to strengthen this broken system by further empowering insurance companies and disenfranchising the individual. Since EVERYONE is now forced to have healthcare insurance this eliminates any opportunity for individuals to negotiate or bargain for themselves.

Ultimately, we live in a system where the insurance companies dictate how much they will pay hospitals and how much they will charge consumers. Meanwhile, there has been no progress toward a system that promotes competition, dives prices down, or leads to better services.

Should we be worried about Climate Change?

With all of the media-created controversy about global warming I can’t see past the propaganda to form an opinion.  It seems like every climate change discussion is a prize fight between two entertainers (i.e., not scientist).

I get lost in the entertainment and can’t decipher the facts from the manufactured drama. It makes the whole topic of climate change seem like a farce. If we are really on the verge of death it seems like someone would stand up and say “Stop everything!” That hasn’t happened.

If things are as bad as climate activist would have us believe then why aren’t world leaders like President Obama taking monumental steps toward protecting the nation’s interests? There should be an immediate and mandatory ban on global emissions, all military and civilian resources should be dedicated to building flood barriers, creating alternative energy, and growing food reserves. None of this has happened.

Instead, even the most liberal politicians, have done nothing. We still protect oil pipelines in the middle east, we still have highest GDP on earth, and our economy still functions as the largest producer of pollution making machines (tanks, cars, and airplanes) on earth. That seems pretty anti-environmentalist if you ask me.

There are too many mixed messages and I think that is why so many people do not take climate change seriously. And for the average non-climate-change-scientist it is almost impossible to form an educated opinion.

I honestly do not know what to believe. I do not know if climate change is man-made or just part of the normal life-cycle of mother nature. I don’t even know if there is anything we can do about it.

Spirituality, God, and Self-Delusion

I used to talk to God all the time. I would pray for God to help me succeed. To help me accomplish goals, to help me get over problems, and for comfort. It was an excellent feeling knowing that something bigger and more powerful than myself would take care of me. Sometimes I miss that feeling. I wish I could get it back.

Sometimes, just out of habit, I find myself talking to God. When I realize what I’m doing I pause and reflect on the fact that no one is listening. Damn. I kind of wish there was someone listening. Maybe it’s a healthy delusion.

When I examine God I sometimes wonder if I could convince myself it’s real. Could I revert back to my adolescence and start believing again? This time it wouldn’t be the Christian God. It couldn’t be. There are just too many gaps on that front. But what about a deity? Just some higher power. Even then, I don’t think I could ever believe that this higher power is involved in my personal life.

Many of the founding fathers were deists. They believed there was something out there. Somewhere. Not an “it” but a “something”. At least they seemed to believe that. I’d like to believe that too. The comfort in such a thought is almost too appealing to ignore. Maybe there is some energy, some common and unseen force that connects all of the Universe. Maybe I can buy into that.

I really don’t know, but I do think spirituality is important. It is important for mental health, I think. But being spiritual doesn’t give you that sense of community traditional religion does – so what’s the alternative? I don’t know. Maybe it is just a common appreciation of everything.

I’d like to be more spiritual, but I can’t compromise truth to do so. I can’t lie to myself just to feel better. If there be such a deity self-delusion is not doubt the greatest sin. I guess I’ll just keep searching for my own truth – if there be such a thing. That’s all I can do.

The Appalachian Trail

Hills. The Georgia portion of the Appalachian Trail is a hill – both ways – always going up. Except when you’re going down. Going up or going down – uncomfortably down.  Trails that go up hills, then sharply down them. At least that’s what it feels like after 31 miles of them.

Beauty. There are beautiful views – views that make it clear why they call them the Blue Ridge Mountains. There are streams that run along most of the valleys that are equally as beautiful. It’s a great hike.

Appalachian Trail - 26

Thinking. At about 15 miles in my hiking partner and I stopped talking. The combination of exhaustion and spending the last 12 hours together left us without much to stay. That’s when most of the thinking begins. The valuable part of hiking. You start to think about a lot of stuff. Shower thoughts. Like:

  • It’s weird that we can drink filtered sewer water, but we’re supposed to boil fresh mountain spring water.
  • It seems strange that I spend 10 hours a day in a small room looking at a screen when there is so much outside.
  • I wonder when the last person to step here was. And here. And here. And here…
  • If I’m so happy hiking – with almost nothing – why do I feel like I need so much stuff?
  • I could eat so much right now.

This Damned Blog

Getting ahead in life is all about knowledge. The only problem is: You don’t know what you don’t know. That’s my problem at least.

I try to work my way through life. I try to make the right decisions. It’s tough though because for the most part I have to make these decisions myself. It’s kind of a one man show.

Sometime I wish I had a mentor. Just a guy with a ton of knowledge and experience that could occasionally steer me in the right direction. An old guy sitting in a rocking-chair with a southern-but-educated kind of voice. The kind of guy that commands authority, but doesn’t demand it.

The kind of person I would most appreciate would probably be smart enough to keep his advice to himself anyways. So it probably wouldn’t be much help. He would probably sit back with his arms crossed and listen while I talk. Occasionally nodding his head to show that he’s listening.

When I’m done talking he’d ask me if I want something to drink. I’d say sure, we’d talk about something else for a while, and I’d go home. I guess the kind of mentor I’d most like isn’t too much different from this damned blog.