The Financial Folly of the U.S. Healthcare System
I write this, aware that as a physician, I am at least at times partially complicit in the financial folly that is the U.S. healthcare system. The one which ostensibly Congress is “improving,” but which is in fact doing very little, if anything to address the myriad issues with our healthcare system (and to the extent it is addressing it those issues, it is making them worse).
Read Part II here.
Healthcare and Transfarency
Southwest Airlines likes to advertise they have “transfarency” — stating you know what you are paying/getting from them when you pay your airline fare. There are no surprise fees.
Healthcare has adopted the exact opposite approach, through an arbitrary and evolutionary system that is essentially Frankenstein, cobbled together with spare parts and ideas. Healthcare pricing is opaque as vantablack (I don’t have time to think of a clever play on that word).
Several years ago, Rogue Two was diagnosed with pyloric stenosis — an obstruction of the stomach outlet muscle that prevented food from passing from the stomach to the intestine. The events leading to that diagnosis is its own story, however to make the diagnosis required an ultrasound.
The ultrasound tech who looked at his stomach muscle must have been extra thorough, because they also obtained some pictures of his kidneys (and maybe other organs). The radiologist noted that there was trace hydronephrosis on one side — the kidney was slightly dilated, but not an urgent or emergent issue. It had no bearing on his stomach issue, and had never caused a problem. My wife’s prenatal ultrasound did not show any problems with his kidneys.
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However the radiologist recommended a follow-up ultrasound in a year to make sure it resolved. Rogue Two had no problems in that year — no infections, no unexplained fevers, no concern from his physician (or us) that his kidneys had issues.
My wife and I forgot about it, but our pediatrician remembered the recommendation — so we went to our children’s hospital to have the ultrasound performed.
Rogue Two, over a year old, was not a fan of the non-invasive/painless test — I had to hold him down screaming for 10 minutes while the ultrasound tech obtained the images.
The ultrasound was normal.
Opacity in Pricing — A Healthcare Special
We were (and still are) on a high deductible health plan, so while there was an insurance negotiated discount, we had to pay the full cost of the facility fee for the ultrasound and the radiologist fee for reviewing the ultrasound, as we had not reached our deductible yet.
The “charge” for the US was $907. The insurance “adjustment” was $204.98, leaving a balance of $702.02 ($25 of which paid via copay at time of service).
Of note, since our hospital offers a 25% discount to those with NO insurance, had I not used my insurance plan at all, the cost would have been $680.25. So we were charged more by filing an insurance claim than had we not used my insurance. This was November, and as we didn’t meet the deductible, I may have actually saved money by not using insurance before the new year arrived.
The radiologist bill (from the university, not the hospital) for interpreting the US was $126, which was adjusted down to $88.77 by insurance (still not meeting deductible), a separate fee from the charge for obtaining the images.
I decided to compare the cost to two other places in town that provide pediatric care.
Place #1 — charge for the same US is $929, however they give an immediate 40% discount for those w/o insurance, bringing the cost to $557.40. However if that is paid in full immediately, they decrease it another 25%, meaning that someone without insurance who pays in full would pay $418.05 for the same test.
Place #2 — charges $890 and gives a 35% discount for those without insurance, making the total $578.50.
None of these numbers include the physician bill, though they likely would have been lower as well.
How do I have this info available?
When I received the bill, I was ticked off. I called these competing hospitals to obtain the pricing, and then sent a lengthy email to the president of our hospital detailing my concerns regarding the cost of the ultrasound. I found that old email and copied/pasted the information into this blog post (with some edits for anonymity).
Let me tell you — obtaining this information is not easy, and I am someone who knows the language and business of healthcare quite well.
I had a pleasant email exchange and in-person meeting with our hospital president, though I learned nothing new from the exchange. I’m well aware of why costs are so outrageous.
