14 thoughts on “What if everything worked like health care?”
The mystery of health care costs are so ingrained in me, that I never have even asked a doctor about the cost of a procedure.
I’ve had seven surgeries, two that required a week’s hospital stay, and the rest all outpatient. I didn’t ask about the price of anything, because it never even occurred to me to ask. It may seem ridiculous, but in my mind, the culture of patient/doctor just doesn’t include asking about costs. Of course, after the doctors decided on a course of action and had discussed it with me, I was sent to the scheduler and insurance person, where coverage, etc. was discussed but no final figures were ever in the discussion.
I always just assumed my insurance company and I would work it all out later. And, at 20%, over the years the cost to me has been roughly $80,000. I’ve had these surgeries over the last 30 years or so, and as I’ve seen health care go up, I often receive the bills and am shocked at costs, but I have never felt that I had any choice in having the surgeries done.
I also have been surprised when I’ve read how much of that final figure actually goes to the surgeon. It’s really not nearly as much as people might think. On a final figure of $20k, the surgeon may receive as little as $1,500.
Last year, I went into anaphylactic shock after a bee sting. I never had been allergic before but suddenly I was, and ended up in the emergency room via ambulance. I was only there for four hours, and the cost was $7,000. We’ve been lucky enough to have health savings accounts through our work, but we have still had to be on payment plans at times. I will say that I have had the most excellent care over the years, and looking back on it, if I had been given an option of a cheaper procedure with another doctor and medical facility, I wouldn’t have wanted to do anything different.
I am very cost conscious in all of my shopping and I love a bargain. But I have always accepted not shopping prices with medical tests, exams, or procedures. I wouldn’t pick price over my doctors, even if I knew that they were above the national average cost because I think all of them have been the best at what they do.
I’ve always had very good health insurance through my job, which I realize has afforded me good medical care. I do think that a lot of people are starting to question costs more, and health costs are bound to become more transparent as the way things have always been done starts to change. I still can’t picture shopping the ads for price comparisons on something like the surgeries I’ve had, but I also cannot picture the future in health care within the next twenty years or so. Everything is going to change radically, and “shopping” health care may be a big part of that.
Thanks for your perspective here. I suspect that you’re not alone in not “shopping” health care. When I was hospitalized for a heart attack five years ago, it never occurred to me to discuss the costs of my E.R. visits, medical care, cardiac procedures, drugs, hospitalization in the Coronary Care unit, etc.
There’s an example of inequity of power, when cost is billed without prior agreement, and that control is not by Patients. It reinforces the feeling of being a hamster in a jungle where no one speaks hamster language, and no one wants you to learn theirs.
That being said… a comment by jlndewitt jumped out at me. “On a final figure of $20k, the surgeon may receive as little as $1,500.”
Begs the question of where the rest of the money goes, doesn’t it?
Here in Canada… especially Ontario… there is Health-care and there’s Patient-care…with a huge disconnect between the two. Here, our healthcare seems to mean staff wearing suits and dresses get 6-figure salaries, while staff wearing uniforms and rubber soles, get laid off, and Patients suffer the impact.
Colour me weird, but I’ve never been able to figure out why ‘managers, admins and CEO’s” get such cushy salaries, while the men and women who actually do the work, ie: saving lives and easing suffering, seem to be at the bottom of the funding priority list.
I guess it’s the difference between a corporation and a resource: A resource takes care of the recipients of its services… a Corporation takes care of itself.
Hi Joanne – I too live in Canada, where because of universal health care coverage, we are generally even more unaware of the total cost of our medical care. We don’t have to worry about co-pays or paying off hospital balances or being denied insurance coverage because of some small print disclaimer in our policies. But such care is not “free” – the taxpayers of Canada are footing the bills, and we – as taxpayers – should know what we’re paying for.
However, that would come under the section of transparency and accountability, and as much as we hear the lip service, I don’t believe such an open-book policy in lay-language will ever happen.
You’re right..it’s not “free”, we do pay for this healthcare thru our taxes, yet taxpayers have little or no input on how that money is spent. I ‘m not sure how it is out west, but here in Ontario, our hospitals are extremely top-heavy. It’s ironic, to listen to patter of how unsustainable our healthcare is, coming out of the mouths of hospital staff who are raking in 3-4 hundred thousand a year out of a 1 billion dollar annual budget. And when I see some sunshine-list manager cutting funding to much needed staff, services and programs, I fume helplessly.
I had started thinking that maybe the American healthcare might be better, and in terms of waiting lists and availability, perhaps it is. I don’t know enough about it yet.
