What Is Wrong With Healthcare

Healthcare is a mess in the USA. Based upon my personal experience, here are some thoughts on what is wrong with the cost aspect.

There are some major issues with the way costs are calculated and health insurance is used and abused.

  1. Health is insurance is INSURANCE, not a tool to pay for a simple checkup. When you change tires on the car, get the smog check done, change the oil, do you claim on your car insurance – NO. When you have a minor accident in the car that puts a small scratch on the car, do you claim on insurance – NO. When your roof needs fixing/replacing after 20 years, do you claim on home insurance – NO. When you go for an annual check-up at the doctor do you expect the insurance to pay – YES!!!. Why is that the case – we will explore in item 2. below. My first main point is this – Health insurance is for that major health issue – broken arm, stroke, cancer, car accident…… It is not for the flu, annual check-up……
  2. People expect to use insurance because costs for medical procedures have gone way out of line – actually not out of line, but the billing process appears to me to be ILLEGAL. Consider these three examples.
    • A prescription for a generic drug that costs $10 with a free prescription card is quoted as $210 retail. Or $12 with free prescription card, but quoted as $275.99 retail.
    • Dye for an MRI $1,800 billed, with adjusted cost to insurance only $28
    • Cost of blood draw and analysis for anal check-up $1,100 billed, with adjusted cost to insurance $131.62
  3. What is wrong with all these numbers? There is a 10:1, 20:1 or even 50:1 difference between what the provider says it should cost, and the ‘negotiated insurance rate. Can you think of a single consumer item that has two prices, the high cost for you and a super low cost for somebody else. I can’t think of one – that is why I think this practice is illegal. When you negotiate a price for a car, you pay get 5%, 10% discount on MSRP – but you don’t get 90% off. Its like buying a car that is marked at $300,000 and you get it for $30,000.

Because the cost structure is all messed up, I think this leads directly to fraud and abuse at many levels. How can a government wrap its brain around healthcare, when the cost of healthcare is shrouded in inflated numbers?

I for one don’t get it. Perhaps others who read this article can help explain!

3 thoughts on “What Is Wrong With Healthcare

  1. I literally have no idea how they come up with rates and why different insurance companies charge differently and different doctors charge differently. Seems like it’d be nice if there was a flat rate for everyone and it is what it is.

  2. I see the same problems as you. I am self-insured under ACA. In the past half year I had an appendectomy under general anesthesia and an unrelated very minor surgical procedure done in the office by a physician’s assistant that took one incision and lasted all of two minutes. Both were billed at $2000 each for the surgeon and the physician’s assistant, even though their education and skill levels were of course vastly different. The appendectomy had an allowed charge by insurance of $600, while the minor procedure had an allowed charge of $1900. WTF??

    The appendectomy was performed at a hospital, which billed $50,000 but the insurance allowed only $9,000 so that was what it was finally billed at. Unbelieveable how messed up the system is. I’m sure this has been happening for a long time, I just pay more attention now since I am self-insured.

    1. As you say the numbers don’t make any sense, yet I don’t hear anybody on the news making a big deal about it. I think there are too many special interests involved and too many people making too much money. I’m still waiting to hear of a real life example where something is billed at $50,000, but as a special deal to you (“sshh don’t tell anyone”) I will take a mere 18%. Those doctors, hospitals and insurance companies must be so charitable!

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