Andy Rankin

No, I’m not going to propose a solution to our health care cost problems.  I’m just going to give a great example of the problem (and maybe point out that a lot of the effort made so far on solving the problem is… trying to solve the wrong problem).

My oldest daughter’s birthday is in early September.  The Commonwealth of Virginia requires her to be immunized against certain diseases before they will let her attend public school.  Our insurance company will not allow my daughter to have a checkup within 365 days of her last one.  This gets us into a situation where school is starting, she needs some shots, but we can’t take her in to the see the doctor.

Our pediatrician understands this situation and had our daughter come in and get shots from the nurse.  Problem solved!

Well, now the insurance company is saying that they’ll cover the cost of the shots but not the nurse’s visit.  If she had been seen by a doctor they claim it would have been covered (I’m not sure that it is true because of the 365 days thing - but I’m pretty sure the person on the phone wouldn’t be able to figure that out).  Because the doctor tried to save everyone money by having the shots given by a nurse (actually, the nurse always gives the shots - it’s just that the doctor didn’t stop by to check on my daughter during this visit), we end up on the hook for part of the cost (which is only $37 - almost not worth arguing over).

The best part is the amount of overhead involved: our doctor submitting the claim, the claim being reviewed and partially rejected by the insurance company, the insurance company sending me a letter about it, me writing a letter in response, the insurance company reviewing my letter and then spending 15 minutes on the phone explaining it to me and then writing up the conversation and sending me another letter.  And, it could get worse.  I suggested to the insurance person that maybe the doctor did actually stick her head in to see my kid and so I might have the doctor’s office file again - the insurance person thought that would be a good idea (wink, wink).  So, here comes more overhead - I’ll call the doctor’s office, they’ll file another claim to the insurance company, the insurance company will review it and (maybe) send the doctor’s office a check (for a lot more than the $37 that they would have paid the first time around).

Just because I save $37 from this whole mess doesn’t make me happy.  I’m sure I end up paying for it in the long run - the cost of insurance is jacked up 15-20% every year.

It seems to me that the government is trying to figure out who should pay for health care… but what they need to do is figure out how to make the entire health care industry 100 times more efficient.  If you do that then figuring out who pays for it becomes a lot easier.