I do believe, tho, that if Taxpayers knew the incredible amount of funding that goes into the bank accounts of desk-jockeys, there would be one heck of an uprising. Maybe that would be a good thing. Maybe that would finally bring change about.
That video reflects a model particular to the U.S. health care business. In recent years there is a media push to blame Rising Medical Costs on “consumers” for insufficient “price shopping” and for making unreasonable demands when, as the video shows, few of us have access to price and quality information, or the leisure to carry on an investigation.
Recently a New York Times reporter tried to research ‘normal birth’ at local hospitals for her uninsured daughter, and simply could not get figures from most hospitals, even when she pulled out her Reporter card.
When we are sick or injured, we need and want the best care we can get for the best outcome. To worry about costs is counterproductive at that time (or any time).
Really, I think the whole bruhaha about costs is to distract us from where most of it goes. In the US, a huge proportion is devoted to insurance companies and fighting over who pays what. And to the profits of pharma and makers of medical devices. But mainly insurers, who produce absolutely nothing and have done so much to distort the process.
My brother is one of the few (anymore) who has an individual private practice, and nearly half the time of his office staff is devoted to fighting insurance companies for payment.
Good points, Kathleen. I suspect that awareness of what things actually cost is less important to comparison shopping during a health crisis (although some of my American counterparts routinely tell me of reluctance to call 911 during their heart attacks because they feared they would simply not be able to afford the ambulance). More to the point, it’s very important amidst the growing issues around pervasive rates of over-treatment, unnecessary testing, inappropriate screening recommendations, etc. Why, for example, does Manhattan have the lowest rate of knee replacement surgeries in the U.S. (4.0 per 1,000) while Lincoln, Nebraska, has the highest rate (15.7 per 1,000)? That’s a lot of very expensive surgery that’s simply not explained by the hospitals allowing this. More here on what doctors euphemistically call “practice variation”.
Inappropriate treatment and testing is far too common, and so is denial of appropriate treatment and testing. Some form of financial reward is usually at the bottom either way, and neither serves the patient.
The fact that people in midst of a health crisis are afraid to call an ambulance because of the cost – that speaks volumes.
I work at a great company called Castlight Health where we are working hard to bring real transparency – both on cost *and* quality – to health care. We work with employers, and then employees of those companies can use our tool to search for care using a very “consumer”-like experience. It’s been a real game-changer, IMHO. I think we’re on the right track!
Hi David – I’m aware of your company and I too think you’re on the right track. My understanding, however, is that your services are for employers and health care plans – not for the vast majority of individual consumers of health care whose employers don’t subscribe to Castlight. I’m not an American, but I’ve heard that in the U.S. the cost of a basic chest x-ray, for example, isn’t carved in stone (negotiable for insurance companies, far higher for the uninsured, varies from hospital to hospital, etc.) That’s what happens when you have for-profit insurance companies basically running your health care system.
Joanne, you’re so right about wondering about where the rest of the 20k goes, when a surgeon might only get about $1500. When I have looked over bills after surgery, so much is poured into the radiology required to find a problem, pre-surgery care and medications, the room for pre-surgery, the operating room, the medicine for anesthesia, bill for the anesthesiologist, supplies during the operation, nurses and assistants during the operation, the cost of the recovery room, the recovery room nurses, then the post op care in the same pre op room and the nurses there…..of course it’s all kind of lumped in such a way that you can’t really see, for example, the exact price you paid for the hour you spent in pre op getting hooked up, examined, and dosed up and queried. Some of the cost is also in the post op doctor visits, stitches removal, etc.
Then of course there are all the administrative costs associated with everything else at the doctor’s office. Who knows how much is hidden in a cut for the upper management? All of my surgeons, and my internist, are in big (actually huge) groups. All of my surgeons have been very caring, patient centered, and extremely good at explaining procedures. Two of them, an orthopedic surgeon and a general surgeon, seemed to thrive on teaching me exactly what was wrong, what needed to be done, how it would be done, etc…… to the point of drawing pictures on the exam table paper. They are friendly and personable, even at 2 A.M.! For an abdominal problem, the surgery took much longer than expected…. eleven hours… because body parts weren’t cooperating, although it wasn’t anything dangerous, just tedious. It ended at about 10 pm and then my surgeon had to race off to two emergencies at other hospitals. ; a ruptured appendix, and a cancer patient. He apologized to my husband for having to be brief in his post op chat with him because of that, and my husband said that although he looked tired and sweaty, he still seemed to be energetic and was quick but very polite in his assessment. He promised to talk with him more later. He showed up back at my bedside at about 2 AM to check on the incision. I was pretty out of it but I remember that he apologized for coming in at that time, but said that he feared he wouldn’t make it for 6 AM rounds, and so wanted to stop by and check on me then. That next night they had to awaken him well after midnight in order to change a medication. So when you find that his portion, which has included all pre op and post op office visits, plus all the hours for the surgery and hospital checks, it doesn’t really seem all that enriching in terms of money.
