Better And Better

If you don't draw yours, I won't draw mine. A police officer, working in the small town that he lives in, focusing on family and shooting and coffee, and occasionally putting some people in jail.

Thursday, June 09, 2011

You want to fix the medical system? You want reform?

I've got a very simple law that we could pass that will go a LONG way toward medical healthcare reform.

Require that, within one business day, the healthcare provider give you a straightforward answer to this question:

"How much is this going to cost?"

Mom is in rehab for her new knee, which she had put in last week. The orthopedic surgeon called it one of the worst --if not the single worst-- knees that he's ever had to replace. He told me that Mom should have come in 10 years ago to get that knee swapped out. Mom's answer (she walked 150 yards in to the pre-op room, unassisted) is simply, "Yeah, but think of how far that replacement knees have advanced, in the last ten years." Good point.

Mom's a super star at rehab, and is actually being released early. This makes her cranky elder son very happy; we've been missing her next door. (Yes, I've been visiting daily, but it's not the same.) But when her family liaison person called me to ask me if I had any questions, I asked her, "What's the cost of this? How much are we saving daily by having her come home early? What is the average daily cost of her care?"

She didn't know, but turned me over to a person at their facility who could "better answer my questions." That lady didn't know, either. "We don't do any billing here," she told me. "That's done from the corporate offices in Pennsylvania."

But she went on to assure me that the bill was to be sent to Mom's insurance companies, who typically covered most of these things, before we'd ever get a bill.

"But somebody, somewhere, knows what this costs," I protested.

"No, we won't really know, until we bill the insurance companies, and see what they pay," she told me.

This is ridiculous.

The attitude that it doesn't matter, because there is insurance, is the reason why the costs are spiraling.

On the first of this month, I changed over from my old PPO to a new Health Savings Account*. Thus, when it's medically-oriented, I want to know what EVERYTHING costs.

I know what I make per hour. I know what the overhead is for my job. I could, after checking a few figures, answer the question "How much does it cost to run the police department in Matt G's little town for a single day?"

Why is this so hard?

*I've got a $3000 deductible to fill each year, before my account turns into a classic PPO. My job kicks in $180 a month to a savings account that I pay out of.

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At Thursday, June 09, 2011 5:50:00 PM, Blogger Old NFO said...

Matt, they don't WANT to answer you, because you would go off the deep end... Expect $12 per aspirin, and it goes up from there! You are correct, that we SHOULD know, but we never will...

At Thursday, June 09, 2011 7:07:00 PM, Blogger Jim said...

I've never seen a better short essay on why medical care costs so much.

At Thursday, June 09, 2011 10:33:00 PM, Anonymous Anonymous said...

Actually, they DON'T know, because the "allowable charges" are set by the insurance company, not by the providers.

At Thursday, June 09, 2011 11:44:00 PM, Blogger Art said...

This is one of my pet peeves.
Name one other industry that operates like this. I can't.

You can find out the cost easily.
Just say "No insurance. I'm self-pay"

BTW .. Get Well wishes to Mom

At Friday, June 10, 2011 2:19:00 AM, Blogger Matt G said...

Jim, you're getting the cart before the horse. The cost is what it is, without regard to the insurance companies. Have the medical folks come up with a figure, and stick by it. If the insurance companies can't or won't pay it, there will be a reckoning. Either the insurance will have to go up, or the people will have to pay more out of pocket, or folks simply won't be getting that level of care.

There is a single facet of the medical industry where costs are going down: Lasik. Most insurance companies won't pay for lasik, so if you want to fix your eyes, you have to pay out of pocket. This means that people shop for the best price, and the opthamologists that offer the service have to be up-front about their pricing. With direct competition, the price of the surgery is steadily dropping. Lasik is one of the reasons that I chose a Health Savings Account; I can use it to pay for the surgery and quit my glasses.

We need to quit letting the price depend on what the insurance companies pay, and demand that the price be known. If I know that I can get the same orthopedic or opthamolic surgery for thousands cheaper at another hospital, with the same level of care, why wouldn't I choose to take my business there?

Hold your healthcare provider accountable for what things cost!!!!

At Friday, June 10, 2011 2:21:00 AM, Blogger Matt G said...

Oh, and thanks, Art! She's rehabbing well ahead of the expected schedule, which means that I'm bringing her home early. She'll sleep in her own bed on Saturday. :)

At Friday, June 10, 2011 10:26:00 AM, Blogger Jim said...

Matt, I guess I don't understand your objection unless we're dealing with a distinction between "cost" and "price."

Using them as synonyms, either one is a piece of information, or news, reporting value. This works only if the seller and buyer have equal access to the information -- the cost or price.

Inserting a third party such as government or an insurance company into the transaction and hiding the cost or price from the ultimate consumer may distort value, or perception of value, to one or more of the parties. The resulting information vacuum leads to the problems you cite.

I stand by my primary point. You provided an admirable summary.

At Friday, June 10, 2011 1:21:00 PM, Anonymous Dwight Brown said...

"This means that people shop for the best price, and the opthamologists that offer the service have to be up-front about their pricing."

Yes, yes, a million times yes!

Matt, if you haven't read the "How American Health Care Killed My Father" article from The Atlantic, I commend it to your attention.

At Friday, June 10, 2011 6:25:00 PM, Blogger Matt G said...

Jim, perhaps I'm using terms relevant only to me. To me, the "Cost" of healthcare is what what value the healthcare providers have put into their service, with a reasonable profit. (I LIKE profit incentives. Expecting an industry to run "out of the goodness of their hearts" is for suckers.)

"Price" is what they are asking be paid for their service. It seems to be crowded into a box with kitty cat, a geiger counter hooked up to a servo, and a weight suspended over a flask of poison.

Thus, value is what you got, cost is what they spent, price is what they want you to spend, and profit is in the middle. :)

At Sunday, June 12, 2011 5:26:00 AM, Blogger KD5NRH said...

Old_NFO; your hospital has aspirin? The last few I've been to were halfway through fishing out two $20 (each) Tylenol before I had a chance to tell them I'd be paying cash. Amazing how fast they can put 'em back and re-cap the bottle when they hear that.


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