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On the Third Hand: Dr. Upcode

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Paul Fronstin has published a great analysis of the Patient Protection and Affordable Care Act of 2010 (PPACA) health insurance exchange provisions in a new brief distributed by the Employee Benefit Research Institute (EBRI).

Fronstin suggests that the PPACA exchange system could lead to a return to the idea of creating an employer-sponsored defined contribution health benefits system, in which employers give the employees a set amount of cash and tell the employees to go buy their own guaranteed-issue, mostly community-rated coverage through the exchanges.

Some of the challenges would be worker satisfaction with group health coverage, group purchasing efficiencies, worker health literacy, and the role of the employer in defending workers against insurers.

I think what Fronstin leaves out, and what all the many polite people who respect the hard, stressful work that doctors do to save lives leave out, is that, at least when it comes to billing, many doctors’ offices see a high-cost procedure in every checkup.

On the one hand: The provider contracts big carriers now negotiate with the doctors are probably unfairly tough. The prices doctors get for many services may be so unrealistically low that the doctors have no choice but to engage in creative coding.

On the other hand: It seems really unfair, from the perspective of a reporter who’s an employee, group plan enrollee and sometime patient, to make a consumer who has no aptitude for bargaining to police health care bills.

On the third hand: Maybe one of the keys to getting everyone to get real about health care costs is to make patients face up the possibility that doctors’ and hospitals’ charges are part of what’s ailing the health care system.


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