Healthcare Costs

All the talk about the “Affordable Healthcare Act” or “Obabmacare” (whichever you prefer to call it) makes me question whether the actual problem is being addressed.

The current healthcare solution makes health insurance more available and more affordable. What a great thing. If you don’t look any further. I’m not knocking the effort but from my experience, the difficulty in obtaining affordable health insurance is a symptom of a much bigger problem–the cost of healthcare is simply too high. This legislation treats the symptom, not the cause.

When my first child was born (1990), the hospital promised us prenatal care and delivery for $4,000. We got the childbirth classes and the free diaper bag. After it was over, they billed the insurance company for $12,000. Upon questioning, they said that the $4,000 was if we paid cash. They had never said this before. This got my wife and I angry, so we requested itemized bills from the hospital. Many items were obviously overpriced and there were many duplicate items as well. Just a few items that I recall–a styrofoam water pitcher $24 (we got one; they charged for two), 2 pints of blood ~$50 each (we used none; they charged for two and explained that it had been reserved for us), Tylenol $6 each, and the list goes on. We complained to the insurance company and provided them with a copy of the agreement for $4,000. The insurance company paid the full $12,000. Two years after the birth we got another explanation of benefits for $4,000 more in charges. We contacted the hospital again and requested an itemized bill. They explained that they were billing for items they had forgotten to bill for originally. We scrutinized the bill carefully and determined that every single item on the bill was a duplicate or triplicate charge from the original list of charges. We contacted the insurance company to tell them not to pay the fraudulent bill. They thanked us for letting them know. They paid it anyway. This one uncomplicated birth should have cost $4,000 but actually cost $16,000.

I recently went to my eye doctor (an ophthalmologist)  for a routine eye exam with charges of about $100. While there, I inquired about a tag on my eyelid. He offered to remove it saying it would be very simple to do. I agreed. He pulled out what appeared to be medical grade fingernail clippers and in about 3 seconds, removed the tag. He explained that there wasn’t an insurance code for removing a tag, so he would submit another code. Using this code brought him a $400 from the insurance company for a few seconds of time.

My friend George had a kidney stone. He did not have insurance. He requested an estimate of charges before going in to have the stone removed. The hospital was very reluctant to provide the estimate; they are much more comfortable when you don’t know the price ahead of time. $50,000! This would have bankrupted the family. Out of necessity, he shopped price and had the same procedure done at a surgery center for $2,400 (yes two thousand, four hundred).

These are just three illustrations of the REAL problem–the price of healthcare is too high! Hospitals charge too much; doctors manipulate insurance claims to their financial advantage; fraud abounds; and insurance companies do not verify with the patient what services were actually received. The result of all of this is that insurance premiums are too high. We don’t try to fix the real problem at all, we just charge the patient more and pay whatever the healthcare provider bills. The reason we’re in a jam is because we’ve gone beyond what people can pay.

Here is one more illustration that will surely make a few pharmaceutical reps hate me. A close relative of mine is such a rep. She maintains a computer database on her laptop with information about the doctors she calls on. Included in the database are such things as secretary’s children’s names, birthdates, likes and dislikes, favorite gifts, etc. She regularly buys and delivers breakfast for all the staff in the doctors’ offices in order to win them over. She also brings flowers and other gifts to buy their favor. She does this everyday for various doctors’ offices. Who pays for all this? We do! We pay in the form of higher cost of medicines and higher insurance premiums.

To really make healthcare more affordable, we must eliminate the fraud, the overpricing of everything related to healthcare, and buying doctors’ favor with gifts.