I hope others realize that while it is true that their doctors do well financially, it probably isn’t anywhere near what we might guess. After paying off their medical school loans, yearly professional fees, malpractice insurance, continuing education, and whatever portion they have to pour into administrative costs at their practices, their salaries are not the megamillion ones that we imagine. But costs in this country are truly being scrutinized and my own internist now advocates a complete physical, with all the blood tests, etc. only every other year, and since I’m 61 and have never had any kind of problems with my reproductive system, I no longer have to have the yearly pap smear, etc. He did say that after 65 he would have to recommend that more often. He is very forward thinking and is part of the movement toward patients managing their own health with their doctor as a mentor.
He says that the focus in the future will be keeping patients healthy and hopefully keeping office visits way down, and that doctors might even be paid on a retainer type of system instead of the current “pay for a problem.” Doctors won’t be trying to find something wrong so that they can code something for the insurance company to pay for. I see huge changes coming, and I recently read on a health site that medical costs are already going down. Hopefully that trend will continue to reduce unnecessary tests and repeat hospital admissions.
At least now, the big dollar sign elephant in the room of wasteful medical costs is being addressed very seriously. I believe there really will come a day when a patient can shop a procedure and look at exact costs for everything. In twenty or thirty years, people will look back and be incredulous that we ever went in for an operation not having a clue as to the cost. I wonder if I would now ask about costs if I had to have another operation. Knowing that I wouldn’t go with a different doctor or facility anyway…. probably not, unless I was just curious about the bill ahead of me.
And that’s the bottom line, jlndewitt 🙂
When you’re blessed with a team that works for/with you, then cost is a secondary consideration. All the price-shopping in the world is not going to replace what you seem to have right now. It works for you.
I’ve learned quite a bit just by reading your posts here..thank you for that.
The Ethical Nag 
The mystery of health care costs are so ingrained in me, that I never have even asked a doctor about the cost of a procedure.
I’ve had seven surgeries, two that required a week’s hospital stay, and the rest all outpatient. I didn’t ask about the price of anything, because it never even occurred to me to ask. It may seem ridiculous, but in my mind, the culture of patient/doctor just doesn’t include asking about costs. Of course, after the doctors decided on a course of action and had discussed it with me, I was sent to the scheduler and insurance person, where coverage, etc. was discussed but no final figures were ever in the discussion.
I always just assumed my insurance company and I would work it all out later. And, at 20%, over the years the cost to me has been roughly $80,000. I’ve had these surgeries over the last 30 years or so, and as I’ve seen health care go up, I often receive the bills and am shocked at costs, but I have never felt that I had any choice in having the surgeries done.
I also have been surprised when I’ve read how much of that final figure actually goes to the surgeon. It’s really not nearly as much as people might think. On a final figure of $20k, the surgeon may receive as little as $1,500.
Last year, I went into anaphylactic shock after a bee sting. I never had been allergic before but suddenly I was, and ended up in the emergency room via ambulance. I was only there for four hours, and the cost was $7,000. We’ve been lucky enough to have health savings accounts through our work, but we have still had to be on payment plans at times. I will say that I have had the most excellent care over the years, and looking back on it, if I had been given an option of a cheaper procedure with another doctor and medical facility, I wouldn’t have wanted to do anything different.
I am very cost conscious in all of my shopping and I love a bargain. But I have always accepted not shopping prices with medical tests, exams, or procedures. I wouldn’t pick price over my doctors, even if I knew that they were above the national average cost because I think all of them have been the best at what they do.
I’ve always had very good health insurance through my job, which I realize has afforded me good medical care. I do think that a lot of people are starting to question costs more, and health costs are bound to become more transparent as the way things have always been done starts to change. I still can’t picture shopping the ads for price comparisons on something like the surgeries I’ve had, but I also cannot picture the future in health care within the next twenty years or so. Everything is going to change radically, and “shopping” health care may be a big part of that.
Thanks for your perspective here. I suspect that you’re not alone in not “shopping” health care. When I was hospitalized for a heart attack five years ago, it never occurred to me to discuss the costs of my E.R. visits, medical care, cardiac procedures, drugs, hospitalization in the Coronary Care unit, etc.
