Can we talk about healthcare?

Specifically, an example of how the healthcare system here in the US is not efficient. Oh good, you’re willing to humor me – thanks!

So I’ve forever ranted that it is a shame that a person doesn’t truly know the cost of an encounter with the medical system until after it happens. If you ask for the price of a procedure or a medication or a consult with a doctor, you will get the same answer: it depends. The cost will depend on whether or not you have insurance, what type of insurance, the amount of coverage, whether you’ve met your deductible, and a slew of other factors that make a price estimate impossible to give. I believe, if we could solve this problem, we could solve at least part of the reason why healthcare costs in the US have ballooned over the past decades.

You see, the typical arguments are either that (a) the cost of a medical procedure doesn’t factor into most decisions or that (b) if you, personally, don’t pay for the procedure out of pocket, then it doesn’t matter what the gross cost is. Both of these arguments are faulty; let’s tackle argument (b) first:

If the gross cost of your doctor’s visit is $500 and you end up paying nothing (after insurance discounts, deductible calculations, etc), the $500 doesn’t just disappear. Someone is paying for it, namely the insurance company. True, they are probably not paying the full $500 (see: insurance discounts), but they are paying a portion of it. Let’s call it $200. The doctor got $200 of his billed $500 and you feel like you’ve gotten off scott-free because you didn’t pay a dime out of pocket. Wheeee!!! Free medical visits for everyone! Now here’s where that logic is a tad faulty: the insurance company isn’t insuring just you and your doctor (likely) isn’t an idiot. The cost to your insurance company ($200) gets added together with all the other insured families’ costs and guess what, the insurance company needs to cover their costs. They are doing this through premiums (which means they’re charging you more than enough to cover their costs), either now or in the future. Which leads to higher costs for you (healthcare is never free, you just get to control when you pay for it – now or later). Also, that part about your doctor not being an idiot: if he knows that he’s only going to get $200 for his $500 of work, he’s going to bump up his gross charge so that he gets what he needs to cover costs. It’s like the fallacy of those stores that always have sales – if the store always runs sales, those sale prices are no longer “sale” prices, that’s just the price.

TL;DR: Healthcare is never free, you just get to control when you pay for it and your doctor is not an idiot.

Now for argument (a), that the cost of a procedure doesn’t matter. This is likely true for some procedures (think your true emergencies like resetting a fractured bone or surgery after an accident). However, for most things I would wholeheartedly disagree. Let me give you an example: you fell on your ankle two days ago playing basketball. You’re in a fair amount of pain still and the swelling hasn’t lessened, but you’re pretty confident you just sprained it and have found plenty of advice for self-care. Your mom (being mom) urges you to go in to the doctor for an examination anyway. Now let’s say that you knew it would cost you $150 to get that examination – wouldn’t that price affect whether you go? If you’re confident that you sprained it, you’re unlikely to spend the $150. If you’re somewhat confident and also strapped for cash, you’re also unlikely to spend the $150. If you’re starting to question your self-diagnosis, you’re probably more likely to shell out the cash. What if the examination was going to cost $20? That might change your course of action. The same would apply to shopping around for a doctor. If you knew one cardiologist charged five times the amount of another, when they appear to have equal levels of expertise, you’d probably go to the cheaper one because no one likes getting ripped off.

TL;DR: No one likes paying too much if they don’t have to.

If only the healthcare system were more transparent on prices, it would likely cut down on some of the cost in the long run (one would hope anyway).

So let’s back up and let me put all of this into context for you. I mentioned a couple of weeks ago that we were referred to a high risk doctor for a Level II ultrasound to examine Little Dumpling’s heart. That doctor’s visit was the single most expensive doctor’s visit I have ever had in my entire life (based on the gross billed cost, mind you). The ultrasound alone was almost enough to pay our mortgage for the month. Ridiculous, true, but also necessary in our eyes and not unexpected (that’s what happens when you go to a specialist – everything costs more!). Thank the heavens for insurance discounts!

What really took me by surprise was the blood test. With my mother as my witness, I swear the doctor described the test to me as “a newer blood test that’s a bit more accurate that will give [me] a little more peace of mind.” That little blood test was $2,700 (gross – insurance hasn’t processed it yet because they want “additional information” – lmao). TWENTY SEVEN HUNDRED DOLLARS. When I told my OB, he said they must have run a full genetic profile on Little Dumpling – the same blood test they run for high risk pregnancies to detect chromosomal abnormalities with 99% accuracy. That was the blood test they ran so that I could have “a little more peace of mind.”

What’s done is done. I’m not about to refute or argue, especially since this could have been avoided if only I’d pressed for more details about what this little test actually was. However, this is absolutely a scenario in which the cost of the test would have changed my mind. A hundred dollar blood test for a little more reassurance? Sure! Absolutely! A twenty seven hundred dollar full genetic profile for a little more reassurance? No. I was not that concerned. In my gut, I knew Little Dumpling was fine and I felt confident after seeing the specialist. I did not need to have that test done.

Silver lining though – his results came back and Little Dumpling really is perfectly fine in there!