I Have Solved National Healthcare – You’re Welcome

I’ve written a few posts about my experiences with our health care system.  I’ve also noted several times that I have no silver bullet solutions to fixing the system.  I’m not a health care scholar, I’m just a pragmatist who can speak to his own experiences with the system.   However, today, on my way back from attending the NH Health Exchange Advisory Board meeting, I had an epiphany: a way to improve the current system.  Listen up.

In my most recent post I wrote about problems for individual plan purchasers like myself who are losing options under Anthem’s new “narrow network” in New Hampshire.   Now, remember that we currently have no idea (for a few more weeks) what the new plan options, costs, or coverages are going to look like, other than that I am concerned that my main hospital (Concord Hospital) isn’t part of the new network.

So I was thinking of my main pup, Oscar.



We used to have pet insurance for Oscar, and it worked like this: each ailment had a specific monetary value set by the insurance company.   If Oscar was diagnosed with (and treated for) infected anal glands, the insurance company sent me a check for, say, $75.   It didn’t matter which vet treated him or how much we paid: they still sent us $75.

Now let’s review what the problem was between Anthem and Concord Hospital.  As Sarah Palermo quoted the relevant parties  in the Concord Monitor:

Concord Hospital was invited to join the network, but declined because Anthem “did not offer us anything that we considered reasonable,” said CEO Mike Green. “They were substantially below what they offer in their other plans and would have been hard for us to break even using those rates.”

“There was no comparison” between the rates proposed and the rates Anthem pays for other patients, he said. “It was unreasonable from our perspective. We’re always open to negotiations (but) they never came back to the table.”

“Concord remains a really important partner for us in providing care,” Guertin said. And while “we don’t talk about specific rates or specific discussions . . . we believe we offered a very reasonable rate, and 17 hospitals clearly agreed.”

“Guertin” is Anthem President “Lisa Guertin.”

Ok – so it’s the problem is that Concord Hospital wants more for services than the rates Anthem proposed.   That happens in free market negotiations sometimes, right?  I, on the other hand, am upset that I’m losing access options in terms of doctors and coverage.   This seems solvable:    enter the Kid Dynamite Initiative.  Maybe we should just call it the Oscar Plan:

a) I am an Anthem Customer.   As an Anthem Customer, I am entitled to have Anthem reimburse doctors for services rendered to me at rates approved by Anthem and agreed to by the participating doctors.   example: $165 is the current rate for skin cancer screening by my dermatologist.

b) Doctors have some incentive to agree to Anthem’s rates, because if they do, I’m more likely to go to them.  By accepting Anthem’s rates they get a smaller piece of a bigger pie:  they lose some profitability but hope to make it up with more volume.

c) Doctors also have the right to say that Anthem’s rates are too low.  They should respond by publishing their own desired rates.  Example:  new dermatologist (let’s call him Dennis) who is not part of Anthem’s network because he did not accept Anthem’s rates says “My fee for a skin cancer screening is $225.”

d) I, the consumer, can go see Dennis, and pay the *difference* between Anthem’s rate and the doctor’s asking price.   Anthem will pay the doctor $165, I will pay the doctor $60.  The doctor gets his asking price.  Anthem pays the rate they’ve deemed appropriate.  I pay for the added service that I want.  Q.E.D.

e) This requires transparency in pricing from all parties.  Would that be an issue?  It shouldn’t be:  although all of this pricing information is hard to get your hands on before the fact (one of the main problems with the current system?), it’s not top secret and I end up seeing all of these number eventually anyway on my EOB (explanation of benefits)

f) In reality, what is probably happening with the new Narrow Network is that, in an effort to decrease the monthly cost of the new insurance offerings, Anthem is lowering the amount they are offering my current dermatologist from $165 to $105, and my dermatologist is saying “no way – not enough – I’m out of your plan.”   I should be able to pay the difference: the $60 that he wants, and make everyone happy.

So what is the problem with my master plan?  I’m guessing objections will be something like:

1) Anthem won’t like this because it will require them to pay out more times.   But no – that’s not true, right?  I’m going to the dermatologist anyway.  Anthem is going to pay $165 no matter who I see.  The Oscar Plan just allows me to “super size” my choice of provider and to pay the difference.

2) This will be so hard to administer – to keep track of everything: the different rates and coverages.

To that I say, Bollocks.  We live in a world where a Congressman can “Tweet” dong-pics to hundreds of thousands of constituents in real time.    We live in a world where Google knows what question you’re going to ask before you finish typing half of it.  We live in a world where I no longer have to send out blanks & postage  (Maxell XL-2-s! Who’s with me?) to tapers to get bootlegs of live concerts that I went to: I can download them in lossless audio by the time I get home.   We live in a world where I can comfortably and safely manage my finances online without getting out of my chair.

We can do this.

My goal, as a maker of public policy, would be to enact policy that rendered the objections of the critics of my policy moot.   Currently, one valid objection to the implementation of the Affordable Care Act in New Hampshire, as I explained at detail in my prior post, is that I am going to lose access to my current plan and doctor.  I’m losing CHOICE, access, etc.   Consumer choice is important, and we can satisfy my concerns with the Kid Dynamite Initiative as a pareto-superior improvement to the Affordable Care Act.

Please – tell me what’s wrong with my super simple plan*.


The President Lied To Me – ACA Edition

Health Insurance Needs Reform

My Health Insurance Bill Just Increased By 48%


*I’m sure there’s something wrong with it, but I’m not sure it’s something that can’t be solved…


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