While I could provide a list of reasons (price discrimination based on insurance type, location, academic affiliations, etc), ultimately this is the system we have because it’s the system we deserve. After decades of making small tweaks that only reinforce that this is how the system should be, it is the system it is supposed to be.
We have many people arguing that Obamacare is an affront to capitalism, forced socialism, etc. and needs to be fully repealed so we can go back to what we had. The system we have, which is not that different from what we had before Obamacare, is poorly designed and not well thought out. It’s not the system anyone would design from scratch (neither the GOP nor the Democrats would build the current system if given the chance).
Overtesting in Healthcare
Going back — not only did the price of the ultrasound bother me, it’s possible our son may not have needed the ultrasound at all. The original finding from when he was an infant was something found incidentally.
The purpose of the test was to look at his pylorus — that was the only reason. The kidneys are not necessarily something they should have looked at, so one could argue we should never have known.
That’s a mixed bag — sometimes you find cancer by accident and are glad you did, and sometimes you find an incidentaloma and waste time and money and hurt the patient by chasing down things that are inconsequential. This was most likely an innocuous finding.
I tell residents I work with all the time — if you are going to order a test, be prepared to handle the results. Don’t go looking for a problem if you can’t handle the results. Sometimes we evaluate things with blood tests or xrays or ultrasounds just because we can, often because we think the results will reassure us.
Then we obtain a test result that is not normal, incur cost and inflict anxiety and stress, and end up doing nothing anyway.
Playing the Game — The Good Ole Boy System
The reason for this post is not this ultrasound from three years ago. It came back to me today after I learned Rogue Three likely needs ear tubes because of many recent/recurrent ear infections. The reason for this flashback hopefully will become clear.
We’ve already met our deductible for the year so are in the phase of the year where healthcare costs are subsidized — as a family using a HDHP, that’s a big deal.
The difference between surgery this month and next month is potentially thousands of dollars out of our pocket. Surgery this month is 80% or more covered by insurance. Surgery next month means we have to meet our deductible again before insurance pays anything.
Having been through this before, the 5-minutes it takes for an experienced ENT to insert the tubes will easily generate a few thousand dollars in bills. The doctors are the cheapest part — an ENT surgeon and anesthesiologist won’t charge a thousand dollars. The hospital will charge much more than that for use the OR, the cost of the anesthesia medication, the post-op room, the post-op Tylenol, etc.
Our hospital is not atypical — this is how it is everywhere.
Well, the ENT clinic couldn’t fit us in until January — after all, it’s mid-December and the holidays are close. This condition is not life-threatening — he does not need it right away.
No, if it’s going to happen, I want it to happen this month so we can save thousands of dollars (potentially — if we hit our deductible next year for other reasons it wouldn’t matter, but I can’t predict 2018).
Again, another ridiculous part of our system — the amount billed by the hospital/doctor does not change because of the New Year, but the cost to the consumer changes completely. It is not a capitalistic effect — supporters of the current system who decry socialism should remember that.
The supply of the surgery is not changing, the demand is not changing, the cost to the provider to do the surgery is not changing, the amount billed by the provider is not changing.
The only thing is changing is a new year means the deductible starts over. So it behooves me to use a TON of healthcare now, and avoid healthcare use when possible until I am forced to because of other things.
So I leveraged the good ole boy system (as my wife said) and contacted the ENT directly to see if they could squeeze us in this month to assess officially for the need for the surgery, and perform it this month if officially indicated.
Thankfully we have access to a wonderful and responsive ENT who should be able to accommodate us.
While I recognize I’m fortunate to have the ability to make that connection, it bothers me that I need to do so. I do not like asking a professional colleague to inconvenience themselves in this way, and especially not because of financial reasons.
I was honest with the surgeon about my motivation when contacting them, because it’s fair for them to know, and because I wanted them to have an out to say “no” by just telling us they were not available if really was going to be a pain to fit us in or didn’t appreciate my motive.
