Tam Harbert

I wonder how much difference the new healthcare legislation is going to make in a system in which doctors are indifferent to costs and in fact often favor expensive and elaborate treatments over individualized patient care and common sense.

When I see a doctor, I pay attention to prices. My high-deductible insurance plan means I pay for the first $2,600 of my health costs every year. Often, the healthcare system doesn’t like it when I insist on knowing what things cost. This story is an extreme but telling example.

I went to a specialist for treatment of my herniated discs. The specialist was highly rated by a local magazine, so I expected top-notch care. What I found was a practice that seems designed to minimize contact with the patient while maximizing the amount of insurance money it can extract.

When I made the appointment and asked how much it would cost, the response was: “insurance will cover it.” When I explained that I would be paying for it and asked again for the cost, they claimed they couldn’t give me a price because it would be based on the doctor’s diagnosis after our consultation.

My first appointment was hardly a consultation. In fact, the doctor and his staff barely talked to me. I had been asked to fill out a 10-page questionnaire in preparation for our meeting. When I arrived, I reminded them of my concern over cost, and the receptionist assured me that I’d be presented with the price after the doctor had determined my treatment. I waited 45 minutes to see the doctor, who finally breezed in and spent all of 10 minutes with me. He then explained the procedure he recommended, and something about the way he said it made me think it was the exact same recommendation he would give to the 35 other patients he would see that day. Then he handed me a printout of the other things I should buy to treat the problem: a prescription pain patch, a back brace and a home transcutaneous electrical nerve stimulation (TENS) machine to relax back muscles and reduce pain. I wonder how much of a kickback he is getting from the manufacturers.

Again I asked what all this would cost. Again the standard response: “insurance will cover it.” He brushed me off when I tried to explain why that wasn’t an adequate answer.

No one ever gave me a list of the costs. I went ahead and had the procedure, because I was in pain and desperate (I later found out it cost more than $2,000), but didn’t follow the rest of his recommendations right away. I checked with my pharmacist and the pain patches cost $200. Each. When I went back for what turned out to be a five-minute followup, the nurse practitioner chided me for not following the doctor’s orders. And when I tried to explain to her my concern about cost? You guessed it: “insurance will cover it.” When it was clear I wasn’t buying, she yanked the info sheet on the TENS machine out of my hands and told me I could wait on that, but insisted I get the back brace. It came in the mail the other day. It looks expensive, but I won’t know how much it is costing me until the doctor bills my insurance company, and the insurance company in turn bills me.

My primary care doctor doesn’t even take insurance. I find that liberates both of us to cut through the insurance bullshit. He’s straightforward about costs. His rate is $90 per half hour. Period. He’s not trying to push more tests, procedures or pills on me. In fact, when I needed an MRI for my back, he gave me two different labs to call. He advised me to call both, explain that I was a “self pay,” and then dicker with them on the price. The first lab wouldn’t come down on the $1,100 sticker price. The second one dropped the price to $500.

Why is there such a lack of transparency, not to mention logic, in healthcare prices? Somebody in this system is making a lot of money from the fact that “insurance will cover it,” and those people have an obvious interest in obscuring costs. Until more patients have to pay more directly for their healthcare, which will in turn force all the players to be more accountable, I doubt that the system will change.

I have to admit that I haven’t been following the evolution of the health insurance reform legislation in Congress. That’s because it was making me sick. When I saw old people whipped into a frenzy by Republican extremists circulating misleading information about government death panels, I simply tuned out. It’s just not worth raising my blood pressure over. Literally. If I get sick, or even if I go to the doctor for my annual checkup, I pay out of my own pocket. At least, the first $2,600 of it every year.

That’s the deductible on the health insurance plan that I buy through the State of Maryland. You see, I have personal experience with a “public option,” and not by choice. When I went out on my own as a freelance writer, I could not buy private health insurance. It’s not that I could not afford it. It’s that no private insurer would sell me a policy. At any price.

No, I don’t have a terminal disease. I’ve never had cancer. Don’t have HIV. Or a heart condition. Or even high blood pressure. (For some reason, it’s incredibly low. A nurse once asked me if I was dead.) However, like anyone who’s been on the planet awhile, I do have a few conditions, none of which I consider particularly serious. But apparently the arthritis that I was diagnosed with in my mid 40s – just a few months before I left my job to freelance full time – is enough to make me a leper in the world of private health insurance. No one would touch me.

Maryland is one of 35 states that maintain “high-risk pools” for people who are denied private coverage. The premiums are typically higher than private insurance, unless you fall below a certain income, at which point the rates are partially subsidized. The system has worked well for me so far. I pay my premiums and also contribute regularly to a health savings account, which I can tap into to pay for my own healthcare costs up to the amount of the deductible. Because I pay out of my own pocket, I make more careful choices about what healthcare services to use. I’ve found some helpful sites on the Web (like http://www.healthcarebluebook.com) that tell me what the going rate is for certain services, like x-rays.

I’m grateful, and lucky, that Maryland has such a plan. Freelancers in states without high-risk pools have tough choices. They could become a part-time barista at Starbucks, a company that provides insurance even to part-time employees. They could change their marital or dependency status. (Recently, a friend’s 23-year-old daughter left a job and thought she would buy private insurance, only to find that – because of a melanoma removed from her leg 10 years ago – she was denied. She and her boyfriend moved up the wedding by a year so she could get onto his policy.) They could return to the full-time, traditional workforce.  Or, if they are healthy and feel lucky, they could risk going without insurance.

Whether through a state-run program or by manipulating the private system, people like us are getting by, at least some of us are. Anti-reform zealots complain about the government rationing healthcare. The fact is, healthcare is already rationed – by big companies whose obligation is to make profits, not protect the health of citizens. If we don’t get meaningful reform now, we will in a few years, as a larger percent of the population experiences the arbitrariness and unfairness of the current system in America.