Wednesday, January 11, 2012

We Don't Know What It Costs

A blogpost from a friend up in the Fox Valley got me thinking about how Big Pharma and Big Medicine and Big Insurance took over our health care system without firing a shot.  Of course, it took the rental of several hundred politicians at no small expense, but it began, I believe, when we stopped actually paying for things involving our health care.

Centuries ago, when I was a young man in my twenties, I had something almost none of my other friends had: health insurance.  Blue Cross/Blue Shield, which I’ll call BC/BS for the balance of this rant. I had it because my father was a prudent man and insisted that I have it.  I don’t recall how much it cost.

This was in a time (the roaring 70’s) when outfits like radio broadcasting companies didn’t offer health insurance as a “fringe benefit” (that’s what such things used to be called).  Nor did most companies.  If you wanted health insurance, you purchased it.  It had nothing to do with your job,  just like car insurance.  You just bought it.  Or you didn’t.

One night, playing softball with the radio station’s team (I was a hard-hitting first baseman, sports fans) I fell on my arm.  Pretty hard fall, and it came in a loss to the County Sheriff’s Department’s softball team. After a couple beers following the game, the arm still hurt like the dickens.  One of the deputies said “you oughtta have that looked at”, so I did.

In those days, there were no “urgent care centers”.  If you hurt yourself after regular business hours, you went to the hospital, which I did.  Before I could cross the threshold into the emergency treatment area to be dealt with, I had to either produce proof of insurance or sign a bunch of papers saying I understood I was responsible for ALL costs incurred in treating me.  So I produced the little paper card with the BC/BS logo on it, and was ushered into a large treatment area.

Since my little BC/BS card said “X-Ray and Diagnostic Tests” on it, there was no question about getting the arm X-rayed, and a short while later the ER doc said “your regular doctor happens to be here in the hospital making rounds of his patients; I’ve mentioned you’re here and he’ll be coming to take a look at you shortly”.  I said “but doc, is my arm broken?” He said “no, it’s not.  Your doctor will be here shortly.”

Had I known what was going on, I would have said “you tell old Doc FeelGood that I don’t want or need to see him – you’re my doc right now, and if my arm’s not broken, I’m outta here; if it is, I want you to treat me”.  But I didn’t understand the system, until several weeks later, when BC/BS sent me a statement indicating that both the ER doc and my regular guy, Dr. FeelGood, had submitted an invoice for (I believe it was $150 apiece) “examination and treatment”.  My treatment, by the way, was a quick hello from Dr. FeelGood, who confirmed that my arm was not broken and would probably be sore for a few days, and I should take a couple aspirin to dull the pain.  (This was long before the NSAIDs like Ibuprofen were available to regular folks over the counter.)  Total time of his “examination and treatment” was approximately 60 seconds; total time of my contact with the ER doc was probably about the same.  Not a bad racket; these boys bill out at a cool nine thousand bucks an hour (150 bucks a minute).

So, BC/BS, which was even back then in the roaring 70’s in bed with the doctors and drug companies, coughed up the exorbitant payment to BOTH docs.

Also, as a young man I was prone to sinus infections, and Dr. FeelGood would from time to time prescribe antibiotics for me.  Each course of antibiotics cost about $28.  I know that, because way back in those days, whether you had insurance covering medications or not, you paid the pharmacist when he or she dispensed the medication.  If you had insurance, AFTER you paid the pharmacist, you mailed the paid receipt to your insurance company, and they reimbursed you for the cost (up to the limits of your policy).  There was no “co-pay”; you just paid it. 

The point of this needlessly long exposition is that back before Big Pharma and Big Medicine and Big Insurance took over everything related to our health care, we were connected in the sense that we knew what things cost.  We knew how much the doc charged for an office visit, because we paid it, right then and there, to the receptionist, before we got to see the doc.  We knew how much antibiotics cost because we paid for them, out of our own pocket, before we could walk out of the pharmacy with the medication.  Health insurance had nothing to do with your employment (unless you worked for a huge union operation, like Ford Motors or General Electric).

The cost of hospitalization back then?  I really don’t know.  That was covered by the part of BC/BS they used to call “Major Medical”, and thank heaven I never needed that part of the coverage back then.

When you have a direct connection to how much things cost, you have a far better sense of control. That’s the way free market capitalism is supposed to work, I think.   If the guy with the plow on the front of his pickup truck says he wants an additional ten bucks a time more this year than last year to plow your road when it snows, you have the option of simply paying him more, bargaining for a better deal, hiring someone else, or buying your own plowing rig.  Your decision.  You know what it costs.   When you go to the store to do your grocery shopping, you know what things cost before you toss them into the cart.

The beginning of the end of our control over health care was when we stopped knowing how much things cost.   Now, we don’t care what it costs, as long as our insurance covers it.  And that, to me, is the biggest part of the problem.


  1. Heh.

    First child, complete, 4 day hospital stay, big dinner for both of us on last day: $1,000.00 neat. All-in. Doc, hospital, everything.

    Last child: 2.2 days in hospital, regular delivery, no steak dinner: $8,000.00 plus change.

    About 14 years' difference.

  2. I remember those days. I did have insurance via my employer, but the experience was similar, pay and get reimbursed. And I did have a couple of hospital stays,and those statements from the hospital, especially with surgery, were dozens of pages long with every box of kleenix, aspirin, gauze, and tube listed with the cost. The insurance picked up most of it, but I could see what was charged, and some of those charges were insanely expensive. All that went out when we changed over to HMOs, which were supposed to hold costs down. So much for that.

  3. I think another issue is that the people working at the hospitals also don't know what things cost. But they're told to "upsell" items. I just had my knee 'scoped in Dec. I have no idea what it cost. While there, I was asked: "Do you need an extra blanket? Would you like a meal after surgery? An extra pillow?" After every question, I asked how much each item would cost. They admitted each item would add to the bill, but claimed not to know how much. So my long-winded point is that the customers and the purveyors of healthcare don't know the costs. Oh...and there's no such thing as a "free market" except maybe for illegal drugs.

  4. One of my favorite soap boxes. The response to rising health industry costs to consumers is always: find another source for payment or you don't get treated, healed, mended, validated.

    The response should be: lower the costs. I recall looking up, for the fun of it, the so-called "non-profit" that administered/sheltered/ignored my health insurance plan at one time, and found the salaries of the administrators to be in the high six figures. These were not doctors.

  5. Ah, yes, HMO's.

    Ted Kennedy's gift to the US.

  6. Unlike other goods and services, however, demand for health care is somewhat inelastic. If you can't find a lower-cost provider of cancer treatment, will you choose to die, or will you give up your house and all your other assets for the chance to live? The AMA carefully limits the number of new doctors entering the market, in order to keep supply down and prices up. Health care should be regulated like a public utility, not left to the free market. We should also nationalize the drug companies. Talk about up-selling. Most of their profits come from convincing reasonably healthy people that they need to take a prescription drug to treat a made-up "syndrome", or from convincing doctors that their new drug is superior to a perfectly good generic.