However similar to the tax bill and charitable donations I discussed last week, this is the system we designed and the behavior we are encouraging. This is not gaming the system — this is the system.
To My Physician Colleagues
Remember the downstream consequences of what we do.
A “painless” test can cause distress in unforeseen ways.
An innocuous diagnosis can reverberate in ways we never consider.
We’re human and we’re going to falter.
Keep your patients and your colleagues in mind at every step — it’s really the only option.
With that in mind, remember that perfect and pure motivations within an imperfect system can still cause harm, and we need to know the system well enough to make it work for us and our patients.
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It’s tough to be on the receiving end of this messy health care system sometimes. Some think it’s a case of “what comes around goes around,” but that assumes you and I are the ones who designed or control the system and are sending out the bills. I do the clinical work and collect a salary; that’s it.
A couple years ago, my son had an adenoidectomy. The turbinates were also reduced, an extra step that added a couple minutes to the procedure. That extra two minute procedure added something like $3,500 to a surgical bill that would have otherwise been under $1,000. Of course we didn’t meet the deductible that year, so it was all out of pocket (or HSA, technically). It’s frustrating, but what can you do? There were no prices posted for turbinate reduction or we may have declined.
Best,
-PoF
It’s almost enough to make one go into healthcare administration! I think every doctor needs to understand better what it’s like to be a patient, not just physically but financially.
While doctors aren’t solely at fault for the mess that is our system, we do drive a lot of overtesting and unnecessary procedures. That part we can help, even though that’s only a small fraction of the costs of our system.
I have been around and around at my hospital over a facility fee also. The bill was $250 for a blood draw. The actual blood testing was covered by insurance. The fine print of my policy states that the facility (hospital lab in a POB connected to the hospital)” can” charge a facility fee of $250. The insurance company stresses “can charge” meaning at the discretion of the facility. The hospital says “oh it just your insurance”. Implying a bad policy (state medical association). I refused to pay it and it went to collections. I actually owed $550 for physical therapy after I met my deductible. I stated I will pay it today if you take the $250 from the $550. I paid it. One month later the hospital is calling back. I blocked their number and we will see if they send a letter. What about your credit score? Ah the advantage of knowing you will never need to borrow money again.
Good work taking a stand! I haven’t looked at fine print, but I have called and battled bills from my own hospital and university and successfully had them reduced for charges that were clearly inappropriate. I’ve also lost that battle before too…
It definitely helps to be part of the system. More responsive care, ability to navigate and understand. It always frustrates me when I see people who do not understand the system. I feel they are being taken advantage of by the entire system.
This is why I am for a centralized health system despite it likely hurting my wallet. It is not right for some people to get better health care or cheaper health care while others can’t afford it.
Yes, definitely many people who do not consider healthcare a right. That doesn’t stop them from passing unfunded mandates like EMTALA. While that law is necessary, the system as a whole doesn’t know how to use the ER (not just patients — doctors and administrators and insurers also).
I think it’s unfortunate that there is such a bias against anything that is potentially viewed as “socialism” in the US. While I’m not in favour of a fully socialist economy, I do support universal healthcare and a social safety net. Using some of the excess wealth to take care of the most disadvantaged members of society is just the morally right thing to do, and it’s sad that anyone who suggests this is immediately attacked as a scary socialist.
You nailed it with this post RD! There is so much wrong with our healthcare system, it is sickening. I work in healthcare and refuse to accept insurance because of the inevitability of not being reimbursed for my services. I know too many therapists that are owed thousands of dollars for work they provided and won’t see a dime of it because of the insurance companies.
I’ve also used my insurance for personal services, to find out how some places over bill for services to ensure that they receive the most money that they can. I received a bill from my insurance company and when I asked the facility about it, they told me I didn’t have to pay it and enlightened me on their explanation of why. A simple visit that should have been under $200 was billed at around $800-$900 in attempt to max out their earnings for that visit, what craziness.
