And if you’re on the individual market, then you are dealing with our highly flawed system up close and personal, and I feel your pain.
We are in that category, and as small business owners, we know just how exorbitant the cost has become.
It’s a situation that most people with employer-based insurance cannot understand or relate to because, typically, employer-based insurance is much cheaper and covers much more than individual policies do.
Now, despite the many problems with the ACA, many aspects of insurance coverage have improved since it came into effect.
As an example, prior to the passage of that bill, two of my sons could not even get insurance, simply because one had allergies, and the other had had surgery on his knee.
I'm not making that up. They were UN-insurable on the individual market, based on supposedly pre-existing conditions.
It was a source of endless stress to me when they were young adults, my husband was laid off, and we had to find our own insurance.
Prior to that, we had always had employer-based, so we were largely sheltered from the dark side of health care insurance in this country.
Of course, the costs were rising steadily even when my husband worked for a Fortune 500 company.
By the time he left the job, we were paying about $7000 for our portion of the premium for a family of six. The company paid an equal amount to cover us. So it was quite expensive.
But we had virtually no out-of-pocket expenses.
I laugh now when I think of how we complained about those costs. I could only wish for such low premiums and out of pocket expenses at this stage of our lives.
By contrast, we are now paying $15,000 in premiums, just for my husband and me, and we have a deductible that's close to $15,000 as well. That’s $$25,000-30,000 in healthcare costs if, God forbid, one or both of us becomes ill or suffers an accident.
That’s real money we're talking about.
And if you happen to have a medical event, such as an accident or serious illness late in one year, so that treatments carry over into the next year, well, then, you're talking about out-of-pocket expenses that would make a crater-sized hole in anybody's savings.
My husband gets so upset about the costs that he talks about going "bare" (without insurance).
But that would be really dangerous, since one major accident or illness could run well into tens and hundreds of thousands of dollars for treatment, which would truly decimate a whole lifetime's worth of savings. It's just not an option for us.
So we're caught between a rock and a hard place on this issue.
Shopping Around for Providers to Limit Out-of-Pocket Expenses
Naturally, with that kind of deductible, I'm interested in what treatments and tests cost so that I can keep my out of pocket expenses as low as possible.
So when I needed a diagnostic cat scan (CT scan) recently, I wanted to try to find the lowest cost one I could.
That involved doing initial research online to find the radiology test centers in our area.
Then I had to contact each one to get their prices. It was a time-consuming process of calling, being transferred to the billing department, being put on hold, then providing my insurance information, and waiting while they looked up the price.
In the course of this research, I discovered that a good deal of consolidation has occurred in our area, with the local hospitals buying up doctor and specialist practices at a great rate.
And when they do that, the prices for services typically rise substantially.
It got to the point where I would call a facility and ask if they offered the hospital pricing, or their own. At 6 different centers I got the quoted hospital rate of $1450.
As shocking as that price is, I was braced for far worse, based on my family's previous experience with radiology scans.
My 3rd son had a serious accident in college, and the hospital where he was treated charged $7000 each for his scans. Fortunately, at that time, my husband's employer covered the vast majority of it. Otherwise, I'm not sure what we would have done.
So I was actually relieved to hear this hospital price of "only" $1450, crazy as that sounds. But I still wanted to see if I could save more money, so I continued calling around.
On my 7th call, I found what I think is the last remaining independent radiologist anywhere in our region.
There I was quoted a price of $950 for the diagnostic test.
That's a substantial savings over the hospital rate, no doubt about it.
But it's still a whole lot of money.
So I decided to do even more research to see if I could reduce my out of pocket even more by extending my search to Europe.
Exploring Lower Cost Healthcare Options Abroad
That sounds crazy, but we have family there, so it's not a stretch at all for us to explore this possibility, and I also happen to know that costs there are typically much, much lower than here.
I am aware of this because I have had the privilege of living, working, and traveling in countries where healthcare works far better than it does here, contrary to what many here in the USA believe.
Europeans, for example, are generally very happy with their “socialized” medicine and would never in a million years trade places with us for our more market-based one.
In fact, the Europeans I know and have talked to in our travels just shake their head at our mess over here. They frequently ask why we don’t have universal healthcare with a single payer system.
Or a system more like Germany and Switzerland that uses private insurance companies, but strictly regulates prices to keep it truly affordable.
To give you an idea, I have four personal experiences with these cost differences to illustrate this point.
Many years ago, my brother- and sister-in-law were visiting us for an extended period of time. After sleeping on fold-out mattresses for a couple of weeks, my bother-in-law (BIL) developed a very painful hip condition.
