Why is dog health insurance simpler and more transparent than human health insurance?
Dog healthcare is mostly provided in a true marketplace, while human healthcare is provided in a hyper-regulated mishmash of market and government. Because there are more regulations and more risks of malpractice for human healthcare, more and more providers work for large healthcare firms. It’s much easier to have a small independent veterinary practice than a small independent human healthcare practice. So we find more competition in veterinary practices, resulting in prices that are lower and more transparent.
For humans the mega-providers gain with lack of transparency. Insurers are vertically integrated with hospitals, doctor practices, and obscure middlemen called Pharmacy Benefit Managers (PBMs). I would like to confirm my strong guess: few dog health insurance firms own veterinary practices.
(p. A24) I rushed around the patient as he lay motionless with his eyes closed in the emergency room. He was pale and sweaty, his T-shirt stained with vomit. You didn’t have to be a health-care worker to know that he was in a dire state. The beeps on the monitor told me his heart rate was dangerously slow. I told the man that he was going to be admitted to the hospital overnight.
After a pause, he beckoned me closer. His forehead furrowed with concern. I thought he would ask if he was going to be OK or if he needed surgery — questions I’m comfortable fielding. But instead he asked, “Will my insurance cover my stay?”
This is a question I can’t answer with certainty. Patients often believe that since I’m part of the health-care system, I would know. But I don’t, not as a doctor — and not even when I’m a patient myself. In the United States, health insurance is so extraordinarily complicated, with different insurers offering different plans, covering certain things and denying others (sometimes in spite of what they say initially they cover). I could never guarantee anything.
. . .
The killing of Brian Thompson, the chief executive of UnitedHealthcare, the country’s largest health insurer, has reignited people’s contempt for their health plans. It’s unknown if Mr. Thompson’s tragic death was related to health care, and the gleeful responses have been horrifying. But that reaction, even in its objectionable vitriol, matters for how it lays bare Americans’ deep-seated anger toward health care. Around the country, anecdotes were unleashed with furor.
Among these grievances is the great unknown of whether a treatment recommended by a doctor will be covered. . . .
Unsurprisingly, despite my platitudes, my patient did worry. Instead of resting on the stretcher, he and his wife began calling his insurance company. To keep him from leaving, I tried to be more persuasive, even though I didn’t know what kind of health plan he had: “I’m sure your insurance will pay. I’ll document carefully how medically necessary this admission is.” I added that social workers and other advocates could also assist in sorting out his insurance once he was admitted. And worst-case scenario, if they couldn’t, I crossed my fingers that the hospital’s charity care would help.
I said what I could to get him to stay, but I understood why he wanted to be certain. The average cost of a three-day hospital stay is $30,000.
. . .
My one family member with solid insurance is my dog. He got elective surgery recently, and I was astounded by the straightforward nature of his insurance. Once we meet the deductible, everything is simply covered by 80 percent. This is clearly described in a packet I received when I first signed him up. It’s an imperfect comparison to insurance for humans — I pay in full first, then get reimbursed — but it’s incredible to think that insurance for pets and possessions is easier to navigate and more consumer-friendly than insurance for people.
For the full commentary see:
(Note: the online version of the commentary has the date Dec. 8, 2024, and has the title “What Doctors Like Me Know About Americans’ Health Care Anger.”)