Dear Hospital,
--
I’m sorry, but there’s no delicate way to put this — you’re being scammed. Here’s what happened:
My wife had a baby the other day (as pregnant women tend to do), and afterwards she got some Ibuprofen. We’re home now, happy with the baby (good job, labor and delivery), but then we got the bill.
Now I know you’re really busy, so maybe you didn’t notice, but the bill says that each Ibuprofen cost $5.74. They were the big 800mg ones, not the wimpy 200mg things — high powered stuff. So understandably, you might assume that $5.74 is a good price. But… did you know at Target, you can get them for 6¢ each? And at Costco, they’re only 3¢ each (that’s $0.03, not $3).
I know you like to keep your profit margins razor thin, so I just thought you’d like to know that whoever’s selling you your meds is cheating you. Or maybe you didn’t know you could buy them in bulk?
Anyway, I’d like to become your Ibuprofen supplier. Call me.
Sincerely,
New Father
Healthcare costs too much, for several reasons. The first reason is that we call it “healthcare.” If we’re gonna fix this, we’ve got to start right there. It’s not healthcare it’s healthbusiness. Hospitals don’t care about you. Hospitals are businesses. They pay their employees with money that they earn. Don’t believe me? Try not paying your hospital bill — you’ll see how much they care :)
Don’t say, “I work in healthcare.” You work in healthbusiness.
Except for you nurses. Y’all work in healthcare. You’re the bedrock, rockstars of caring — the caring tip of an uncaring iceberg. Okay, okay, and some of you doctors care, too.
There’s at least 3 other reasons seeing doctors costs too much:
Problem 1: Hidden Pricing
Visiting the hospital is like shopping at a grocery store. With no price tags. And a nice man in swanky scrubs putting things in your cart. And a 12-foot alligator chasing you. And the ground is lava. But they sell alligator guns and lava shoes. The nice man even shoots the alligator for you. The cashier’s only purpose is to verify the address to which the bill should be sent. Because… even they don’t know right away how much the stuff in your cart costs.
There’s no way costs will go down unless we know what the costs are.
Proposal: Force doctors and hospitals to publish pricing. It’s probably impossible to publish predictive pricing on procedures, though. (Do I win an alliterative award?) But it would make sense to publish prices for what actually happened in a given month. In other words, in March publish the price of everything you billed customers in January.
Problem 2: Too many hands in the pie
In a bygone time, you’d get sick and the doctor would come visit. Then you’d pay him. If you couldn’t afford it, you’d ask your family and friends for help (think GoFundMe, but with your legs instead of the Internet) or strike some kind of deal with the doctor. Or go to debtors prison?
Since reacting to sudden costs often doesn’t work as well as planning for them, people came up with informal insurance pools. And then more formal ones. And then, at some point, insurance pools became businesses in themselves. Ruh-roh.
And then instead of primarily dealing with patients, these companies started inserting themselves between patients and doctors. Insurance companies got bigger (more employees) and so did hospitals and doctors’ offices. And the bureaucracies grew and became more inefficient.
So now we have an inefficient, bureaucratic business (whose goal is to make money) in between us and our inefficient, bureaucratic healthbusiness (whose goal is to make money). As the distance between us and our doctors has increased, so have our costs. We can’t even Kevin Bacon it to our doctors anymore.
Proposal: Reduce the number of people/businesses in between us and our doctors. Government power should be used to trim down insurance companies and medical bureaucracies, not force us to sign up for them.
There is the idea floating around (single payer) of replacing insurance companies with the government. Which I think is a terrific idea, because I can think of no institution that’s more fair, quick, efficient, responsive to the needs of its customers or good with money than the U.S. Government…
Baahhahahahaha hahahahaaaahahahahahahaaaaaa!
hahahaaaa!
Problem 3: We’re too good at saving lives
Used to be, you’d catch the plague, call your doctor and then probably die. Nowadays, people don’t die so much. (Actually, we’re still running at about 100% mortality, but we can procrastinate a bit more than our forefathers)
Because we can save lives (and improve them) we naturally do, no matter the cost. Except… the cost doth matter. Saving your child’s life can bankrupt you for the rest of your life.
A friend once put it like this: “If we’re all sharing the cost, how many broken arms could be set for the cost of one stay in the ICU?” It sounds cold, but it’s rational.
HOWEVER, I disagree. I’m in favor of the ICU. I’m in favor of letting people do everything they can to save their loved ones. Because in their situation, I would do the same — bring on the bankruptcy.
But isn’t that what insurance is for?
Proposal: Let’s revert insurance to insuring the unpredictable, catastrophic misfortunes instead of every doctor visit. If insurance was used less, insurance companies might get smaller and costs might go down overall. For instance, my goal is to use my life insurance 0 or 1 times (I’m leaning pretty heavily toward the 0, though). Likewise, I’d like to have health insurance in case my kids become sick, not for regular checkups.
In summary
Tell your congress-people (maybe start with your state government):
- That you want hospitals and doctors to publish what they charge people.
- That you want insurance companies diminished, not to be forced to pay them more money. (I’ll admit, I’m not actually sure how the government should play a role here other than certainly not increasing the size of the insurance business)
If the prospect of contacting your congress-people seems futile then imagine how it will feel when they’re in charge of your health insurance.
