The Odd Thing About Insurance

by Joanna Smith on Feb 7, 2013

I was in the waiting room of a doctor’s office recently, and I overhead a patient talking with the receptionist.  She was saying she would wait to have a skin biopsy scheduled because she was only a few months from being on Medicare.  She currently had a high deductible insurance policy, and if she had the procedure done now, she would have to pay for it completely herself; if she waited for Medicare, she would only pay a very small amount for the procedure.

This conversation started me thinking about insurance in the U.S..  In an attempt to offer policies that people could afford, insurers designed and started to offer “high deductible” policies where the initial $2,500 or $5,000 or even $7,000 would be paid by the consumer and then the insurer would step in if the yearly amounts for healthcare exceeded that amount.  The problem, of course, is that many people started using their insurance as a “major medical” policy only and did not seek routine care because they would be responsible for the cost of the care.

Enter Medicare, where there are HMOs and Original Medicare–each of which costs the patient much less when they need a procedure or other care.  But that is exactly the problem:  people who must self insure defer care during the years they self-insure.  They build up “unmet need” by the time they are Medicare eligible, and  Medicare will then cover it.  This is the opposite of the way medical care needs to be delivered.

If we are to reduce the cost of Medicare, let’s start with providing complete care for people in their earlier lives so they won’t build up so much unmet, expensive care needs as they age.  Yes, older people have serious and complex medical conditions, but some of those are the result of deferred care earlier in life.

We need to start with government-funded care for everyone early in life: early intervention saves later intervention.  If we want to reduce the cost of Medicare, we have to start providing care early in life,  ensuring good access to care.  It will be cost-effective and it will be good care at the right time.

Never Events in Healthcare

by Joanna Smith on Jul 29, 2012

Medicare has a list of “never events”—situations that are devastating, unambiguous and preventable in healthcare.  For a complete list, follow this link:  National Quality Forum Never Events

I have created a new set of “never events’ from the Consumer’s viewpoint:

  1. I should never leave a doctor’s appointment without understanding what was said
  2. I should never say yes to a procedure I don’t understand.
  3. I should never feel a question is silly
  4. I should never be interrupted 15 seconds into my story
  5. I should never think I’m taking up too much of the doctor’s time
  6. I should never see that lack of insurance is shutting me out from needed, medically appropriate care.

In the Hospital:

  1. I should never see a provider walk to my bedside without washing his/her hands first, and I should not have to be the one to remind them to do so.
  2. I should never be asked to sign papers in a hurry without a family member or friend to review them;
  3. I should never be approached by a discharge planner I’ve never met on the morning I’m discharged;
  4. I should never feel that I’m taking up too much of the doctor’s time;
  5. I should never be surrounded by a team of students or providers without my permission;
  6. I should never have blood drawn without knowing why.
  7. I should never be sent home without a clear, verbal explanation of what my follow-up care will be.
  8. I should never be scared to go home.

These are some of the events healthcare advocates can help their clients avoid, and these are some of the ways to ensure good healthcare is being delivered to you and your family.

Understanding the Mysteries of Medicare

by Joanna Smith on Sep 2, 2009

Need help with Medicare?  It’s a complicated system to understand, especially when you’re first enrolling.  Join me in at a workshop in Portland, Oregon September 12th to learn and understand how it works.  The text of the flyer follows:
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