Recently I had routine outpatient surgery to remove a scalp cyst. I’ve had a number of these done before, so I didn’t consider it a huge deal. Today, though, I got a bill telling me that my insurance covered less than half the cost, and I owe hundreds of dollars. This is annoying because on the one hand, the options for avoiding these situations are few, but at the same time I wasn’t paying attention. While I was working at Harvard I had top-class insurance coverage, which meant I never owed more than a few dollars, and I got careless. I still have insurance, but it’s a lower level of coverage.
The problem is that our health care system has turned into one where the patient isn’t the doctor’s customer or even the insurance company’s customer, but the product. Lopsided tax incentives, and now Obamacare’s tax on the uninsured, pressure everyone to get insurance from their employers if at all possible, and laws require that they provide very broad coverage. People believing that they’re entitled to have their medical bills paid (the recent righteous demands for mandating birth control coverage are a case in point) add to the push. Today I talked to someone who told me his health insurance should be free. I said, “You want me to pay for it.” He said, “No, I mean free!” Magical thinking is America’s leading political philosophy.
Doctors assume you’re covered by insurance and don’t take the cost into account when making referrals. The doctor who performed the procedure is a plastic surgeon; if I’d been thinking more carefully, I’d have realized that would mean a large bill and asked some questions. For the cyst before that, I was in a hospital operating room, with an anesthesiologist standing by doing nothing, but I was at Harvard at the time and my insurance paid everything but a token copayment. Or maybe the insurance compensation was so low because the doctor performed the procedure in his office instead of an operating room and I’d have been better off financially with the full surgical team. It takes a greater expert than me to know. In any case, the lack of economic connection between patient and payment have made costs rise at escape velocity.
Have you ever tried to get a quote from a doctor? I need to push harder for that next time, but from what I’ve heard, it’s impossible to get one that’s more precise than a factor of ten between the low and high ends.
For me a bill that size is an inconvenience. For people with no income at all, they may not get great treatment, but their bills will be paid for. The people who get squeezed the worst are self-employed people with low incomes, such as a lot of musicians. It’s not uncommon for them to get stuck with huge bills that threaten to ruin them financially. Upper middle-class progressives have driven medical costs up with their “I wannit” philosophy, and the people in the lower income brackets get hit hardest.
I need to learn how to ask the questions that doctors don’t want to answer. It has to be possible to grab some measure of control back, even if it takes a lot of work.