July 11, 2018

Transparency in Medicine: Know the Costs

By J.R. Martin, Alive & Well Mobile Medicine

The other day, a friend of mine—a middle-aged, working, middle-class American—smiled as he told me about an experience he had while purchasing his prescription. He told me that, for years, he had paid his customary $15 co-pay when picking up this prescription. However, due to skyrocketing health insurance premiums, he was forced to change health insurance plans. He ultimately switched to a less expensive plan which did not cover medications. He decided it was worth the risk. With a little fear and trepidation, he braced himself as the pharmacy technician totaled his bill. He had no idea how much he would owe. Then, the number presented itself. He was told, “That will be $10.” Whew! He felt immediate relief. Then confusion flooded in. He responded, “There must be a mistake. My new health plan does not cover medication. I have been paying $15 for years on a health plan that does cover medication.” The pharmacy staffer responded, “I know, but that amount was your co-pay. The medicine only costs $10.” My friend left the pharmacy, still confused. He thought, Why have I been paying more so I can pay more?

Amid the healthcare reform storm, the question remains…

Why are middle-class Americans still paying more for the “benefit” of paying more?

Last week, I watched an expert in health care economics respond to simple questions posed by a reporter. The reporter wanted to know why health care was so expensive. In an effort to answer that question, they discussed the evolution of medical economics, legislation, Obamacare and President Trump’s most recent executive health reform action. After dialogue on these issues was exhausted, the reporter was running out of time and summarized their discussion this way:

Reporter: “So, the reason healthcare is so expensive is because the healthcare system charges so much?” 

Expert: “Yes.”

Reporter: “So, the answer to controlling healthcare costs is to discuss how to reduce costs?”

Expert: “Yes.”

Reporter: “So, how many meetings are there in Washington discussing how to control the expenses?”

Expert: “None.”

Reporter: “Why?”

Expert: “Because lobbyists are strong in Washington and do not want the costs to go down.”    

So, if our elected and appointed government leaders are unwilling or unable to meet to discuss lowering health care costs, the responsibility shifts to us. This is a new paradigm.   

Do you ever feel like you don’t have the right to ask? Do you ever feel like you are a victim of the system? Do you ever look with one eye open and your heart pounding as you open your explanation of benefits to find out (months later) just how much you owe? Does it feel like a crap shoot?

We can ask. We can find out. We can know. We can choose.

For example, St. George Surgical Center posts the exact cost of over 200 surgeries on their website. Healthcare Blue Book provides for the healthcare market what Kelly Blue Book does for the car market. There are friendly pharmacists, phone apps, and other resources to help us find the most cost-effective ways to obtain necessary medications. Cash-pay pricing on procedures and tests often offers big savings to consumers. It may take a little sleuthing and a little time, and as with any product or service, it may require a little travel to find the best deal. They do exist. 

This newfound knowledge is saving my friend thousands of dollars on his healthcare. No longer does he live in fear and trepidation wondering how much his health care will cost. Now he knows. I hope by asking, it will do the same for you.

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