Then when Mr.Wow was hit by a car while riding his bike, it all came to a head. First, the ambulance took him to an ER that was out of our network, dramatically increasing our cost just by this simple fact. Then every bill we received showed a differing price, making absolutely no sense as to what we were paying for. Since the insurance companies were both dragging their feet, we had to pay out of pocket for everything to avoid the charges going to collections and then hope and pray that we get reimbursed for everything. It was such an awful experience that took about a year and many frustrating phone calls and visits to the hospital to figure out.
Fingers crossed that you can get that surgery scheduled this month!
You and Mr. Wow must have been commenting at the same time! What type of therapy work do you do? Concierge practices for physicians, where they don’t rely on insurance, is growing more common, but I had not heard of it in other areas.
The odds are definitely stacked against the consumer when it comes to healthcare and cost — even the insiders have no influence on it.
Rogue Three has his tubes scheduled for this week if all goes well, but you never know.
I am an occupational therapist and there are cash-based practices popping up more and more these days. It is a hard mentality to break since most people want to go the insurance route, but honestly I am finding that people value quality of service and will pay a little more for that once they realize they aren’t getting that through their insurance.
So I was reading your post and then told my husband to read it since we had our own debacle with insurance and the healthcare system following his accident. He’s written a few posts about it and figured he’d appreciate your words as well. Thanks for sharing and I’m glad to hear that Rouge 3 is set for this week.
The insurance aspect is tricky. Given the setup of our healthcare system, I have no desire to pay 100% out of pocket for everything. But I’m also fortunate that I am a doctor, employed by a medical school attached to a big healthcare system, and thus have better access than most.
Hopefully all goes well with the little one — his ENT still has to actually see him and agree he needs the surgery. 🙂
As a consumer and not a Dr, I fully agree with you. Were kind of at the mercy of what is perscribed and have no knowledge of alternatives.
Its frustrating the a hospital has no idea what the cost is. I was in an accident and the EMTs took me to the nearest hospital which happened to be out of network. I was completely out of it with a severe concussion, how am I supposed to know? Or the EMTs? Shouldn’t they be concerned with getting someone the best care quickly?
This system is a disaster. I’m glad to hear that you, as a doctor, think that way as well.
So, the question is, how do we fix it? Or at least set the ball rolling?
Your wife commented simultaneously on the accident — sounds terrible. The EMTs aren’t shouldn’t have to consider insurance, and there should be no such thing as out of network emergency care.
I don’t think there is a true “fix” for the existing system, because the pricing structure is deeply flawed. You can patch it and help at the margins, but it needs a tear down that also takes our entire economy and tax system into account. Either go pure capitalist approach or healthcare for all with a private supplement.
Incidentalomas are a real thorn in the side of all doctors, especially radiologists (like yours truly). Once you see one, however, you can’t unsee it. Thankfully your son’s mild hydro was nothing. But it could have just as easily been mild vesicoureteral reflux that, if missed, could result in permanent kidney damage.
Which brings me back to the root problem of much wasted healthcare dollars in this country: defensive medicine. If doctors were less scared of getting sued, they would be more likely to chase possible diagnoses with vanishingly small probabilities, “just to be sure.” Of course, patients would have to also accept that, if they have a rare disease or unusual presentation, it might get missed the first time around because we didn’t order the “just to be sure” test.
whoops, should read LESS likely to chase possible diagnoses…
Diagnostic uncertainty is a part of my job every day. I have to decide on almost every patient whether a test or image or medicine is warranted, and I unequivocally feel it’s incumbent on front line providers to NOT chase everything. Yes it’s really hard not to chase something once you see it, but sometimes that’s actually correct. I don’t chase every low WBC with a series of tests, not do I chase every blood culture with Staph epi with follow up cultures just to prove it was a contaminant. If you can’t accept some level of uncertainty then you are doomed to order and poke and prod on everyone.
