Ever go on a
first date where it was understood that you were the one who was picking up the
tab and you got seated in the restaurant and the menu had no prices? Then your
date ordered the shrimp cocktail, the Marjoram Roasted Rack of Lamb with Morel
Panna Cotta, dessert, and champagne. Then the tab showed up and you blew your
rent money on dinner. Then you took your date home and got a firm handshake and
a "thanks, it's been fun, but I don't think we should see each other
again."
Welcome to
health care in the United States, where one is never to ask the price of, well,
anything. It’s just not done. And for quite a few decades that was okay with
most patients because “I have insurance and they’ll just pay for it.” Except
that now, as the “Affordable” Care Act has settled in and made itself at home,
insurance pays for less and less and you pay for more and more. More premiums,
higher deductibles, higher copayments.
Maybe it’s
finally time to start focusing on the real problem with health care in the
United States, the cost of medical and pharmaceutical services. For too long
our attention has been deflected and re-focused on the big bad insurance
companies. But after all, insurance just pays the bills. The health care and
pharmaceutical companies set the rates.
One of my
clients had hip replacement in April. Everything went fine, no complications,
good recovery. He did all of his homework, double checked the terms of his
insurance plan, and prepared to pay his share of the tab. The procedure was a
success however the patient lost his savings.
The “retail” tab so far is about $160,000 and the bills are still coming
in. Of course, the insurance company has applied its many “pre-contracted price
adjustments” and the actual tab is now at only about $40,000.
My client,
being a responsible and credit conscious person, paid the bills as they came
in, not waiting for his insurance to pay its share. So far, he is out of pocket
more than $9,000 even though his insurance plan limits his out of pocket to
$6,000. It’s now his task to recover the overpayments from the hospital and
doctors who treated him. There are about six of them, some who he has seen,
some who he never heard of…we call the unseen ones the “…ologists”. They’re the
pathologists, radiologists, and anesthesiologists, all of whom seem to have
really great billing services.
So, let’s go
back two paragraphs. The tab for hip replacement, after “adjustments” was about
$40,000. In fact, throughout the United States the average cost of a hip
replacement is about $40,300. How does that compare to the rest of the world?
Below is a sampling of costs of hip replacement in other parts of the world.
So why is
hip replacement surgery in the United States anywhere from 10% to 700% more
costly than in other countries? Well, part, but not all of the reason is that
we have lived in a system where it is taboo to ask prices and it never really
mattered much anyway because insurance picked up most of the bill.
It doesn’t
end with medical procedure and facility costs. Pharmaceuticals, in general, are
much more expensive in the United States. Here are two examples:
How can you
begin to reverse this situation? Well, the next time that you need medical care
(not an emergency, of course) think of the menu in the restaurant that doesn’t
display any prices. Outrageous, right? Well, it’s just as outrageous for the
health care system to make pricing questions so difficult to answer. Another
restaurant analogy…now imagine that you’re ordering from the “no prices” menu
and you ask your waiter the price of the meatloaf. The waiter says, “Well, do
you mean the retail price that you would pay today, the credit card price that
you pay over time, or the pre-paid dining plan price? And, by the way, which restaurant
network does your pre-paid dining plan use? We may not be in network. And you
know, just because our restaurant may be in your network doesn’t mean that the
chef or the busboy is in your network. So, I’m afraid that I can’t give you a
firm price today, you’ll just need to eat your dinner and take your chances.”
It’s time to
become just as outraged with health care and pharmaceuticals as it would to be
outraged at the “no prices” restaurant. Stick up for yourself or your family
member. Insist on firm pricing information and, most important, research prices
for care. Until we all begin to behave like consumers the health care system is
going to get away with highway robbery. Thanks for reading.
Alan
Leafman, President
