Insurance for basic health care makes sense as a matter of Public Good. It’s right up there with meat inspections, potable water, public schools, and libraries. Despite passage of The Affordable Care Act, health insurance remains confusing, controversial and expensive. Why can’t the health insurance industry start doing business the American way, like entrepreneurs instead of mountebanks in white coats? I’d love to see genuine market forces in action.
Let me give you an example. I scheduled a colonoscopy and the facility assured me it was entirely routine: a one-hour procedure, two professionals, a curtained space, and modified video setup. (Actually, it wasn’t bad.) The next month, mystery bills started to arrive … doctor’s fee … diagnostic fee … fee for the person who made the diagnosis … lab fee … supplies fee.
The worst was not knowing what to expect, and then it occurred to me I have NEVER known what to expect. If the procedure was “routine” and “preventative” like the brochure said, what the heck were all these EOBs and invoices showing up in the mail? I called the doctor to inquire. “Well, it’s just like car insurance,” said the young woman. “You have insurance on your car, and then if you have an accident you have to pay.”
True, but when I take my car in for repairs, the shop gives me a written estimate before I commit to anything. I can also go to another shop and compare prices. Nothing of the sort with a medical procedure. In fact, once when my husband required outpatient surgery, I called the hospital finance department beforehand to ask how much it would be with our insurance. Deer in the headlights, they didn’t have a clue, like no one had ever operated on a BC/BS-insured hernia before. Later the hospital called back and gave me a range over several thousand dollars, reflecting that liquid proviso – depending. Depending on what? On what is found, on what the doctor orders, on what the insurance company decides…
I say if health care is a market commodity, then providers should have to operate like a real business, at least for non-emergency procedures. I want to walk into my doctor’s office and see the prices on a board above the reception counter. I want to have to sign an estimate before they even reach for a band-aid. And I want any used parts to come home with me, or at least be available for inspection. (What better incentive to stick to your diet than a polyp in a little jar on the windowsill?)
Why isn’t there a package price for regular procedures done every day — a flat rate for your inguinal hernia repair, your colonoscopy, your D&C, sprained ankle taping, bunionectomy. Maybe even specials of the month, coupons in the monthly shopper, and how about a referral discount? A family plan for procedures in the same month? Why isn’t there a hospital administrator breaking in on the evening newscast with a commercial: Come to my hospital for your tonsillectomy – we will not be undersold!
The health insurance industry has had it easy. The aura of the white coats holds us at bay, discouraging us from being efficient shoppers. Medical procedures are standard enough to be coded for billing, so why can’t they be transparent to the patient? I don’t want a 20-page welcome brochure from my insurance carrier with smiling people in soft-focus interspersed with poignant copy about how much they care about my health, I would prefer a price list that details exactly how much I will have to pay for common things, and the phone number for a service adviser I can call for the rest.
The current process feels like shopping at a grocery where nothing is priced and you don’t know what will end up in your cart at check-out or how much it will total. It feels un-American, and I’m tired of it. No other business gets away with this, why do we allow health insurers to do it?