Ms. Hart? This is Catherine at Dr. X’s office. I’m calling to tell you that your health insurance will no longer pay for your allergy drops. If you want to pay for them, they are two-forty a vial.
“As in two hundred and forty dollars?” This is for less than 1 ounce of antigen.
A vial of this medicine lasts about 5 weeks. My husband needs the same treatment, so double the family price. Because the insurance will still pay for us to get weekly shots, we have options.
An investigation into the benefits that our insurer provides revealed a great deal.
Our doctor bills the insurance $320 for the vial of antigen. After the insurer performs what some might call some “voodoo bookkeeping,” it pays $247 for the medicine Catherine offered me for $240. When I opt for the shots, my insurance pays $160 for the antigen and $20 every time I get a shot, which amounts to about $100 per vial of antigen. The difference between the drops and shots is that a negligible amount of sweetener is added to the drops; chemically, there is no other difference. Here is where it becomes clear that I am not the consumer in the process.
For me, taking the medicine every day at home is a better choice. Having to make time to show up at the doctor’s office, wait my turn and get a shot each week is more than inconvenient. I must drive to the office and allow a minimum of 30 minutes to go through the process, a waste of time and office resources. I get a maximum of two minutes of face time with the staff each week, hardly worth the money paid on my behalf. Finally, the insurance company actually pays out more when I get the shots.
The doctor is charging whatever the market will bear for the medicine. The insurance company looks at the bill for preparing the antigen and balks because it costs “more” for the drops. In absolute terms, it does not cost more, but try telling a corporation anything. The doctor is content, because his policy ensures that he gets top dollar either way. Note the $7 discount they offer me for paying cash. Whoopee. They know I won’t take them up on it.
Now multiply this issue by 20 per cent of the people in this country with health insurance, because this is not an isolated issue. That is a lot of waste.
Every time someone says “We need to let market forces regulate the health care industry,” remember this story. The market has already regulated prices in the health care industry. The free market is about the consumer and the provider. In the case of health care, the patient is neither. He or she is not part of the equation. The insurer is the consumer. What the patient needs is only tangential to the process.
Health insurers are not the whole problem, either. Medicare and Medicaid have a schedule of benefits that encourage procedures over care. They pay for enormous numbers of patients, and they only pay so much for any procedure. This practice encourages doctors and other health care providers to do more voodoo bookkeeping and perform more, duplicate, and defensive procedures, necessary or not.
Nobody thinks that doctors should be poor. No one thinks that the person who compounds my antigen should live in poverty. But the numbers on the books are reflective of a system that amounts to dickering at best and price-fixing at worst. The office bills the insurance for X, hoping to get paid 75 per cent of X. If you are not part of the system, life gets tough.
President Obama wants to make it mandatory for all Americans to have health insurance. It might be better for everyone if no one had it. The plan as it stands keeps the power with insurers and out of patient hands. The insurers like it that way. It keeps their Beemers running and their sailboats painted.