“Coverage” Isn’t “Care”
By Dr. G. Keith Smith
If you are following health-related topics on social media you have likely encountered coverage is not care, as a theme or #hashtag. This phrase/quip should be viewed as an opportunity and lens through which the dysfunction of the crony-dominated healthcare system in this country can be viewed.
Not only is coverage not equivalent to care, coverage can and many times does create a barrier to care.
It might shock you to learn that the cash price for many medications at your local pharmacy is less than the co-pay if you are using your coverage to buy these same medications. In other words, you are better off claiming to be uninsured when you buy certain pharmaceuticals! Why is this? Your coverage represents an additional, contracted layera toll booththrough which the exchange between you and the pharmacist must take place. This toll to pharmacy benefit companies/wholesalers is removed from the purchase if you represent yourself as uninsured. The presence of this middleman/distributor can and does increase the price of pharmaceuticals dramatically, representing as much as 50% of the purchase price for a large number of medications.
The same goes for the care at many physician offices. Any physician who is contracted with insurance companies labors under their fee schedules, any departure from which risks expulsion from the network. Physicians who waive all or part of deductibles for patients or treat cash-strapped patients free of charge run the risk of running afoul of these same network contracts and may also face legal action. What gives?
Waiving deductibles or co-pays for those short on funds lowers the barrier upon which the insurance carriers rely to protect their own corporate wallets. After all, a patient who cannot muster their deductible represents little or no financial risk to those providing the coverage, and the higher the deductibleor barrier to care, the greater the likelihood the insurance companies will pay nothing at all. The courts have been no friend to those well-intentioned physicians and facilities that have waived deductibles/co-pays in an attempt to help their patients. Once again, if you have coverage and are low on funds, you should always ask the cash price for a service before revealing that you actually have coverage.
Do you have coverage and have no trouble meeting your deductible? Do you therefore think you can safely access the care that you need? Think again. Insurance companies employ hidden techniques that deny various types of care to those who have coverage. Intentionally paying physicians below an acceptable rate for certain treatments and procedures serves as a powerful rationing tool, leaving certain treatments in short supply. Moreover, if a treatment is theoretically covered but is denied in your case, say because the insurer deems it unnecessary or inappropriate, the physician cannot accept payment from you because of the hold harmless clause in his provider contract. Thus, he must either provide the care at his own expense, or agree with the insurer that you shouldnt get it.
Perhaps the only gift of Obamacare was that the deductibles were very high and very few physicians or facilities actually signed contracts with these plans. This created a vigorous cash market, where patients who are covered but without benefit, could negotiate cash prices with physicians and facilities for the care they needed. At the Surgery Center of Oklahoma we continue to see a large number of patients who are attracted to the pricing on our website (www.surgerycenterok.com) that is a fraction of their Obamacare or other coverage deductible.
Fans of universal coverage should keep in mind the countless covered Canadians who buy their care in the U.S. or overseas due to long access lines. Canadian provinces balance their budgets by stringing patients out on long time lines, extracting a painful and merciless time tax from their citizenry. Fans of Medicare for all should know that while violating a private insurance contract can be a hassle for their physician, violating the terms of a contract with Medicare is a crime. Unless a physician has opted out of Medicare he is not at liberty to waive deductibles or co-pays or charge less than the amount Medicare allows. In short, Medicare has criminalized charity, as demonstrated in a recent case of a Medicare beneficiary with a broken ankle who is stuck in a wheelchair because she cant come up with her $2,000 deductible.
Leave it to government to force the purchase of this coverage. All who have been victimized by this cronyism have earned a seat on the #metoo bandwagon.
Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.
In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedure. He launched the Free Market Medical Association which provides a platform where those seeking to obtain high quality and affordable health care can find free market-minded providers, both physicians and facilities.
He has made appearances on the John Stossel Show, CNBC, Huffington Post, The OReilly Factor, Capital Account, The Ron Paul Channel, NBC Nightly News and has been featured by Reason Magazines TV division and has been written about in The New York Times, Time Magazine, ABC news and Forbes to name a few.