Health Care Economics
Sunday, September 20, 2009 at 12:07 AM EDT
Obviously, there is a great deal of discussion going on in the US at the moment around the issues involved in health care reform. It is a lamentable fact that the US spends more money per capita than any other country in the world; yet the US, on the basis of many standard public health measures (e.g., life expectancy, infant mortality), gets far from the best outcomes.
There have been many reasons adduced for this sorry state of affairs â€” and I certainly do not intend to discuss them all here â€” but a recent article in the New York Times has confirmed the involvement of one of the usual suspects: stupidity.
There are people who, suffering from a variety of health problems, including ALS (also called Lou Gehrigâ€™s disease), Down syndrome, and strokes, need the use of a computer-driven voice synthesizer to turn text into spoken language. (Physicist and Nobel Prize winner Professor Stephen Hawking is probably the most well-known.) These devices can make an enormous difference in the personâ€™s quality of life, not to mention their potential to contribute to society, but it was initially a struggle to get insurance to cover them at all:
Although some patients require very specialized equipment, many have found that they are able to manage with, and in fact prefer, using everyday devices with appropriate software. According to the Times article, Ms. Kara Lynn has found that an Apple iPhone ($300) with text-to-speech software ($150) is preferable to a cumbersome and much more expensive PC-based device:
There is only one problem. Medicare, and private insurance companies, will generally pay for the $ 8,000 PC system, but they will not pay for the alternative using the iPhone which is 94% cheaper. And although the PC system uses a Microsoft Windows operating system, and therefore might be used for other functions, too, the public and private insurers insist that its ability to do anything else (like send E-mail, or surf the Web) be disabled. The â€œreasoningâ€ behind this policy is worthy of Through the Looking Glass:
In other words, in order to be reimbursed, the patient must obtain a machine that costs 10-20 times what an equivalent machine would cost on the open market, so that some of the deviceâ€™s functions can be disabled. Just to make the lunacy complete, in some cases the patient can then pay to have the disabled capability re-enabled, once reimbursement has been obtained:
If the patient wants a smaller, cheaper device (like Ms. Lynnâ€™s iPhone), the only way to get is to pay for it out-of-pocket.
Now maybe I am being too harsh. Perhaps the fear is that unscrupulous people will use a claimed need for a speech-synthesizing device to finagle a PC paid for by their health insurance. I have not personally applied to get one of these devices â€” anybody that knows me at all knows that I am quite capable of talking â€” but I presume that some sort of medical need certification is required before a reimbursement is approved. In order for the existing rule to make sense, the insurers must believe that they would get (and approve) at least 9 bogus claims for every real one. Although Iâ€™m sure that they are more acquainted with their own incompetence than I am, this seems a trifle unlikely.
Unfortunately, I think this illustrates an all-too-common mentality within the health care industry in general, and the insurance industry in particular, that the patients are adversaries who have to be prevented from getting things that they donâ€™t really deserve.
I am glad that Prof. Hawking is a British citizen who is covered by the National Health Service, so the equipment he needed to carry on his life and work was paid for. (We are bound to remember, in this connection, the ludicrous claim originally published in the Investorâ€™s Business Daily that â€œscientist Stephen Hawking wouldnâ€™t have a chance in the UK, where the National Health Service would say the life of this brilliant manâ€¦ is essentially worthlessâ€.) Prof. Hawking, who I think can be presumed to know something about his own situation, was quoted by the New Scientist as saying, â€œI wouldnâ€™t be here today if it were not for the NHSâ€. And, yes, he said it via his speech synthesizer.
This article originally appeared on Rich's Random Walks.