Recently, a colleague and I crossed the Potomac into Washington for an all-too-common sort of meeting: yet another round of “Let’s Fix Health Care by Turning the Whole System Upside Down.” Afterward, while waiting for our cab, she suggested some reforms that could actually make life better for ordinary Americans and reduce dissatisfaction with health care.
Of course, American health care has some big problems that ought to be addressed. Thirty million people don’t have health insurance. Medical bills bankrupt some (though not nearly as many as popularly thought). There’s plenty of waste and error in medicine (though probably no more than other industries). These are worthy items to tackle but, as we’ve seen, they’re far tougher to resolve than would-be reformers generally assume.
But despite all of these problems, American health care is by most measures the best on earth. (If you believe otherwise, Google my 2018 article, “The Din of Healthcare: Myths and Maybes.”) But there is a logistical problem that may be the single greatest source of consternation, and which ought to be the most remediable.
That’s the paperwork nightmare the system foists on ordinary Americans.
Medical encounters result in streams of paper: receipts, bills and “NOT A BILL” documents that look like bills. They drift in by post and email over weeks or even months. They’re of different shapes and sizes, making them difficult to collate for reimbursement.
Filing reimbursement claims means stuffing receipts in drawers until all have arrived. Some must be taped onto paper and put through scanners or photocopiers. Then there’s the anguish of matching receipts with bills. For those with health savings accounts, health reimbursement accounts, flexible spending accounts and the like, there’s deciding which credit or debit card should be used for different bills. Some, by the way, are due before the date on which you receive them.
Solve the paperwork problem and we can more calmly focus on the more daunting questions about how (or if) insurance ought to be restructured. Or, better yet, how actual care should be delivered.
Anger over medical billing becomes turbocharged when inconvenience is combined with surprise — when one has to wait for the end of that stream of bills and receipts, only to learn what a medical encounter actually costs.
The political landscape is currently rife with proposals to outlaw “surprise billing.” Some proposals would effectively require medical providers to state the price of a service in advance. I’m not optimistic that such ideas are feasible, as the cost of producing a service is often unknown at the outset. A particular surgery might last for one hour; or, when the surgeon opens up the patient, she might realize that the surgery will require four hours. The hospital stay afterward might be for one night or, with complications, a month. As with auto repairs, we're not likely to eliminate surprises.
Medicare didn’t solve the paperwork problem. The Affordable Care Act didn’t solve it. Repeal-and-replace proposals won’t solve it. A single-payer proposal such as Sen.Bernie Sanders’ “Medicare for All” bill might, in fairness, solve the billing problem — and bring on far more serious problems in exchange. That’s a debate we’ll save for another day.
I’m confident, however, that the paperwork agony can be drastically reduced. Imagine a world in which bills from all of your providers flow into a single, readable online or printed document, payable with a single card — all with the amounts listed a very short time after medical treatment is completed. My MasterCard and online banking work this way, and no one has ever persuaded me that the same is impossible for health care.
The federal government has grasped at the idea, often under the buzzword “interoperability.” But I suspect solutions will eventually come more from banks, credit card companies or people who design apps — those who are experienced in such matters, rather than government functionaries.
For the most part, our lawmakers forsake the small-but-impactful fixes as they focus on their preferred, sweeping solutions.