Healthcare Checkup

    By Jessica Rosenthal, FOX News Radio Reporter

    What would you give up to fix our broken healthcare system?

    We’ve heard a lot about healthcare from politicians over the past decade, mostly surrounding Obamacare. This summer though Congress failed to repeal the Affordable Care Act and so it remains the law of the land.

    But many working on the front lines of healthcare and dealing with it every day, say the healthcare system we have in this country is, unhealthy. Words to describe it, like, “broken,” were thrown around by doctors. Patients feel it’s frustrating and limited. One patient advocate called the system “insane.” They point to high cost and lack of communication, and wonder, should the healthcare insurance system be non-profit?

    It once was.

    Just as the Great Depression was beginning, Blue Cross plans were being created. Meant to increase access to healthcare at Baylor University’s hospital in Texas, “a non-profit prepaid mechanism,” was created, according to a Consumers Union report about the history of healthcare insurance. These plans became popular during the 1930’s and operated based on “care before profit.” But over time, more groups like the elderly and poor, were being left out of these mostly employment based plans. Medicare and Medicaid were created. And by the 1970’s for-profit insurance companies were providing stiff competition.

    Some of the doctors with whom we spoke for our hour long special report “Healthcare Checkup,” said a for-profit insurance system is the problem. Their reimbursement rates from Medicare, private insurance, and especially Medicaid, keep decreasing. And most health care dollars stay with the insurance companies. Emergency Room Dr. Alan Heilpern said, “insurance companies don’t do any healthcare. The insurance company doesn’t work with me in the emergency department at 2 AM taking care of someone vomiting up blood. But they’re taking a large amount of the money that is available in the healthcare system.”

    Retired physician Mitch Leventhal disagrees, “you really want to know who’s responsible for the high cost of medical care? Look in the mirror!” He says patients demand too much, especially use of technology, which is expensive. Both doctors agree some sort of rationing of care is required to keep costs down. Heilpern says the system tries to give everything to everyone and it can no longer do so.

    Patients blame a lack of communication among doctors, inefficient and lazy keeping of medical records, and high costs for their frustration. Los Angeles resident Shayna Sorrentino, has been dealing with flaring pain off and on for years and has been engaged in an ongoing effort with multiple doctors and trips to the Mayo Clinic, to determine precisely what is wrong. She dreads going to her mailbox, “Not for any other bills than medical ones. Because what if it’s that one thing that you got the prior authorization for and it’s still denied?”

    The two healthcare insurance company executives who agreed to be interviewed concur about why costs are so high. Gene Rapasardi with Cigna, says technology has improved, which is more expensive. Adding “there are whole new classes of medications out there, especially specialty drugs, that are really miraculous in what they’re doing but they’re expensive. Craig Hankins with United Health Care agreed saying, “Healthcare is becoming more expensive because of new advancing technologies that are more expensive, the cost and role of prescription medications has grown significantly as well.”

    We reached out to several pharmaceutical companies none would comment for this report. But the Pharmaceutical Research and Manufacturers of America did. Priscilla Vanderveer with Pharma says they know costs are high. But they try to negotiate with insurance companies and pharmacy benefits managers. “Those insurance companies and pharmacy benefits managers are getting bigger and bigger discounts and rebates, and they’re not being passed on,” to the patients.

    Vanderveer blamed the media in part for the perception that prices are high. “What often is covered in the media, are the list prices…when the reality of the marketplace is that the actual cost of medicines to health insurers particularly but also to the broader drug supply chain are not increasing at rates that you might think based on media coverage.” She says a third of all spending goes to others in that supply chain, including those pharmacy benefit managers, insurers, drug distributors and wholesalers, and others.

    Lawyers who sue insurance companies on behalf of patients, blame insurance companies for looking for ways to deny claims. Even though under the affordable care act, they have to spend 80%  paying out premiums. Attorneys David Lilienstein said “there is no way a for profit insurance company should be deciding who gets healthcare.” Attorney Scott Glovsky agreed with some of the doctors about how things should work. Basic government provided coverage for all, and if you want extra, you pay for additional private insurance on top of that.

    So what’s a sick person to do with all this?

    Patient advocates help navigate peoples’ healthcare bills, claim denials, appeals, and much more on behalf of patients. They want people to negotiate their bills. And know what their coverage plan provides. If it’s too hard to understand the plan, call the provider and ask someone to go line by line through the coverage agreement. Advocate Lisa Berry Blackstock argues every procedure can be negotiated. She urges people to use to find out the true cost of the care they are receiving. And find out what the “cash price” is for care. People without insurance often pay the cash price, which is often less than what doctors and hospitals bill insurance companies.

    In this hour long special “Fox News Radio’s Healthcare Checkup,” we examined what’s wrong with healthcare and how to fix it, according to those on the front lines; the patients, advocates, attorneys, doctors, insurance executives and more.


    Follow Jessica Rosenthal on Twitter: @JessicaFOXNews