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Coupon Book with Scissors
The way we pay for things is changing rapidly. Apple Pay can be used in millions of stores including at ACE Hardware, Best Buy, Crate and Barrel, Dunkin’ Donuts, KFC, Kohl’s, Macy’s, McDonald’s, PetsMart, Pizza Hut, Staples, Starbucks, Walgreen’s, and Whole Foods. Simply place your Apple Watch or iPhone near the payment terminal and payment is completed. 

In addition to payments at stores, millions of consumers are paying each other, friends and family, and providers of personal services. For example, you can pay a housekeeper, landscaper, painter, or carpenter with your smartphone. Zelle, a digital payments network launched in 2017, is operated by Early Warning Services, a private financial services company owned by Bank of America, BB&T, Capital One, JPMorgan Chase, PNC Bank, US Bank, and Wells Fargo. Fifty other banks are participating. The Zelle service enables consumers to electronically transfer money from their bank account directly to another registered user’s bank account, within the United States, using a mobile device or the website of a participating bank. Money is transferred in minutes with no checks, no envelopes, no stamps, and no fees. According to Reuters, nearly 250 million transactions valued at $75 billion were transferred through Zelle in 2017. Apple Pay, Zelle, and others represent the beginning of a major shift in how we make payments.

Then there is UnitedHealthcare, the largest health insurance provider in America. A UnitedHealthcare unit had been chosen to fix the healthcare.gov website. They are reputed to be a company with the technical expertise to make the health care system run more efficiently. Efficiency is desperately needed in healthcare. How efficient is United Healthcare?

A few months ago, my wife and I changed banks. Our monthly premiums are deducted from our bank accounts, and we made the change online at UnitedHealthcare’s website, probably the worst website I have ever used. A month later we each received a Coupon Payment Book. Yes, a physical paper payment book with printed coupons in it along with 12 envelopes in which to return checks for our monthly premium payments. The last coupon book I can recall was from a bank when I bought my first car in 1967. I cannot remember the last time I wrote a check. This is the digital 21st century, but our nation’s largest healthcare insurance company is using coupon books. They do offer the option of automated deductions, but they hang on to the methods of the past.  

I do not like to make negative statements here about individual companies, but I must say I find UnitedHealthcare more than disappointing. This post is partly a rant, but mostly about a serious issue — the cost of American healthcare. We spend more  than two-and-a-half times as much as most developed countries in the world, including relatively rich European countries like France, Sweden and the United Kingdom. As I detailed in Health Attitude: Unraveling and Solving the Complexities of Healthcare, there are numerous reasons why our healthcare is so expensive, but, in part, higher costs arise because the U.S. has been slow to adopt progressive information and communications technology to improve the administration of healthcare and to reduce waste.

I believe the best solution is for the government — yes, the government has a role — should mandate the industry develop payment standards. Hospitals and doctors must adhere to uniform accounting standards to report their financial performance, but they can use whatever payment and electronic medical record system they want, or chose to use none. There are 250+ EMR vendors and they are less than compatible. Germany has 300+ healthcare insurance companies, but they all must comply with certain standards. One study showed if the United States had the same administrative efficiency as Canada, we would save $300 billion. 

I know a number of my readers favor a single payer system. As I detailed in Health Attitude, I believe we should have national standards for payment and EHRs, but healthcare administration should be done at the state level. New York, Ohio, Florida, and Texas are truly different from one another, and themselves larger than many countries. Healthcare.gov showed us one size does not fit all. We need to adopt standards and encourage the states to develop efficient information technology systems.

Meanwhile, Reuters reported a federal judge ruled the U.S. Justice Department can move ahead with a $1 billion lawsuit against UnitedHealth alleging it used inaccurate data for Medicare Advantage patients to bilk the government.