Street Rats and the Future of U.S. Healthcare

Ever Hear of "30 Net 10"?

It's a trade expression, whereby you're given a 10% discount if you pay for your purchase within 30 days, and it's a pretty much standard operating in most trades.

You want to get paid immediately? Gimme a discount.

Increasingly, this is what U.S. healthcare might look like, too -- one where medicine is looks more like a Moroccan marketplace (such as this one from Disney's Aladdin) than a hospital or doctor's office. But it's the road our so-called healthcare system (the word Bazaar comes to mind, or maybe bizarre!) is headed.



That's not a scenario most Americans are accustomed to, but the reality is, it might look that way if Congress doesn't do anything to change things to address the healthcare issue soon.

There's no other place for it to go, as the current growth rates in U.S. healthcare costs are simply unsustainable. And I'm fortunate enough to actually be employed and have healthcare insurance, while many others aren't so lucky.

According to a Kaiser Family Foundation/USA Today Harvard School of Public Health Healthcare Costs Survey (conducted April 25-June 9, 2005), only 11% of Americans actually negotiated healthcare costs (although among the percentage of uninsured Americans, it was higher at 24%). But what's more interesting about this finding is not the fact that some enterprising people have decided to negotiate on price, but how many of them were able to get discounts, 58% of them to be exact. This suggests that's there's plenty of fat in the system that can be trimmed.

Today's Wall Street Journal featured a story that indicated that increasingly, doctors are seeking payment of the entire bill for patient share of the cost up-front. They claim they have to request their fees while patients are still at the office because bills sent later typically recover only about half of what a practice is owed, according to McKinsey & Co. (an even smaller percentage among uninsured patients). But most companies get a discount for rapid payment, in fact those practices are the basis of much of our economy.

At my last endo visit, my doctor asked for the full amount due. Now, I have a new insurance plan that began in July, and it has a relatively high deductible, but rather than switching endos yet again (this would have been the third time in 3 years I'd been required to do so thanks to insurance coverage changes from my employer -- so much for the Congressional argument that you can keep your doctor!), I availed myself to the out-of-network benefit of the new plan. But when I left, the doctor asked for the entire amount of the invoice, rather than a portion of it. Sure, I could have pushed back and said I'd pay only part of the bill that day, but since the total was like $150, and I can pay for it with pre-tax dollars thanks to my Flexible Spending Account (FSA), I just paid it and submitted the claim to my insurance to apply towards my deductible, while submitting another copy to my FSA administrator for reimbursement.

The practice of billing up-front is apparently pretty common, and is growing among doctors. The Wall Street Journal reports that "According to a questionnaire sent to its medical-practice customers by NaviNet Inc., which provides a Web service that allows doctors to communicate with insurers, found that more than half of the 650 respondents in a survey were trying to get money beyond just co-payments during patients' visits."

But suppose I wasn't able to cover this amount?

Knowing myself, I would have pushed back when they asked (in fact, I was a bit pissed they asked for all of it up-front since my insurer doesn't pay them immediately, and next time, I'm going to make them bill me for everything except my co-pay amount because I'd rather earn interest on the money than let the doctor's office earn interest on it!).

Having a closer look at the bill my doctor's office provided revealed some interesting findings. I had a regular appointment, and they drew blood for my HbA1c and other lab tests. Consider just one example of the waste in the system: $10.50 for "specimen handling"? Hello. Quest and LabCorp pick up the blood samples at the office, so basically the doctor's office just holds the blood samples in the fridge until they come the same evening. Needless to say, that $10.50 is a cost that my healthcare plan didn't pay for, and next time, I'm not going to pay for it, either. Plus, I want a 10% discount on everything for paying them up-front (back to the "30 net 10" I mentioned earlier).

I suppose all of this is meant to make us as patients more aware of exactly what we're paying for (and it does this, to some extent) but I'd prefer to have a system like I enjoyed when I lived in Finland, where it's all handled automatically, certainly not this s#!t. Plus all of the administrative work I encounter for submitting the invoices to both my FSA Administrator and another to my insurance company is a pain in the @$$, folks. It does nothing to reduce costs, efficiency and frankly, it's a nuisance. I suppose electronic medical records would partially address this, but as I've written before, these aren't necessarily the big cost-saver the proponents claim they are, plus Congress provides us almost no protections if someone should break into the system and steal these records (none of that is addressed in the bill Congress is blabbering about right now). And for those of you who are uninsured (as 47 million Americans are) this is a cost that's increasingly, out-of-reach.

This so-called "system" sucks, and it's a hassle, too. I'm lucky to have a plan, but it's nowhere near as good as what they enjoy in Europe or Canada (no matter what opposition is saying now in commercials), plus those socialized plans get to the core of what the so-called "system" is supposed to be about: healthcare, NOT how to invoice and pay for it, which is increasingly all the American system is worried about.

Anyway, it is starting to look like we may sooner (rather than later) have a healthcare system that resembles the marketplace in the Disney animated film Aladdin: where those who get the most from the "system" are effectively "street rats" are able to maneuver through (or around/over/under) the system, while others avoid it at all costs.

Welcome to the future of U.S. healthcare, street rats!