Health care policy was the big planning news this quarter and for good reason. The management and funding of health care reflects personal values and impacts finances, for each of us individually and for society. It became a hot political topic this quarter with the new administration having to pull the vote they had planned to start a shift away from the Affordable Care Act.
Here are personal planning implications as we wait to see what happens next:
Electronic medical records do not cross systems. If you get care in more than one health care system, be prepared to convey medical history information yourself across systems. Plus, older medical record data was not digitized in the switch to electronic records, which means much of your historical medical data is, for practical purposes, gone. Pay attention to what is in your record. There is a learning curve for entering full and accurate information into any new data management system. Many hands are touching your electronic medical record with regulatory review that is at best evolving. Plus, being alert to odd entries in your medical record is the first line of protection against medical identity theft.
It’s not just about whether or not you have coverage. Even if you have health insurance coverage, test whether you have access to your current and possible future preferred medical resources, and consider the impact on your finances of paying the premium, the deductibles, and the co-payments. Access to a specialist increasingly requires a referral, often from a doctor within the system where the specialist practices.
Required coverage differs when your employer has more than 20 full-time equivalent employees: If you leave employment, you have access to COBRA coverage for 18 months or, in cases of death or divorce of the insured, for 36 months. (NOTE: If you turn 65 while on COBRA, expect to lose eligibility for COBRA coverage.) Plus, you can postpone Medicare enrollment beyond age 65 until separation of service.
Better pricing is more typical in group plans because group plans have more negotiating power than individuals. Medical expenses from a catastrophic medical condition, even when the patient has health insurance, is a leading cause of personal bankruptcy in our society.
It is difficult to find out ahead of time the likely cost to you of a health event. Opaque pricing comes in part from the rise of the medical coding industry. Insurance reimbursement is based on an elaborate diagnostic coding system, with providers aiming for the highest reimbursable code and insurers for the lowest, creating a ‘need’ to pay for coding consultants and auditors.
While you have some personal control over your health through the personal choices you make, at the societal level, personal health status is distinctly lower for those with lower education and family wealth.
These conditions suggest that the public conversation could be usefully expanded. Wouldn’t it be great if there could be a civilized national conversation about:
Who owns your data? How important is transparent pricing?
What is the safety net that each of us can count on? Does a safety net necessarily imply centralized decision-making? Who is welcome in this safety net? Is it related to employment?
What difference would a better educated population make?
What does it mean to be a professional in a big system?
As with personal financial planning, excellence in public policy requires the relevant parties taking time to identify core values and desired results, and then next steps. What do you want from our health care system?