Each time you accept diagnostic uncertainty, you are accepting risk. All doctors do this, but each has a different risk threshold. Those who have been sued in the past are less likely to accept risk.
I agree that doctors need to accepting some level of uncertainty, but the associated risk of that acceptance should be not be fully on doctors’ shoulders. Unfortunately, some doctors without direct patient interaction (ahem) cannot explain their decision processes to patients.
Lol — we are definitely feeling the pain from opposite sides. I am a big fan of shared decision making when it’s appropriate — it isn’t always appropriate, and I am also advocating in many cases for a child when trying to talk with the parents, which makes it challenging. Giving clinical advice when you do not get to see the patient is extremely challenging — I do it to a degree when outside EDs call for advice or when talking with colleagues, but you are an entire level removed from that, so you are essentially obligated to be exhaustive in many cases. However i have a great deal of respect for you and your colleagues when you are definitive, because it’s hard for you to do but makes my life much easier.
I should say I do agree with your sentiments in the post, and it sounds like you take care before ordering a test, which I have great respect for.
If we could eliminate lawyers, politicians, and insurance companies from meddling in our health care system, we might start getting somewhere 🙂
My wife needed some routine Gyn tests including bloodwork U/S and radiology. The local hosp (where I worked for 18 years) wanted $5500 up front. I sent her 20 miles down the road and paid $500 cash for the same tests including a radiologists opinion. MRI’s are the same way $2000 in house v $350 at a free standing including reading. The free standing scanner is a better scanner. PE tubes at a surgery center are probably half or less than what you’d pay at a hospital. If your kid is normal there is no difference in risk between the two. If your kid has special medical issues the surgery center has guidelines of acceptable risk and won’t take them anyway
You want University level hospital care for routine cases you get the University level bills. Medicine IS hosed with multiple pricing schemes and pricing opacity but nobody’s holding you hostage. A University hospital is great for multiple trauma or diagnosing Cronkhite-Canada but way overkill for a routine U/S or PE tubes.
Moral: shop around.
What is Cronkhite-Canada? I need to google that.
I agree regarding the price differences regarding types of facilities. One of the places above where I price shopped the ultrasound is an academic facility and the other is a private/community hospital.
Any number of ENTs could do ear tubes, but with where I am in my cost continuum with my HDHP I had no reason to shop on price. Being so close to end of year meant going to my own shop was the most likely way to get in as well.
Great article and good job with diagnosing many of the problems afflicting our health care system.
As a fellow physician, I get so frustrated every time I hear some one say that free market health care brought us to this mess. Really! Free market! How free is the market when govt either directly provides (through VA, Indian Health, etc) or pays for (Medicare, Medicaid, Tri Care) over 50% of the health care in this country? Add to that the endless government mandates like EMTALA, JCAHO, and we have the farthest thing from a free (private) market in health care. The system is an unholy alliance of big government and big Insurance/Hospital systems that are designed for their benefit. The patients and doctors are only necessary appendages to the system, annoying as they may be to the real power players.
There is a reason that the two industries (health care and Higher education) that government has been so actively subsidizing for the last 40 years have seen exponential price increases during this time, while those goods and services outside of government’s tender care have seen massive price reductions and huge quality improvements over the same time frame.
Thank you. I don’t know if a true free market for healthcare is what we want, but it’s we certainly do NOT have one now. Whatever “reforms” the current Congress is pursuing, it is not making it into a true free market. Simply giving insurance companies free reign is not even close — it’s giving all the power to one side. I do believe regulation is required, but that’s not the same as socialism. However I also believe all people need the ability to access SOME form of healthcare without going bankrupt, which many do call socialism (I disagree on that point).
I agree that giving insurance companies free reign would be catastrophic and is the furthest thing from a free market. They should be forced to compete in a market place and if their products are inferior or not competitively priced, they can go bankrupt, period. No bailouts, subsidies or coercion of customers to buy their products.
