Cost, Not Access, Is the Biggest Problem with Health Care

The current health care debate fails because it does not address the fundamental barrier to healthcare access — which is not insurance coverage, but rather the cost of healthcare coverage.

Dr. Anish Koka writes about the issue in Medical Economics:

Consider the bill a friend of mine who has health insurance through her employer recently received after her daughter had an echocardiogram and an ECG done – $4800 for the echocardiogram, $1200 for the ECG.  Last I looked, Medicare pays about $12 for an ECG, and about $140 for an echocardiogram.  The facility was out of network, so the insurance company paid about 80%, leaving the remainder of approximately $1000 as the patient’s balance.

This raises the interesting question: Are insurance companies forced to pay what hospitals charge, or do hospitals charge what insurance companies will pay?

The truth is somewhere in between: both parties are complicit.  Insurance companies turn out to be very poor stewards of your money.  Hospitals, emboldened and strengthened by consolidation that reduces competition, are more than happy to set outlandish charges that insurance companies will pay.  It is  a cruel irony lost on most that the Democrats, who were supposed to be the party of ‘adults’, the party of technocrats, the party that traditionally speaks for the common man has a platform built on an individual mandate to buy health insurance and support this hospital-insurance nexus.

Koka notes that health care’s access problem is also really a cost problem. Lower the price of care, and the path to universal access to healthcare becomes much easier.