There’s an example of inequity of power, when cost is billed without prior agreement, and that control is not by Patients. It reinforces the feeling of being a hamster in a jungle where no one speaks hamster language, and no one wants you to learn theirs.
That being said… a comment by jlndewitt jumped out at me.
“On a final figure of $20k, the surgeon may receive as little as $1,500.”
Begs the question of where the rest of the money goes, doesn’t it?
Here in Canada… especially Ontario… there is Health-care and there’s Patient-care…with a huge disconnect between the two. Here, our healthcare seems to mean staff wearing suits and dresses get 6-figure salaries, while staff wearing uniforms and rubber soles, get laid off, and Patients suffer the impact.
Colour me weird, but I’ve never been able to figure out why ‘managers, admins and CEO’s” get such cushy salaries, while the men and women who actually do the work, ie: saving lives and easing suffering, seem to be at the bottom of the funding priority list.
I guess it’s the difference between a corporation and a resource: A resource takes care of the recipients of its services… a Corporation takes care of itself.
Hi Joanne – I too live in Canada, where because of universal health care coverage, we are generally even more unaware of the total cost of our medical care. We don’t have to worry about co-pays or paying off hospital balances or being denied insurance coverage because of some small print disclaimer in our policies. But such care is not “free” – the taxpayers of Canada are footing the bills, and we – as taxpayers – should know what we’re paying for.
Totally agree, Carolyn..
However, that would come under the section of transparency and accountability, and as much as we hear the lip service, I don’t believe such an open-book policy in lay-language will ever happen.
You’re right..it’s not “free”, we do pay for this healthcare thru our taxes, yet taxpayers have little or no input on how that money is spent. I ‘m not sure how it is out west, but here in Ontario, our hospitals are extremely top-heavy. It’s ironic, to listen to patter of how unsustainable our healthcare is, coming out of the mouths of hospital staff who are raking in 3-4 hundred thousand a year out of a 1 billion dollar annual budget. And when I see some sunshine-list manager cutting funding to much needed staff, services and programs, I fume helplessly.
I had started thinking that maybe the American healthcare might be better, and in terms of waiting lists and availability, perhaps it is. I don’t know enough about it yet.
I do believe, tho, that if Taxpayers knew the incredible amount of funding that goes into the bank accounts of desk-jockeys, there would be one heck of an uprising. Maybe that would be a good thing. Maybe that would finally bring change about.
That video reflects a model particular to the U.S. health care business. In recent years there is a media push to blame Rising Medical Costs on “consumers” for insufficient “price shopping” and for making unreasonable demands when, as the video shows, few of us have access to price and quality information, or the leisure to carry on an investigation.
Recently a New York Times reporter tried to research ‘normal birth’ at local hospitals for her uninsured daughter, and simply could not get figures from most hospitals, even when she pulled out her Reporter card.
When we are sick or injured, we need and want the best care we can get for the best outcome. To worry about costs is counterproductive at that time (or any time).
Really, I think the whole bruhaha about costs is to distract us from where most of it goes. In the US, a huge proportion is devoted to insurance companies and fighting over who pays what. And to the profits of pharma and makers of medical devices. But mainly insurers, who produce absolutely nothing and have done so much to distort the process.
My brother is one of the few (anymore) who has an individual private practice, and nearly half the time of his office staff is devoted to fighting insurance companies for payment.
Good points, Kathleen. I suspect that awareness of what things actually cost is less important to comparison shopping during a health crisis (although some of my American counterparts routinely tell me of reluctance to call 911 during their heart attacks because they feared they would simply not be able to afford the ambulance). More to the point, it’s very important amidst the growing issues around pervasive rates of over-treatment, unnecessary testing, inappropriate screening recommendations, etc. Why, for example, does Manhattan have the lowest rate of knee replacement surgeries in the U.S. (4.0 per 1,000) while Lincoln, Nebraska, has the highest rate (15.7 per 1,000)? That’s a lot of very expensive surgery that’s simply not explained by the hospitals allowing this. More here on what doctors euphemistically call “practice variation”.
Inappropriate treatment and testing is far too common, and so is denial of appropriate treatment and testing. Some form of financial reward is usually at the bottom either way, and neither serves the patient.
The fact that people in midst of a health crisis are afraid to call an ambulance because of the cost – that speaks volumes.
I work at a great company called Castlight Health where we are working hard to bring real transparency – both on cost *and* quality – to health care. We work with employers, and then employees of those companies can use our tool to search for care using a very “consumer”-like experience. It’s been a real game-changer, IMHO. I think we’re on the right track!
