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Ali Javanbakht M.D.: H1N1 Is a Case Study in the Need for Reform
Let’s pretend you’re the CEO of a for-profit health insurance company. Here are the facts:
This could be a tough flu season with two strains of the viral infection: the seasonal flu and H1N1.
Each year, 200,000 people are hospitalized with the flu and 36,000 die. That number could be double this year because we have two flus.
For a patient to spend a day in a regular hospital ward (not the Intensive Care Unit) costs about $1,000 a day. That does not include meals, medications, procedures, IV fluids, injections, doctors’ evaluations or physical therapy.
There are vaccines available that could stop someone from getting either flu. The vaccines cost around $20 to $30 per dose.
The Centers for Disease Control and Prevention and local public health agencies, aka the government, will handle acquiring and delivering the vaccines to local health-care providers.
Knowing all that, what do you do? If you’re the CEO of a for-profit health insurance company in America, the answer is: nothing. And who takes over educating providers and patients? The CDC and local public health agencies. In other words, the government.
My wife is a pediatrician. Her clinic got a call from the Public Health Department informing her that it had not received an order for H1N1 vaccines from her clinic. The boarding school at which I work has its own special liaison at the Public Health Department to help with acquiring and delivering the vaccines.
How much does the government stand to make from its involvement? Close to nothing. How much does the for-profit health insurance industry stand to make from people getting vaccinated? Potentially, millions of dollars.
So why haven’t for-profit insurance companies contacted their high-risk patients more aggressively? Why do they still charge their patients a co-pay for the vaccine? Why not do a reverse co-pay, i.e. pay the patients who get the vaccine? Why not offer transportation to those who need it? Where are their advertisements encouraging people to get vaccinated? All of these efforts would cost a fraction of a CEO’s bonus, could potentially save the company millions, and would dramatically improve the company’s public image at a time when they need it most.
And still, there are those who argue the merits of a for-profit system.
— Ali Javanbakht M.D. is a family physician in Santa Barbara.
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» on 11.05.09 @ 04:26 AM
I guess Dr. Javanbakht, I start with the assumption that Americans are adults who can be bothered to stay informed. And that they’re not children who need to be led by the nanny state to health. I further presume, that our current system, which does provide good, fast care to 85% of our population, can be improved, but that regulatory reform and free markets will provide a better solution than trading a big corporation based system for a big government based system. Been to the DMV lately? I also happen to pay attention to what is happening in Europe, as I went to school in France and try and keep up with the language. The French (and a number of other European) socialized medicine systems are going broke, so there goes the cost savings you allude to. Add to that the way in which our politicians will arrange to get illegal aliens covered by the proposed plan (and yes, they will do it - to buy votes with other people’s money) the whole Pelosi-Reid plan becomes intolerable. In closing, let me say your focus on CEO bonuses leads me to wonder if we ought to cut MD’s salaries to save money in a government system? Sounds like there is more money there than in executive salaries. Nota bene: envy is not good economics (or health care policy for that matter).
» on 11.05.09 @ 05:48 AM
Great article!
» on 11.05.09 @ 08:52 AM
I have been to the DMV lately. Once in Goleta with an appointment and the process was efficient and fast. The second visit was in Santa Barbara as a walk-in. I was not waiting more that 10 minutes before called to a window where everything ran smoothly. It is a mystery how they can run so well without bonuses and a highly paid CEO.
Perhaps if I spoke French I would have gotten slowed down.
» on 11.05.09 @ 02:27 PM
Allow me to answer the good doctor’s questions:
1. “More aggressively” must mean that they are not notifying people like you think they should. Never mind that the vaccine is just now becoming available to the general public and there is still a woeful shortage.
2. The co-pay is because that was the agreement between the customer and the insurance company. It’s called a contract. I believe there are federal rules as to when you get to waive the co-pay. The feds to the rescue once again!
3. The absence of a reverse co-pay: see point #2
4. Why not offer transportation? Why? How do people get to the doctor’s offices now? Plus, they aren’t sick and there’s no vaccine, so what’s the emergency? Can’t they just schedule the shot when it would be convenient for them?
5. Where are the advertisements? Everywhere. It’s all over the radio, TV, Internet, grocery stores, drug stores. You would have to be literally living in a cave not to know about H1N1.
As for trying to beef up their image…why? The Democrats are soon to deliver tens of billions of dollars of extra annual revenue their way when coverage becomes mandatory. This is a win-win for insurance companies. And a lose-lose for patients as we see while we’re waiting for our government delivered vaccine to slowly make it’s way through the system.
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