Thursday, March 31, 2011

Q: Where do you get the best price for an MRI?

 How can you find the best price for an MRI (and why would you care)? I should have gone to, but didn’t. “My bad,” as the kids say.

My wife tore her meniscus during 2009. By the spring of 2010, the pain had finally became too great. We though she needed surgery. Since we have a Health Savings Account (HSA), though, we wanted to make sure an expensive surgery made sense.

We headed to Summit Orthopedics to see Dr. Jack Drogt.

Drogt suggested first to treat her with a cortisone shot, rather than recommending an MRI and surgery. That made sense. The shot, at $180, could knock the pain down and surgery – at thousands of dollars – could be unnecessary. (He never said it, but I suspect this is a practice guideline for all but the most obvious surgical situations.)

Weeks later we returned with the sorry report: The knee hurt, and perhaps even more. Drogt prescribed an MRI with a consultation thereafter.

Can you tell me the price of an MRI (no fair looking at an Explanation of Benefits – once you have that, it’s too late to worry about price)? Have you ever asked? If you did, would anyone tell you? Do you care about the price? You do if you have an HSA and want to hang onto your money.

In Minnesota, the law requires doctors, hospitals, and insurance companies to tell you ahead of time the price of a medical service, product, procedure, medicine, and so forth. The law (Sec. 62J.81) calls this price quote a “good faith estimate;” like going to the auto repair shop to get new brakes. Auto mechanics are used to giving you an estimate – doctors not so much, but this transparency idea is a new thing.

I called three MRI service providers. One quoted $1,050. A second, $980. These two clinics were free-standing, non-hospital based. I knew better than to call the hospital for a quote, because I had made that mistake in 2008. The third option, an MRI machine dragged around in a 40’ trailer, gave an $750 estimate, but I felt wary of their service.

I also knew about Smart Choice, an MRI clinic in Milwaukee. Smart Choice promises a $600 price for all MRIs, regardless of what kind of scan the doctor prescribe. I had to decide whether it was worth it for me to drive five hours to save the money, and therefore, chose not to do so.

We chose the $980 option – and wasted $600. I could have checked, and received the MRI for less than $400 at a clinic just a few miles away., founded by my good friend and Canadian expatriate Ralph Weber, allows a person to input a request for bid for a variety of medical procedures, including MRIs. You should check out right now (no, this is not a commercial and I do not get paid for it – I just believe in what they are doing).

Dr. Drogt performed the surgery, and my wife received therapy at his clinic. We spent several thousand dollars, but her knee seems “fixed.”

Drogt is a first-class orthopedic surgeon, but guess what? If I would have gone to, I could probably have found an equally first-class surgeon in a nearby community to do the surgery and saved hundreds or thousands of dollars. (Now I remember!)

I tell you about because it is an example of how the marketplace can answer the health care pricing problem. It is not “the” answer, it is “an” answer.

What we must guard against is a government bent on destroying the types of  innovation or the two people working day and night in a garage somewhere to create the next miracle medical device.

What I fear, and fear is the right word, is an Independent Payment Advisory Board deciding that even though is a fabulous idea, it does not fit their payment model and therefore, must be shut down. Or, it must be shut down because Ralph Weber is an outspoken critic of government-run health care.

Saturday, March 26, 2011

Board to Death and The Coming Revolution

No, I did not get the headline wrong. Using independent boards to strip us of our freedom appears to be the modus operandi of the Obama administration.

Since my focus has been on health care reform for the past six years, I have not kept up with the broad range of constitutional concerns to which we all should pay attention. My sense, however, has been that the Obama administration is busily, and often quietly, carving out a series of administrative cabals that threaten to choke off liberty: You have heard of the czars?

Czars run this or that project, and many do not answer to Congress nor to voters – only to the person that appointed them: President Barack Obama.

Each czarist fiefdom seizes on one or another project “in the public interest” with the clear intent of controlling the organic behavior of private industry, or that of private individuals. Simply stated, your personal liberty is being eroded by a group of nearly-silent streams of incremental bureaucratic overreach. You know you feel uncomfortable, but not quite able to decide if it is something about which to fuss or fume.

Perhaps this will help bring some focus: Stories about two of new federal ruling boards intersected on my digital desk this week, causing me to finally put pen to paper (or keyboard to software).

·         The Consumer Financial Protection Bureau
·         The Independent Payment Advisory Board (IPAB)

Taken by themselves, these two command structures are reason enough to recall the President – but darn it, the Founders never gave us that option, except at election time.

Elizabeth Warren runs the Consumer Financial Protection Bureau cabal right out of the White House. Despite Congress and the law, knowing the Senate would never approve of her appointment, Pres. Obama let her set up shop without bothering with the constitutional nuisance of actually getting the U.S. Senate to approve her appointment.

Warren and her Czarist Bureau, with a projected budget of more than $500 million, answers to no one, except on paper (written with disappearing ink). She is already badgering banks to shake them down to refinance home mortgages. Warren believes mortgage holders should cough up $20 billion, sometime before the 2012 election, to write off mortgage principle for thankful debtors – called voters.

