Paul Ryan‘ s plan to change Medicare to a system that gives seniors both greater freedom of choice and greater responsibility for their own care has been under heavy attack. It isn’t surprising. I suspect if more investigation were done we would find that some of those attacks are at least funded by the people who have managed to learn how to make a profit under the current system.
But this isn’t about them. This is a real life example, me, of why Ryan is right. My physician has been my physician for 15 years or so. I adore him. He is a very smart guy. But, like most physicians, he works for a big healthcare clinic and has little or no idea what even HIS services cost. Nor do I until long after the fact.
Recently, due to administrative boondoggles and my own carelessness I found myself without Part D– Prescription Coverage for a year. No big deal except I will have to pay a penalty when I re-enroll. So, I have discovered the Target generic $4.00 prescription program. Basically, if it’s not on their generic list and it won’t save my life, I am usually of the opinion that I don’t need it. Walgreen’s and Walmart have similar programs. My doc and i have had a few exchanges. By the way, a lot of stuff is on their generic list and my health has not been endangered. Recently he prescribed a nice new drug for some arthritic pain I have been suffering. When I arrived at Target to pick up the prescription, they told me they didn’t stock it. Then they asked if I had any coverage because, oops, it was going to cost $287.00 to fill. Long e-mail exchange shortened, I told my doc I was not in $287 worth of pain, did a little research and found a drug on the generic list which is not quite as good that costs $4.00. I am NOT willing to have some bureacrat in Washington or some other city or some anonymous insurance administrator make that decision for me. But I am perfectly willing to make it myself.
Under one version of Ryan’s plans, there will be Health Savings Accounts, and just like I do when the money is coming out of my own pocket as it is now, I will benefit from making a decision that saves money.
John Mackey caused a storm at Whole Foods when he pointed out that we know the cost of nearly everything we buy before we buy it EXCEPT for our medical care. Here in California, your auto mechanic has to give you an estimate before he fixes your car. Your doctor doesn’t even have to post prices. A lot of medical care is very routine. You can already buy kits at your local drug store to diagnose a UTI. A lot of HMO’s will let a physician’s assistant write the prescription for it. Why should you have to pay $200 or $300 to get the prescription? We need to extract ourselves from a system in which medical care providers charge people with money up the kazoo to cover the people who don’t have money. And we need to consign those who don’t have money to a system which is already partly in place– publicly provided medical care that is means tested. See, for example, Los Angeles County General Hospital, where, believe it or not you can get some pretty decent medical care.
In fact, to all those Hollywood folk who think Obamacare is going to be great, let me make a suggestion– sign up for LACGH’s medical care plan and you will get a real preview. The LA system has three teaching hospitals staffed by residents and faculty from two of the best medical schools in the nation– UCLA and USC. So, while you will wait all day for an appointment, if luck is with you you may actually be able to see a world renowned physician. Or not.
But I digress, the point of my post is, once we can set up a plan which allows its participants to benefit from making thrifty decisions, we will see the cost of medical care brought under control. Is this going to be simple? No. But the reality is that the way our system works now, if you have great insurance there is no reason for you to say no to the nearly three hundred dollar pain pill.
Oh, by the way, in my first 8 months off of Medicare Part D I have spent less money on prescriptions than the coverage would have cost. Just saying. Thank God I am healthy and thank God there is still a little competition in the prescription drug market.