The pain grew so bad that it was impacting his mobility and function, so I took him to our local hospital emergency room. (There were no walk-in clinics in our area at the time).
I told the ER staff that he had no insurance, so we did not want any x-rays, or other tests.
The ER doctor spoke to my BIL for a few minutes, did a quick examination (under 5 minutes) and tentatively diagnosed bursitis. He said the best course of action was anti-inflammatory treatment and pain relief medication to see if that would help.
So he wrote a prescription, and we left. The whole interaction took less than 15 minutes.
When the bill came for that 15 minute doctor visit, it was $1200!
Now, my BIL had left $250 with us to cover the cost, thinking that would be way more than enough. Little did he (or we) know!
In the end, my husband told the hospital that was all they could expect to get. It was that, or nothing. After some negotiation back and forth, the hospital eventually accepted the $250 as full payment.
We visited my relatives in Europe every summer for an extended stay when my children were small. On one such visit when my youngest was 3 years old, he fell and hit his head on my in-laws' hard tile floor.
At first, I thought it was no big deal and comforted him as best I could. But he was inconsolable. And then, he threw up.
I know that can be a sign of a possible skull fracture or concussion. Realizing that it could be serious, we immediately rushed him to the local hospital emergency room.
There they examined and x-rayed him, and although they could find no evidence of concussion or fracture, they decided to keep him overnight for observation.
And the bill for that "full service" 24-hour hospital stay?
$25 Euros, or about $35 U.S. dollars at that time.
Just a bit different from my BIL's experience in this country.
My husband has chronic allergies and asthma and requires an inhaler to treat it, so he was prescribed Symbicort here by his doctor.
The monthly cost for the prescription is $355. That's no small amount. At.All.
Well, on a recent visit to family in Europe, he forgot his inhaler.
So he stopped by a pharmacy ---- where he was able to get the EXACT same medication over-the-counter, without the expense of a doctor visit, for $50.
That's $5-0. Some difference from $355. A mere fraction of the cost here, in fact.
The savings over a couple of months are more than the cost of a plane ticket home for my husband.
Tell me again how bad socialized medicine is?
Let me go back to my CT scan. As I mentioned earlier, given what I know about the lower costs overseas, I decided to find out how much a CT scan would cost there.
We had family make a few phone calls, and discovered that the same CT scan that cost between $950-$1450 here, costs only $375 there.
That's a big difference.
We immediately had my brother-in-law book us an appointment, and I set about booking flights. Because it was off season, I was very pleased to be able to find plane tickets for the extraordinarily good price of $550.
The math here isn't hard. Even including airfare, it was cheaper for me to have the scan done in Europe than to have it done here.
And that's exactly what I did -- I underwent the scan at a modern, state-of-the-art facility with a U.S. trained, expatriate technician (who chooses to live in Europe because of the quality of life and lower stress, even though her salary is substantially lower than it would be here at home.)
And I got in a lovely, week-long visit with family besides.
But having to jump through these hoops and travel abroad for affordable care simply should not be the case, and I challenge anyone to tell me that this makes any sense at all. Or to defend our system as so much better than the ones you find in the rest of the world.
These costs are simply indefensible. I'm just grateful that I have the resources to find alternatives.
Simple Reforms That Could Make a Big Difference
But what's a consumer to do in the face of these daunting challenges?
Short of any legislative changes to improve the situation, I recommend shopping around as I did. Even as time consuming at it is, it's well worth it for the hundreds and even thousands of dollars of savings.
But then there is still the underlying problem. And that means if we want real change, we need to push for some reform by talking and writing to our legislators to bring it about.
Here's one I read about recently that I think could help: the State of Maryland requires all hospitals to charge patients the same rate, regardless of their insurance status.
That's one reform that is definitely worth exploring as a national policy.
And here's another one.
It’s quite simple, really. It would be a rule that requires medical providers to post their prices for procedures in an easily accessible spot on their website.
Yes, yes, I know - there are the arguments that it’s all just too complicated for them to be able to do that because of different negotiated prices with the various insurance companies, etc., etc., etc.
But I just don’t buy that.
After all, if Amazon can post the price for thousands and thousands of different products, I fail to understand why a medical institution or provider couldn’t post the prices for a few hundred services.
We do live in the computer age, after all.
And if such a price list was posted on the website of facilities, it would be easy for patients to see the differences and make an informed decision about their medical expenditures.
They would know where their medical dollars will go the farthest and could make choices accordingly. Just as they do with other spending decisions.
I have little doubt that such price transparency would also encourage competition among providers to cut costs to avoid losing patients. At least it would do that as long as there's no provider monopoly in that geographic area.
It would be an important first step in controlling those costs.
I say let’s make it happen.