US Health Care Payment Systems are Broken

As a corporate attorney, I do paperwork for a living.  I pay attention to details, don’t mind reading long documents and I am fairly organized.  Even with my training and experience, I have come to the realization that all the paperwork related to healthcare billing, payments, insurance coverage, explanation of benefits and related documents is almost incomprehensible.  Simply matching the bills to the insurance paperwork is hard.  Sometimes healthcare providers make you pay an “estimate” before providing service.  That estimate almost never matches the actual charges.  Then, when a mistake is made (and lots of them are made) it adds to the complexity.  In my case, one hospital billed part of the charges to Shawn Jr (age 21) and part of the charges to me (age 44).   Because we have separate individual out-of-pocket maximums, this  caused us to be charged more than we should have.  While our insurance company went back and corrected it, that took some time.  All-in-all, I bet I have spent 40 hours working on reconciling and paying healthcare bills.  This is a picture of only a small portion of the bills and related paperwork.  

I have another personal observation.  About two years ago my doctor I had used for several years decided to move to a concierge practice.  In case you are not aware, this is a practice where you pay a monthly retainer and the doctor does not take health insurance.  I asked him why he was moving in that direction.  He said the overhead cost and administrative hassle of billing, collections and payments made it almost a necessity.  A significant portion of his costs were going to dealing with all the insurance and payment tasks.  So he was getting out of that business.  This guy was literally the best doctor I had ever had.  Too bad our system is driving them to this point of frustration.  

Being a strong political conservative I have always resisted the concept of universal government-funded healthcare.  While I still don’t think that is the right answer, something has to change.  The current complex billing and payment systems coordinating various payments from government funded, private insurance and individual payments are simply not working.  I would also note that nearly 50% of all healthcare expenses are already paid by the federal government (through Medicare, Medicaid, VA and other government programs).  This combined with rather complex private insurance has resulted in a government heavy Frankenstein of pricing arrangements, authorizations, payment processes and other inefficiencies.  This is a contributing factor to the skyrocketing cost of healthcare in the US (along with many other factors).   I don’t know what the answer is.  But, because we are in such a mess and because the government is already so deep into healthcare, I think we need to carefully study and consider a single-payer healthcare program.  

This is a HUGE step for me ideologically.  I never think the government is the right answer.  In fact, the government is nearly always the wrong answer (except for limited instances such as national defense, environmental regulations, certain infrastructure projects and other programs which facilitate public goods that are not incentivized / possible within private capitalist systems).  However, I am also a pragmatist and know the US healthcare system is a mess and we are not totally privatizing that system for the next several generations.  Therefore, we must consider an alternative.  The next best alternative might be a single payer system.