Mon November 14, 2011

Health Insurance and Other Absurdities

KUNC commentator Dr. Marc Ringel has been following the economics of the medical industry for the better part of 40 years. He’s seen the inconsistencies from the inside and now most recently the outside.

A friend of mine buries gold in his backyard because, as he sees it, our society and economy are on the brink of collapse.  In fact, he has predicted six of the last two recessions.

When it comes to observing the health care non-system I’m usually looking through dung-colored glasses similar to my friend’s.  Way back when I was a medical student in the early 70’s, it was clear to me that American medicine was in deep trouble.  Health care was so wasteful, abusive, and far off the mark in meeting the population’s real needs that I expected the whole enterprise to collapse soon under its own bloated weight.  At that time the medical sector accounted for six percent of the gross national product.

Today the health care enterprise takes up 16% of the GNP.  And inflation of medical costs just goes up and up with minimal gain in quality of service and severe loss of breadth of coverage.  The Denver Post ran a story on October 28 under the headline, “In today’s health care 9.4% rate hike a relief.”  The piece was about health insurance premiums, which are predicted to increase only 9.4% in 2012, compared to 14.4% in 2011 and 11.8% in 2010.  The overall inflation rate for those two years was under 3%.  Can you imagine, health insurance premium inflation that is just three times the general economy’s is good news?

And so it’s been for the 40 years that I’ve been following medical economics.  Things go on and on in the same unsustainable direction.

My wife recently had her own personal encounter with health care that is at a level of absurdity worthy of Franz Kafka or the Marx Brothers.  She has taken thyroid replacement hormone for years.  Once a year her doctor orders a couple of blood tests to assure that the medication dosage is keeping her blood hormone level in the target range.

My spouse followed doctor’s orders (I like to remind her that I’m a doctor, at which she just laughs) and had her blood drawn at the hospital laboratory.  The good news was that her thyroid hormone dose was just right.

The bad news was that the bill came to $243.30.  Because we had not come even close to meeting our $6000 annual deductible, we had to pay the full amount, minus $29.19 that our insurance company had negotiated off the full rate.  So I wrote a check for $214.11.

I called the hospital lab to inquire about what seemed like an outrageously high charge for a couple of routine blood tests.  The nice person who answered explained to me, “Our rates are comparable to others in the region.”  I believe her.

I looked into what the charges would have been had my wife gone to a lab and requested the studies herself, without a doctor’s order.  When I was in practice I used to do this for uninsured patients.  I’d write down on an unsigned prescription instead of an official lab requisition, what tests they needed and counsel them to present themselves to our hospital laboratory with this paper and ask that the studies be performed under the patient requested testing program.

Ordered this way, laboratory tests are way cheaper.  The only disadvantage is that, without an official order, the results go directly to the patient who must then forward them to the provider herself.

The luxury of an automatic report to a provider is hardly worth the cost.  If my spouse had walked into the outpatient blood drawing station that is affiliated with the hospital and requested those tests herself, the total charge would have been $58.85, one quarter of what we paid, for the exact same tests performed at the exact same hospital laboratory.

I won’t try to explain the cost discrepancy.  It is simply part and parcel of a health care system that is rife with inconsistency and excess.  Perhaps the worst thing about this arrangement is that the person who has no health insurance and can least afford it is most likely to be charged the full rip-off rate.

Maybe the time finally has come for that revolutionary shift in American health care that my friends and I have been expecting for so many years.  Whether or not the Affordable Care Act, what some call Obamacare, survives the next administration, it seems the reform camel has gotten its nose under the tattered tent of American medicine.

In the meantime, I’m burying gold in the backyard that I plan to spend on health insurance, while I await the revolution.


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