Friday, March 7, 2014

Lake Wobegon Healthcare Edition

Ezekiel Emanuel, who helped design the Affordable Care Act, thinks healthcare choice is overrated. Instead the problem is that the narrow networks that he helped make possible are not of sufficiently high quality. Some of you are facepalming right now at the vision of a world where all the health networks are above average. I sympathize. For the other 90%, here's a breakdown why this is jaw droppingly irresponsible and stupid.

For a doctor, insurance is a cost, both in time and in money. For each insurer you accept, for each of their plans that you're on, there is a certain amount of overhead that is taken up both in time and money. The rules change. How you report to them changes. It reduces the number of patients you can see (administrative time spent dealing with them) and increases what you need to charge for each procedure (the cost to pay for the extra billing overhead).

The narrow networks of high quality that Emanuel is suggesting we use to cure the problem of lack of patient choice implies that those doctors who are at the peak of their profession and the best in the business would need to belong to a large number of these narrow networks to avoid the creation of second class networks. This would maximize their paperwork and expense while minimizing the medical good they could do. Very few doctors would take that deal. Why should they? At that quality level they could operate entirely on cash and still have a full patient panel.

Emanuel illustrates his article with a woman who was stymied from going to get the second opinion on her cancer diagnosis she wanted. In the end, she went to a different center for a second opinion, a happy ending, says Emanuel. But there is no guarantee that the second opinion is correct, nor that the Houston clinic the patient wanted to go to in the first place would not have arrived at a different answer. But she got a second opinion, the second opinion box got checked off and therefore all is well with the world, according to Emanuel. Insert facepalm here.