HEALTHCARE – COSTS!
As we stand on the edge of what is now lovingly called “sequester,” a leaf from our own life needs to be turned.
We have health insurance. We have a prescription benefit as well, in addition to a secondary healthcare insurance policy.
When we became (voluntarily and happily) “free-lance,” our accountant advised us not only to purchase such plans but never to let them go.
The cost of this good advice at one time ran as high as $11,000 a year BEFORE any benefits were paid.
We were fortunate indeed to be able to keep these policies in force.
But one result of this constant financial pressure has always been a focus on what exactly a test costs, a procedure, an operation, an aspirin in a hospital can run. We have been known to smuggle into our hospital rooms our own aspirins, sleeping pills, and prescription pills rather than collapse in rage and shock later when billed by an institution for its wonderful care.
This has not made us the perfect patient. There is a saying: “a little knowledge can be a dangerous thing.”
Which is to say if and when something goes awry, we check it out.
We ask our friends about their experiences, their doctors, their hospitals, their insurance company standards.
And like millions of other ordinary beings, we use the internet to research symptoms, cures, practitioners, success rates, mortality figures both by disease and by physician. And we try never to confer with any physician before an operation alone, unless the procedure is one we’ve already experienced. We walk into that examination room as a team…albeit sometimes a curious one, but nonetheless armed by the knowledge that what is said is witnessed and discussed thoroughly by more than ourselves.
So — what?
Like millions of other Americans, we are scheduled for a colonoscopy from time to time. Annually in the US, these procedures are performed on from a million and half people to six million, depending on your source of information.
Why are we discussing this?
Because recently we understood perhaps for the first time how easily and carelessly we as American healthcare devotees have allowed healthcare costs to increase.
And because we asked one doctor to do something about it.
This fellow is genial, knowledgeable, close to retirement, and far from being a fire-brand politically. The question we neglected to ask ourselves in the mini-drama that followed was whether he should also be concerned with the details of the care he offered his clients, i.e., the cost, or whether he should simply concentrate on doing the very best job he can for us.
Those who have experienced the discomfort of this procedure, which exists more in the preparation for it than the examination itself, will be acquainted with the scenario.
Of course, there is a pre-op visit to the physician.
In our case, before we were even seated across from the doctor in his office to bring him up-to-date on medications and current standard of health, the physician himself came out to help explain a new little wrinkle in how this event would take place.
One of his assistants held up a cardboard container with plastic bottles included with which we were to fill cold water and a solution that would later make the viewing field clearer. It was explained to us that a prescription for this kit was already on order in our neighborhood pharmacy, and that the unit came with a discount coupon.
Now, this was new. So was the price.
“A hundred dollars!” we exclaimed.
“But with the coupon…”
“A hundred dollars?”
“But you have insurance. And with the discount coupon…”
“A hundred dollars!”
By the time we did get into the doctor’s office to discuss what he was planning to do, we were steaming. As we recalled, on our last go-round for this particular part of the event, we had paid more like twenty dollars for the liquid prep. Now, obviously, a new gold standard had been reached.
We sat quietly for a few seconds, listening to the advantages of this new solution.
Not for very long. “You could stop this, you know,” we said. “This is exactly how healthcare costs rise year after year. People just shrug and say, sure, I’ve got insurance, and they stop worrying.”
That attitude, of the already insured, of the habitually insured, is what Big Drug companies depend on: once you are insured, you no longer worry about cost. Therefore, any price they want to put on any pill or procedure is theirs for the asking.
“You could stop this,” we repeated.
The doctor shook his head. “How?”
“You belong to a medical association, to a specialty. Suppose you and your colleagues united and sent a letter saying to the drug companies that most of your clients cannot pay this fee, regardless how spotless it makes them. You don’t think that would make a difference?”
“They’d just tell us to go elsewhere.”
“Well, fine, go elsewhere. Unless the drug companies understand that too much is sometimes far too much, how will they ever stop this extortion?”
“Ah, but…you don’t want to get into a law suit with Big Pharma,” he advised. “Besides, I’m out of here in a couple of years, I’m not political, and this makes my work easier and more successful. For you, too, I want to point out.”
“But…” and we realized we were sounding like a fifteen year old naïf, “you could do something about this. You should do something about this.”
Looking at the doctor’s face, we knew we were approaching meltdown. This was a good doctor whose services we needed. We ceased and shut up.
But inside we were deeply disappointed.
On reflection, we realized we were asking more of this fellow than he could give. More, probably, than most doctors could give. He was, after all, only one part of a system out of control. The new fee had not been instigated by him. What he needed we needed: the best possible tools. As long as he felt confident he was providing these, over what else should he worry or fragment his attention?
And yet, this is exactly how the American public too faces astronomical medical costs without flinching. It’s not their money. It’s not their concern.
We believe is it their concern.
Which is why we feel so strongly that more confrontational discourse between physicians and Big Pharma are needed.
We’re not complaining now about the wizardry of this particular doctor, or the years of experience he’s had to get to the top level of his specialty.
But if he doesn’t worry about the financial costs of what he’s doing, no one else is going to, either.
And that is the disease that’s breaking the backs of Medicare and Medicaid around the country.