The System Is Sick

People in profitable positions tend to align themselves with the politicians funding their movements. Is that part of the challenge here, or can people rely on the government to help?

Some of the biggest lobbying organizations in the country are health care institutions. There are hundreds of millions of dollars being fueled into Congress.

Still, we’ve seen some encouraging signs on the policy front, like the medical debt issue mentioned above. We’ve also seen other things with price transparency that have been a huge, huge benefit for consumers. The states of Texas and Tennessee recently passed laws that allow cash payments that patients make to be applied toward an insurance deductible.

Why pay cash?

The cash price is often lower than the discounted rate that your insurance company has obtained for you. So one of the first things I recommend to anybody, even if you have insurance, is to check the cash price. See if it’s lower than your insured price. And if you’re on a high deductible health plan, it might make more sense for you to pay cash instead of running it through your insurance.

What are the changes you want to still see in the health care system?

1. Show the prices. Consumers are entitled to know the prices of services up front, and these prices should be honored, without other types of fees or hidden costs. Clinicians and hospitals need to be upfront with their prices.
2. Know why any claim has been denied. There needs to be transparency when insurance denies payments. Right now, you’re seeing millions of claims get denied, but because of limited transparency, it’s difficult to appeal, and the process is lacking integrity.
3. Accountability for mistakes. One of our leading causes of death are hospital-acquired injuries, infections, and surgical errors. And there’s very little transparency about these. The details aren’t disclosed to patients, and they aren’t accurately recorded in medical records. Patients have a right to know what happened and a right to know that it’s been corrected, so at least they can be sure that whatever harm they’ve suffered won’t happen to other people.
4. Public access to ratings and information. Right now, there’s very little reliable, quality information that’s being published for the public about the quality of health care. Doctors should be reporting their complication rates. They should be reporting the volume of procedures they perform.

I always encourage people, if you’re going to any doctor for any type of procedure, ask them how many times they have done that exact type of procedure, and ask them what their complication rate is. And honestly, if they’re even measuring their complication rate, if they even have an informed answer, that’s already a real positive, because in a lot of cases, doctors aren’t measuring their complication rates.

Unfortunately, our health care system is like a giant assembly line with very little quality control mechanism on the back end. Doctors and hospitals and insurance companies are pumping patients through without actually evaluating the cost or the quality of the care that’s being provided.

Studies show that about 100 million people have medical debt right now. So that’s about one in every three or four Americans. Would a medical provider be able to turn someone away because they have medical debt?

Not for emergencies. There’s a federal law that says if you go to a medical facility with an emergency need, they have to treat you regardless of your ability to pay, whether or not you’ve had medical debt at their facility or not. But for elective care or non-emergency care, they could turn you away.

I’m hearing more and more cases of patients who require surgery, but before the hospitals even schedule the surgery, and surely before they operate, they’re demanding the payment from the patient up front, before it’s even been processed by their insurance plan. And I think that’s a really unfair situation to put the patient in.

You’ve shared some really strong points. Do you think patients are just victims of the system, or can they do something about it?

They definitely can! I think it’s one of the great shames of our country — that we are spending twice as much on average per citizen in this country for our health care needs compared to other developed countries. And our outcomes are much, much worse.

But the flip side of this is that patients have an incredible amount of power to push back when they’re being taken advantage of. Never underestimate the impact of an individual telling his story and calling people to account for unfair treatment.

So when you have a patient who’s being billed for services that did not even happen and you can show that to the billing person, the bogus biller, you can effect change.

Even a powerful institution may actually relent when you can prove that you are being billed for services you didn’t receive, or that you’re being charged thousands of dollars more than other patients were billed for the exact same service at the same facility. It’s a compelling argument.

-You never want to delay urgent care, but you do want to make sure that the care you’re receiving right now is what you actually need.

-I define success as saving a ton of money on health care while still getting the treatment that you need.

-What kind of a business doesn’t give people a price up front? If we’re providing services to a client and they want to know what our fee is or what our rate is, we tell them so they can take it or leave it. Medical care should be no different.

(Originally featured in Mishpacha, Issue 990)