Over the past few years it has become abundantly clear to me that the health care system in America is fundamentally broken. What we have tried to do as a country is build our health care system on capitalist principles. On its face there’s nothing wrong with that approach, if – and this is a BIG if – there are safeguards in place to prevent rampant greed from posing what has come to be called “systemic risks”. What the financial crisis has taught us, if nothing else, is that without sufficient regulation and oversight, a capitalist system that allows greed to run amok is eventually going to break down. And that is precisely what has happened to our health care system.
Capitalism functions on the premise that consumers have a choice over where to spend their money and competition exists to keep prices reasonable. But in the case of a necessary medical procedure, you just can’t call around to get the best price for what needs to be done. Instead you go into a hospital or doctor’s office, have a treatment and then get the bill. The provider basically gets to charge you whatever they want, and there is no real competition to keep prices down.
Here is an interesting example. About a year ago my wife had some pre-natal blood work done. For one reason or another, our insurance company would not cover the procedure. Not only would they not cover it, but they would not even give us an EOB (explanation of benefits) stating the amounts we are required to pay based on the rates that the lab has negotiated with the insurance company. The lab charged us about $1000 for the blood analysis. However, I found out from my current insurer that the price reimbursed to them would have been just $200. That’s a 500% markup for people without proper health insurance! Of course, with health insurance we would pay even less than that.
Then last November I went to the ER complaining of stomach pain. Eventually my doctor ordered a CT scan. The price of the scan to someone without insurance? $6000 for a 6 minute test – that’s $1000 per minute! The price to someone with insurance? Just $1000, one sixth the cost.
This is just sheer insanity, the result of unbridled greed. And the system which allows that greed flourish unabated is just plain broken. The main problem we face now is that premiums for health insurance are so high that companies either stop offering it to their workers, or only offer to cover you and not your dependents. That’s my situation currently, and it costs me about $12,000 per year just to cover my wife and two kids.
But what happens when you can’t afford it, or when you’re laid off? If you get caught without insurance and need even non-critical medical care, you’re screwed, plain and simple. A visit to ER will probably set you back several thousand dollars.
Before you throw your hands up in despair and say there’s no other way, know that it doesn’t work this way in most other countries (say in Canada, France or Great Britain). Yes, the government is involved and there are inconveniences. But we’re reaching the point when it doesn’t matter anymore. If things stay the way they are now, hardly any of us will be able to afford health insurance and will face financial ruin in the event of an illness or accident.
The moral of the story? If you don’t have health insurance now, don’t walk but run out and go get some, even if it’s not worth the paper it’s written on. Why? Because even if the insurance won’t cover a procedure, you will pay the negotiated rate between the hospital and the insurance company. Otherwise, you’ll get gouged in a way you never imagined.