Once upon a time in this country and in an era of vastly lower standards of living, nobody had health insurance but virtually everyone had access to health care. Big difference. Most hospitals were founded by religious orders who viewed their Christian mission to provide care for all, regardless of ability to pay. Relative to incomes at the time, care was remarkably more affordable. than what we see today.
Seems hard to believe in an era of $32K ED bills for scorpion antivenom.
https://www.abc15.com/news/state/32k-for-scorpion-antivenom-in-az-hospitals
This might be a controversial thing to say, but this kind of pricing disparity is why my Dad and I have gone to Mexico for cheaper healthcare (me for dental and my Dad for dental and healthcare). I’m sorry for the doctors who do need to get paid (and now that I have slightly better insurance/am young and healthy, I do see a doctor for preventative care now), but when you’re quoted $5,000 for a procedure in the US, but we can walk across the border and pay $1,000 there, there’s no question.
We’re pretty solidly middle class and I still tell my husband that, if I were to need a major medical procedure (and I was cognizant/could walk – obviously with a car accident, I’d probably have to go to a US hospital), I would prefer to get the work done in Mexico.
The doctors and dentists we’ve found there were US educated and extremely competent. Of the ones we’ve used, two doctors decided to relocate to Mexico because of better cost of living for them and their families, and another doctor married a Mexican spouse and moved down to Mexico to practice and be close to her family. They all mentioned how unfair the US system was, and they were tired of billing, waiting, having to pay admin while waiting for payments to come through, negotiating, etc. etc. Prescriptions are also heck of a lot cheaper in Mexico. 🙂
Not saying this works for everyone (it probably works for very few people). But a few years ago when I did it, it was either go into medical debt, not get the procedure done, or go to Mexico.
It’s a shame the US system is set up so terribly, and I don’t blame doctors at all. They’re trying to do what’s right for patients and cover their bases. But if healthcare were cheaper/affordable/why, even free for all! then more people would use healthcare… be healthier… causing less of a drain on the US economy because of sick leave, absences, etc. Seems logical to me, but not to Congress.
That’s a phenomenal insight and not something I had on my mind when I quickly wore this. However what you are describing is actually very common — it’s called medical tourism and is a booming industry. It’s something I recall studying going many years back. Many countries will let you do all expense paid trips for things like knee replacements or other non emergent conditions at a cash price wel below what people without insurance would pay in the US (and sometimes cheaper than WITH insurance depending on your plan). It’s a completely legitimate thing and I blame no one who pursues it. THAT is a free market and capitalism at play — other countries undercutting us because we won’t even try to compete on price. They are taking advantage of our inefficiencies. That industry has to grow a lot bigger to impact us, because for most conditions and most people, traveling to another country for medical care isn’t feasible. Those who can take advantage of it should do so as long as they do their due diligence. Disclaimer: I’ve no direct experience with it and don’t want people taking this as medical advice. From an economic standpoint you may win, but I from a medical standpoint you have to spend time to make sure you are receiving good care.
Thanks for sharing this story. I’ve been very frustrated with the healthcare system as well. With almost every other service we consume, the price is clear and up front. With medicine, it never is. This makes sense in an emergency. For a planned procedure, it’s unacceptable. As a consumer that’s not in medicine, all I can do is rely on the experts to give me the best care and hope I’m only given necesary services. I’ll never know if a procedure or test is really needed. Usually neither the patient nor the doctor know the out of pocket costs to the patient. The system is broken. I don’t know if it will ever get fixed.
Hi Jason — spot on. Doctors lament the lack of control we have over the healthcare system, and it’s true that our control has eroded since before I entered medicine. However in many circumstances, especially when dealing with individual patients, we have a great deal of influence and not many people questioning us. However even we have little idea of cost. Obtaining it from our own hospitals is difficult, and even then we are only talking about charges and not cost to the patient.
There are very few efforts to increase price transparency to the consumer, especially through insurance. However you can get the out of pocket costs if you make enough phone calls. As someone suggested above, medical tourism is an option for planned procedures, but that’s clearly not a solution for most and is a bandage at best.
