Americans like to believe they have the best health care system in the world. They certainly seem to believe that access to specialist physicians and high end technology is important in maintaining the “quality” of the health care delivery system. Little by little, the word is getting out that more is not necessarily better and almost certainly is often worse. The most egregious example of this is Michael Jackson’s death which was ruled a homicide, allegedly perpetrated by his personal cardiologist. Turns out that having a cardiologist attending you 24/7/365 may not be a good thing. On a more mundane note, NPR decided to look into this and has posted an in-depth look at health care variation that is very well done. The key points of this report are that 1) Americans are the same no matter where you go (despite the belief of some folks that we’re made differently), 2) doctors influence patient choices when determining among choices of equally appropriate healthcare, and 3) money and payment structure influences doctors. This is not rocket science but the fact that it took Alix Spiegel 20 minutes to explain may mean it is more difficult for the average person to grasp than I might believe (and then again, I suspect the NPR demographic may not be average anyway). NPR quotes the Dartmouth Atlas data that suggests almost 1/3 of all healthcare costs are for procedures that are not helpful and may be harmful.
Why is this important to Alabama? The talk of “Health Care Reform” has morphed into “Health Insurance Reform” and now has morphed again into “Covering the Uninsured with Private Health Insurance.” In 2008, Blue Cross of Alabama reported $4,000,000,000 in premium collection. Most of this business, as I understand it, was done with companies who use Blue Cross of Alabama to administer their plan. They have no risk (the companies put money into the plan and take money out) but they take a percentage of the money (8%) and get to hold the premium in the bank (drawing interest) until it is needed. It would seem that they do better as more money is spent on health care, necessary or not. I certainly hope that someone pressures them to look at the payment structure and outcomes, not just Alabamians’ satisfaction with their product.