I want to put to a wider audience a question that came up last week during the excise tax debate. It’s a question I feel cuts to the heart of the debate, and one that this site does not have agreement on. Last week I received two answers that are incompatible with each other. If we are to successfully reform healthcare, this question needs a single answer: What is the level of care we should expect from the healthcare system such that we can successfully manage costs?
First, the background on my question. One morning I dropped a piece of concrete on my foot and thought it was broken. I hopped into the ER for an x-ray, which came back negative. Great, I thought, and got up to hop back to the car. Not so fast, the ER wanted to take two more x-rays, just to be sure. Plus they forced me to wear an air cast I didn’t want and couldn’t even wear properly because my foot was swollen up. But it was already on my leg, so it was mine for keeps.
I ended up with more care than I felt I needed, and of course it cost more.
In an excise tax debate thread last week, I read a comment stating that, paraphrasing, "the excise tax on Cadillac Plans is necessary to reduce frivolous healthcare spending."
Now I didn’t feel that the two additional x-rays were medically necessary, but I was not given a choice by the ER staff as to whether I wanted the extra procedures performed or not. The ER staff decided they were necessary. Whether that need was medical or to avoid legal liability I can’t speak to, but the end result is the same. The ER ran up the bill. So who decides what care is frivolous? How does the excise tax do anything to control those costs? What cost control do I have as a consumer to reduce frivolous cost runups?
Another commenter disagreed with me, suggesting that the ER needed to ensure I didn’t have a hairline fracture not visible in the first x-ray and the ER had only my best interests at heart. Well in that case, what is the reason for the excise tax if the Cadillac plans are providing a legitimate level of care?
So the question: Which is it?
Is my "Cadillac" insurance plan wasteful for covering frivolous extra charges? Or is that the true level of care that is needed?
Who rations the care to reduce cost and by what means?
Should I be forced into a cheaper plan that only reimburses 1 x-ray? How then do I keep the hospital from performing procedures my high deductible junk insurance won’t cover?
If the 3 x-rays are necessary, then why are we proposing taxing the healthcare plans that cover them as "frivolous"?
If I can’t afford the extra x-rays and accept a reduced level of care to save costs, can I just sign something promising not to sue? If not, who assumes legal liability for the hospital if I did have a break? Or does the excise tax just mean I’ll have to pay out of pocket for the hospital’s CYA, and there is no cost saving?
The cost control measures in the healthcare system are completely broken. Forcing people into junk insurance won’t keep the hospitals from running up the bill, it’ll just cause another round of medical bankruptcies as the denied claims are passed on to the public. I’ve tried getting an upfront answer on costs from doctors. The only answer I’ve ever got is "We won’t know what it costs until we’re done". In other words, there’s no way to tell if you can afford the bill until you get it. That’s why Cadillac Plans exist! It's why union workers accept them in exchange for reduced salary.
If the plan for the excise tax is to save costs by reducing the level of care provided, then we must have tort reform and other cost containment measures to assume legal liability so that care can be effectively rationed and hospitals no longer have a motive to run up the bill. Because simply passing a tax that cuts insurance reimbursement does not reduce the costs at the time of treatment, it has no mechanism to do so.