Hypothetical Mean

Commentary from an Actuarial and Economic Perspective

Health Insurance does not Equal Health Care, Part N

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Logical fallacies abound in the current healthcare reform debate.  A small example of this is in Cohn’s piece, “At What Cost?”

the very act of expanding insurance coverage should help make the system more efficient and, as such, relatively less expensive. This may seem paradoxical, since that requires spending more government money. But it makes perfect sense if you understand the dynamics of the health insurance market and health economics.If there’s one thing we know about medical care, it’s that consistency and stability lead to better, more effective treatments. The reason places like the Cleveland Clinic or Group Health of Puget Sound can offer such good care for so much less money is that they see the same patients year after year–and that the patients, in turn, are part of one system in which medical providers communicate with each other and share information.

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But continuity is the exception today in American health care, not the rule. With no guarantees of coverage and no uniformity of what coverage looks like, people are constantly switching insurance plans and, in many cases, losing insurance altogether.

This employs the common trick of confusing health care financing and health care.  You can switch between large PPO networks today and frequently maintain full access to the exact same physicians and facilities.  Many states’ “Any Willing Provider” laws have almost guaranteed this.  Therefore, changes in insurance carriers may have absolutely nothing to do with whether you change doctors.

In contract, integrated and hailed organizations that link the financing and care, like Kaiser, run the risk of interrupting care if the individual or their employer seek an alternative insurance vehicle.

Adding irony, I don’t see any evidence that the Cleveland Clinic limits itself to a particular insurance company.  In other words, Cohn’s examples may have absolutely nothing to do with his main point.

Lastly, we should have a national debate on where “continuity of care” electronic records properly reside.  Physician offices?  Insurance plans?  A 3rd party?  There’s a lot of griping about the continuity of care, but there’s little discussion at the level necessary to effect meaningful improvements.


Written by Victor

July 15, 2009 at 1:44 am

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