The coronavirus has placed the spotlight on health care in the U.S., but it is still an area most Americans have trouble understanding.
Knowing how to pay for it, where to get reasonable prices, how to find the best care and what to ask insurance companies are just a few of the ways in which health care can be confusing for the average person. Without fully understanding the complexities of the process, some individuals end up receiving surprise bills in the mail — and the cost could be exorbitant. Others may just avoid going to a doctor, which could lead to serious consequences.
Author Philip Moeller wrote “Get What’s Yours for Health Care: How to Get the Best Care at the Right Price,” (Simon and Schuster) another book in his series, which includes Social Security and Medicare. In it, Moeller breaks down tools and strategies everyday Americans can use to make sense of a tedious health care process, as well as explains how the industry is changing. The book will be released on Jan. 12.
Moeller spoke with MarketWatch about how Americans of all ages should approach their health care, the ways in which the pandemic has altered the course of this industry in the U.S. and what you need to do to get the best care.
MarketWatch: How would you describe the state of the health insurance system in the United States?
Philip Moeller: Health insurance works well for most of the people most of the time. It is way too expensive because the U.S. health care system is way too expensive. We pay twice as much for health care per capita as any developed country. The insurance industry has not done a good job of reducing those costs but instead has profited off the system and, in a sense, has further increased costs because it can. It is a regretful development that our profit-oriented system has taken over health care. The key thing about insurance is when it does not work, if you can’t get insurance, the system doesn’t work for you. I think President-elect Biden will have great administrative ability to expand the reach of the Affordable Care Act. The other area where the system is stressed is Medicaid. States are strapped and Medicaid is under a lot of pressure.
MW: What are the biggest challenges Americans face when it comes to health care?
Moeller: I think one of the biggest challenges is understanding it. We got it in our minds things should be easier and when they’re not easy something is wrong with them. Health care is not easy. Health care is also on you to get right. No one will look out for you. The bulk of Americans are incapable of navigating this system and making it easier should be a national priority.
The other is the cost of health care. It is just too expensive in this country. It leads people to forgo care, it leads people to make bad choices or are not able to afford insurance or care at all. So the book’s purpose in part is to help people find better sources and lower costs. It is not easy to get to, but increasingly, we can have access to a world where prices are more transparent and you can make good decisions based on prices. Consumers are not trained to do this, and don’t even know they can do it, so I think it is one of the biggest shifts. That is going to empower consumers to make better decisions about the health care they get.
MW: Does health care change as a person ages?
Moeller: There are certain life cycle elements in health care. So for example, health care issues that people face when they’re younger are different than when they reach Medicare age, and what we found for millennials is that they’re taking worse care of themselves than their parents did, and they’re going to have serious health consequences. The important thing, especially for younger people, is to understand the family medical history of your children and that you can aggressively move to get preventive care as needed.
As people age, they move more into being active health care consumers. They tend to have chronic health conditions and needs, and in this case, they have a great interaction. When I wrote my Medicare book I said you should get health care designed for the future you, not the present you. One of the things important for consumers is to have a good primary care doctor. Because of the complexity of medicine, having a good coach to guide you to a specialist and other care providers. That is more important than ever because health care is so complicated. Some of it being complicated is a good thing — miracle cures, surgical procedures that treat conditions even 10 years ago were not treatable. But it’s not easy and you need people to help you do that. Having a continuing relationship with a doctor over time, you need to have a place where you can go where they know you have health care records. That continuing care is valuable.
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MW: How would you say COVID-19 and this pandemic has shone a spotlight on the health system?
Moeller: There are several enormous impacts from COVID-19. It has exposed tremendous vulnerabilities in nursing homes. It is a national tragedy. It is going to take money to beef up the supervision of nursing homes and provide more funding to help provide higher quality of care for our most vulnerable systems.
The pandemic has raised focus on home-based health care, which is going to become an increasingly substantial part of health care. It will be a challenge for companies to understand how to do home-care. It went from a nice sounding thought to a requirement. I am 74 and I am not going to go to a nursing home. They are the last place I want to be. The focus of aging in place is really going to be part of the health care system and it will have to make big adjustments.
Also, telehealth has become a major part and I think permanent part of health care delivery. It was a requirement because of the pandemic but it is not going away, especially for older consumers. Having the technical resources can be a challenge for not only older households but those who don’t have proper access to internet bandwidth and the tools you need.
And the fourth area — we have seen how valuable our health care providers are. Nurses, doctors — they have become deservedly heroes and they deserve our support as much as military heroes. The corollary for this is these people are the faces of a health care system that exploits people, charges way too much money and a system that stands in the way of records. The more we value our front-line workers, the less likely Congress is to have the muscle to move these big providers. The position with the American public is more favorable than in years because of not only health care heroes but also miraculous progress to develop vaccines at a record pace.
MW: How can people get the best care for themselves and their families?
Moeller: People who don’t think much about health care won’t read this book. For people who don’t care about health care, I would say they need a primary care doctor, you need to understand your family medical history and you need to get preventive care even, and especially, for younger people who don’t think they need it.
Understand your health insurance. Talk to your insurer — not as an enemy but as a potential ally. You’re paying money for health care, you should understand what you’re paying for. Most people don’t. And get a doctor.