Hi David – I’m aware of your company and I too think you’re on the right track. My understanding, however, is that your services are for employers and health care plans – not for the vast majority of individual consumers of health care whose employers don’t subscribe to Castlight. I’m not an American, but I’ve heard that in the U.S. the cost of a basic chest x-ray, for example, isn’t carved in stone (negotiable for insurance companies, far higher for the uninsured, varies from hospital to hospital, etc.) That’s what happens when you have for-profit insurance companies basically running your health care system.
A picture says a thousand words. A video may say ten thousand. Brilliant. And the principle applies in other countries too.
You’re right, Dr. Joe. Here in Canada, we are equally ignorant of what even the most basic medical procedure costs!
Joanne, you’re so right about wondering about where the rest of the 20k goes, when a surgeon might only get about $1500. When I have looked over bills after surgery, so much is poured into the radiology required to find a problem, pre-surgery care and medications, the room for pre-surgery, the operating room, the medicine for anesthesia, bill for the anesthesiologist, supplies during the operation, nurses and assistants during the operation, the cost of the recovery room, the recovery room nurses, then the post op care in the same pre op room and the nurses there…..of course it’s all kind of lumped in such a way that you can’t really see, for example, the exact price you paid for the hour you spent in pre op getting hooked up, examined, and dosed up and queried. Some of the cost is also in the post op doctor visits, stitches removal, etc.
Then of course there are all the administrative costs associated with everything else at the doctor’s office. Who knows how much is hidden in a cut for the upper management? All of my surgeons, and my internist, are in big (actually huge) groups. All of my surgeons have been very caring, patient centered, and extremely good at explaining procedures. Two of them, an orthopedic surgeon and a general surgeon, seemed to thrive on teaching me exactly what was wrong, what needed to be done, how it would be done, etc…… to the point of drawing pictures on the exam table paper. They are friendly and personable, even at 2 A.M.! For an abdominal problem, the surgery took much longer than expected…. eleven hours… because body parts weren’t cooperating, although it wasn’t anything dangerous, just tedious. It ended at about 10 pm and then my surgeon had to race off to two emergencies at other hospitals. ; a ruptured appendix, and a cancer patient. He apologized to my husband for having to be brief in his post op chat with him because of that, and my husband said that although he looked tired and sweaty, he still seemed to be energetic and was quick but very polite in his assessment. He promised to talk with him more later. He showed up back at my bedside at about 2 AM to check on the incision. I was pretty out of it but I remember that he apologized for coming in at that time, but said that he feared he wouldn’t make it for 6 AM rounds, and so wanted to stop by and check on me then. That next night they had to awaken him well after midnight in order to change a medication. So when you find that his portion, which has included all pre op and post op office visits, plus all the hours for the surgery and hospital checks, it doesn’t really seem all that enriching in terms of money.
I hope others realize that while it is true that their doctors do well financially, it probably isn’t anywhere near what we might guess. After paying off their medical school loans, yearly professional fees, malpractice insurance, continuing education, and whatever portion they have to pour into administrative costs at their practices, their salaries are not the megamillion ones that we imagine. But costs in this country are truly being scrutinized and my own internist now advocates a complete physical, with all the blood tests, etc. only every other year, and since I’m 61 and have never had any kind of problems with my reproductive system, I no longer have to have the yearly pap smear, etc. He did say that after 65 he would have to recommend that more often. He is very forward thinking and is part of the movement toward patients managing their own health with their doctor as a mentor.
He says that the focus in the future will be keeping patients healthy and hopefully keeping office visits way down, and that doctors might even be paid on a retainer type of system instead of the current “pay for a problem.” Doctors won’t be trying to find something wrong so that they can code something for the insurance company to pay for. I see huge changes coming, and I recently read on a health site that medical costs are already going down. Hopefully that trend will continue to reduce unnecessary tests and repeat hospital admissions.
At least now, the big dollar sign elephant in the room of wasteful medical costs is being addressed very seriously. I believe there really will come a day when a patient can shop a procedure and look at exact costs for everything. In twenty or thirty years, people will look back and be incredulous that we ever went in for an operation not having a clue as to the cost. I wonder if I would now ask about costs if I had to have another operation. Knowing that I wouldn’t go with a different doctor or facility anyway…. probably not, unless I was just curious about the bill ahead of me.
And that’s the bottom line, jlndewitt 🙂
When you’re blessed with a team that works for/with you, then cost is a secondary consideration. All the price-shopping in the world is not going to replace what you seem to have right now. It works for you.
I’ve learned quite a bit just by reading your posts here..thank you for that.