Continuing from yesterday’s entry in which I address Regina Herzlinger’s article If healthcare were run like retail…, we come to point number 5:
“Individuals get generous tax breaks to buy their own insurance, with subsidies for those with low incomes.”
Since Ms. Herzlinger enjoys the car-to-healthcare analogy, let’s use something she’d understand. Since 2005, the IRS has provided a tax credit on hybrid cars. However, even with such an incentive for the past half decade, these alternative vehicles have not replaced the standard gas-guzzlers (and fuel sippers) that still occupy our roads. A tax break does not necessarily elicit certain desired behaviors. Similarly, let’s remember the tax rebate checks from 2008. All of us heard stories of how many people either simply saved the money or bought foreign technology products, rather than using the money to purchase American goods. Those folks didn’t act exactly as we’d hoped…even with the tax rebate break.
Those with low incomes are in an even more precarious situation. We must realize that insurance to them is likely not necessarily the highest priority, particularly when plenty of hospitals exist that will provide charity care for them. Food, rent and daycare may take those top priority spots. Once those bills are paid, surely there is not much left—if any—with which to purchase insurance, no matter how high the subsidies.
Hospitals are already feeling the pressure of charity care, as described in a recent Wall Street Journal article. Mount Sinai, on “Chicago’s poor and blighted side” has “spent $16.6 million on charity care last year and another $16.2 million to subsidize specialists, such as cardiologists, who wouldn’t otherwise work in the neighborhood because reimbursements are so low.”
That same article points out that because of the way it’s designed, Medicaid, the government health-insurance plan for the poor, makes higher payments to one of Chicago’s richest nonprofit hospitals, University of Chicago Hospitals, than it does to Mount Sinai. Maybe that’s where we start. Perhaps Robin Hood ought to team up with our new Secretary of Health and Human Services to even out such inequalities.
At the risk of stating the incredibly obvious to Ms. Herzlinger, healthcare is not like buying a car. I don’t want to base the care that I receive solely on sticker price, but rather on such things as quality performance, evidence-based care practices, attention and care received when admitted, and zero adverse event rates (or as close to zero as I can possibly find). We’re talking life and death here. There’s no do-over. Yes, prices—charged and received by hospitals—must be put into balance. But a lower price on, say, a spinal implant procedure isn’t necessarily the most important thing in patient care. Patient care is the most important thing in patient care—and that all boils down to quality, not price.
This blog first appeared at Action for Better Healthcare. - Ed.