Until Health Care is Fixed Few Will Enjoy True Financial Security
As long as the federal government plays at the margins in trying to fix the great debacle that is health care in the United States, few families will be able to enjoy lifelong financial security.
Last week I received a bill for an x-ray that I recently had on my knee. I guess that I should have expected it, but the scheduler who contacted me to make the appointment never mentioned that I would be responsible for paying for it, and I didn’t think to ask what this was going to cost me. Luckily I had the money in my Flexible Spending Account (FSA) to cover it, so after my initial shock wore off I realized that it wasn’t too much of a big deal for me.
Paying for health care is not like ordering a value meal at a fast food chain
It reminded me of the time years ago when my son was a toddler. He was a cute copacetic little guy, and after a while I realized that he wasn’t babbling and trying to say words the way his toddler peers were. I mentioned this to my pediatrician (whom I deeply admire and respect) and he brushed it off as no big deal. When I mentioned it to him again six months later, he decided that it was time to look into the reason why my son was not talking. Among other assessments, he recommended that my son have a comprehensive hearing test to rule out hearing loss as a reason for his speech delay.
This happened during the early post-Recession years. My husband had taken a pay cut from his job (at least he had a job!) and I was self-employed with two little kids, so, you know, we didn’t have a lot of extra money lying around. We were fortunate to have health insurance through my husband’s employer, but the health insurance did not cover a comprehensive hearing test for a toddler. My health plan recommended that I call around to various audiology clinics to see what they would charge out-of-pocket for this recommended test.
Okay, so I thought, I am a research-minded person. Certainly I can call a bunch of clinics, ask if they serve toddlers, and see what the out-of-pocket cost would be have a comprehensive hearing test. The good news is that I live in Boston, so there were about seven audiology clinics in the region that I could reach out to. But finding those seven phone numbers was the only easy part of this research project.
First of all, not all of the clinics had staff to answer the phone. Some of the clinics were attached to university training programs and did not operate during the summer (when I was conducting my research). Those were out. Of the few audiology clinics that did answer the phone, NOT ONE could tell me what a comprehensive hearing test would cost.
One by one I would explain to these staff people what my predicament was, and how I needed to pay for this test out of pocket. Some said that they would get back to me (they never did). Others gave me another telephone number within their hospital to dial, and the second person did know how much the hearing test would cost either. After weeks of dialing numbers and keeping phone logs of these conversations, I gave up. I could not navigate the health care system in order to figure out how get my kid the medical test he needed.
[Addendum: My son finally got old enough to being able to have a comprehensive hearing test that was covered by our health insurance. His hearing is normal.]
Will the White House fix this?
My story of health care woe is minor compared to others. In this piece by Paige Winfield Cunningham of the Washington Post she reports on a proposal coming out of the White House to force hospitals to post their rates so that consumers can do more comparison shopping, thereby bringing down the cost of health care. According to Amy Goldstein and Josh Dawsey, also of the Washington Post, this proposal does enjoy bipartisan support, as opposed to earlier actions that have weakened the Affordable Care Act.
Who doesn’t support this proposal are the hospitals, who claim that this level of transparency will drive prices higher rather than lower. And from my own experience in health care comparison shopping, it would take some major work in defining what these consumer-facing prices actually are, and in creating a protocol for sharing them with health care consumers.
So what are we as consumers expected to do? In the past few years I have become accustomed to asking doctors who suggest some procedure or medicine, “What is this going to cost?” Their go-to answer is, “I have no idea. That is beyond my purview.” But if I am supposed to be a savvy consumer of health care, shouldn’t a discussion of cost be a part of a treatment plan?
The gross inequity across health insurance policies
My mom will occasionally recall how my dad, after two bouts with cancer, never paid a dollar out of pocket for his medical care. He was covered by my mom’s union-negotiated health insurance and so while we were worried about my dad’s health, we were insulated from having to worry about my parents’ financial situation as a result of the diagnosis. What a luxury.
This is so different for the many, many people who are diagnosed with cancer or a chronic condition and do not have health insurance adequate to cover their bills. This piece by Noam Levey of the Los Angeles Times explains the hardships that people face when confronted with a diagnosis that is not covered adequately by their health insurance, and how their other financial responsibilities – for their home, for food, or for maintaining their savings or debt load – take a hit as a result. When reading this article it is not surprising that medical debt is the leading cause of bankruptcy in the United States.
So I ask again, what as consumers should we do about this? How much responsibility should we have to bear for our health care? For decades health care providers and insurance companies have brokered deals out of the light of day to make sure that their customers were served while they enjoyed their expanding profit margins. Now that health care spending is reeling out of control and the federal government is trying to right the ship while not compromising the profit-making ability of the health care industry, what will happen next?
Some think that tweaking health care at the margins will make a difference. Others think that we should blow up the system and replace it with single-payer health care, aka “Medicare for All.” Who knows what the right approach is, but what is certain is that working families will not be able to attain full financial security while contending with their first bad medical diagnosis in this current state of our health care system.