Shopping for Healthcare

Suppose you walk into a sporting goods store to buy a pair of gloves.  At the checkout the clerk told you that the manager is an expert in outerwear and to ensure every customer is properly attired, you are not allowed to buy gloves without also buying a winter jacket.  You also know that if you walk out without the gloves or the jacket, you will be charged for the time spent serving you.  Outrageous!  How would they expect to stay in business – unless all their competitors acted the same way?

Almost that exact thing happened to me a couple of years ago, except in a doctor’s office.  I had my annual checkup and one aspect of the blood work was slightly elevated, so I was asked to return in six months to retest and monitor the possible problem.  When I returned and sat down to have the blood drawn, two test tubes appeared.  I commented that it was a lot of blood just for one test.  No, I was told, the doctor’s policy was to order a full set of tests each time.  (Can’t buy your gloves without buying a jacket; it’s the rule.)  I explained that I was on a high-deductible insurance plan, that it only pays for one preventive screening per year, and that I did not want to pay out of pocket for the extra, unnecessary tests just to placate the doctor.  While I sat there with my sleeve rolled up, the technician left to get permission to order the single test.

Under a different insurance plan I may have been paying a $20 co-pay either way and would not be concerned how much blood they took or how many tests they ordered.  How are we supposed to be good consumers and try to control the cost of healthcare under this current system?  Under today’s system you walk in without knowing what services you will be getting or what each will cost.  Often the doctors don’t even know or care about the costs.  Even the components of a routine physical vary from one provider to the next.  Weeks after the fact you receive an explanation of benefits from your insurance company telling the cost of each, what they will cover and what you owe.  Many people, too busy to check the accuracy of these, just pay what they are told.  (Mine was a comparatively minor example, but see this article about how preventive care can turn into diagnostic without you even knowing about it and cost you money.)

We can’t be smart consumers of healthcare, when we have so little information about the total costs or the intentions of the providers, and remain a third party to the financial transaction.  I’m not against universal healthcare as a concept, but providing everyone with insurance will do nothing to change the upwardly spiraling cost.  Under the current system it would only increase the number of people who have to deal with the headaches of working through the insurance providers instead of working directly with their healthcare providers.