For practically everyone with incomes below that of Bill Gates, health-care costs have become a frequent irritation. Polls suggest that while most Americans generally approve of the care they receive, they do not appreciate its cost.
All parties in the system, including doctors and patients, have a role to play in addressing this issue. Medical facilities should disclose the prices of medical procedures and treatments in advance, and Americans should get accustomed to discussing the cost of the services they receive.
Cheaper Alternative Treatment Never Mentioned
Consider my recent visit to the emergency room due to kidney stones. While discussing care with the resident physician, I mentioned staff conducting a CT scan, as had been done during my previous kidney stone episodes. Initially, the staff seemed hesitant but eventually sent me for a scan.
After my stay, I reviewed the chart because I had concerns about the quality of care. I discovered that doctors noted I had “requested” a CT scan. I also found an order for an ultrasound, a procedure that was never mentioned to me.
I honestly don’t know if I received the appropriate care during my hospital stay. The internal “review” that George Washington University Hospital undertook about my case contained no details about the substance of my care, other than its claim that it acted appropriately (they would say that, wouldn’t they?). The physician assistant I saw for follow-up care, who also works at Georgetown University’s emergency room, seemed surprised that the GWU staff did not immediately order a CT scan.
The punchline came when the bill arrived. The line item for the CT scan was $12,040. Thankfully, my insurer only paid a general fee for my ER stay and not a separate charge for the scan.
This episode highlighted a larger issue. The ER staff at GWU never mentioned the option of an ultrasound or the astronomical cost of a CT scan. Had I known, I might have opted for the ultrasound, assuming it was the cheaper option. But I was not given the chance to make an informed decision and defaulted to the more expensive option based on my past experiences.
Not Talking About Costs
A few weeks later, before I had received all the bills from my hospital stay, I learned I needed another ankle surgery, my fourth in just over a year. Before the procedure, my surgeon told me he would provide a new boot for post-surgery. When I reminded him I already had a boot, he insisted I needed a new one for the new surgery.
My initial reluctance turned to shock and outrage when I saw my insurer’s statement. The company charged $495 for the boot, which my insurer reduced to $230.62. Even that “discounted” price seems outrageous for a piece of plastic likely costing one-tenth that amount.
That exorbitant bill led to a belated discussion with my surgeon about its cost and utility. He pointed out that he must guard against infection, as he could be sued if a patient develops one. My prior boot, having gone through half a dozen surgeries over a decade, had developed some wear and tear.
However, adhering strictly to the “new boot for a new surgery” approach would have cost me nearly $1,000 for boots alone during my four procedures over the past year. Given that I already spent over 15 percent of my income on medical expenses last year, these additional costs would have significantly increased my medical expenses. Even if my insurance covered some of the costs, ultimately, patients like me pay for these expenses through higher premiums.
Need for Prudent Spending
In the end, as I reminded my surgeon, money matters to me and most other Americans facing the growing burden of health care costs. If we don’t get more comfortable discussing health care costs, the expense will overwhelm the country.
Of course, it is difficult for patients to discuss health care costs because we often don’t know what we don’t know. Transparency about prices will help, especially for nonemergency care. However, it also requires patients and doctors to have potentially awkward conversations in the exam room. As I discovered recently, these awkward conversations might prevent astronomical bills and help avoid making the system more unsustainable.