“But,” you protest, “One of the primary obligations of government is to enforce legal contracts.” Czar Warren, however, threatens to use government police power to cajole unwilling contract-holders – mortgage lenders – into giving up their legal rights.

Next is the 15-member Independent Payment Advisory Board (IPAB) created by the Democrats with the “Affordable Care Act of 2010.” We will someday come to call this the Absolute Coercion Act.
The IPAB will execute a financial stranglehold on how, how much, when, and what for doctors, hospitals, and health care providers are paid. Never mind the individual medical needs. Never mind the financial aspects of providing medical services. The 15 Czars in the new command-and-control health care system will decide what is good for us, and how much professionals should be paid to favor us with it. Is there anyone on the planet that can call this liberty? Yet, it gets worse.
Although the Absolute Coercion Act of 2010 (see above) requires the President to win Senate consent for the 15 IPAB Czars, that does not mean it will happen. The Congressional Research Service explains:
“There is no constitutional or statutory qualification on the President’s ‘Power to fill up all Vacancies ....’ Because the President’s recess appointment authority is unqualified, it appears that he could fill member positions on the IPAB by recess appointment during any period when he could otherwise make such appointments.”[1]
Silly idea, apparently, requiring presidents to get the approval of elected U.S. Senators for the appointment of people that will hold the power of the federal purse in their hands.

Knit these two boards together (the IPAB and the CFPB). Political appointees of the current president, without the approval any single elected official or a single citizen vote, will hold power over lending, shelter, life, and death. But more worrisome: These are but two of the many federal fiefdoms fostered by this president.

The Declaration of Independence makes it clear: Government serves by the consent of the governed. Government is established for the singular purpose of protecting the unalienable rights of the governed. Among these unalienable rights are protecting human life, securing individual liberty, and providing maximum latitude for the individual decisions we make about pursuing our own happiness.

The Obama Czars are a direct assault on unalienable rights, a clear violation of the purpose of government, and war against government by consent of the governed.

The Declaration also states clearly that once government has thrown aside the rights of citizens to consent to their government, citizens have the right and duty to throw off that government, and create new forms that will protect rights. We still cling to the hope of correcting this at the next election. Pray that we will do so, because if we do not throw out the Czars in 2012, what follows after will make the American Civil War look like an afternoon skirmish.

[1] Staff. (2011). Independent Payment Advisory Board Membership: The President’s Recess Appointment and Removal Authorities. Memorandum. Congressional Research Service. March 18, 2011. Washington, D.C.

Tuesday, March 8, 2011

$289,000 or maybe $812,000

I am going to suggest we are not good men [people]. “A good man leaves an inheritance to his children’s children… Proverbs 13:22A.
The two numbers that title this missive relate to the unfunded Medicare (just Medicare) debt we are leaving for our children, children’s children, and even their children. It is immoral.

According to the U.S. Census Bureau, about 128 million Americans are 30 or younger. These are the ones that will be paying the unfunded Medicare debt. The debt, depending on whose numbers one uses, and the assumptions you accept, ranges from $37 Trillion to as much as $104 Trillion.

We are leaving our progeny with somewhere between $289,000 and $812,000 (or more) each to pay for our profligate health care spending. Some people blame the 78 million Baby Boomers for this (I am one, and Medicare eligible in 2012). I blame politicians for being gutless.

Oh, did I mention, this is only the Medicare debt, and does not account for Social Security shortfalls, or the Obama deficits.

A farmer that eats his seed corn dies. A nation that consumes its children’s inheritance dies, and deserves to do so.

As a 63-year old father and grandfather about to become Medicare-eligible, I suggest four immediate changes to Medicare coverage (if those already on Medicare refuse to participate, so be it – nothing stops us from embracing change):

1)      Delay enrollment for Baby Boomers. I am 63. I will wait – 70 sounds like a good starting point. And then index it.
2)      Means test it.
Medicare is a welfare program. There, I said it. Welfare. The average Medicare enrollee today has paid in less than $40,000 over a 40 year work life, and will receive more than $250,000 in free services during Medicare enrollment. That is a welfare program.
3)      Allow doctors and hospital to “balance bill.” This means, let medical providers charge a fair rate, instead of the underfunding they receive today. Without doing this, Baby Boomers will seldom find a doctor willing to serve them.
4)      Change Medicare to a defined contribution program. Instead of paying for benefits, no matter what they are, provide a fixed amount each month to be used to purchase health coverage. The Medicare enrollee will have to make up any difference in cost (yes Matilda, we can make some arrangements for low-income welfare recipients, but it’s the middle-class and wealthy Medicare welfare recipients that need to start paying their own way.
5)      (Yes, I know I said four, but this one is profound enough to make you think. Maybe it’s time we came face-to-face with the reality that we do not have the right to live forever, when it means we steal from our great-grandchildren.)

Let’s have a robust discussion about this. How many of you could care less about what we leave for our children’s children? Okay, you three move further to the left. The rest of us want to fix this problem.