Susan Handelsman offers this advice:
How to protect yourself and others from your health insurance, hospital, and Congress
Want to use time off productively?
Learn about the deliberately overpriced, inefficient and destructive (to patients and providers) healthcare system that we all have allowed to take complete power over most of our lives and deaths.
Health insurance companies can raise profits one way only: increase their revenues (not, as one might assume, by decreasing expenditures to providers).
Medical Loss Ratio (MLS) limits profits and administration to 20% of revenues (premiums paid by clients or government).
Therefore, the more insurance companies pay out, the more they are allowed by law to earn in profits.
There are virtually no regulators allowed to see insurers’ cost information let alone regulate it (because most health insurance revenues are now generated by their new RISK-FREE status as third-party benefit administrators, who earn monthly fees from government and employers to administrate– and set reimbursement rates, affecting co-pays!!–for most of the healthcare services provided in this country).
Stark Laws tie doctors hands from offering far more reasonably-priced competitive services, and politically controlled Certificates of Need are required in Illinois to protect any threat to hospital monopoly power.
Meanwhile, Federal Anti-Kickback Laws have a safe-harbor provision for GPOs (group purchasing organizations) and to a certain degree PBMs (pharmacy benefit managers).
PBMs and GPOs are paid according to the same incentives as private health insurance companies: the higher the cash flow the higher their profits.
There is zero incentive for these middlemen to lower costs to the end users.
Accordingly, they develop formularies and deal with exclusive providers based upon how big their personal kickback will be.
As we are now seeing, the monopolistic destruction of possible competitors producing hospital commodities like masks or saline bags has a murderous effect when a pandemic emergency occurs.
Who is to blame and what can we do about it?
We, the patients are to blame.
We don’t pay attention and allow ourselves to be divided along nonsensical partisan political lines…when there is really only ONE political party protecting this freakshow now and it is a party to which we taxpayers and human bodies seeking healthcare are not invited, we are on the menu.
What can we do now?
1. EVERY time you get a prescription for a drug, call around to at least 3 pharmacies for price comparisons (cash payer price, vs. GoodRx price, vs your co-pay with your particular ‘insurance’).Costco is often the lowest priced for cash payers. The pharmacists don’t like it? Too bad. They can easily POST PRICES ONLINE as alternative. They leave us no other option.
If you feel the risk is warranted, buy medications overseas. Many are not manufactured here: producers in Ireland sell the identical product to USA and Canada (although in Canada at less than half the price).What are the risks? You may be the test case for Federal prosecution forbidding Americans who cannot afford medication in America to import it. You may be buying adulterated, or counterfeit medications. You may not be able to sue if you have an adverse reaction to your medications. The risks are profound but so are the alternatives (not being able to afford medications).
2. EVERY time you are prescribed a test (radiology imaging, serum testing) call around for price comparisons (cash payer price at hospital, your insurance co-pay at your hospital, independent MRI and blood testing labs, a doctors office). Try to NEVER go to a hospital for an elective diagnostic test as your co-pay will frequently be significantly higher than your cash price at an independent testing center.
3. EDUCATE yourself online, about this healthcare cost crisis so devastating to so many of your fellow Americans. Twatting that you hate Trump or Pelosi does not fulfill anyone’s civic duty. If you cannot make the effort to learn what is happening, at least refrain from voting for predatory sociopaths who enabled the current circumstances and who now fight fiercely to defend it from disruption.
http://truecostofhealthcare.org/ (David Belk M.D.)
https://stanmed.stanford.edu/2017spring/how-health-insurance-changed-from-protecting-patients-to-seeking-profit.html From An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal, published by Penguin Press, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC.