Dr. Elaina George says the United States needs to return to a health care finance system based more on catastrophic health insurance, traditional indemnity insurance and patients’ own cash, and less on efforts by giant insurers or giant, hospital-based “health care systems,” to manage care.
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“Insurers, hospitals and pharmaceutical companies tend to dominate those care management efforts, and they tend to adopt rules and procedures that favor themselves, rather than the physicians or the patients,” George recently said in an interview.
George, a board-certified ear, nose and throat surgeon based in Atlanta, has a bachelor’s degree from Princeton and a medical degree from Mount Sinai School of Medicine in New York City. She serves on the physician advisory board of Liberty HealthShare, a Canton, Ohio-based health care cost-sharing ministry. She is also the author of “Big Medicine: The Cost of Corporate Control and How Doctors and Patients Working Together Can Rebuild a Better System.”
In theory, existing care management programs, insurance cost-sharing arrangements, and personal health account programs, such as the health savings account, are supposed to prod and help patients to shop for care themselves.
But, in the real world, when a physician calls a health plan to try to help a patient negotiate with the plan, “they’re not available,” George said. “You cannot even get them on the phone. It’s all email.”
In many cases, plans interfere in care decisions, even when patients with high deductibles and health savings accounts are using HSA cash to pay for part or all of the care, George said.
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George began practicing medicine on her own in 1998. She once took Medicare, Medicaid and many commercial plans. She said she had to stop taking Medicare, Medicaid and one-third of the commercial plans because the red tape and discounting demands got to be too much.
“It’s not worth it to me,” she said.
In 1998, George said, patients were complaining about health maintenance organizations that paid primary care doctors “capitation payments,” or flat fees per patient served, and limited the patients’ ability to see the doctor of their choice.
Now, in the era of tight Affordable Care Act provider networks, “it’s capitation on steroids,” George said.
In many cases, George said, plans avoid paying for what is obviously the best treatment option by classifying it as “experimental.”
The best medicine is to get public and private payers out of trying to manage patients’ care, or, at least, to ensure that patients have a real choice between going with managed care and having the tools they need to manage their own care, George said.
“Price transparency is the antidote for all of this nonsense,” George said.
One cash-only surgery center in Oklahoma publishes all of its prices on the web, for all to see, and that’s the kind of effort that give patients a real ability to shop for care, George said.
George noted that she has indemnity health insurance, which pays a fixed amount of cash to an insured who suffers a covered event, herself. Use of catastrophic insurance is a good way to protect people while freeing market forces to improve the state of health care system, George said.
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