My skirmishes in the health care war

The healthcare debate rages on and on, and for good reason. Our system is broken, and I have serious doubts about whether or not Obama care fixes it. I also have misgivings about the personal mandate, but once again, I look out at the debate-scape and for the most part, I once again see everyone arguing about the wrong things and asking the wrong questions.

Here’s my personal conundrum: My family is lucky enough to have by most standards a pretty good plan. We do have a $30 copay, but I rarely leave the doctor’s office feeling like I’ve resolved much. From the moment the doctor steps in the room, I feel like she’s already got a foot out the door. Three scripts, a little chit chat, and I’m done, on my way, and thirty bucks lighter.

In the eight years I’ve lived here, I’ve had five doctors — all working in the same practice. One time I peaked into my doctor’s actual office, and it looked like a paperwork bomb exploded. The vision hardly inspires confidence. My doctors know little about me beyond what they see in my folder. It’s obvious they’re overworked. And every bit of care for the most part seems to be administered by a playbook. And if my copay is $30, what’s the balance on that visit?

Here’s another symptom of the problem: In 2007, I underwent a sleep study that determined I had mild sleep apnea, and the doctor prescribed a CPAP machine. This device blows a steady stream of air into my nose to keep my airways from flapping around so I don’t snore and suffocate. I don’t remember the exact price of the machine, but Community Surgical Supply likely charged my insurance company at least $900 or more for Community Surgical to supply and deliver it to me.

Recently, that device now out-of-warranty malfunctioned, and I had a choice. I could either have Community Surgical come out and fix it on my dime, or I could ask my doctor to write a new prescription for a new machine. I’m no idiot. Of course, I called my doctor, and I got my new machine. Again, I looked at the invoice: $1500. This time, however, I had some perspective on the matter. I had long given up on Community Surgical to supply the consumables for this thing — the hoses, the nose masks, the filters, etc., because I did a little online research and found a company at CPAP.com which provided the same exact products for less than my deductible!

In other words, Community Surgical, the insurance company supplier of choice marked up the items so high, that my deductible exceeded the actual market cost of the items. In fact, that $1500 CPAP cost $299 at CPAP.com. I could, of course, buy from the website and then submit the bill to my insurance company, but past experience with that method has lead to headaches. Diverge from the standard practice, and you encounter a great deal of resistance, frustration, and confusion.

The lesson I learn from this experience — and others — is that the health care system is broken because it has completely detached the customers from the actual purchasing process. We pay our insurance companies not only to protect us against the costs of getting sick, we also delegate the purchasing responsibilities to them.

Health care insurance is the American dream of one-stop-shopping. In a perfect world, that should give insurance companies incentive to bargain down health care costs, but in practice, the industry, like most large industries, care more about market predictability and stability than they do about the price of my CPAP. They also know that thanks government regulations, we have few (if any) choices for providers, so frankly, it’s easier for companies to pass on increase costs to us than it is to drive them down at the suppliers. In other words, for the industry has developed some cozy relationships that does them no good to disrupt.

When was the last time you called up a doctor’s office and asked the cost of a visit? Not the copay, but the full visit? In the years I didn’t have insurance, I made those calls from time to time. The answer generally went like this: “You don’t have insurance? Uh, well, it’s [about 50% less than what we charge insurance].”

In the mid-1990s, with no insurance, I decided that three years was long enough to go without a dental exam and cleaning. So, I chose a practice that looked professional enough and made an appointment. When I revealed that I  would pay out of pocket, I detected a palpable change in attitude toward me. Suddenly, I had a radioactive glow. I spent more than 90 minutes in the exam chair waiting for someone to even look at me.

At the end of this ordeal, the dentist accompanied me to the cashier, instructing her with a voice loud enough for the whole room to hear, ” This gentleman’s visit will cost [X], BECAUSE HE DOES NOT HAVE INSURANCE.” A month or so later, I discovered that the state shut them down for insurance fraud, but the experience gave me the sense that they were trying to play an established game just a little outside the more generally accepted rules.

The health care system has become unmoored and buffered from the laws of supply and demand, plain and simple. This condition has lead to an industry that sustains itself outside of the economic forces that affect the rest of us. We are dealing with a cartel, but one largely created by the rules and regulations originally designed to protect us from such dealings. And now, the government, complicit with causing the problem in the first place, now rides to the “rescue” again? How does that not make me feel better?

Health care, despite its vaunted purpose and importance to our quality of life, is still just another service. When we shop for a mechanic or a vet or a landscaper, we ask a simple question: “How much?” We never seem to ask it of our doctors, and maybe it’s time we start before things get really out of hand.