Dr. Murray Buttner said America's health insurance system is treated as though it's prepaid health care.
People expect to have all of their medical services covered by insurance, which is like expecting auto coverage to pay for oil changes or homeowner's insurance paying for house cleaning, Buttner said.
The Pomfret-based primary care physician was one of several speakers who talked about their roles in a changing health care system during a seminar Wednesday morning at The Hartford Club.
The goal of the program — hosted by the benefits consulting group Blue Back LLC, based in Hartford — was to give small-business managers ideas for providing benefits to workers as alternatives to simply paying part of the employee's health insurance.
Buttner said he offers "concierge medicine," stripped of the insurance system. People pay $500 per year and $20 per visit, and in exchange, they get more of his time than if he was managing a larger patient population that had higher overhead costs and required additional staff to bill insurers. He changed his business model after becoming frustrated with insurance billing.
"You only get paid to see people, and there's this convoluted Byzantine coding system that is how you're actually able to bill the insurer," Buttner said. A doctor's office needs a staff of people to properly code medical procedures and bill for them, which means doctors have to see more patients to make the business work — meaning less time for patients.
"To pay all that overhead, you've got to see 20, 30 patients a day," Buttner said. "If you're going to be seeing 20, 30 patients a day, you need that much more support crew. So it's this vicious, vicious cycle. … What gets lost in the whole thing is the humanity of the whole thing."
Some of Buttner's patients even have health insurance, including government-funded Medicaid, but they pay the annual fee in order to have time with a doctor, Buttner said. They also get his phone number and e-mail for those middle-of-the-night emergencies.
Serious illnesses, referrals to specialists and hospitalizations could become expensive for a patient, which is why the concierge system is sometimes paired with having health insurance — such as a high-deductible plan in which premiums are less expensive.
Another speaker, benefits consultant Eric Thompson, talked about the changes that are facing employers next year as certain aspects of the federal Affordable Care Act take hold.
Employers with more than 50 workers face a penalty if they don't provide health coverage to workers. Thompson talked about the public health exchanges, where individuals and small-businesses will be able to compare and shop plans. He also talked about private health exchanges, similar marketplaces without the same mandates as public exchanges. And he mentioned the idea of a defined contributions, when an employer pays a set amount of money and directs workers to an exchange where they can buy coverage of their choice.
Thompson, founder of his consulting group Blue Back LLC, offered the audience an explanation of how insurance pricing could change this fall for health plans that take effect next year. Aspects of the Affordable Care Act that are designed to lessen the affect of age and gender on premiums means that men and young people will pay more, he said.
"We're also worried about the exodus of young, healthy people due to this price increase and an entrance of low-income plan participants of poorer health," Thompson said.
Federal health officials have often mentioned that anyone who makes up to 400 percent of the federal poverty level — that would be $44,680 for an individual or $92,200 for a family of four — is eligible for a taxpayer-funded subsidy to reduce the price of premiums.
"Most of the focus is on access to insurance on the federal level, and the subsidies, versus, 'What does it cost and am I actually going to get care?'" Thompson said.Copyright © 2015, CT Now