You’ve got to be a rocket scientist to make heads or tails of the system. I’m sorry you went through this. Here’s a story of mine.
My gyno suggested a blood test during a routine exam that she had recently found out about through a sales person making the rounds. But she thought I needed it. When you’re lying there with your feet in stirrups it’s hard to say “hold on, let me call my insurance company”. I trusted her. And how expensive could a blood test be?
$1,000 that’s how much it was. And it was not ordered properly (the test is used for someone already determined to have cancer, not as a screening device). I made an appeal, got help from the manufacturer of the test, which is covered by Medicare, so as sure as heck, the manufacturer wants it covered by other insurers. I even enlisted the help of a healthcare ombudsman/arbitrator who told me I had no case because my doctor ordered the “Mac Daddy” of all tests when that was not the correct protocol.
I negotiated the fee down to the un-insured rate of $500 and never went back to the doctor again. She was a good doctor but I was so full of resentment I could not look at her.
I am sure this experience makes you more conscious of what your patients have to navigate. As someone with a chronic condition I have to navigate the cost opacity alot. Any suggestions on how to make my Dr understand that I don’t want to have tests run in house or at the hospital but rather at lower cost facilities? The defaults are frustrating; it is assumed you will go where they suggested because the results will be automatically placed in the system for them. I generally explain there is a cost issue and request the script/order to use place of my choice but I always feel like am complicating their life.
Calling to get costs ahead is never accurate as the all in costs are not included as they come from third parties. It is sad that I get more transparency into car repair then health services.
Heather — it just so happens I’ve got a couple blog posts sketched out (in my head) that I plan to write for late Jan or sometime in February, that may help answer some of your questions. It’s meant to be a guide for consumers to better navigate the existing healthcare system.
But the most brief answer I can give you is to be frank while being understanding. It’s okay to be cost-conscious as a patient, and most physicians try to be cost-conscious from their end. But they (we) often want to be the ones deciding when it’s okay to be cost-conscious, and don’t realize the impact on the patient.
Physician’s lives are full of minor hassles that we are not compensated for, and tracking down lab results from seemingly random places is a time-consuming, uncompensated task that makes patient care more difficult, and that’s where we want to spend our time.
But if you are up front about your cost concerns and try to partner with them to ensure you still get reliable test results from wherever you go (and they get back to the doctor for review), they should try to accomodate you.
Thank you, Rogue Dad, for this very informative and sobering post. If a doctor has trouble navigating the landmines of our healthcare system, how does a poor schlub like me stand a chance? In my mind, our biggest problem is the lack of price transparency and competition. But how do we introduce these things into the system when the most influential players–Big Pharma, Big Insurance, Big Medical-Device Manufacturers, Big Hospitals, Big Medical Schools, and, sadly, Big Doctors–don’t want them in the system? Sigh. Anyway, I’m glad I found your website. You have a keen mind and I look forward to your ruminations on finances, life, and our crazy healthcare system. Cheers.
Hi Mr. Groovy — thanks for stopping in and your thoughts.
While the average non healthcare person is at a huge disadvantage, even being IN the system doesn’t provide a lot of leverage to get what I want or better pricing. I don’t get a doctor discount at my own hospital/unversity, though sometimes docs who manage their own billing will give that courtesy to other docs. However fewer and fewer doctors do that, and more and more are becoming employees and don’t control billing at all.
The system is stacked against the consumer, but I do think general awareness of these concepts can help a great deal, because there are still choices to make. When you have insurance, you can choose your pharmacy (usually), you can choose your outpatient doctors (usually), and other things that give you a chance to reduce cost. When you do not have insurance, you have even more ability to shop around and determine the cash price of services. It is easier to figure out the cost to you of something with NO insurance than WITH insurance, because there are no middlemen or deductibles in between you and the cost.