By Nancy Mathieson
As the U.S. Health Care debate rages on, we now know Americans view health care services and what we’re paying for them in many ways. You rarely hear a consumer say they have exactly the health care they need, or their services are a bargain. It’s a brand-new world from a generation ago, when the cost of care wasn’t a huge portion of the family budget or a regular source of consumer outrage.
What has changed? According to Dr. Kevin Wacasey, a physician at the Colleyville Medical Clinic near Fort Worth, Texas, the dominance of the insurance industry over you and your health care provider has created a cultural sea-change in how we view health care. Unlike other items we purchase (and health care is undeniably a large purchase), we no longer comparison shop, haggle on prices, or demand services before we walk away.
In his new book Healthcareonomics 101: 500 Ways You’re Being Ripped Off By The Health Insurance, and Health Care Industries. Any Questions? Dr. Wacasey goes as far as to say “Health insurance is sold through employers because if it were only sold to individuals…. nobody would buy it.”
Turning Health Care Issues into Debates About Health Insurance for Over 40 Years
Somewhere along the way we’ve gotten confused over the difference between health care and health insurance. The Patient Protection and Affordable Care Act “Obamacare” (2010) and the more recent American Health Care Act (2017) have much, much more to do with regulating insurance coverage than with regulating health care. And for some reason, neither our policy makers or the large insurance companies supported by these new rules have a vested interest in clearing up the confusion.
“How” we got to insurance industry dominance is a whole other topic. Here are some ideas about what we can do about it.
The Real Cost of Services
What does your MRI test really cost the health care provider? According to Dr. Wacasey, about $350. A sonogram? About $150. How about an EKG test? The time of the staff who administers/reads it. So why do we see these charges on our statements from the insurance company? MRI test: $5,000. Sonogram: $800. EKG test: $300.
Dr. Wacasey is the unusual practitioner whose patients directly pay for services instead of utilizing health insurance. You may believe in today’s world this is impossible… but is it, or are we just used to thinking that way? Historically it’s been hard for health care consumers to comparison shop and determine how much doctor visits or hospital stays will cost them. Hospitals and other providers generally don’t publicize how much they’re paid for services (which varies depending on who’s footing the bill).
However, a new array of websites such as HealthCareBlueBook.com try to lift the veil on health care pricing, and allow consumers to comparison shop. Of course, you should also pay attention to quality of care, by checking sites such as LeapfrogGroup.org or Medicare’s Hospital Compare.
How Do We Really Get Health Care Costs Down? (and How About That Push to Buy Insurance Across State Lines?
C. Steven Tucker of Small Business Insurance Services is a frequent on-air radio guest who knows a lot about health insurance and current legislation. Tucker agrees with Dr. Wacasey that the #1 way we can get costs down is by demanding transparency and price shopping. And for those of you, like me, who thought purchasing health insurance outside of Illinois wasn’t even on the table, there is legislative progress. The U. S. House of Representatives in March passed the Competitive Health Insurance Reform Act, (by a bi-partisan vote of 416-7) which would repeal the 1945 McCarran-Ferguson Act anti-trust exemption for health insurers, and allow consumers to purchase health insurance out-of-state.
So, What Can We Do?
Let’s all pay attention to upcoming health care legislation. Also, keep in mind this legislation involves health care insurance; we as consumers should be the decision-makers of our own health care.
Nancy Mathieson has a 30-year career in business, securities regulation and public policy. Nancy held positions at the Chicago Mercantile Exchange (CME) and the New York Stock Exchange (NYSE), where she was a Director of Market Surveillance and managed a professional staff in the investigation of securities trading violations. She also served as Operations Director at Truth in Accounting, a Chicago think-tank whose mission is to promote transparency in government financial reporting. She was a Contributing Editor for Wirepoints Illinois News, and is currently Communications Director for Vernon Township G.O.P. in Lincolnshire, IL. Nancy received her B.S. in Economics from the University of Illinois at Chicago and her M.B.A. from New York University.